After having a vertical sleeve gastrectomy performed, a 42-year-old male client returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a client-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the post-op plan of care for the first 24 hours?

Teach the client to support the surgical site while deep breathing and coughing

Teach that PCA use may slow the return of bowel function, so the client should not overuse it

Irrigate and reposition the NGT frequently

Offer cups of fruit juices at frequent intervals

Answer and Explanation

The Correct Answer is A

A.   Teach the client to support the surgical site while deep breathing and coughing: This action is appropriate as it helps prevent complications such as atelectasis and pneumonia by promoting lung expansion and clearing secretions. Supporting the surgical site while deep breathing and coughing helps reduce pain and discomfort during these activities.
B.   This is an important teaching point for clients using PCA for pain control after surgery. Opioid medications used in PCA can lead to gastrointestinal motility issues, including constipation. However, pain management is central within the first 24 hours post operation.
C.   Irrigating and repositioning the NGT frequently can increase the risk of complications such as displacement or irritation of the surgical site. NGT care should be performed as needed based on institutional protocols and the client's condition.

D.   The client's diet will likely be advanced gradually, starting with clear fluids and progressing to full liquids and then solid foods as tolerated. Fruit juices may be introduced gradually as part of the liquid diet once the client's gastrointestinal function has recovered sufficiently.

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Correct Answer is C

Explanation

A. This statement reflects an understanding that medications such as orlistat are typically prescribed as an adjunct to lifestyle changes, including diet and exercise. It is important for clients to attempt lifestyle modifications before resorting to medication for weight loss. Therefore, this statement demonstrates appropriate knowledge.
B. Orlistat, a medication used for weight loss, can cause gastrointestinal side effects such as oily spotting, flatulence with discharge, fecal urgency, and oily or fatty stools.
C. Orlistat is not typically used as a long-term treatment for weight loss. It is usually prescribed for a limited duration to aid in initial weight loss efforts or to help maintain weight loss achieved through lifestyle modifications.
D. Orlistat has been shown to lead to modest weight loss in clinical studies, typically ranging from about 6-11 pounds (2.7-5 kg) over 6-12 months when used in conjunction with lifestyle modifications. However, individual weight loss outcomes can vary, and it is important for clients to have realistic expectations regarding the effectiveness of weight loss medications.

A. "I'm so glad I will be able to drink orange juice while I'm taking these medications." B. "While I'm taking these medications, my bowel movements could be black." C. "I'll include more calcium and vitamin D in my diet to prevent osteoporosis." D. "I have a medicine at home to take when I start having loose stools."

Correct Answer is B

Explanation

B. Bismuth subsalicylate, one of the medications prescribed for peptic ulcers, can cause blackening of the stools. This discoloration is harmless and temporary but is an important side effect to be aware of.
A. Citrus juices, including orange juice, can exacerbate symptoms of peptic ulcers due to their acidic nature. Therefore, it would not be appropriate for the client to consume orange juice while taking famotidine and bismuth subsalicylate.
C. Osteoporosis is not a known side effect or concern associated with these medications.
D. Constipation and not diarrhea, is a potential side effect of bismuth subsalicylate.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse recognizes that the client requires additional teaching when he states, "Drugs like orlistat will:

Correct Answer is C

Explanation

The nurse teaches a client newly diagnosed with a peptic ulcer about the prescribed medications famotidine and bismuth subsalicylate. Which statement made by the client indicates that the teaching was effective?

Correct Answer is B

Explanation

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