A nurse is caring for an older adult client. The nurse informs the client that straining while defecating can cause which of the following?
Dysrhythmias
Dilated pupils
Gastric ulcer
Diarrhea
The Correct Answer is A
A) Dysrhythmias:
Straining while defecating can trigger the Valsalva maneuver, which involves taking a deep breath and bearing down. This can lead to increased intrathoracic pressure, decreased venous return to the heart, and subsequently a sudden drop in blood pressure when the strain is released. These changes can cause cardiac dysrhythmias, particularly in older adults or those with underlying heart conditions.
B) Dilated pupils:
Dilated pupils are not a known consequence of straining while defecating. Pupillary dilation is typically associated with responses to low light, certain medications, or neurological conditions, rather than gastrointestinal strain.
C) Gastric ulcer:
Gastric ulcers are caused by factors such as Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), or excessive stomach acid. Straining during defecation does not contribute to the development of gastric ulcers.
D) Diarrhea:
Straining while defecating is more likely to be associated with constipation rather than diarrhea. Diarrhea involves frequent, loose, or watery stools, whereas straining typically occurs due to hard stools and difficulty passing them.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Palliative care is limited to clients who are in a healthcare facility: Palliative care can be provided in various settings, including hospitals, hospices, long-term care facilities, and even in the client's home. It is not limited to clients who are in a healthcare facility.
B) The goal of palliative care is to cure an acute illness for a client: Palliative care focuses on providing relief from the symptoms and stress of a serious illness, rather than curing the illness itself. The primary goal is to improve the quality of life for both the client and their family, focusing on physical, psychosocial, and spiritual aspects of care.
C) Palliative care is restricted to clients who are terminally ill: While palliative care is often associated with end-of-life care for clients with terminal illnesses, it is not limited to this population. Palliative care can be provided at any stage of a serious illness, from diagnosis through treatment, survivorship, or end-of-life care.
D) Palliative care can be provided to a client who is receiving a curative treatment: This is the correct statement. Palliative care can be integrated with curative treatment for clients with serious illnesses. It focuses on managing symptoms, providing emotional support, and improving the overall quality of life, regardless of whether the client is receiving treatment aimed at curing their illness.
Correct Answer is C
Explanation
A. You should advance your weak leg forward to the cane, then move your strong leg:
Advancing the weak leg first and then the strong leg is not the proper technique for using a cane. The correct method is to hold the cane on the stronger side and move the cane and the weaker leg forward together, followed by the stronger leg.
B. You should advance the cane 12 to 14 inches before taking a step:
Advancing the cane 12 to 14 inches is too far. The cane should be advanced approximately 6 to 10 inches to maintain balance and support.
C. The cane’s height should be the same as the distance from the floor to the crest of your hip bone:
The correct height for a cane is when the handle is at the level of the wrist when the user is standing with the arm hanging naturally at their side. This typically corresponds to the distance from the floor to the greater trochanter (hip bone). This ensures the cane provides the right amount of support and reduces the risk of strain or imbalance.
D. You should hold the cane in your weak hand when ambulating:
The cane should be held in the stronger hand, not the weak hand. This allows the cane to provide support to the weaker side of the body and helps to balance the weight distribution more effectively.
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