Which of the following dietary interventions should a nurse consider after the removal of the nasogastric tube in a client who has undergone surgery for a liver disorder?

Correct Answer: A

Rationale: After the removal of a nasogastric tube following liver surgery, it is crucial for a nurse to consider providing small sips of clear liquids to the client. The rationale behind choosing option A is that clear liquids are easier to digest and are less likely to cause discomfort or complications in the immediate postoperative period. Clear liquids help prevent dehydration and provide essential hydration without putting excessive strain on the digestive system, which may still be recovering from the surgery. Option B, providing small sips of fruit juice or soup, may not be ideal immediately after the removal of the nasogastric tube as these options may contain pulp or solid pieces that could be difficult for the client's digestive system to handle. In the early stages of recovery, it is essential to start with easily digestible and gentle options like clear liquids. Option C, providing a small meal of soft foods, and option D, providing a meal of protein-rich foods, are both inappropriate choices after nasogastric tube removal in a client recovering from liver surgery. Introducing solid or heavy foods too soon can overwhelm the digestive system and may lead to complications such as vomiting, discomfort, or delayed healing. In an educational context, it is important for nurses to understand the rationale behind postoperative dietary interventions to promote optimal recovery and prevent complications. Clear communication with patients and their families regarding dietary recommendations post-surgery is essential to ensure the best possible outcomes for the client's recovery.

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: In this scenario, the correct answer is D) It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying. Ondansetron (Zofran) is a selective serotonin 5-HT3 receptor antagonist commonly used to prevent nausea and vomiting caused by chemotherapy. It works centrally by blocking serotonin receptors in the chemoreceptor trigger zone (vomiting center) and peripherally by enhancing gastric emptying. Option A is incorrect because ondansetron is not a derivative of cannabis, nor does it have a potential for abuse. Option B is incorrect as ondansetron is not primarily an antihistamine and does not induce sedation or sleep. Option C is incorrect because ondansetron is actually a first-line treatment for chemotherapy-induced nausea and vomiting due to its efficacy and tolerability. Educationally, understanding the mechanism of action of ondansetron is crucial for nurses caring for patients undergoing chemotherapy. Knowing how the drug works helps nurses provide safe and effective care by anticipating and managing potential side effects and assessing the drug's effectiveness in controlling symptoms. This knowledge also enables nurses to educate patients about the medication and its expected outcomes, promoting better patient understanding and adherence to the prescribed treatment plan.

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.