A patient is recovering from a common bile duct exploration and has a T-tube drain in place. As the nurse, which action is most appropriate to ensure proper function and patient safety?

Flush the T-tube with sterile water every 6 hours to maintain patency.

Clamp the T-tube for 12 hours each day to reduce bile flow

Secure the T-tube to the patient's gown to prevent accidental dislodgement.

Maintain the drainage bag below the level of the abdomen to promote gravity drainage.

Answer and Explanation

The Correct Answer is D

A. Flush the T-tube with sterile water every 6 hours to maintain patency: T-tubes are generally not flushed unless prescribed by a healthcare provider because flushing can introduce bacteria and cause complications. Patency is typically maintained by gravity drainage alone.

B. Clamp the T-tube for 12 hours each day to reduce bile flow: Clamping the T-tube is not routinely recommended for such long periods unless directed by the healthcare provider. Clamping is usually done gradually, often for 1-2 hours, to assess the patient’s ability to tolerate bile drainage naturally before tube removal.

C. Secure the T-tube to the patient's gown to prevent accidental dislodgement: While securing the T-tube prevents accidental dislodgement, the tube should be taped to the skin rather than the gown, as attaching it to clothing can increase the risk of unintentional dislodgement with movement.

D. Maintain the drainage bag below the level of the abdomen to promote gravity drainage. This is the correct answer because positioning the drainage bag below the abdomen allows for gravity to assist in the flow of bile from the bile duct, preventing backup and promoting proper drainage.

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Correct Answer is A

Explanation

A. Dumping Syndrome: Dumping syndrome is a common complication following gastrectomy, where food moves too quickly from the stomach to the small intestine. Symptoms such as weakness, dizziness, and sweating, particularly after meals, are characteristic of this condition.

B. Peptic Ulcer Disease: While this can occur after gastrectomy, it typically presents with epigastric pain rather than weakness and dizziness after eating.

C. Gastroesophageal Reflux Disease (GERD): GERD typically presents with heartburn and acid regurgitation, not the postprandial weakness and sweating seen in dumping syndrome.

D. Irritable Bowel Syndrome (IBS): IBS symptoms usually include bloating, abdominal discomfort, and altered bowel habits, which are different from the described symptoms.

A. The patients have lowered their cholesterol levels from previous laboratory results. B. The patients have improved blood pressure readings to be within expected reference range. C. The patients are choosing healthier food options for their diet plans. D. There is a significant decrease in the patients BMI measurements.

Correct Answer is D

Explanation

A. The patients have lowered their cholesterol levels from previous laboratory results: Lower cholesterol levels are a positive health outcome but could result from factors other than weight loss, such as medication or diet changes. It is a good sign but not the most direct measure of the intervention's success.

B. The patients have improved blood pressure readings to be within expected reference range: Blood pressure improvements are important and can result from weight loss, but other factors like medications could influence this outcome.

C. The patients are choosing healthier food options for their diet plans: While choosing healthier food options is a positive behavior change, it is a process measure rather than an outcome. It does not necessarily indicate the interventions are working as effectively as a decrease in BMI.

D. There is a significant decrease in the patients' BMI measurements. A significant reduction in BMI is the most direct indicator of effective weight-loss interventions. A decrease in BMI reflects a measurable outcome that directly relates to weight loss.

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A patient is recovering from a common bile duct exploration and has a T-tube drain in place. As the nurse, which action is most appropriate to ensure proper function and patient safety?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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