A nurse is planning care for a client who is postoperative and at risk for paralytic ileus.
Which of the following interventions should the nurse plan to take to promote peristalsis?
Decrease fluid intake.
Offer the client the bedpan every 2 hr.
Increase protein intake.
Increase ambulation.
The Correct Answer is D
Choice A rationale
Decreasing fluid intake can lead to dehydration and constipation, which would further impede peristalsis rather than promote it. Adequate hydration is essential for maintaining bowel regularity and facilitating the movement of intestinal contents.
Choice B rationale
Offering the bedpan every 2 hours does not directly stimulate peristalsis. While it provides an opportunity for bowel elimination, it does not address the underlying issue of decreased intestinal motility associated with paralytic ileus.
Choice C rationale
Increasing protein intake does not directly promote peristalsis. While protein is important for overall healing, it does not have a significant impact on stimulating bowel motility. Fiber intake is more directly related to promoting bowel function.
Choice D rationale
Increased ambulation stimulates peristalsis by promoting intestinal motility. Physical activity helps to move gas and fluids through the intestines, reducing the risk of paralytic ileus, which is a functional obstruction of the bowel often occurring after surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandins, which play a protective role in the gastric mucosa by promoting mucus and bicarbonate secretion, maintaining mucosal blood flow, and inhibiting acid secretion. Chronic NSAID use can disrupt these protective mechanisms, leading to mucosal damage and increasing the risk of peptic ulcer formation.
Choice B rationale
Bulimia nervosa is an eating disorder characterized by cycles of binge eating followed by compensatory behaviors such as vomiting. While vomiting can cause esophageal damage and dental erosion due to stomach acid exposure, it is not a direct risk factor for peptic ulcer disease.
Choice C rationale
Moderate alcohol consumption, such as a glass of wine with dinner, has not been consistently shown to be a significant risk factor for peptic ulcer disease. While excessive alcohol intake can irritate the gastric mucosa, moderate consumption is generally not considered a primary cause.
Choice D rationale
Green tea contains antioxidants and has some anti-inflammatory properties. Studies have not shown a link between green tea consumption and an increased risk of peptic ulcer disease; in fact, some research suggests potential protective effects on the gastric mucosa. .
Correct Answer is A
Explanation
Choice A rationale
Encouraging the patient to write down questions promotes active engagement in their care and ensures that all their concerns are addressed during the consultation with the provider. This empowers the patient to seek clarification and understand the proposed plan of care directly from the healthcare professional responsible for it.
Choice B rationale
Providing internet articles about colon cancer stages can overwhelm the newly diagnosed patient with potentially complex and sometimes unreliable information. The specifics of the patient's diagnosis and treatment plan should come directly from their healthcare provider, who can tailor the information to their individual situation and answer specific questions.
Choice C rationale
While it is true that the provider will explain the planned treatment, this response does not actively address the patient's immediate need for information and may make the patient feel dismissed. Encouraging the patient to prepare questions ensures a more productive and informative discussion with the provider.
Choice D rationale
Explaining treatment options based on cancer stage is the responsibility of the healthcare provider, who has the complete clinical picture and can discuss the risks, benefits, and potential outcomes of each option in the context of the patient's specific case. The nurse's role at this stage is to facilitate communication between the patient and the provider, not to provide detailed medical explanations.
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