A nurse is assessing a client with suspected gastroenteritis. Which finding would be most concerning and require immediate intervention?
Mild abdominal cramping and bloating.
Absence of bowel movements for 24 hours.
Blood in stool or dark, tarry stools.
Nausea and occasional vomiting.
The Correct Answer is C
A) Incorrect. Mild abdominal cramping and bloating are common symptoms of gastroenteritis and may not require immediate intervention.
B) Incorrect. While absence of bowel movements for 24 hours is concerning, it may not be an immediate emergency compared to other options.
C) Correct. The presence of blood in stool or dark, tarry stools indicates potential gastrointestinal bleeding, which requires immediate attention.
D) Incorrect. Nausea and occasional vomiting are common symptoms of gastroenteritis and may not be an immediate concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Correct. Skin turgor and mucous membranes are important indicators of hydration status, which is a critical concern in clients with gastroenteritis.
B) Incorrect. While blood pressure and heart rate are important vital signs, they may not provide immediate information about the client's hydration status.
C) Incorrect. Urinary output and specific gravity are important indicators of renal function, but they may not provide immediate information about the client's hydration status.
D) Incorrect. Respiratory rate and lung sounds are important assessments, but they may not provide immediate information about the client's hydration status.
Correct Answer is B
Explanation
A) Incorrect. Antidiarrheal medications can be considered but are not the first-line treatment for severe cases of gastroenteritis.
B) Correct. Rehydration is the primary intervention for clients with severe abdominal pain and signs of dehydration due to gastroenteritis.
C) Incorrect. Increasing fiber intake is not recommended in the acute phase of gastroenteritis, as it may exacerbate symptoms.
D) Incorrect. Fasting is not recommended in gastroenteritis; rehydration and appropriate nutrition are crucial.
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