A nurse is assisting with the implementation of a bowel training program for a client. For the program to be effective, the nurse should take the client to the bathroom at which of the following times?

Every 2 hr while the client is awake

When the client has the urge to defecate

Immediately before meals

After the client feels abdominal cramping

Answer and Explanation

The Correct Answer is B

Choice A: Taking the client to the bathroom every 2 hours while awake is not an effective strategy for bowel training. This may disrupt the client's natural bowel rhythm and cause unnecessary stress and frustration. Bowel training aims to establish a regular and predictable time for elimination, not a frequent and arbitrary one¹².
Choice B: Taking the client to the bathroom when they have the urge to defecate is the best option for bowel training. This helps the client to respond to their body's signals and avoid suppressing or delaying the urge. It also reinforces the association between the urge and the act of defecation, which can improve bowel control and prevent constipation¹².
Choice C: Taking the client to the bathroom immediately before meals is not a good idea for bowel training. This may interfere with the client's appetite and digestion, as well as their social and emotional well-being. Bowel training should not be associated with negative or unpleasant feelings. Moreover, eating stimulates the gastrocolic reflex, which increases the motility of the colon and the likelihood of having a bowel movement after a meal¹³.
Choice D: Taking the client to the bathroom after they feel abdominal cramping is not a reliable method for bowel training. Abdominal cramping may indicate various conditions, such as irritable bowel syndrome, food intolerance, infection, or inflammation. It may not always be related to the need to defecate. Waiting for cramping to occur may also delay the evacuation and worsen the symptoms¹³.

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Correct Answer is D

Explanation

Choice A reason: Crackles auscultated over the client's lung fields are not a sign of pleural effusion. Crackles are abnormal breath sounds that indicate fluid or secretions in the alveoli. They can be heard in conditions such as pneumonia, heart failure, or pulmonary edema.

Choice B reason: Crepitus palpated on the client's chest is not a sign of pleural effusion. Crepitus is a crackling sensation that occurs when air leaks into the subcutaneous tissue. It can be felt in conditions such as pneumothorax, chest trauma, or chest surgery.

Choice C reason: Substernal retractions noted on the client's chest are not a sign of pleural effusion. Substernal retractions are inward movements of the chest wall below the sternum that indicate increased respiratory effort. They can be seen in conditions such as asthma, bronchiolitis, or croup.

Choice D reason: Dullness percussed over the client's lung fields is a sign of pleural effusion. Dullness is a flat sound that indicates the presence of a solid or liquid mass in the thoracic cavity. It can be detected in conditions such as pleural effusion, atelectasis, or consolidation.

A. Numbness of fingers B. Abdominal pain C. Dry skin D. Lethargy

Correct Answer is D

Explanation

Choice A reason: Numbness of fingers is not a sign of respiratory acidosis. It can be caused by other conditions such as peripheral neuropathy, Raynaud's syndrome, or carpal tunnel syndrome.

Choice B reason: Abdominal pain is not a sign of respiratory acidosis. It can be caused by other conditions such as gastritis, appendicitis, or gallstones.

Choice C reason: Dry skin is not a sign of respiratory acidosis. It can be caused by other conditions such as dehydration, eczema, or hypothyroidism.

Choice D reason: Lethargy is a sign of respiratory acidosis, as it indicates a low level of oxygen and a high level of carbon dioxide in the brain. Lethargy is a state of reduced mental and physical activity, which can progress to confusion, coma, or death if not treated.

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A nurse is assisting with the implementation of a bowel training program for a client. For the program to be effective, the nurse should take the client to the bathroom at which of the following times?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data on a client who has a pleural effusion. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

A nurse is collecting data on a client who has respiratory acidosis. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

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A nurse is caring for a client who has pneumonia and has been receiving oxygen therapy for several days. When collecting data from the client, the nurse should identify which of the following findings as an indication of an adverse effect of oxygen therapy?

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