The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client's daily care?

Correct Answer: C

Rationale: Rationale: 1. The correct answer is C) Swab the client's tongue, gums, and lips with a soft foam applicator every 2 hours. This technique helps maintain oral hygiene by removing debris and bacteria that can lead to infections, especially in clients who cannot perform oral care themselves. Regular cleaning every 2 hours helps prevent plaque buildup, reduces the risk of oral infections, and promotes overall oral health. 2. Option A) Assess the oral cavity each time mouth care is given and record observations is incorrect because while assessment is important, it does not address the actual oral hygiene maintenance needed for the client. 3. Option B) Using a soft toothbrush to brush the client's teeth after each meal is incorrect because clients who cannot perform oral care themselves may have difficulty tolerating tooth brushing, and brushing after each meal may be too frequent and could potentially cause harm to the gums or oral tissues. 4. Option D) Rinsing the client's mouth with mouthwash several times a day is incorrect because frequent use of mouthwash can disrupt the natural flora of the mouth, leading to imbalances and potential oral health issues. Additionally, rinsing alone may not effectively clean the oral cavity compared to physically swabbing the tongue, gums, and lips. In summary, the key learning point is that for clients who cannot perform oral care themselves, regular swabbing of the tongue, gums, and lips every 2 hours with a soft foam applicator is a more appropriate and effective technique to maintain oral hygiene and prevent complications.

Correct Answer: B

Rationale: The correct answer is B) The procedure will result in anastomosis of the gastric stump to the jejunum. This explanation is accurate because a Billroth II procedure involves the surgical removal of part of the stomach (subtotal gastrectomy) and the attachment of the remaining stomach to the jejunum (anastomosis). This allows for the stomach to continue to empty its contents into the small intestine for digestion. Option A is incorrect because a subtotal gastrectomy does not involve enlargement of the pyloric sphincter. Option C is incorrect as the duodenum is not removed during a Billroth II procedure. Option D is incorrect as the vagus nerve is not repositioned during this surgery. In an educational context, understanding the specifics of surgical procedures like the Billroth II procedure is crucial for nurses caring for patients undergoing such surgeries. Providing accurate pre-operative teaching empowers patients to participate in their care and recovery effectively. It also ensures that they have realistic expectations and are prepared for the post-operative period.

Correct Answer: A

Rationale: In the context of a subtotal gastrectomy, the correct answer is A) Dark brown for nasogastric tube drainage 12 to 24 hours postoperatively. This drainage color indicates the presence of old blood from the surgical site. After gastrointestinal surgery, it is common for blood to be present in the gastrointestinal tract due to manipulation and tissue trauma during the procedure. Option B) Bile green is incorrect because bile typically has a greenish-yellow color and would not be expected in nasogastric drainage immediately after surgery. Option C) Bright red is incorrect as it would suggest active bleeding, which would be a concerning sign postoperatively and would require immediate intervention. Option D) Cloudy white is incorrect as it does not reflect the typical drainage color seen after a gastrectomy. Educationally, understanding the expected postoperative drainage colors helps nurses provide appropriate care and identify potential complications promptly. This knowledge enables nurses to differentiate between normal and abnormal findings, ensuring optimal patient outcomes in the postoperative period.

Correct Answer: C

Rationale: In the context of caring for a client after a subtotal gastrectomy, option C - "Monitor the client for N/V, and abdominal distention" is the correct nursing intervention for the care of the nasogastric tube and drainage system. Rationale for option C: After a subtotal gastrectomy, the client is at risk for postoperative complications such as nausea, vomiting (N/V), and abdominal distention due to alterations in their gastrointestinal anatomy and function. Monitoring for these signs and symptoms is crucial as they can indicate issues with gastric emptying, bowel obstruction, or other complications that may require prompt intervention. Explanation for why the other options are incorrect: A) Option A suggesting to irrigate the tube with sterile water every hour is unnecessary and can disrupt the natural drainage process, potentially leading to complications such as electrolyte imbalances or tube displacement. B) Repositioning the tube if it is not draining well (Option B) may not address the underlying cause of poor drainage and could cause discomfort or injury to the client if done without proper assessment. D) Option D advising to turn the machine to high suction if drainage is sluggish on low suction is not appropriate as high suction can cause trauma to the gastric mucosa and increase the risk of complications. Educational context: Understanding the rationale behind each nursing intervention is essential for providing safe and effective care to postoperative clients, especially those undergoing gastrointestinal surgeries. By prioritizing monitoring for common post-gastrectomy complications like N/V and abdominal distention, nurses can promptly identify and address any issues, ensuring optimal recovery and outcomes for the client.

Correct Answer: D

Rationale: In the scenario of a client who has undergone a subtotal gastrectomy for cancer, the expected nutritional outcome would be to achieve optimal nutritional status through oral or parenteral feedings, which is option D. This is because a subtotal gastrectomy involves the removal of a significant portion of the stomach, impacting the client's ability to adequately digest and absorb nutrients from food. As a result, they may require supplemental nutrition through oral or parenteral routes to meet their nutritional needs and prevent malnutrition. Option A, regaining weight loss within 1 month after surgery, is not the most appropriate outcome to focus on immediately post subtotal gastrectomy as the client's ability to consume and absorb nutrients will be compromised. Option B, resuming normal dietary intake of three meals per day, may not be feasible due to the reduced stomach capacity and altered digestion post-surgery. Option C, controlling nausea and vomiting through regular use of antiemetics, addresses symptoms but does not directly address the client's nutritional needs. In an educational context, understanding the nutritional implications of gastrointestinal surgeries like subtotal gastrectomy is crucial for nursing students. It highlights the importance of individualized nutritional care plans and the use of alternative feeding methods to ensure clients receive adequate nutrition despite anatomical changes. This knowledge helps students provide holistic care and support to clients undergoing such procedures.