Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

Correct Answer: C

Rationale: In the context of a patient with peritonitis who is NPO and complaining of thirst, the priority action is to provide frequent mouth care, as indicated by the correct answer C. Providing frequent mouth care helps to maintain oral hygiene, reduce dryness, and alleviate the sensation of thirst without compromising the patient's NPO status. It also promotes comfort and prevents complications such as oral mucosal breakdown and infection. Addressing the patient's thirst through mouth care is a non-invasive and safe approach that aligns with the patient's dietary restrictions. The other options are not the priority in this situation: - Option A (Increase the I.V. infusion rate) may not be necessary solely for thirst relief and could potentially lead to fluid overload or other complications. - Option B (Use diversion activities) is not the most appropriate intervention when the patient's primary concern is thirst related to NPO status and peritonitis. - Option D (Give ice chips every 15 minutes) is contraindicated for a patient who is NPO due to the risk of aspiration and potential worsening of the underlying condition. Understanding the rationale behind prioritizing mouth care in this scenario reinforces the importance of individualized patient care, critical thinking, and evidence-based practice in the field of medical-surgical nursing.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Red. After a partial gastrectomy for adenocarcinoma of the stomach, the gastric secretions are expected to be red due to blood in the stomach. This finding is significant as it indicates the presence of bleeding, which could be a complication postoperatively and requires immediate attention. Option A) Brown is incorrect because brown gastric secretions are not typically expected after this type of surgery. Brown color may indicate the presence of old blood or bile. Option B) Clear is incorrect as clear gastric secretions are not typical post-partial gastrectomy and would not be expected in this context. Option D) Yellow is also incorrect because yellow gastric secretions are more commonly associated with issues like bile reflux rather than immediate postoperative findings after a partial gastrectomy. Educationally, understanding the color and significance of gastric secretions post-gastrectomy is crucial for nurses caring for surgical patients. Recognizing abnormal findings like red gastric secretions can help prompt timely interventions and prevent complications, highlighting the importance of thorough assessment and clinical judgment in postoperative care.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Gastric pH. A gastric vagotomy involves cutting the vagus nerve to reduce acid secretion in the stomach. As a result, gastric pH increases because there is less stimulation for acid production. This surgical procedure is often done to manage peptic ulcers by decreasing the acidity in the stomach, which can help in ulcer healing and prevention of recurrence. Option A) Peristalsis is not affected by a vagotomy as it is primarily controlled by the autonomic nervous system and smooth muscle in the gastrointestinal tract. Option B) Gastric acidity decreases after a vagotomy due to reduced acid secretion as a direct result of cutting the vagus nerve. Option C) Gastric motility may be decreased after a vagotomy because the vagus nerve plays a role in regulating gastrointestinal motility, but it is not the factor that increases as a result of vagotomy. Understanding the effects of a gastric vagotomy on various physiological processes is crucial for nurses caring for patients who have undergone this procedure. It helps in providing appropriate postoperative care, monitoring for complications, and educating patients about dietary and lifestyle modifications to promote recovery.

Correct Answer: B

Rationale: Clients with Crohn's disease often experience fatty stools (steatorrhea) due to malabsorption of fats. This occurs because the inflammation caused by Crohn's disease can affect the small intestine, impairing the body's ability to absorb nutrients. Bloody diarrhea is more commonly associated with ulcerative colitis. Weight gain is not a typical symptom of Crohn's disease; instead, weight loss is more common due to malabsorption and decreased appetite. High fever can occur during acute flare-ups but is not a primary finding of Crohn's disease.