A nurse in the emergency department is caring for a patient who reports severe abdominal pain in the left quadrant. The healthcare provider suspects a ruptured ectopic pregnancy.
What sign should the nurse look for that indicates the patient has blood in the peritoneum?
Lower quadrant pain
Cullen’s sign
Goodell’s sign
Chadwick’s sign
The Correct Answer is B
Choice A rationale
Lower quadrant pain is a common symptom of many conditions, including ectopic pregnancy. However, it does not specifically indicate the presence of blood in the peritoneum.
Choice B rationale
Cullen’s sign, which is the appearance of bruising in the skin around the umbilicus, is a sign of blood in the peritoneum. It can occur in conditions such as a ruptured ectopic pregnancy.
Choice C rationale
Goodell’s sign is a softening of the cervix that typically occurs early in pregnancy. It does not indicate the presence of blood in the peritoneum.
Choice D rationale
Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia that occurs in early pregnancy. It does not indicate the presence of blood in the peritoneum.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Drinking a full glass of water after taking the medication is a good practice when taking calcium carbonate antacids. This helps to ensure that the medication is fully swallowed and reaches the stomach, where it can neutralize stomach acid.
Choice B rationale
Limiting sodium intake is not directly related to the use of calcium carbonate antacids. While a low-sodium diet may be recommended for other health reasons, it is not a specific recommendation for patients taking this medication.
Choice C rationale
Consuming the medication alongside dairy products to enhance absorption is not recommended. Calcium carbonate antacids can interact with dairy products, potentially leading to an excessive intake of calcium.
Choice D rationale
Reducing dietary fiber to counteract the potential side effect of diarrhea is not a typical recommendation for patients taking calcium carbonate antacids. While calcium carbonate can cause constipation in some people, it does not typically cause diarrhea.
Correct Answer is D
Explanation
Choice A rationale
Lubricating the suction catheter tip with sterile saline is not recommended because it can introduce bacteria into the tracheostomy tube and cause infection.
Choice B rationale
Hyperventilating the patient on 100% oxygen prior to suctioning is not necessary and can cause complications such as oxygen toxicity.
Choice C rationale
Performing chest physiotherapy prior to suctioning is not typically done during tracheostomy care. Chest physiotherapy is a separate procedure that involves physical techniques to remove mucus from the respiratory tract.
Choice D rationale
Suctioning two to three times with a 60-second pause between passes is the correct action. This helps to remove secretions effectively without causing hypoxia.
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