Food and drug therapy will prevent the accumulation of hydrochloric acid or will neutralize and buffer the acid that does accumulate.

Option A: Uninterrupted sleep for 8 hours is good, but it does not directly affect the production of acid.
Option B: Monitoring vital signs every 2 hours is unnecessary. It can be monitored every shift or every 4 hours.
Option D: Milk could aggravate the production of hydrochloric acid. The nutrients in milk, particularly fat, may stimulate the stomach to produce more acid.

The effects of heparin are monitored by the PTT is normally 30 to 45 seconds; the therapeutic level is 1.5 to 2 times the normal level.

Option A: There is no need to stop the infusion since the PTT is at a therapeutic level. In patients receiving concomitant heparin and warfarin therapy, PTT reflects the combined effects of both drugs. Because of the marked effect of warfarin on the PTT, decreasing heparin dose in response to a high PTT frequently results in subtherapeutic heparin levels.
Option C: The PTT is not used to monitor warfarin therapy, but PTT may be prolonged by warfarin at high doses.
Option D: The level is correct; increasing the dosage is unnecessary. Warfarin markedly affects PTT, for each increase of 1.0 in the international normalized ratio, the PTT increases 16 seconds.

The stoma drainage bag is applied in the operating room. Drainage from the ileostomy contains secretions that are rich in digestive enzymes and highly irritating to the skin. Protection of the skin from the effects of these enzymes is begun at once. Skin exposed to these enzymes even for a short time becomes reddened, painful, and excoriated.

Option A: If the application of the drainage appliance is delayed after surgery, the skin around the stoma would be most likely irritated and damaged due to the digestive enzymes present in the secretions of the drainage.
Option C: An ileostomy needs a drainage bag before it starts to function so that the secretions from the drainage would be caught up by the bag, preventing contamination of the skin.
Option D: The client would have irritated, damaged skin once the drainage comes out from the stoma and comes into contact with the skin.

To avoid the complication of a painful spinal headache that can last for several days, the client is kept flat in a supine position for approximately 4 to 12 hours postoperatively. Headaches are believed to be caused by the seepage of cerebrospinal fluid from the puncture site. By keeping the client flat, cerebral spinal fluid pressures are equalized, which avoids trauma to the neurons.

Option A: The client may experience a severe headache if kept in a side-lying position. Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the tough membrane (dura mater) that surrounds the spinal cord.
Option C: A supine position for 4 to 12 hours would prevent seepage of cerebrospinal fluid from the puncture site. There is no need to flex the knees.
Option D: Lying on his stomach would be uncomfortable to a postoperative patient, and would cause a painful spinal headache from the spinal anesthesia.

This finding suggests that the level of consciousness is decreasing.

Option A: A blood pressure level of 110/70 mmHg is within normal limits. Increased intracranial pressure is caused by an increase in blood pressure.
Option B: A pulse rate of 95 bpm is within the normal range. When arterial blood pressure exceeds the intracranial pressure, blood flow to the brain is restored. The increased arterial blood pressure caused by the CNS ischemic response stimulates the baroceptors in the carotid bodies, thus slowing the heart rate drastically often to the point of bradycardia.
Option D: Anorexia is not related to increased intracranial pressure. Anorexia is an eating disorder characterized by abnormally low body weight, an intense fear of gaining weight, and a distorted perception of weight.