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 A

Explanation

A. Loops of large bowel become visibly outlined through the abdominal wall is a typical late clinical finding of a large bowel obstruction. In fact, visible loops of bowel through the abdominal wall may be observed in cases of a severe bowel obstruction, but it is not typically considered a late finding.

B. Intense thirst, parched tongue, and dry mucous membranes suggest dehydration, which can occur as a result of vomiting, decreased fluid intake, or fluid loss due to the obstruction. However, dehydration may occur earlier in the course of a bowel obstruction and may not be considered a late finding.
C. Vomiting in large bowel obstruction is commonly of fecal contents.
D. High-pitched, frequent bowel sounds is not a typical late clinical finding of a large bowel obstruction. Instead, bowel sounds are usually diminished or absent in cases of bowel obstruction due to decreased peristalsis beyond the site of obstruction.

A. "Most of the weight you will lose at first is water rather than fat." B. "You will need to change your diet and exercise habits permanently in order to lose any weight." C. "You will decrease your risk for future health problems like atherosclerosis by losing weight now." D. "You will probably begin to notice changes in how you feel with just a few weeks of diet and exercise."

Correct Answer is D

Explanation

D. "You will probably begin to notice changes in how you feel with just a few weeks of diet and exercise.": This statement focuses on short-term benefits of weight loss, such as improvements in energy levels, mood, and overall well-being. Teenagers may be more motivated by immediate or short-term results rather than long-term outcomes. Feeling better quickly can provide positive reinforcement and encouragement to continue with healthy habits.
A. Water weight loss may not lead to significant changes in appearance or health outcomes, which are often key motivators for weight loss.
B. This statement emphasizes the importance of making lasting lifestyle changes for successful weight loss, which is a key concept for long-term success. However, it may sound daunting or overwhelming to a teenager.
C. Connecting weight loss to long-term health outcomes is unlikely to motivate some teenagers. This is because most teenagers feel immune to most chronic illnesses.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who has a large bowel obstruction. Which late clinical finding would the nurse expect?

Correct Answer is A

Explanation

Which statement made by the nurse to a 14-year-old extremely obese teenager is most likely to motivate him to lose weight?

Correct Answer is D

Explanation

After successfully losing 0.5 to 1 pound weekly for several months, a client at the clinic has not lost any weight for the last month. The nurse should first:

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The nurse is caring for a client who has acute gastritis due to food poisoning. The client is experiencing nausea and vomiting. The nurse would question which of the following medications, if ordered?

The nurse is caring for a hospitalized client who is attempting to pass a kidney stone. Which clinical manifestation should the nurse recognize as Indicating a potential emergency situation?

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