After a subtotal gastrectomy a client demonstrates signs of dumping syndrome. about 90 minutes after the initial attack, the client reports feeling shaky. what does the nurse determine is the cause of the latter effect?

There are choices for this question namely:

A. A second more extensive rise in glucose.
B. An overwhelmed insulin-adjusting mechanism.
C. A distention of the duodenum from an excessive amount of chyme.
D. An overproduction of insulin that occurs in response to the rise in blood glucose

Dumping syndrome is an unsynchronized mechanism wherein there is a higher than normal rise of insulin levels causing transient but severe hypoglycemia. This typically presents within 1 and a half hour after eating wherein there is a physiological transient hypoglycemia but then overwhelmed by the non-synchrony of insulin effects causing severe hyperglycemia. Therefore the correct answer is "an overwhelmed insulin-adjusting mechanism." The choice "an overproduction of insulin that occurs in response to the rise in blood glucose" is wrong because an overproduction of insulin will result to lower blood glucose. 

To kill bacteria from our body especially from stomach

Self-reports would be the answer.