A nurse is caring for a client diagnosed with systemic scleroderma five years ago. The nurse plans to assess the client to document the disease’s progression. In addition to skin changes, which of the following findings should the nurse expect?

Periorbital edema.

Excessive salivation.

Finger contractures.

Thinning of the skin.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Periorbital edema is not typically associated with the progression of systemic scleroderma.
Choice B rationale
Excessive salivation is not typically associated with the progression of systemic scleroderma.
Choice C rationale
Finger contractures can be expected in a client diagnosed with systemic scleroderma. As the disease progresses, it can cause tightening and hardening of the skin, which can lead to contractures.
Choice D rationale
Thinning of the skin is not typically associated with the progression of systemic scleroderma. In fact, the disease often causes the skin to thicken.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A rationale
Increasing sodium intake is not recommended for a client with cirrhosis and ascites. Sodium can cause fluid retention, which can worsen ascites.
Choice B rationale
Increasing saturated fat intake is not recommended for a client with cirrhosis and ascites. A balanced diet with adequate protein and carbohydrates is recommended.
Choice C rationale
Decreasing fluid intake can be a part of the management plan for a client with cirrhosis and ascites. This can help manage fluid balance and prevent further accumulation of fluid in the abdomen.
Choice D rationale
Decreasing carbohydrate intake is not typically recommended for a client with cirrhosis and ascites. Carbohydrates provide a source of energy that is necessary for the body’s functions.

A. Document the bowel sounds as hypoactive B. Administer prescribed drugs for constipation C. Review dietary intake for the past 24 hours D. Continue to listen for at least another 60 seconds

Correct Answer is D

Explanation

Choice A rationale
Documenting the bowel sounds as hypoactive is not the most appropriate action. Hypoactive bowel sounds are fewer than three bowel sound events in a minute or none at all. However, the absence of bowel sounds does not necessarily mean they are hypoactive. It could be due to other reasons such as ileus.
Choice B rationale
Administering prescribed drugs for constipation is not the immediate course of action when the nurse doesn’t hear any gurgling while listening to bowel sounds. Constipation is a condition that can cause hypoactive bowel sounds, but it’s not the only reason for the absence of bowel sounds. The nurse should first confirm the absence of bowel sounds before considering this action.
Choice C rationale

Reviewing dietary intake for the past 24 hours is not the immediate course of action. While diet can affect bowel sounds, it’s not the first step when bowel sounds are not heard. The nurse should first confirm the absence of bowel sounds before considering this action.
Choice D rationale
The correct action when the nurse doesn’t hear any gurgling while listening to bowel sounds is to continue to listen for at least another 60 seconds. Bowel sounds are produced by the movement of fluid, gas, and contents through the intestines. An absence of bowel sounds for greater than two minutes may indicate that there is no peristalsis—which implies an ileus.
Therefore, the nurse should continue to listen for at least another 60 seconds to confirm the absence of bowel sounds.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is caring for a client diagnosed with systemic scleroderma five years ago. The nurse plans to assess the client to document the disease’s progression. In addition to skin changes, which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care?

Correct Answer is C

Explanation

The nurse doesn’t hear any gurgling while listening to bowel sounds. What should be the nurse’s next course of action?

Correct Answer is D

Explanation

A nurse is assessing a postoperative client who has anemia due to excessive blood loss during surgery. What findings should the nurse expect?

A nurse is caring for a client who is experiencing chills and back pain during a blood transfusion. What should be the nurse’s priority action?

After thyroid surgery, the nurse suspects damage to the parathyroid glands when the patient develops which of the following?

A nurse is preparing discharge instructions for a patient who has been treated for acute pancreatitis. Which of the following statements is important to include in the instructions?

Which body substance should the nurse observe to evaluate the effectiveness of pancreatic enzyme replacement for a patient with chronic pancreatitis?

What effect does chronic exposure to ultraviolet (UV) rays have on the skin that increases the risk for skin cancer?

A nurse in a clinic is reviewing the laboratory values of a patient who has primary hypothyroidism. The nurse should anticipate an elevation in which of the following laboratory values?

A nurse is setting health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should be included in the plan?