A client with peritonitis presents with an elevated temperature, rapid heart rate, and shallow breathing. The nurse recognizes these signs as indicative of:
Hypothermia
Hypertension
Hyperventilation
Systemic inflammatory response
The Correct Answer is D
Choice A reason:
Hypothermia refers to abnormally low body temperature and is not associated with the clinical presentation of peritonitis.
Choice B reason:
Hypertension refers to high blood pressure and is not directly associated with the signs of peritonitis.
Choice C reason:
Hyperventilation involves rapid breathing but may not always be present in peritonitis.
Choice D reason:
The client's elevated temperature, rapid heart rate, and shallow breathing are indicative of a systemic inflammatory response, which is a characteristic feature of peritonitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Bradycardia is not a concerning finding in this context and may indicate a vagal response or be a side effect of certain medications.
Choice B reason:
Hypotension is a concerning finding and may indicate hypovolemic shock, a potentially life-threatening complication of peritonitis.
Choice C reason:
Hyperactive bowel sounds are not a concerning finding in this context and may be a sign of gastrointestinal motility.
Choice D reason:
Increased urine output may be a positive finding but does not directly relate to the development of hypovolemic shock.
Correct Answer is A
Explanation
Choice A reason:
Peritoneal dialysis involves inserting a catheter into the peritoneal cavity, which can increase the risk of infection at the insertion site and lead to peritonitis.
Choice B reason:
High blood pressure is not directly related to an increased risk of peritonitis in clients undergoing peritoneal dialysis.
Choice C reason:
Elevated cholesterol levels are not directly related to an increased risk of peritonitis in clients undergoing peritoneal dialysis.
Choice D reason:
An allergic reaction to the dialysis solution is a possibility but is not the primary reason for an increased risk of peritonitis in clients undergoing peritoneal dialysis.
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