Which assessment findings will the nurse anticipate in the client with cholelithiasis?
Coffee ground emesis, nausea/vomiting
Right lower quadrant abdominal pain, constipation.
Absent bowel sounds, abdominal pain
Right upper quadrant abdominal pain, nausea/vomiting
The Correct Answer is D
Cholelithiasis refers to the presence of gallstones in the gallbladder or bile ducts. The most common symptom is right upper quadrant abdominal pain, which may be colicky or steady. Nausea and vomiting are also commonly associated with cholelithiasis.
Coffee ground emesis and constipation are not typical findings associated with cholelithiasis. Absent bowel sounds may be a sign of bowel obstruction but are not specific to cholelithiasis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Hip spica casts are typically used to immobilize the hip joint and are often used in the management of hip dysplasia or after surgery. These casts can cause restricted mobility and limit blood flow to the legs and feet, which can lead to complications such as swelling, decreased circulation, or pressure sores.
Checking capillary refill in the toes is a critical nursing intervention to assess for the presence of adequate circulation and blood flow to the affected limb. If capillary refill is slow or absent, it may indicate compromised circulation and require immediate intervention to prevent further complications.
Palpating a brachial pulse, assessing bilateral radial pulses, or auscultating the heart rate apically are not the priority nursing actions for an infant with a hip spica cast. While monitoring vital signs and circulation are important components of nursing care, the priority at this stage is to assess and manage the immediate postoperative needs of the patient, including monitoring for potential complications related to the hip spica cast.
Correct Answer is B
Explanation
Cushing's syndrome is a disorder characterized by excessive production or prolonged exposure to high levels of glucocorticoids, particularly cortisol. This can occur due to various reasons, such as the use of corticosteroid medications or overproduction of cortisol by the adrenal glands. Elevated glucocorticoid levels result in a variety of clinical manifestations associated with Cushing's syndrome, including weight gain, central obesity, muscle wasting, thinning of the skin, easy bruising, and impaired glucose metabolism.
It's important to note that Cushing's syndrome can have different underlying causes, such as adrenal tumors, pituitary tumors, or ectopic ACTH production. Regardless of the cause, the common feature in Cushing's syndrome is the excessive glucocorticoid levels, which contribute to the signs and symptoms of the condition.
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