A nurse is caring for a patient who is 2 days postoperative from abdominal surgery.
The patient reports discomfort from abdominal distension and flatus. Which of the following suggestions should the nurse include?
Assume a position with legs and rectum lower than the stomach.
Use a straw.
Ambulate several times a day.
Drink cold liquids.
The Correct Answer is C
Choice A rationale
Assuming a position with legs and rectum lower than the stomach is not typically recommended for managing postoperative abdominal discomfort.
Choice B rationale
Using a straw can actually increase the amount of air swallowed, which can contribute to gas and bloating.
Choice C rationale
Ambulation, or walking, is often recommended after abdominal surgery to help reduce gas buildup and stimulate the digestive system.
Choice D rationale
Drinking cold liquids is not specifically recommended for managing postoperative abdominal discomfort. However, staying hydrated is important
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Correct Answer is D
Explanation
Choice A rationale
Pursed-lip breathing can help improve oxygenation and reduce shortness of breath in clients with COPD. However, it is not the priority action when a client reports difficulty breathing.
Choice B rationale
Increasing the oxygen flow rate without a physician’s order can lead to oxygen toxicity or suppress the respiratory drive in clients with COPD. Therefore, this is not the priority action.
Choice C rationale
Coughing and expectorating secretions can help clear the airways, but it is not the priority action when a client reports difficulty breathing.
Choice D rationale
Evaluating the client’s respiratory status is the priority action. The nurse should assess the client’s breath sounds, respiratory rate, use of accessory muscles, and oxygen saturation to determine the severity of the client’s difficulty breathing and guide further interventions.
Correct Answer is C
Explanation
Choice A rationale
High hemoglobin is not typically a symptom of a perforated peptic ulcer. Hemoglobin is a protein in red blood cells that carries oxygen. While changes in hemoglobin levels can indicate various health conditions, they are not directly associated with a perforated peptic ulcer.
Choice B rationale
Yellowing of the skin, or jaundice, is a symptom typically associated with liver disease, not a perforated peptic ulcer. Jaundice occurs when there’s too much bilirubin, a yellow-orange substance, in your blood.
Choice C rationale
Acute, sharp, and severe abdominal pain is a common symptom of a perforated peptic ulcer. A perforated peptic ulcer is a medical emergency that occurs when an ulcer goes through all the layers of the stomach or duodenum wall, creating a hole. This allows stomach or intestinal contents to leak into the abdominal cavity, causing severe abdominal pain.
Choice D rationale
High hematocrit is not typically a symptom of a perforated peptic ulcer. Hematocrit is the proportion of your total blood volume that is composed of red blood cells. While changes in hematocrit levels can indicate various health conditions, they are not directly associated with a perforated peptic ulcer. Dumping syndromeDumping syndrome Explore
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