A nurse is reinforcing discharge teaching with a client following a gastrectomy. Which of the following foods should the nurse instruct the client to consume to prevent dumping syndrome?

Ice cream

Peppermints

Coleslaw

Poached eggs

Answer and Explanation

The Correct Answer is D

Post-gastrectomy care requires dietary modifications to prevent complications such as rapid gastric emptying, commonly known as Dumping syndrome. This condition occurs when hyperosmolar food contents move too quickly from the stomach into the small intestine, leading to fluid shifts, abdominal cramping, diarrhea, dizziness, and tachycardia. Prevention focuses on dietary adjustments that slow gastric emptying, reduce simple sugars, and increase protein intake. Clients are typically advised to consume small, frequent meals that are high in protein and moderate in fat while avoiding high-carbohydrate foods.

Rationale:
A. Ice cream is high in simple sugars and lactose, which can rapidly increase osmotic load in the small intestine. This leads to fluid shifts, abdominal cramping, and diarrhea, worsening dumping syndrome symptoms. Dairy-based sugary foods are generally discouraged in post-gastrectomy dietary planning.

B. Peppermints may worsen symptoms because they can relax the lower esophageal sphincter and contain sugar, depending on formulation. Sugar-containing foods increase osmotic activity in the intestine, triggering rapid fluid shifts. They do not provide nutritional stability needed to prevent dumping syndrome episodes.

C. Coleslaw may contain cabbage and mayonnaise, but it often includes added sugar and high-fat dressing variations. While fat slows gastric emptying, the presence of raw fibrous vegetables can also cause gastrointestinal discomfort in some post-gastrectomy clients. It is not the most appropriate choice for preventing dumping syndrome compared to high-protein options.

D. Poached eggs are an excellent source of high-quality protein with minimal carbohydrate content. Protein-rich foods slow gastric emptying and reduce the rapid osmotic shifts responsible for dumping syndrome symptoms. They are recommended in post-gastrectomy diets to promote better tolerance and nutritional stability.

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Correct Answer is B

Explanation

Postoperative clients require close monitoring for early signs of complications such as infection, bleeding, and impaired wound healing. Surgical site infection typically develops within a few days after surgery and is associated with localized inflammatory changes and systemic responses. Nurses assess wound appearance, drainage characteristics, vital signs, and laboratory values to detect deviations from normal healing. Early identification of infection allows for timely intervention and prevents progression to systemic sepsis.

Rationale:
A. A WBC count of 8,000/mm³ is within the normal range and does not indicate infection. Although elevated white blood cells can suggest infection, this value does not reflect an inflammatory or infectious process. Normal laboratory findings alone do not support postoperative infection.

B. Edema around the incision site may indicate localized inflammation associated with a developing surgical site infection. In Postoperative wound infection, swelling may be accompanied by warmth, redness, pain, and possible purulent drainage. While mild edema can occur normally after surgery, increasing or persistent swelling beyond expected healing patterns suggests infection and requires further assessment.

C. Serous drainage in a closed suction device is expected in the early postoperative period and represents normal healing. Serous fluid is clear or pale yellow and indicates plasma leakage without infection. Infected wounds typically produce purulent, foul-smelling, or cloudy drainage rather than serous fluid.

D. A urine output of 40 mL/hr is within the normal expected range for an adult (generally ≥30 mL/hr). This finding reflects adequate renal perfusion and does not indicate infection. It is unrelated to surgical site infection unless systemic complications develop.

A. Writing a short story depicting themselves as a superhero. B. Punching the bed pillow when the staff denies the use of the telephone. C. Having an aggressive outburst when meal selection is unavailable. D. Blaming their parent for a lack of attention received during childhood.

Correct Answer is B

Explanation

Defense mechanisms are unconscious psychological strategies used to reduce anxiety and protect the ego from distressing emotions. In anxiety disorders, clients may use maladaptive coping mechanisms when they are unable to directly express feelings such as anger or frustration toward the actual source. Displacement occurs when an individual redirects emotional responses from a threatening or inappropriate target to a safer substitute. Nurses assess these behaviors to better understand coping patterns and emotional regulation.

Rationale:
A. Writing a short story depicting themselves as a superhero reflects fantasy, which is a defense mechanism involving escape into imagination to avoid reality. While it helps reduce anxiety, it does not involve redirecting emotions toward a substitute target. Therefore, it is not an example of displacement.

B. Punching the bed pillow when staff denies telephone use is an example of displacement because the client redirects anger from the authority figure (staff) to a safer object (pillow). The emotional energy is shifted from the real source of frustration to an acceptable substitute. This aligns with the definition of displacement in Defense mechanisms.

C. Having an aggressive outburst when meal selection is unavailable reflects direct expression of emotion rather than displacement. The behavior is directed at or in response to the actual triggering situation. This is more consistent with poor impulse control than defensive redirection.

D. Blaming a parent for lack of attention in childhood represents projection or possibly rationalization, where the client attributes feelings or responsibility to another person. It does not involve redirecting emotions to a safer target. Therefore, it is not an example of displacement.

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A nurse is reinforcing discharge teaching with a client following a gastrectomy. Which of the following foods should the nurse instruct the client to consume to prevent dumping syndrome?

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