Exhibits

For each potential assessment finding, click to specify if the finding is consistent with Crohn’s disease, appendicitis or intussusception. Each finding may support more than 1 disease process.

Temperature

Vomiting

Abdominal findings

Stool

Pain rating

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,C"},"B":{"answers":"A,B,C"},"C":{"answers":"B,C"},"D":{"answers":"A,C"},"E":{"answers":"B,C"}}

Rationale:

Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.
Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.

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Correct Answer is D,A,B,C

Explanation

Rationale:

A. Insert the catheter until resistance is felt: The catheter should be gently advanced into the tracheostomy tube until resistance is met, which typically indicates reaching the carina.

B. Withdraw the catheter 1 to 2 cm (0.4 to 0.8 inch): Slight withdrawal prevents trauma to the carina and positions the catheter optimally for effective suctioning.

C. Rotate the catheter while suctioning: Rotating the catheter as suction is applied allows for even clearing of secretions along the tracheal walls and helps prevent localized tissue damage.

D. Lubricate the catheter with sterile saline: Lubrication ensures smooth insertion and reduces trauma to the tracheal mucosa. This is the first action after applying sterile gloves.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}

Explanation

Rationale for correct choices:

Spontaneous abortion: The client is at risk of a spontaneous abortion, as evidenced by bright red vaginal bleeding, cramping, and an open cervix at 10 weeks gestation. These findings are classic for an inevitable abortion, particularly when fetal viability has not been confirmed and symptoms are active.
Cervical dilation: Cervical dilation during the first trimester, especially in conjunction with vaginal bleeding and uterine cramping, confirms that the miscarriage process is in progress. In a viable pregnancy, the cervix remains closed, so dilation is a key indicator of pregnancy loss.

Rationale for incorrect choices:

Molar pregnancy: While molar pregnancies can cause elevated hCG levels, they typically present with painless bleeding, absence of a fetus on ultrasound, and may show signs like early-onset preeclampsia or hyperemesis. The presence of pain and cervical dilation points away from a molar pregnancy.
Ectopic pregnancy: An ectopic pregnancy more often presents with sharp unilateral lower abdominal pain, low or slowly rising hCG levels, and an empty uterus on ultrasound. The findings of cervical dilation and an hCG level consistent with intrauterine pregnancy reduce the likelihood of an ectopic pregnancy.
Bright red vaginal bleeding: Although bright red bleeding suggests active hemorrhage and is concerning, it can occur in a variety of obstetric conditions. Without cervical dilation or signs of fetal compromise, it cannot alone confirm spontaneous abortion.
History of chlamydia infection: While a history of chlamydia increases the risk of ectopic pregnancy due to tubal scarring, it is not a direct indicator of current pregnancy loss. It does not outweigh the importance of current symptoms like cervical dilation in determining the client's current risk.

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Exhibits For each potential assessment finding, click to specify if the finding is consistent with Crohn’s disease, appendicitis or intussusception. Each finding may support more than 1 disease process.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Correct Answer is D,A,B,C

Explanation

A nurse is caring for a client at the clinic. Exhibits Complete the following sentence by using the lists of options. The client is at risk for dropdown as evidenced by dropdown.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}

Explanation

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Exhibits

For each potential assessment finding, click to specify if the finding is consistent with Crohn’s disease, appendicitis or intussusception. Each finding may support more than 1 disease process.