The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:

Correct Answer: D

Rationale: In this scenario, the correct answer is D) An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum. A pyloroplasty is a surgical procedure performed to treat conditions like peptic ulcer disease by widening the opening between the stomach and the small intestine to improve gastric emptying. This procedure helps to alleviate symptoms such as gastric outlet obstruction and allows for better passage of food from the stomach to the intestines. Option A) Cutting the vagus nerve is incorrect because a pyloroplasty does not involve this nerve; the vagus nerve plays a role in regulating various functions in the gastrointestinal system. Option B) Removing the distal portion of the stomach is incorrect as this describes a different surgical procedure, such as a partial gastrectomy, which involves removing a portion of the stomach, not the pylorus. Option C) Removal of the ulcer and a large portion of the cells that produce hydrochloric acid is incorrect as it describes a different surgical intervention for peptic ulcer disease, such as a gastrectomy or ulcer removal, not specifically addressing the pylorus. Educationally, understanding the rationale behind surgical procedures like pyloroplasty is crucial for nurses caring for patients undergoing these interventions. It ensures accurate patient education and effective post-operative care to promote optimal outcomes and enhance patient understanding and compliance with treatment plans.

Correct Answer: B

Rationale: In assessing a client with acute cholecystitis, it is crucial for the nurse to understand the typical presentation of this condition. The correct answer is B) Upper quadrant and radiates to the right scapula and shoulder. This is because cholecystitis is inflammation of the gallbladder, which is located in the right upper quadrant of the abdomen. The pain typically radiates to the right shoulder and scapula due to referred pain patterns. Option A) Upper quadrant and radiates to the left scapula and shoulder is incorrect because cholecystitis pain does not typically radiate to the left side. Option C) Lower quadrant and radiates to the umbilicus is incorrect as cholecystitis pain is not typically located in the lower abdomen or radiating to the umbilicus. Option D) Lower quadrant and radiates to the back is also incorrect as cholecystitis pain is not usually felt in the lower quadrant or radiating to the back. Educationally, understanding the specific pain patterns associated with different conditions is essential for accurate assessment and diagnosis in nursing practice. By knowing the expected location and radiation of pain in cholecystitis, nurses can provide prompt and appropriate care to clients experiencing this condition.

Correct Answer: D

Rationale: In the immediate postoperative management of a client who has undergone gastric resection, monitoring for symptoms of hemorrhage (Option D) is crucial. This is because gastric resection is a major surgery that carries the risk of postoperative bleeding, which can be life-threatening if not promptly identified and managed. Monitoring for signs such as tachycardia, hypotension, pallor, and changes in drainage output is essential to detect hemorrhage early and initiate appropriate interventions. Assessing for bowel sounds (Option B) is important in postoperative care, but it is not the priority immediately after gastric resection. Bowel sounds may be diminished or absent in the immediate postoperative period due to factors like anesthesia and bowel manipulation during surgery. Providing nutritional support (Option C) is essential for long-term recovery but is not an immediate postoperative concern. Monitoring gastric pH (Option A) is not typically a priority in the immediate postoperative period after gastric resection, as it is more relevant in conditions like gastric ulcers or gastritis. Educationally, understanding the prioritization of postoperative interventions based on the client's condition and the type of surgery performed is vital for nursing practice. This rationale highlights the importance of recognizing and addressing potential complications following gastric resection to ensure optimal patient outcomes.

Correct Answer: B

Rationale: In the context of a gastric acid perforation, the immediate management should focus on addressing the critical issues related to the perforation. The correct answer, which is option B) Antacid administration, should not be included in the immediate management of the client. Antacids are not appropriate in the management of a gastric acid perforation because they may increase the risk of complications such as aspiration pneumonia or respiratory distress. Antacids can neutralize gastric acid, potentially masking the severity of the perforation and delaying appropriate interventions like surgical repair. On the other hand, options A, C, and D are crucial components of the immediate management of a gastric acid perforation. Blood replacement (option A) is necessary to address any potential blood loss from the perforation. Nasogastric tube suction (option C) can help decompress the stomach and prevent further leakage of gastric contents into the peritoneal cavity. Fluid and electrolyte replacement (option D) are essential to maintain hemodynamic stability and prevent complications of shock. Educationally, understanding the rationale behind each option enhances students' critical thinking skills and clinical reasoning abilities. By grasping the importance of appropriate interventions in different scenarios, nursing students can provide safe and effective care to clients in real-life situations.

Correct Answer: C

Rationale: In the management of peptic ulcer disease, mucosal barrier fortifiers are used to stimulate mucus production (Option C). The correct answer is C because these medications help enhance the protective mucus layer in the stomach and duodenum, which acts as a physical barrier against gastric acid and digestive enzymes. By increasing mucus production, these fortifiers promote mucosal healing and protect the gastrointestinal lining. Option A (To inhibit mucus production) is incorrect because inhibiting mucus production would worsen the condition by reducing the protective barrier against stomach acid. Option B (To neutralize acid production) is incorrect as mucosal barrier fortifiers do not work by directly neutralizing acid but rather by strengthening the mucosal defense mechanisms. Option D (To stimulate hydrogen ion diffusion back into the mucosa) is also incorrect as this process would not contribute to mucosal protection and ulcer healing. Educationally, understanding the rationale behind using mucosal barrier fortifiers in peptic ulcer disease is crucial for nursing students to grasp the principles of ulcer management. By comprehending how these medications work to enhance mucosal protection, students can provide effective care to patients with peptic ulcers and promote optimal healing outcomes.