Which descriptions warrant additional follow-up by the nurse? (Select all that apply.).
Solid with red streaks.
Formed but soft.
Brown liquid.
Tarry appearance.
Multiple hard pellets.
Correct Answer : A,D,E
- The descriptions that warrant additional follow-up by the nurse are choices A, D, and E.
- Solid with red streaks may indicate blood in the stool1.
- A tarry appearance may indicate bleeding in the upper digestive tract1.
- Multiple hard pellets may indicate constipation1.
Choice B is not an answer because brown liquid stool is not necessarily a cause for concern.
Choice C is not an answer because formed but soft stool is considered normal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A well-approximated incision means that the edges of the wound are close together and aligned properly, which is a sign that the surgical incision is healing properly.
Choice A is incorrect because eschar and slough in the wound are not signs of proper healing.
Choice B is incorrect because beety red granulation tissue is not a sign of proper healing.
Choice C is incorrect because erythema and serosanguineous drainage are not signs of proper healing.
Correct Answer is D
Explanation
Prior to performing digital removal of a fecal impaction, it is important for the nurse to assess the client’s vital signs.
This includes checking the client’s blood pressure, pulse rate, respiratory rate, and temperature.
These measurements can provide important information about the client’s overall health status and can help the nurse determine if it is safe to proceed with the procedure.
Choice A is not correct because abdominal girth is not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.
Choice B is not correct because breath sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.
Choice C is not correct because bowel sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.
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