A child with severe gastroesophageal reflux disease (GERD) is scheduled for Nissen fundoplication. Postoperative nursing management should include (select all that apply):
Starting bolus feedings to stretch the stomach
Venting gastrostomy tube
Keeping child flat in bed to increase absorption of food
Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome
Correct Answer : B,D
Choice A reason: Starting bolus feedings to stretch the stomach is not recommended for a child with Nissen fundoplication as it can cause increased pressure on the surgical site and lead to complications such as bleeding, perforation, or slippage of the wrap.
Choice B reason: Venting gastrostomy tube is a correct answer as it allows for the release of gas and fluids from the stomach and prevents gastric distension and discomfort. A gastrostomy tube is often placed during Nissen fundoplication to facilitate feeding and venting.
Choice C reason: Keeping child flat in bed to increase absorption of food is not advised for a child with Nissen fundoplication as it can increase the risk of aspiration and pneumonia. The child should be positioned at a 30-degree angle or higher after feeding to prevent reflux.
Choice D reason: Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome is a correct answer as it is a potential complication of Nissen fundoplication. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, causing symptoms such as abdominal cramps, nausea, diarrhea, sweating, and dizziness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Slowing the heart rate does not increase diastolic filling time. Diastolic filling time is the time during which the ventricles are relaxed and filling with blood. Slowing the heart rate would decrease the cardiac output and worsen the heart failure.
Choice B reason: Increasing urine output does decrease pulmonary congestion, but it is not the primary effect of Captopril. Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces the blood pressure and the afterload on the heart. Diuretics are the drugs that increase urine output and reduce fluid overload.
Choice C reason: This is the correct choice. Decreasing the afterload means reducing the resistance that the heart has to overcome to pump blood to the body. This lowers the blood pressure and the workload on the heart, which improves the cardiac function and reduces the symptoms of heart failure.
Choice D reason: Increasing serum potassium does not improve cardiac performance. In fact, high levels of potassium can cause cardiac arrhythmias and cardiac arrest. Captopril can cause hyperkalemia (high potassium) as a side effect, which is why patients on this drug need to monitor their potassium levels and avoid potassium supplements or salt substitutes.
Correct Answer is D
Explanation
Choice A reason: This statement is incorrect, as 5% is too high for the risk of mother-to-child transmission of HIV with ART. According to the World Health Organization (WHO), the risk of transmission can be reduced to less than 5% with effective interventions, such as ART, safe delivery practices, and appropriate infant feeding¹.
Choice B reason: This statement is incorrect, as 20% is too high for the risk of mother-to-child transmission of HIV with ART. According to the WHO, the risk of transmission can be reduced to less than 5% with effective interventions, such as ART, safe delivery practices, and appropriate infant feeding¹.
Choice C reason: This statement is incorrect, as 15% is too high for the risk of mother-to-child transmission of HIV with ART. According to the WHO, the risk of transmission can be reduced to less than 5% with effective interventions, such as ART, safe delivery practices, and appropriate infant feeding¹.
Choice D reason: This statement is correct, as 1% is the approximate risk of mother-to-child transmission of HIV with ART. According to HIV.gov, if a woman with HIV takes HIV medicine as prescribed throughout her pregnancy and childbirth and gives HIV medicine to her baby for 2-6 weeks after giving birth, the risk of transmitting HIV to the baby can be less than 1%.
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