Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?

Correct Answer: D

Rationale: In the context of a patient with a retractable gastric peptic ulcer who has undergone a gastric vagotomy, it is crucial to understand the effects of this surgical procedure on various factors within the gastrointestinal system. In this scenario, the correct answer is D) Gastric pH increases as a result of vagotomy. A gastric vagotomy involves cutting the vagus nerve, which plays a significant role in stimulating gastric acid secretion. Without this neural input, the production of gastric acid is reduced, leading to an increase in gastric pH. This change in pH can have implications for the patient's overall digestive process and ulcer healing. Now let's analyze why the other options are incorrect: A) Peristalsis: Vagotomy does not have a direct effect on peristalsis, which is the involuntary contraction and relaxation of muscles in the GI tract to move food along the digestive system. B) Gastric acidity: Vagotomy actually decreases gastric acidity due to the reduction in acid secretion. C) Gastric motility: While vagotomy can affect gastric motility to some extent, it does not directly increase gastric motility. The impact on motility is more complex and not as straightforward as the effect on pH. Understanding the effects of gastric vagotomy on gastric pH is essential for nurses caring for patients who have undergone this procedure. It influences the management of conditions such as peptic ulcers and requires close monitoring and appropriate interventions to support the patient's recovery and overall gastrointestinal health.

Correct Answer: A

Rationale: In this case, the correct answer is A) Ileostomy. An ileostomy typically produces malodorous, enzyme-rich, caustic liquid output that can be yellow, green, or brown in color. This is due to the fact that an ileostomy is created from the small intestine, where digestive enzymes are still present, leading to the characteristic output described. The incorrect options include B) Ascending colostomy, C) Transverse colostomy, and D) Descending colostomy. These types of colostomies are created from the large intestine (colon) where the stool is more formed and less liquid compared to the small intestine. Therefore, they would not produce the same type of malodorous, enzyme-rich, liquid output as an ileostomy. In the context of medical surgical nursing, understanding the different types of stomas and their expected outputs is crucial for providing optimal care to patients with ostomies. Recognizing the characteristics of each type of stoma helps nurses in assessing and managing complications, providing appropriate patient education, and promoting patient comfort and quality of life.

Correct Answer: B

Rationale: The correct answer is B: "The drainage will decrease daily until the bile duct heals." Rationale: This information is crucial for George to understand as it prepares him for what to expect post-surgery. After gallbladder surgery with a T tube in place, the drainage from the tube will gradually decrease as the bile duct heals. This education empowers the patient to monitor his recovery progress and alleviates unnecessary anxiety about the drainage. Option A: "If there is any drainage, notify the surgeon immediately." While it is important to monitor drainage, not all drainage warrants immediate notification. This option could cause unnecessary alarm for the patient. Option C: "First, the drainage is dark green; then it becomes dark yellow." This information, although descriptive, does not provide actionable guidance for the patient in managing the T tube drainage. Option D: "If the drainage stops, milk the tube toward the puncture wound." This instruction is incorrect as milking the tube can lead to complications such as dislodging the tube or causing injury to the bile duct. In an educational context, it is essential for nurses to provide clear, accurate, and relevant information to patients regarding postoperative care, including the management of drainage tubes. Understanding the rationale behind postoperative instructions empowers patients to participate actively in their recovery process and promotes a smooth transition from the hospital to home care.

Correct Answer: C

Rationale: In the context of Maria developing peptic ulcer disease due to NSAID use, the correct answer is C) Misoprostol (Cytotec). Misoprostol is a prostaglandin analog that helps prevent NSAID-induced ulcers by promoting mucus production in the stomach, enhancing mucosal defense, and reducing acid secretion. This drug is particularly effective in patients like Maria who require NSAIDs for pain management but are at risk for developing ulcers. Option A) Calcium carbonate (Tums) is an antacid that provides symptomatic relief but does not prevent NSAID-induced ulcers. Option B) Famotidine (Pepcid) is an H2 receptor antagonist that reduces acid production but does not address the underlying issue of mucosal protection. Option D) Sucralfate (Carafate) is a cytoprotective agent that forms a protective barrier over ulcers but does not specifically prevent NSAID-induced ulcers like Misoprostol does. In an educational context, understanding the mechanism of action of drugs used to prevent and treat gastrointestinal issues related to NSAID use is crucial for nursing practice. Nurses need to know the rationale behind selecting Misoprostol in this scenario to provide optimal care for patients like Maria and prevent complications associated with NSAID therapy.

Correct Answer: C

Rationale: In the context of this question about colorectal cancer risk factors, the correct answer is option C) Herman, a 60-year-old who follows a low-fat, high-fiber diet. This option is the least likely to have risk factors for colon cancer because a diet high in fiber and low in fat is associated with a lower risk of developing colorectal cancer. High-fiber diets help maintain bowel regularity and reduce the time that potentially harmful substances are in contact with the colon lining, thus decreasing the risk of cancer development. Option A) Janice, with a 25-year history of ulcerative colitis, is at an increased risk for colorectal cancer as chronic inflammation of the colon is a known risk factor. Option B) George, whose father died of colon cancer, has a family history of the disease which increases his risk. Option D) Sissy, with a history of breast cancer, does not have a direct risk factor for colon cancer related to her breast cancer history. In an educational context, this question highlights the importance of understanding modifiable and non-modifiable risk factors for colorectal cancer. It reinforces the significance of lifestyle factors, such as diet, in cancer prevention. Educating student nurses about risk factors empowers them to assess patients holistically, provide targeted health promotion interventions, and advocate for appropriate screening measures to improve patient outcomes.