A nurse is planning care for a client who is returning to the unit following open gastric bypass surgery. Which of the following interventions should the nurse include in the client's plan of care?

Provide 60 mL (2 oz) of fluid intake every 5 min.

Measure and compare abdominal girth daily.

Provide a soft diet on the first postoperative day.

Ambulate the client 48 hr after the procedure.

Answer and Explanation

The Correct Answer is B

A.   Provide 60 mL (2 oz) of fluid intake every 5 min. Immediately post-surgery, fluid intake is usually more restricted and administered in smaller, more controlled quantities to prevent strain on the surgical site.
B.   After gastric bypass surgery, monitoring for signs of complications such as leaks, obstructions, or internal bleeding is crucial. Measuring abdominal girth daily is not typically necessary unless specific complications are suspected.
C.   Introducing a soft diet immediately post-surgery is typically delayed to allow healing; patients usually start with clear liquids.
D.   Early ambulation is generally encouraged postoperatively to prevent complications like deep vein thrombosis and to promote gastrointestinal function, often starting as soon as the first postoperative day.

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Correct Answer is ["B","C","E","F"]

Explanation

A. Douching is not recommended during pregnancy as it can disrupt the natural balance of vaginal flora and increase the risk of infection.
B. Loose-fitting clothing allows for better air circulation and can help prevent discomfort and irritation, especially with increased sweating and vaginal discharge during pregnancy.

C. Flat or low-heeled shoes provide better support and stability, reducing the strain on the back and pelvis, which can alleviate backaches common during pregnancy.
D. Hot showers can exacerbate itching, especially if the skin is already irritated.

Lukewarm or cool showers are preferable for relieving itching.

E. Fried foods can contribute to heartburn and indigestion, which are common during pregnancy due to hormonal changes and increased pressure on the stomach from the growing uterus.
F. An abdominal support belt can help alleviate backaches by providing additional support to the abdomen and reducing strain on the back muscles.
G. Eating frequent, smaller meals throughout the day is recommended during pregnancy to help manage heartburn, prevent overeating, and maintain stable blood sugar levels.

A. Chorioamnionitis B. Fetal anemia C. Maternal hypoglycemia D. Maternal fever

Correct Answer is C

Explanation

A. Chorioamnionitis, an infection of the fetal membranes, can lead to fetal tachycardia and no bradycardia
B. Fetal anemia might present with tachycardia rather than bradycardia.

C. Maternal hypoglycemia can cause fetal bradycardia since when a mother experiences hypoglycemia, it can result in inadequate blood glucose levels that are crucial for both her and the fetus. This condition can impair the oxygen and nutrient delivery to the fetus, as the mother's body prioritizes her own metabolic needs. Consequently, the fetal heart rate may slow down as a response to the stress of reduced energy supply.
D. Maternal fever is associated with fetal tachycardia rather than bradycardia.

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Body Systems	Findings
Head, Eyes, Ears, Nose, and Throat (HEENT)	Yellowing of the eyes Blurred vision Dry eyes
Gastrointestinal	Abdominal pain Hard stool
Hematologic	Increased bruising Increased bleeding tendency Insomnia
Genitourinary	Red/orange tint to urine Darkening of the urine

A nurse is planning care for a client who is returning to the unit following open gastric bypass surgery. Which of the following interventions should the nurse include in the client's plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an outpatient clinic is caring for a client. Exhibits Which of the following statements should the nurse include in the client's teaching? Select all that apply.

Correct Answer is ["B","C","E","F"]

Explanation

A nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 min. The nurse should identify which of the following conditions as a possible cause of fetal bradycardia?

Correct Answer is C

Explanation

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