A nurse is caring for a client diagnosed with a paralytic ileus. What would be an expected assessment finding?
Pencil-thin stools
Fecal-smelling breath
Passage of mucus and blood in stools
Absent bowel sounds and absent passage of flatus
The Correct Answer is D
D. In paralytic ileus, there is a lack of bowel motility, resulting in absent or diminished bowel sounds on auscultation and absent passage of flatus. The bowel sounds may be hypoactive or completely absent due to the lack of peristalsis. Additionally, the client may experience abdominal distention and discomfort due to the accumulation of gas and fluid in the intestines.
A. Pencil-thin stools are more commonly associated with conditions such as colorectal cancer or rectal strictures. In paralytic ileus, where there is a lack of bowel motility, the stools are typically absent rather than thin.
B. Fecal-smelling breath is not a typical finding in paralytic ileus. While it may occur in conditions associated with severe constipation or bowel obstruction, it is not specific to paralytic ileus.
C. Passage of mucus and blood in stools is not a characteristic finding of paralytic ileus. It is more commonly associated with conditions such as inflammatory bowel disease or colorectal cancer.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. The expected effect of TPN is to maintain or promote weight gain in clients who are unable to meet their nutritional needs orally. TPN provides essential nutrients directly into the bloodstream, allowing for adequate caloric intake to support energy needs and promote tissue repair and growth.
A. A serum white blood cell count of 16,000/mm3 indicates leukocytosis, which may suggest infection or inflammation rather than a direct effect of TPN.
B. Pre-albumin is a marker of nutritional status, and levels below 10 mg/dl typically indicate malnutrition rather than a positive response to TPN.
D. Negative nitrogen balance occurs when the body loses more nitrogen than it gains, typically due to inadequate protein intake or increased protein breakdown. TPN provides amino acids, which are the building blocks of protein, and aims to promote a positive nitrogen balance to support tissue repair and growth.
Correct Answer is B
Explanation
B. Taking pantoprazole before the first meal of the day allows for optimal acid suppression during the period of increased gastric acid production after waking up. This timing helps maximize the medication's effectiveness in reducing stomach acid and promoting ulcer healing.
A. Pantoprazole is a proton pump inhibitor (PPI) medication used to reduce stomach acid production and promote healing of gastric ulcers. It is typically taken once daily, usually in the morning before the first meal of the day. Taking pantoprazole before bedtime may not provide optimal acid suppression throughout the day when gastric acid production is typically higher.
C. Pantoprazole does not coat the ulcer; rather, it works by inhibiting the proton pumps in the stomach lining that produce acid. By reducing acid production, pantoprazole helps to create an environment in which the ulcer can heal more effectively.
D. While some individuals with conditions such as gastroesophageal reflux disease (GERD) or chronic gastric ulcers may require long-term or even lifelong pantoprazole therapy to manage their symptoms and prevent ulcer recurrence, the duration of treatment varies depending on the underlying condition, the severity of symptoms, and the response to treatment.
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