A nurse is gathering information from a patient who has been experiencing diarrhea for several days.
What symptoms should the nurse anticipate?
Hypothermia
Rigid abdomen
Dehydration
Decreased bowel sounds
Decreased bowel sounds
The Correct Answer is C
Choice A rationale:
Hypothermia, or abnormally low body temperature, is not typically a symptom of diarrhea. While it’s possible for a person with severe diarrhea to experience chills or feel cold, hypothermia is not a direct result of diarrhea.
Choice B rationale:
A rigid abdomen is often a sign of a serious condition like peritonitis (inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen), but it is not typically associated with diarrhea.
Choice C rationale:
Dehydration is a common complication of diarrhea. When a person has diarrhea, they can lose a lot of fluid and electrolytes quickly, leading to dehydration. Symptoms of dehydration can include thirst, less frequent urination, dark-colored urine, fatigue, dizziness, and confusion.
Choice D rationale:
Decreased bowel sounds are not typically associated with diarrhea. In fact, bowel sounds may actually increase in some cases of diarrhea due to increased gut motility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Administering insulin is a crucial step in managing diabetic ketoacidosis (DKA), as insulin deficiency is a primary cause of DKA12. However, it is not the first action to take when a patient presents with both DKA and hypoxia. While insulin helps to reduce blood glucose levels and suppress the production of ketones, it does not address the immediate life-threatening condition of hypoxia.
Choice B rationale:
Hypoxia, or low levels of oxygen in the body, is a medical emergency that requires immediate attention. Supplemental oxygen can help increase the oxygen levels in the patient’s blood, thereby alleviating hypoxia. In the context of a patient with DKA and hypoxia, providing supplemental oxygen would be the first action to take to stabilize the patient’s condition before addressing the DKA12.
Choice C rationale:
Checking the patient’s glucose level is an important part of managing DKA, as hyperglycemia is a key feature of this condition. However, it is not the first action to take in this scenario. While monitoring glucose levels can guide the administration of insulin and other treatments for DKA, it does not address the immediate threat posed by hypoxia.
Choice D rationale:
Administering intravenous fluids is another important step in managing DKA12. Dehydration is a common complication of DKA due to excessive urination caused by high blood sugar levels. However, similar to Choices A and C, while it is an important part of treatment, it is not the first action to take when a patient presents with both DKA and hypoxia.
Correct Answer is ["D"]
Explanation
Choice A rationale:
Petroleum-based ointments like Vaseline are not recommended for moisturizing lips, especially for patients on oxygen therapy. This is because petroleum jelly is not effective at restoring moisture once it’s been lost. Moreover, it can feel heavy and slippery on the lips, and it’s not very eco-friendly.
Choice B rationale:
Oxygen tanks should be kept at a safe distance from heat sources, including electric stoves. However, the recommended distance is not 4 feet but rather at least 5-10 feet away. This is to minimize the risk of fire or combustion.
Choice C rationale:
Wool blankets are not recommended when using oxygen. Wool can cause a spark which can be dangerous around oxygen. It’s important to avoid anything that may cause a spark around home oxygen, including electric heaters, electric blankets, electric razors, hair dryers, or friction toys.
Choice D rationale:
Oxygen tanks should always be stored upright. This prevents any strain on the valves or other components and reduces the risk of damage and potential gas leaks.
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