You're caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy?

Correct Answer: C

Rationale: In the context of caring for a patient who has just undergone ileostomy surgery, it is crucial for nurses to understand the expected drainage from the ileostomy in the immediate postoperative period. The correct answer, option C (1500 ml), is the most appropriate choice. Post-ileostomy surgery, the ileostomy will initially produce a significant amount of drainage due to the presence of residual fluids and secretions in the gastrointestinal tract. This drainage consists of digestive enzymes, bile, mucus, and other fluids. It is essential for nurses to monitor the output closely to assess the patient's hydration status and prevent complications such as electrolyte imbalances or dehydration. Options A, B, and D are incorrect because they do not reflect the typical range of drainage seen in the first 24 hours post-ileostomy surgery. A drainage of 100 ml (option A) would be too low, while 500 ml (option B) falls below the expected amount. A drainage of 5000 ml (option D) is excessively high and would raise concerns about fluid and electrolyte imbalances. Educationally, this question highlights the importance of accurate postoperative assessment and management of patients undergoing gastrointestinal surgery. It emphasizes the need for nurses to have a comprehensive understanding of expected postoperative outcomes to provide safe and effective care to patients with an ileostomy. Monitoring ileostomy drainage is a critical nursing intervention to ensure optimal patient outcomes and prevent complications.

Correct Answer: B

Rationale: The most therapeutic response in this scenario is option B, "You seem upset." This response demonstrates active listening and empathy towards Arthur's emotional state without making assumptions or providing false reassurance. By acknowledging his emotions, the nurse opens up a safe space for Arthur to express his concerns and fears, which can help build trust and facilitate effective communication. Option A, "I know just how you feel," is not the best response because it invalidates Arthur's unique experience by assuming the nurse knows exactly how he feels. This can come across as dismissive and may hinder open dialogue. Option C, "Oh, don't worry about it, everything will be just fine," is not appropriate as it provides false reassurance and minimizes Arthur's emotional distress. It fails to address his concerns and can lead to a breakdown in the therapeutic nurse-patient relationship. Option D, "Why do you think you have cancer?" is not the most therapeutic response as it may come off as confrontational and could make Arthur feel defensive. This question puts the onus on Arthur to justify his feelings rather than focusing on addressing his emotional needs during this vulnerable moment. In an educational context, it is essential for nursing students to understand the importance of therapeutic communication in building rapport with patients. Active listening, empathy, and validation of emotions are crucial skills that nurses must develop to provide holistic and patient-centered care. By choosing the most appropriate responses in challenging situations like this, nurses can support patients effectively through their emotional and physical health journeys.

Correct Answer: C

Rationale: Dumping syndrome is a common complication following a Billroth II procedure due to rapid emptying of food into the small intestine. Option C, dizziness and sweating, is the correct answer as they are classic symptoms of early dumping syndrome. Dizziness occurs due to fluid shifts, and sweating is a response to the rapid release of insulin. Option A, flushed dry skin, is incorrect because flushing is not a typical symptom of dumping syndrome. Option B, headache and bradycardia, are not associated with dumping syndrome; instead, tachycardia is more common due to the rapid shifts in fluid and electrolytes. Option D, dyspnea and chest pain, are not typical symptoms of dumping syndrome and are more indicative of cardiac or respiratory issues. Educationally, understanding the signs and symptoms of dumping syndrome is crucial for nurses caring for patients post-Billroth II procedure to provide prompt and appropriate interventions. Recognizing these symptoms can help prevent complications and improve patient outcomes.

Correct Answer: A

Rationale: In the case of a patient experiencing dumping syndrome after a Billroth II procedure, the correct dietary instruction to include is option A) Omit fluids with meals. Dumping syndrome occurs when undigested food rapidly enters the small intestine, causing symptoms like diarrhea, bloating, and rapid heartbeat. Omitting fluids with meals helps slow down the digestive process and reduces the severity of symptoms by decreasing the volume of food passing quickly into the intestines. Option B) Increase carbohydrate intake is incorrect because increasing carbohydrates can exacerbate dumping syndrome by contributing to the rapid influx of sugars into the intestines. Option C) Decrease protein intake is incorrect because protein is an essential nutrient for healing and overall health, especially after surgery. Option D) Decrease fat intake is incorrect because fats do not significantly impact the rapid emptying of the stomach that characterizes dumping syndrome. Educationally, understanding the rationale behind dietary instructions for patients with dumping syndrome is crucial for providing effective care and promoting optimal outcomes postoperatively. By implementing appropriate dietary modifications, nurses can help manage symptoms, improve patient comfort, and support the healing process following gastrointestinal surgeries.

Correct Answer: B

Rationale: In caring for a patient like Lewis with liver cirrhosis and ascites, it is crucial to understand the rationale behind the symptoms and interventions. The correct answer is B) Dyspnea. Ascites is the accumulation of fluid in the peritoneal cavity, leading to abdominal distension and potentially compromising respiratory function by exerting pressure on the diaphragm. Paracentesis is a procedure to remove this excess fluid, providing relief from abdominal distension and improving respiratory effort, hence relieving dyspnea. Option A) Pruritus is associated with liver dysfunction but is not directly relieved by paracentesis. Option C) Jaundice is a manifestation of liver dysfunction, specifically related to impaired bilirubin metabolism, and is not directly alleviated by paracentesis. Option D) Peripheral Neuropathy is a complication of chronic liver disease but is not directly impacted by paracentesis. Educationally, understanding the rationale behind symptom management in liver cirrhosis and ascites is crucial for nursing practice. Recognizing the effects of interventions like paracentesis on specific symptoms helps in providing holistic care and improving patient outcomes. It also highlights the importance of timely interventions in managing complications of liver disease.