Lewis Med-Surg Test-Bank! Chapter 45 Exam With Complete Solutions 2024

A patient with acute diarrhea of 24 hours' duration calls the clinic to ask for directions for care. In talking with the patient, what should the nurse do? a. Ask the patient to describe the character of the stools and any associated symptoms. b. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal motility. c. Inform the patient that laboratory testing of blood and stool specimens will be necessary. d. Advise the patient to drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. - correct answer-*ANS: A* The nurse's initial response should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment. A 78-year-old patient is transferred to the hospital from a nursing home on developing abdominal pain and watery, incontinent diarrhea following a course of antibiotic therapy for pneumonia. Stool cultures reveal the presence of Clostridium difficile. In planning care for the patient, the nurse will do which of the following? a. Order a diet with no dairy products for the patient. b. Place the patient in a private room with contact isolation. c. Explain to the patient why antibiotics are not being used. d. Teach the patient about proper food handling and storage. - correct answer-*ANS: B* Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. Psyllium (Metamucil) is prescribed for a patient with chronic constipation. In teaching the patient about chronic constipation, what should the nurse stress? a.The use of bulk-forming laxatives is safe, and they do not cause any adverse effects. b.At least 3000 mL of fluid daily must be taken to prevent impaction or bowel obstruction. c.Dietary sources of fibre should be eliminated from the diet to prevent excessive gas formation. d.Supplemental fat-soluble vitamins must be taken because the medication blocks absorption of these vitamins. - correct answer-*ANS: B* A high fluid intake is needed to prevent hardened stools leading to impaction or bowel obstruction. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. A patient is admitted to the emergency department with severe abdominal pain, anorexia, and chills. His vital signs include temperature 38.3°C, pulse 130 beats/min, respiration 34 breaths/min, and blood pressure (BP) 82/50 mm Hg. His pain is more intense in the left lower quadrant but radiates throughout the entire abdomen, with rebound tenderness and abdominal rigidity. The nurse plans care for the patient based on the knowledge that management of his condition initially involves which of the following actions? a.Intravenous (IV) fluid resuscitation b.Exploratory laparotomy c.Administration of IV antibiotics d.Diagnostic testing with barium studies and endoscopy - correct answer-*ANS: A* The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion. A patient is being evaluated in the emergency department for acute lower abdominal pain with diarrhea and vomiting. During the nursing history, what is the most helpful question to obtain information regarding the patient's condition? a."What do you usually eat?" b."Can you tell me about your pain?" c."What is your usual elimination pattern?" d."When did the diarrhea and vomiting start?" - correct answer-*ANS: B* A complete description of the pain provides clues about the cause of the problem. Which stool consistency would the nurse expect to see in a patient with a sigmoid colostomy? a. Semiliquid b.Semiformed c.Formed d.Pasty - correct answer-*ANS: C* A patient with a sigmoid colostomy would be expected to have a formed soot consistency. A semiliquid or semiformed stool consistency would be expected with a transverse colostomy. A pasty stool consistency would be expected with an ileostomy. A 20-year-old university student is admitted to the emergency department for evaluation of abdominal pain with nausea and vomiting. She has a white blood cell count of 14,000 cells/microlitre with a shift to the left. Which one of the following actions is appropriate for the nurse to take? a.Encourage the patient to take sips of clear liquids. b.Apply an ice pack to the right lower quadrant. c.Check for rebound tenderness every 30 minutes. d.Teach the patient how to cough and breathe deeply. - correct answer-*ANS: B* The patient's clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. Heat is never to be applied to the area because it may cause the appendix to rupture.