Á nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first?
Obtain a dietary history from the client.
Review the client's electrolyte values.
Investigate the client's emotional concerns.
Check the client's perianal skin integrity.
The Correct Answer is B
A. Obtaining a dietary history is relevant for ongoing management but is not the initial priority.
B. Reviewing electrolyte values is essential because exacerbations of ulcerative colitis can lead to severe fluid and electrolyte imbalances, which need prompt correction.
C. Investigating emotional concerns is important but does not take precedence over addressing potential electrolyte imbalances that can be life-threatening.
D. Checking perianal skin integrity is relevant for comfort but is not the priority in stabilizing the client during an acute exacerbation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A comminuted fracture is characterized by the bone being splintered or crushed into multiple fragments, as seen in this client’s x-ray.
B. A transverse fracture is a straight horizontal break across the bone.
C. An impacted fracture occurs when bone fragments are driven into each other.
D. An oblique fracture has a diagonal break across the bone but does not involve multiple splinters.
Correct Answer is ["C","D","E"]
Explanation
A. Ecchymosis, or bruising, may be present but does not directly evaluate neurovascular status.
B. Skin integrity is important for general wound assessment but does not specifically indicate neurovascular function.
C. Sensation assessment helps evaluate nerve function, which is critical in identifying potential neurovascular compromise.
D. Color of the affected limb provides information on blood flow, with pale or cyanotic coloring suggesting potential compromise.
E. Temperature can indicate adequate blood flow; a cooler extremity may suggest poor circulation, indicating neurovascular compromise.
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