A nurse is caring for a client who is 1 day postoperative following an appendectomy. Which of the following findings should the nurse report?

Temperature 37.2° C (99° F)

Serosanguineous drainage at the incision site

Red streaks along the incision

Hypoactive bowel sounds in all four quadrants

Answer and Explanation

The Correct Answer is C

Red streaks along the incision. This is a possible sign of infection and should be reported to the healthcare provider. A temperature of 37.2°C (99°F) is within the normal range and does not require reporting. Serosanguineous drainage at the incision site is normal within the first few days postoperatively. Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.

Choice A: A temperature of 37.2°C (99°F) is within the normal range and does not require reporting.

Choice B: Serosanguineous drainage at the incision site is normal within the first few days postoperatively.

Choice D: Hypoactive bowel sounds in all four quadrants can indicate ileus, which is a possible complication following abdominal surgery, but it is not an immediate concern and can be monitored unless other symptoms arise.

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Correct Answer is D

Explanation

The correct answer is choice D. During injection of the contrast medium, the client may experience a feeling of heat. Choices A and C are incorrect because numbness in the fingertips and pain in the jawline are not expected during the procedure. Choice B is incorrect because the urge to urinate is associated with cystoscopy. Choice A is not correct because numbness in the fingertips is not expected during the procedure. Choice B is not correct because the urge to urinate is associated with cystoscopy. Choice C is not correct because pain in the jawline is not expected during the procedure.

A. "I will attend a support group to help me handle difficulties when they occur." B. "I have my partner empty the bag for me, so I don't have to look at it." C. "I look forward to having normal bowel movements again." D. "I wish my sexual relationship with my partner was like it was before."

Correct Answer is A

Explanation

The correct answer is choice A, "I will attend a support group to help me handle difficulties when they occur." This statement indicates that the client is accepting the situation and taking proactive steps to manage any difficulties that may arise. Choice B is incorrect because relying on someone else to empty the bag suggests possible denial or avoidance of the situation. Choice C is incorrect because normal bowel movements after an ileostomy may not happen. Choice D is incorrect because it is not related to acceptance of the ileostomy. Choice B is not correct because it shows possible denial or avoidance of the situation. Choice C is not correct because normal bowel movements may not occur. Choice D is not correct because it is not related to acceptance of the ileostomy.

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A nurse is caring for a client who is 1 day postoperative following an appendectomy. Which of the following findings should the nurse report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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