A nurse is caring for a male client who is postoperative.
Which of the following client findings should the nurse identify as being consistent with dumping syndrome? Select all that apply.
Vital signs
Prescribed diet
Skin appearance
Blood glucose level
WBC count
Correct Answer : A,C,D
A. Vital signs. The client has a significantly elevated heart rate (110/min) and elevated blood pressure (178/82 mm Hg), both of which can be associated with autonomic responses in dumping syndrome. The dizziness and desire to lie down after eating are also classic symptoms. These signs reflect the body’s reaction to rapid gastric emptying and fluid shifts.
B. Prescribed diet. While a bland, soft diet is generally safe post-gastrectomy, it may not prevent dumping syndrome unless it includes specific modifications like low carbohydrate intake and small, frequent meals. However, this option alone does not directly indicate dumping syndrome.
C. Skin appearance. The client is noted to be diaphoretic and pale, which are common symptoms of dumping syndrome due to the vasomotor response and hypoglycemia that can follow rapid gastric emptying.
D. Blood glucose level. The client's fasting blood glucose dropped to 65 mg/dL, which is below the normal range. Hypoglycemia is a hallmark of late dumping syndrome, resulting from excessive insulin release after rapid carbohydrate absorption in the small intestine.
E. WBC count. The WBC count is within normal range (9,000/mm³) and does not indicate dumping syndrome or an infectious process. It is not relevant in this context.
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Related Questions
Correct Answer is C
Explanation
A. Provide frequent stimulation for the newborn. Excessive stimulation can worsen symptoms in newborns with neonatal abstinence syndrome (NAS), including irritability, tremors, and difficulty sleeping. These infants need a calm, low-stimulation environment to reduce neurologic stress.
B. Encourage frequent eye contact with the newborn during feedings. While bonding is important, prolonged or forced eye contact can overstimulate a newborn with NAS. These infants often have difficulty regulating sensory input and may become more irritable with excessive interaction.
C. Decrease the lighting levels in the nursery. A dim, quiet environment helps soothe infants experiencing NAS. Reducing lighting can minimize sensory overload, promote rest, and support neurologic regulation during withdrawal.
D. Wrap the newborn loosely in a blanket. Loose wrapping does not provide the security and containment that helps calm an overstimulated infant. Instead, swaddling the newborn snugly can reduce tremors, promote sleep, and offer comfort during withdrawal symptoms.
Correct Answer is D
Explanation
A. The nurse cannot adjust IV antibiotic schedules solely for convenience, as consistent timing is necessary to maintain therapeutic drug levels.
B. Infusing vancomycin at a faster rate is unsafe and increases the risk of complications such as red man syndrome.
C. This is incorrect because the 2-hour administration window applies to non–time-critical medications. IV antibiotics like vancomycin are time-critical and must be given within 30 minutes of the scheduled time.
D. Time-critical medications, such as IV antibiotics, must be administered within 30 minutes before or after the scheduled time, making this the most accurate response.
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