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?
Watery stool.
Dizziness.
Abdominal distention.
Oliguria.
The Correct Answer is C
Choice A rationale:
Watery stool is not indicative of paralytic ileus. Paralytic ileus is a condition characterized by the inhibition of bowel peristalsis, leading to symptoms such as abdominal distention, constipation, and lack of bowel sounds.
Choice B rationale:
Dizziness is not a specific symptom of paralytic ileus. Dizziness can be caused by various factors and is not directly related to the gastrointestinal condition.
Choice C rationale:
Abdominal distention is the correct choice. Paralytic ileus often presents with abdominal distention due to the accumulation of gas and fluids in the intestines. This distention can cause discomfort and a visible increase in the size of the abdomen.
Choice D rationale:
Oliguria, a decreased urine output, is not a typical symptom of paralytic ileus. It is more indicative of kidney-related issues or dehydration rather than gastrointestinal problems.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2"]
Explanation
To calculate how many tablets of levothyroxine the nurse should administer, we'll need to convert the dose to the same unit as the available tablets. Here's the step-by-step process:
Convert the desired dose to milligrams (mg): 50 micrograms (mcg) = 50 / 1000 mg (since 1 mg = 1000 mcg) 50 mcg = 0.05 mg
Now, find out how many tablets of 0.025 mg each are required to achieve the desired dose: Number of tablets = Desired dose (in mg) / Tablet strength (in mg) Number of tablets = 0.05 mg / 0.025 mg Number of tablets = 2 tablets
Therefore, the nurse should administer 2 tablets per dose.
Correct Answer is C
Explanation
A. Waiting for 2 minutes between suctions is a standard practice to prevent damage to the trachea and to allow the client to recover from the suctioning process. This action is also appropriate and does not require intervention.
B. Suction is typically applied for 10-15 seconds while withdrawing the catheter to prevent hypoxia and trauma to the airway.
C. Encouraging a client to cough during suctioning is generally acceptable because coughing helps expel secretions from the airway.However, the nurse should ensure that the client does not cough too forcefully, as this could lead to trauma or discomfort.
D. The catheter should be attached to suction while being inserted and withdrawn to effectively clear secretions from the airway.
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