A nurse is caring for a patient who is being admitted for an acute exacerbation of ulcerative colitis.
Which of the following actions should the nurse take first?

Choice A rationale

Insertion of a nasogastric tube is expected in a client with paralytic ileus to decompress the bowel by removing accumulated fluids and gas. Paralytic ileus is a non-mechanical obstruction of the bowel characterized by a lack of peristalsis, often occurring after abdominal surgery like an appendectomy. This decompression helps relieve abdominal distension, pain, and nausea, facilitating the return of bowel function.

Choice B rationale

Providing a bulk-forming agent, such as psyllium, is contraindicated in paralytic ileus. Bulk-forming agents work by increasing the volume of stool, which would exacerbate the obstruction and potentially cause further discomfort and complications in the absence of peristalsis. These agents are typically used to treat constipation by adding fiber to the diet and promoting bowel movements.

Choice C rationale

Administering an antacid, such as aluminum hydroxide or calcium carbonate, is not a primary intervention for paralytic ileus. Antacids work by neutralizing stomach acid and are used to treat conditions like heartburn and acid reflux. While a client with paralytic ileus might experience some gastric upset, the underlying issue is the lack of bowel motility, which antacids do not address.

Choice D rationale

Applying a truss is used to provide support for hernias, a condition unrelated to paralytic ileus following an appendectomy. A truss helps to keep the protruding tissue in place and reduce discomfort associated with the hernia. It does not address the underlying lack of bowel motility characteristic of paralytic ileus.

Choice A rationale

While weight loss is generally healthy for obese individuals, this statement dismisses a potential link between obesity and reflux, which may not be entirely accurate. Increased intra-abdominal pressure due to excess weight is a known contributing factor to gastroesophageal reflux.

Choice B rationale

Excess abdominal adipose tissue increases pressure on the stomach. This elevated pressure can overcome the lower esophageal sphincter's (LES) barrier function, allowing stomach acid and contents to reflux into the esophagus, causing the symptoms of gastroesophageal reflux disease (GERD).

Choice C rationale

While a high-fat diet can contribute to reflux by delaying gastric emptying and relaxing the LES, this statement generalizes that all obese people eat more high-fat food. Obesity itself, regardless of dietary habits, can increase intra-abdominal pressure.

Choice D rationale

This statement is a generalization about the eating habits of obese individuals and does not directly explain the physiological mechanism by which obesity can cause reflux. While larger or more frequent meals can increase stomach distension and potentially reflux, the primary link related to obesity is the increased abdominal pressure.