A nurse is preparing a client who has acute appendicitis for surgery. Which of the following actions should the nurse take?
Apply a heat pack to the client's lower abdomen.
Place the client in semi-Fowler's position.
Give the client a clear liquid diet.
Administer an enema to the client.
The Correct Answer is B
A. Apply a heat pack to the client's lower abdomen: This is incorrect as applying heat can worsen inflammation and increase the risk of rupture; ice packs are generally used instead.
B. Place the client in semi-Fowler's position: This is correct as the semi-Fowler's position helps reduce pain and pressure on the abdomen and can improve comfort before surgery.
C. Give the client a clear liquid diet: This is incorrect as a clear liquid diet is not appropriate for a client with acute appendicitis who may require NPO (nothing by mouth) status prior to surgery.
D. Administer an enema to the client: This is incorrect as enemas are contraindicated in acute appendicitis due to the risk of perforation and worsening of the condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Dyspnea: This is correct as dyspnea (difficulty breathing) can be a sign of fluid overload, particularly when excess fluid accumulates in the lungs.
B. Pruritus: This is more indicative of an allergic reaction rather than fluid overload.
C. Fever: This is often associated with transfusion reactions or infection, not specifically fluid overload.
D. Bradycardia: This is less commonly associated with fluid overload and more often seen in other conditions or complications.
Correct Answer is D
Explanation
A. Elevate legs on pillows when in bed: This is incorrect because elevating the legs can reduce blood flow in peripheral arterial disease, and it is generally advised to keep the legs at the level of the heart or lower to promote better circulation.
B. Apply heating pad for 15 min twice per day: This is incorrect because applying heat directly to the legs is not recommended as it can lead to burns or other complications, especially in patients with peripheral vascular issues.
C. Wear knee-high support hose during the day: This is incorrect because support hose can sometimes exacerbate symptoms of peripheral arterial disease by restricting blood flow. Compression stockings are generally not recommended.
D. Begin an exercise program that includes walking: This is correct because walking and other forms of exercise improve circulation and help alleviate symptoms of peripheral arterial disease by promoting better blood flow and cardiovascular health.
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