Priority Decision: Before administering a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy (PEG), the nurse aspirates 220 mL of gastric contents. How should the nurse respond?

Correct Answer: B

Rationale: In this scenario, the correct response is option B: "Return the aspirate to the stomach and continue with the tube feeding as planned." The rationale behind this is that aspirating 220 mL of gastric contents before administering tube feeding is within the normal range of residual volume, which indicates that the stomach has not been adequately emptied from the previous feeding. Returning the aspirate to the stomach and proceeding with the feeding as planned ensures that the patient receives the necessary nutrition without causing harm. Option A suggests returning the aspirate to the stomach and rechecking the volume in an hour. This is not necessary as the residual volume is within an acceptable range, and delaying the feeding may compromise the patient's nutrition. Option C, discarding the aspirate to prevent overdistending the stomach, is incorrect because discarding the aspirate would deprive the patient of necessary nutrition and hydration. Option D, notifying the healthcare provider that feedings are too frequent, is not the most appropriate action in this situation. The focus should be on addressing the immediate need to provide nutrition to the patient while ensuring safety. Educationally, it is important for nurses to understand the significance of residual gastric volume when administering tube feedings to prevent complications such as aspiration pneumonia or gastric distension. Nurses need to be able to make quick and accurate decisions based on assessment data to provide optimal care for patients with enteral feedings.

Correct Answer: D

Rationale: The correct answer is D) irritation of the stomach lining by reflux of bile salts because the pylorus has been removed. Rationale: After a Billroth II procedure, where the lower portion of the stomach is removed and the remaining stomach is connected to the jejunum, the pylorus (the valve that controls the release of stomach contents into the small intestine) is bypassed. This can lead to a condition known as bile reflux gastritis. Bile reflux occurs when bile from the intestine enters the stomach and causes irritation to the stomach lining, leading to symptoms like abdominal pain, nausea, and discomfort. Option A is incorrect because dumping syndrome, a complication of rapid gastric emptying, is not caused by distention of the smaller stomach but rather by the quick passage of food into the small intestine, leading to symptoms like cramping and diarrhea. Option B is incorrect because distention of the smaller stomach would not typically lead to dumping syndrome but may cause discomfort or early satiety. Option C is incorrect because hyperglycemia is not typically associated with dumping syndrome but rather with conditions like diabetes or insulin resistance. Educational Context: Understanding the complications and implications of gastrointestinal surgeries, such as the Billroth II procedure, is crucial for healthcare providers caring for patients postoperatively. Recognizing the symptoms and causes of complications like bile reflux gastritis can help nurses provide appropriate education and interventions to manage these issues effectively. This knowledge is essential for promoting optimal patient outcomes and improving the quality of care in gastroenterology practice.

Correct Answer: C

Rationale: In ulcerative colitis, a chronic inflammatory condition of the colon, diarrhea and vomiting can lead to significant electrolyte imbalances. Option C, which includes decreased levels of Na+, K+, Mg+, Cl-, and HCO3-, is the correct answer. Decreased Na+ may result from diarrhea, while decreased K+ and Mg+ can occur due to vomiting and malabsorption. Decreased Cl- and HCO3- levels can occur as a result of chronic diarrhea, leading to metabolic acidosis. These electrolyte imbalances can result in dehydration, weakness, and other complications in patients with ulcerative colitis. Options A, B, and D are incorrect. Increased albumin (Option A) is not typically seen in ulcerative colitis with diarrhea and vomiting. Elevated white blood cells (Option B) may be seen in inflammatory conditions like ulcerative colitis, but it is not directly related to diarrhea and vomiting. Decreased hemoglobin and hematocrit (Option D) may occur in cases of chronic blood loss or anemia associated with ulcerative colitis but are not specifically related to diarrhea and vomiting. Understanding the laboratory findings associated with ulcerative colitis is crucial for healthcare providers to effectively manage and treat patients with this condition. Monitoring electrolyte imbalances and addressing them promptly is essential in managing the complications of ulcerative colitis. This question helps reinforce the importance of recognizing and addressing electrolyte imbalances in patients with gastrointestinal issues.

Correct Answer: C

Rationale: The correct answer is C) The surgery is needed to allow intestinal flow and prevent necrosis. Explanation of the correct answer: When a hernia becomes strangulated, it means that the blood supply to the trapped intestine is compromised. This can lead to tissue death (necrosis) if not treated promptly. Surgery is necessary to release the trapped intestine, restore blood flow, and prevent further complications like gangrene or sepsis. This explanation helps the patient understand the urgency and importance of undergoing surgery in a timely manner to prevent serious consequences. Explanation of why the other options are wrong: A) Option A is incorrect because relieving constipation is not the primary goal of surgery for a strangulated hernia. B) Option B is incorrect because simply replacing the hernia into the abdomen does not address the underlying issue of compromised blood flow and potential tissue damage. D) Option D is incorrect because it refers to a different type of hernia (umbilical) and does not address the specific situation of a femoral strangulated hernia. Educational context: Understanding the rationale behind surgical interventions is crucial for both healthcare providers and patients. In this case, educating the patient about the necessity of surgery for a strangulated hernia helps them make informed decisions about their healthcare and promotes adherence to the recommended treatment plan. Healthcare providers must communicate effectively to ensure patients comprehend the reasons behind medical interventions and actively participate in their care.

Correct Answer: C

Rationale: The correct response is C) Interferon combined with lamivudine (Epivir) will decrease viral load and prevent complications. This is the most appropriate answer because chronic hepatitis B can be managed with antiviral therapy, such as lamivudine, to reduce viral replication and inflammation. Interferon can also be used to help modulate the immune response. Option A is incorrect because chronic hepatitis B, not just hepatitis C, can be treated with antiviral agents and interferon. Option B is incorrect as there are specific drug therapies available for chronic hepatitis B. Option D is incorrect as there are drugs available for treating viral hepatitis, and appropriate use can help manage the disease and prevent further liver damage. In an educational context, it is crucial for nurses to understand the treatment options for chronic hepatitis B to provide accurate information and support to patients. Educating patients on the importance of adhering to prescribed antiviral therapy can help improve outcomes and quality of life for individuals living with chronic hepatitis B.