Nokea
A nurse is assessing a client who is 3 days postoperative following abdominal surgery and notes the absence of bowel sounds, abdominal distention, and the client passing no flatus. Which of the following conditions should the nurse suspect?
- A. Ulcerative colitis
- B. Cholecystitis
- C. Paralytic ileus
- D. Wound dehiscence
Correct Answer: C
Rationale: The correct answer is C: Paralytic ileus. After abdominal surgery, the bowel can temporarily stop functioning due to anesthesia, handling of the intestines, or inflammation. This leads to absent bowel sounds, distention, and no flatus passage. Ulcerative colitis (A) is a chronic inflammatory bowel disease, not related to postoperative findings. Cholecystitis (B) is inflammation of the gallbladder, typically presenting with right upper quadrant pain. Wound dehiscence (D) is the separation of surgical incision edges, not related to bowel function.
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In planning a treatment and prevention program of chronic fecal incontinence for an elderly client, which intervention should you try first?
- A. Administer a glycerin suppository 15 minutes before evacuation time.
- B. Insert a rectal tube at specified intervals each day.
- C. Assist the client to the bedpan or toilet 30 minutes after meals.
- D. Use incontinence briefs or adult-sized diapers.
Correct Answer: C
Rationale: The correct answer is C: Assist the client to the bedpan or toilet 30 minutes after meals. This intervention is appropriate as it aligns with the natural physiological process of bowel movements after meals, increasing the likelihood of successful evacuation. This timing can help establish a routine and promote regular bowel movements, potentially reducing episodes of fecal incontinence.
Choice A is incorrect because administering a glycerin suppository may not address the underlying cause of fecal incontinence and may not promote regular bowel movements. Choice B is incorrect as inserting a rectal tube is an invasive intervention that should only be considered after less invasive methods have been exhausted. Choice D is incorrect as using incontinence briefs or adult-sized diapers only manages the symptoms without addressing the root cause or promoting bowel regularity.
What causes the systemic effects of viral hepatitis?
- A. Cholestasis
- B. Impaired portal circulation
- C. Toxins produced by the infected liver
- D. Activation of the complement system by antigen-antibody complexes
Correct Answer: D
Rationale: Step-by-step rationale for why choice D is correct: Activation of the complement system by antigen-antibody complexes leads to systemic effects in viral hepatitis. This process triggers inflammation, tissue damage, and immune responses that contribute to the systemic effects seen in viral hepatitis. The other choices (A, B, and C) do not directly cause systemic effects in viral hepatitis. Cholestasis and impaired portal circulation are more localized effects, while toxins produced by the infected liver may contribute to liver damage but not necessarily systemic effects.
Which of the following will have the greatest implication on a client scheduled for a percutaneous liver biopsy?
- A. History of coagulation studies
- B. Allergy to iodine
- C. Family history of GI disorders
- D. Presence of radioactive material in the work environment
Correct Answer: A
Rationale: The correct answer is A: History of coagulation studies. This is because coagulation studies assess the client's ability to form blood clots, which is crucial for a percutaneous liver biopsy to prevent excessive bleeding. It helps determine the risk of bleeding complications during the procedure.
Choice B, Allergy to iodine, is incorrect because an allergy to iodine is more relevant in procedures involving contrast media, not typically in percutaneous liver biopsies.
Choice C, Family history of GI disorders, is incorrect as it does not directly impact the client's safety or outcome during a percutaneous liver biopsy.
Choice D, Presence of radioactive material in the work environment, is also incorrect as it is not directly related to the procedure or its implications on the client's safety during a percutaneous liver biopsy.
Bilateral ovarian metastases presenting as tumor masses are most characteristically associated with carcinoma of the:
- A. esophagus
- B. stomach
- C. small intestine
- D. appendix
Correct Answer: B
Rationale: The correct answer is B, stomach. Ovarian metastases from gastric carcinoma are commonly bilateral due to the close anatomical relationship between the stomach and ovaries. Stomach cancer frequently spreads to the ovaries through direct extension or lymphatic dissemination. In contrast, esophageal, small intestine, and appendix carcinomas less commonly metastasize to the ovaries, making choices A, C, and D less likely. Thus, the characteristic bilateral ovarian metastases are most commonly associated with carcinoma of the stomach.
An individual has the following symptoms: jaundice, pale in color, liver with a buildup of connective tissue. This individual most likely has
- A. gastritis.
- B. pancreatitis.
- C. gall stones.
- D. cirrhosis.
Correct Answer: D
Rationale: The correct answer is D: cirrhosis. Jaundice, pale skin, and liver with connective tissue buildup are classic symptoms of cirrhosis - a condition characterized by scarring of the liver due to long-term damage. Jaundice occurs when the liver is unable to properly process bilirubin, leading to yellowing of the skin and eyes. The pale color can be due to anemia often seen in cirrhosis. The buildup of connective tissue is indicative of fibrosis and scarring in the liver. Gastritis (A) is inflammation of the stomach lining, pancreatitis (B) is inflammation of the pancreas, and gallstones (C) are solid particles that form in the gallbladder. These conditions do not typically present with the combination of symptoms described.