Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?

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.

Correct Answer: A

Rationale: In the context of preventing esophageal reflux, the correct answer is A) Eating small, frequent meals. This dietary measure helps by reducing the amount of food in the stomach at one time, which can decrease the likelihood of gastric contents refluxing back into the esophagus. By eating smaller, more frequent meals, there is less pressure on the lower esophageal sphincter, the muscle that normally prevents reflux. Option B) Increasing fluid intake is not directly related to preventing esophageal reflux. While staying hydrated is important for overall health, it does not specifically address the issue of reflux. Option C) Avoiding air swallowing with meals is more relevant to preventing gas and bloating rather than esophageal reflux. Option D) Adding a bedtime snack to the dietary plan can actually worsen esophageal reflux. Eating close to bedtime can increase the risk of reflux due to lying down shortly after eating, which can allow stomach acid to flow back into the esophagus. In the educational context of medical-surgical nursing, understanding the impact of dietary measures on gastrointestinal health is crucial. By selecting the appropriate dietary interventions, nurses can help patients manage and prevent conditions like esophageal reflux, promoting better outcomes and quality of life. It is essential to educate patients on the importance of dietary modifications in managing gastrointestinal disorders to enhance their understanding and self-care abilities.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) The ulcer has perforated. When a client with a bleeding duodenal ulcer presents with sudden, sharp pain in the midepigastric area and a rigid, boardlike abdomen, it suggests a serious complication like perforation of the ulcer. Perforation leads to the leaking of gastric contents into the peritoneal cavity, causing severe pain and abdominal rigidity. Option A) An intestinal obstruction is incorrect because the symptoms described do not align with those of an obstruction. Option B) Additional ulcers developing is unlikely to cause the sudden, sharp pain and rigidity described. Option C) Inflammation of the esophagus does not typically present with a rigid, boardlike abdomen and sudden, severe pain. In the context of medical-surgical nursing, understanding the complications of gastrointestinal disorders is crucial for timely intervention and preventing further deterioration. Recognizing the signs of a perforated ulcer is essential for nurses to promptly alert healthcare providers for appropriate management, which may include surgical intervention. This knowledge ensures optimal patient outcomes and highlights the importance of thorough assessment and clinical reasoning in nursing practice.

Correct Answer: D

Rationale: In understanding why a hiatal hernia can be caused by weakness of the diaphragmatic muscle (Option D), it is essential to have a grasp of the anatomical structures involved. The esophagus passes through an opening in the diaphragm called the esophageal hiatus. When there is weakness in the diaphragmatic muscle, particularly around this opening, part of the stomach can protrude through the diaphragm into the chest cavity, resulting in a hiatal hernia. Option A, increased intrathoracic pressure, is not a direct cause of a hiatal hernia. While increased pressure in the abdomen can contribute to the development of a hiatal hernia, it is not the primary cause. Option B, weakness of the esophageal muscle, is not a common cause of a hiatal hernia. The primary issue in a hiatal hernia lies in the weakening of the diaphragmatic muscle rather than the esophageal muscle. Option C, increased esophageal muscle pressure, is not a typical cause of a hiatal hernia. In fact, increased pressure within the esophagus can be a result of the hernia rather than the cause. Understanding the pathophysiology of conditions such as hiatal hernia is crucial for nursing practice, especially in medical-surgical settings. Nurses need to be able to recognize the risk factors, signs, and symptoms of hiatal hernias to provide appropriate care and education to patients. By grasping the underlying causes, nurses can better explain the condition to patients and assist in developing effective care plans.

Correct Answer: C

Rationale: In the context of medical-surgical nursing, understanding the manifestations of hiatal hernia is crucial for providing effective patient care. A hiatal hernia occurs when a portion of the stomach pushes up through the diaphragm into the chest cavity. One common symptom associated with hiatal hernia is esophageal reflux, which occurs due to the weakening of the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus. This reflux leads to symptoms such as heartburn, chest pain, regurgitation, and difficulty swallowing. Option A, left arm pain, is not a common symptom of hiatal hernia. Left arm pain is more commonly associated with cardiac issues such as a heart attack. Option B, lower back pain, is also not typically linked to hiatal hernia. Lower back pain may be related to musculoskeletal issues, spinal problems, or kidney conditions. Option D, abdominal cramping, is not a classic symptom of hiatal hernia. Abdominal cramping is more commonly associated with gastrointestinal issues like irritable bowel syndrome or gastroenteritis. Understanding the specific symptoms of hiatal hernia is vital for nurses to accurately assess, diagnose, and provide appropriate interventions for patients experiencing gastrointestinal issues. By differentiating between the common symptoms of hiatal hernia and other conditions, nurses can ensure timely and effective management of patients' health concerns.