A nurse is assessing a client who is postoperative following orthopedic surgery. Which of the following findings should the nurse identify as an indication of paralytic ileus?
Abdominal distention
Watery stool
Dizziness
Oliguria
The Correct Answer is A
A. Abdominal distention: Abdominal distention is a classic sign of paralytic ileus, which is a temporary cessation of intestinal peristalsis. When peristalsis is impaired, gas and fluid accumulate in the intestines, leading to abdominal distention.
B. Watery stool: Watery stool is not typically associated with paralytic ileus. In paralytic ileus, bowel movements are usually absent or significantly reduced due to decreased or absent peristalsis, resulting in constipation rather than watery stool.
C. Dizziness: Dizziness is not a typical sign of paralytic ileus. While the underlying cause of paralytic ileus may lead to electrolyte imbalances, which can manifest as dizziness, it is not a direct symptom of paralytic ileus itself.
D. Oliguria: Oliguria, or decreased urine output, is not directly related to paralytic ileus. Paralytic ileus affects the gastrointestinal tract, leading to symptoms such as abdominal distention and constipation, but it does not directly affect urinary output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A bologna sandwich on rye bread: Rye bread contains gluten, which is harmful to individuals with celiac disease. Therefore, foods containing gluten, such as rye bread, should be avoided in the diet of a preschooler with celiac disease.
B. Corn tortilla with black beans: Corn tortillas and black beans are both gluten-free options and suitable for individuals with celiac disease. Corn tortillas are made from cornmeal, which does not contain gluten, making them a safe choice for individuals with celiac disease. Black beans are also naturally gluten-free and can provide essential nutrients like protein and fiber to the preschooler's diet.
C. Whole wheat pasta with shrimp: Whole wheat pasta contains gluten, which is not suitable for individuals with celiac disease. Therefore, whole wheat pasta should be avoided in the diet of a preschooler with celiac disease.
D. Low sodium vegetable soup with barley: Barley contains gluten and is not suitable for individuals with celiac disease. Therefore, foods containing barley, such as vegetable soup with barley, should be avoided in the diet of a preschooler with celiac disease.
Correct Answer is A
Explanation
A. Placental abruption: Placental abruption is characterized by the premature separation of the placenta from the uterine wall before delivery of the fetus. Sudden, severe abdominal pain, moderate to severe vaginal bleeding, persistent uterine contractions, and uterine rigidity are classic signs and symptoms of placental abruption. Hypotension may occur due to hemorrhage, leading to decreased perfusion to vital organs.
B. Uterine rupture: Uterine rupture involves a tear in the uterine wall, which can lead to severe abdominal pain, vaginal bleeding, and signs of shock. However, uterine rupture typically occurs during labor or delivery, particularly in women with a history of uterine surgery or trauma.
C. Placenta previa: Placenta previa is characterized by the implantation of the placenta over or near the internal cervical os. It can cause painless vaginal bleeding in the third trimester, particularly after 20 weeks of gestation. However, it is not typically associated with severe abdominal pain or uterine rigidity.
D. Amniotic fluid embolus: An amniotic fluid embolus occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, leading to a potentially life-threatening reaction. Symptoms may include sudden dyspnea, hypotension, cardiovascular collapse, and disseminated intravascular coagulation (DIC). While it can cause severe complications, the symptoms described in the scenario are more consistent with placental abruption.
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