The nurse is caring for a client on the third day following abdominal surgery and assesses the absence of bowel sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is experiencing which of the following postoperative complications?

Fecal impaction

Incisional infection

Health care-associated Clostridium difficile

Paralytic ileus

Answer and Explanation

The Correct Answer is D

Choice A reason: Fecal impaction typically presents with the inability to pass stool and may not be associated with the absence of bowel sounds.

Choice B reason: Incisional infection is usually indicated by localized redness, warmth, and possible discharge, not necessarily by the absence of bowel sounds or flatus.

Choice C reason: Health care-associated Clostridium difficile often presents with diarrhea, not the absence of bowel sounds or flatus.

Choice D reason: Paralytic ileus is characterized by impaired intestinal motility and transit, absence of the passage of flatus, diminished bowel sounds, abdominal distension, and intestinal dilatation, fitting the symptoms described.

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Correct Answer is B

Explanation

Choice A reason: While relaxation techniques are beneficial, providing structure is often the first step in helping clients with OCD manage their symptoms, as it can reduce anxiety and prevent time for obsessions and compulsions to occur.

Choice B reason: A structured schedule can help the client focus on tasks and activities, reducing the time available for obsessive thoughts and compulsive behaviors.

Choice C reason: Identifying expectations is important, but it should come after establishing a structured routine that can support the client's participation in care.

Choice D reason: Discussing alternative coping strategies is a part of treatment, but initially providing a structured schedule can offer immediate relief and a sense of control for the client.

A. Injury and age are the greatest contributors to disease development. B. Acutely inflamed joints will respond best to heat therapy. C. It is essential to monitor all body systems for effects of the disease. D. Exercise is poorly tolerated and frequent rest is needed.

Correct Answer is C

Explanation

Choice A reason: While injury and age can be risk factors, they are not the greatest contributors to RA, which is an autoimmune disease.

Choice B reason: Heat therapy can help relieve pain in some cases, but it is not always the best response for acutely inflamed joints; cold therapy is often recommended to reduce inflammation.

Choice C reason: RA can affect multiple body systems beyond the joints, including the cardiovascular and respiratory systems, so it is essential to monitor all body systems.

Choice D reason: Exercise is actually beneficial for patients with RA to maintain joint function and muscle strength; rest is important, but should be balanced with physical activity.

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The nurse is caring for a client on the third day following abdominal surgery and assesses the absence of bowel sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is experiencing which of the following postoperative complications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has obsessive-compulsive disorder (OCD). Which of the following actions should the nurse take first?

Correct Answer is B

Explanation

The nurse is assisting with the care of a patient with rheumatoid arthritis (RA). What should the nurse consider when providing care?

Correct Answer is C

Explanation

The nurse is caring for a 52-year-old male patient with a bowel obstruction. Which of these signs would be the earliest indicator to the nurse that the patient is developing symptoms of shock?

Agoraphobia is characterized by which of the following?

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Mr. G is calling out "Nurse!" When you arrive in his room, he tells you to be careful of the snake in the corner. You do not see anything in the corner. Mr. G is experiencing an:

A patient is receiving IV fluids at 100 mL per hour. Which assessment findings would indicate fluid volume excess? (Select all that apply.)

The nurse is reinforcing teaching provided to a patient with Raynaud's disease. Which measure should the nurse include to prevent an attack?

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