Nokea
The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon?
- A. Bilateral crackles audible at both lung bases
- B. Redness, irritation, and skin breakdown in skinfolds
- C. Emesis of bile-colored fluid past the nasogastric (NG) tube
- D. Use of patient-controlled analgesia (PCA) several times an hour for pain
Correct Answer: C
Rationale: Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.
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The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include?
- A. Drink fluids between meals but not with meals.
- B. Choose high-fat foods for at least 30% of intake.
- C. Developing flabby skin can be prevented by exercise.
- D. Choose foods high in fiber to promote bowel function.
Correct Answer: A
Rationale: Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.
Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass?
- A. Educating the patient about the nasogastric (NG) tube
- B. Instructing the patient on coughing and breathing techniques
- C. Discussing necessary postoperative modifications in lifestyle
- D. Demonstrating passive range-of-motion exercises for the legs
Correct Answer: B
Rationale: Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.
Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?
- A. Take the patients apical pulse.
- B. Check the patients blood pressure.
- C. Ask the patient about dietary intake.
- D. Dipstick the patients urine for protein.
Correct Answer: B
Rationale: Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information also may be obtained by the nurse, but it will not assist with the diagnosis of metabolic syndrome.
A client is awaiting bariatric surgery in the morning. What action by the nurse is most important?
- A. Answering questions the client has about surgery
- B. Beginning venous thromboembolism prophylaxis
- C. Informing the client that he or she will be out of bed tomorrow
- D. Teaching the client about needed dietary changes
Correct Answer: B
Rationale: Morbidly obese clients are at high risk of venous thromboembolism and should be started on a regimen to prevent this from occurring as a priority. Answering questions about the surgery is done by the surgeon. Teaching is important, but safety comes first.
A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority?
- A. Assess the clients pain.
- B. Check the surgical incision.
- C. Ensure an adequate airway.
- D. Program the morphine pump.
Correct Answer: C
Rationale: All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.