The nurse assesses a client admitted four hours ago with a diagnosis of diverticulitis. Which clinical manifestation must be reported immediately to the physician?
Temperature-101.2
Bowel sounds change from normoactive to absent
Left lower quadrant discomfort
WBC count is slightly elevated
The Correct Answer is B
B. Bowel sounds are typically present and indicate normal gastrointestinal motility. A change from normoactive (normal) to absent bowel sounds can indicate bowel obstruction, perforation, or peritonitis, which are serious complications of diverticulitis. This change warrants immediate reporting to the physician as it may indicate a worsening condition requiring urgent intervention.
A. A temperature of 101.2°F (38.4°C) is slightly elevated and may indicate the presence of infection, which is concerning in the context of diverticulitis. Fever is a common symptom of diverticulitis, but an elevated temperature may also suggest worsening infection or the development of complications such as abscess formation or perforation.
C. Left lower quadrant discomfort is a common symptom of diverticulitis due to inflammation in the sigmoid colon, where diverticula are most prevalent. While discomfort is expected in diverticulitis, the severity and persistence of pain should be assessed.
D. An elevated white blood cell (WBC) count is indicative of inflammation or infection and is commonly seen in diverticulitis. However, the significance of the elevation depends on the degree of increase and the presence of other clinical findings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Magnesium hydroxide is an antacid medication that works by neutralizing gastric acid in the stomach. Therefore, if the medication achieves the desired therapeutic effect, the nurse should expect neutralization of gastric acid, which can alleviate the burning sensation in the esophagus associated with GERD.
B. Magnesium hydroxide does not directly affect stomach motility. Instead, its primary action is to neutralize gastric acid. Therefore, reducing stomach motility is not an expected outcome of magnesium hydroxide administration.
C. Magnesium hydroxide primarily acts within the stomach to neutralize gastric acid and does not significantly affect the pH of the duodenum. Therefore, reduced duodenal pH is not an expected outcome of magnesium hydroxide administration.
D. Pepsin is an enzyme involved in the digestion of proteins and can contribute to tissue damage if refluxed into the esophagus. Although reducing gastric acidity can indirectly decrease the activity of pepsin, magnesium hydroxide does not directly increase the barrier to pepsin.
Correct Answer is B
Explanation
B. It is essential to complete the full course of antibiotics as prescribed by the healthcare provider, even if symptoms improve before the course is finished. This ensures that all bacteria causing the infection are eradicated, reducing the risk of recurrence and development of antibiotic resistance.
A. Antibiotics should be taken exactly as prescribed and for the full duration of the treatment course. Incomplete or inconsistent use of antibiotics can lead to incomplete eradication of the infection, development of antibiotic resistance, and recurrence of the infection.
C. While cranberry juice is often recommended for urinary tract health due to its ability to prevent bacterial adherence to the bladder wall, it is not a substitute for antibiotics in treating urinary tract infections.
D. Typically, urine cultures are reserved for cases where the diagnosis is uncertain, or the infection is recurrent or complicated. In uncomplicated UTIs, empirical antibiotic treatment based on symptoms and clinical presentation is usually sufficient.
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