The nurse is monitoring a patient recovering from an emergency appendectomy.
Which finding is most concerning?

Absence of bowel sounds

A centimeter spot of bloody drainage on the dressing

Abdomen rigid on palpation

Pain at the operative site .

Answer and Explanation

The Correct Answer is C

Choice A rationale
Absence of bowel sounds can be a normal finding post-operatively and is not necessarily a cause for concern.
Choice B rationale
A small amount of bloody drainage on the dressing is not uncommon after surgery and is not typically a cause for concern.
Choice C rationale
A rigid abdomen on palpation is a concerning finding after an appendectomy. It could indicate peritonitis, a serious infection of the abdominal cavity that can occur if the appendix burst before or during surgery.
Choice D rationale
Pain at the operative site is expected after an appendectomy. However, severe or increasing pain could indicate a complication and should be evaluated by a healthcare provider.

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Correct Answer is B

Explanation

Choice A rationale
While intestinal obstruction can occur after any abdominal surgery, it is not the most common complication following ileostomy creation.
Choice B rationale
Fluid and electrolyte imbalance is a common complication following ileostomy surgery. This is due to the fact that the ileum, which is now rerouted to an external opening in the abdominal wall, is responsible for absorbing a significant amount of fluid and electrolytes. When it is diverted, these substances can be lost, leading to imbalances.
Choice C rationale
Malabsorption of fat is not typically a primary concern following ileostomy surgery. While malabsorption can occur in diseases affecting the ileum, it is not a direct result of the surgery itself.
Choice D rationale
Folate deficiency is not a common complication following ileostomy surgery. The terminal ileum, which is typically used to create the ileostomy, is primarily responsible for the absorption of vitamin B12, not folate.

A. Condition A. B. Condition B. C. Condition C. D. Condition

Correct Answer is C

Explanation

Choice A rationale
Condition A is not typically associated with a risk for vitamin deficiency. Vitamin deficiencies are usually caused by inadequate intake, poor absorption, or increased demand for vitamins.
Choice B rationale
Condition B is not typically associated with a risk for vitamin deficiency. Vitamin deficiencies are usually caused by inadequate intake, poor absorption, or increased demand for vitamins.
Choice C rationale
Condition C, also known as pernicious anemia, is associated with a risk for vitamin B12 deficiency. This condition impairs the body’s ability to absorb vitamin B12 from the gastrointestinal tract.
Choice D rationale
Condition D is not typically associated with a risk for vitamin deficiency. Vitamin deficiencies are usually caused by inadequate intake, poor absorption, or increased demand for vitamins

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The nurse is monitoring a patient recovering from an emergency appendectomy. Which finding is most concerning?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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The nurse is monitoring a patient recovering from an emergency appendectomy.
Which finding is most concerning?