A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect?
Hyperactive bowel sounds
Increased urinary output
Frequent bowel movements
Rigid abdomen
The Correct Answer is D
Choice A reason: Hyperactive bowel sounds are not typically associated with peritonitis. Instead, peritonitis often leads to decreased or absent bowel sounds due to the inflammation and subsequent ileus (paralysis of the bowel), which slows down or halts peristalsis.
Choice B reason: Increased urinary output is not a common symptom of peritonitis. In fact, peritonitis can sometimes result in reduced urine output due to the body's response to infection and inflammation, which can affect kidney function.
Choice C reason: Frequent bowel movements are not characteristic of peritonitis. The inflammation in the peritoneal cavity often leads to bowel paralysis, resulting in decreased bowel movements rather than increased frequency.
Choice D reason: A rigid abdomen is a hallmark sign of peritonitis. The rigidity is due to the body's protective response to the severe inflammation in the peritoneal cavity, causing the abdominal muscles to tighten and become hard. This clinical sign, along with severe pain, can help healthcare providers diagnose peritonitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A question-and-answer session might provide information but does not specifically encourage the client to share their feelings and concerns about the colostomy. It's more about imparting knowledge rather than addressing emotional needs.
Choice B reason: Discussion is an effective strategy to encourage the client to share their feelings about the colostomy. It creates an open environment for expressing concerns, asking questions, and receiving emotional support.
Choice C reason: Role play can be useful in teaching new skills or preparing for specific situations, but it might not be the best initial approach for someone struggling to accept a new colostomy. Emotional readiness and comfort should be addressed first.
Choice D reason: Return demonstration is a method to confirm the client's understanding of a procedure by having them perform it. It is more appropriate for assessing practical skills rather than addressing emotional concerns and readiness to engage with the stoma.
Correct Answer is A
Explanation
Choice A reason: The mouth serves as the portal of entry for hepatitis A when the virus is ingested through contaminated food or water. The portal of entry is the site through which the pathogen enters the body to initiate infection. In this case, consuming contaminated food allows the hepatitis A virus to enter the body through the mouth, leading to infection.
Choice B reason: The infectious agent is the pathogen responsible for causing the disease. In this scenario, the hepatitis A virus is the infectious agent. However, the question asks about the portal of entry, which is the mouth, not the infectious agent itself.
Choice C reason: A susceptible host is an individual who is vulnerable to infection due to factors like a weakened immune system or lack of prior immunity. While the client in the question is a susceptible host, the specific answer to the question is about the portal of entry, which is the mouth.
Choice D reason: The reservoir is the natural habitat or environment in which the pathogen lives and multiplies. For hepatitis A, common reservoirs include contaminated food and water. The reservoir is not the focus of this question; rather, it is asking about the portal of entry, which is the mouth.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
