Exam (elaborations)

NCLEX Practice Questions Saunders - GI System Questions And Answers Rated A+ 2024.

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NCLEX Practice

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Type Exam (elaborations)
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nclex practice questions saunders gi system qu

Institution NCLEX Practice
Course NCLEX Practice

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NCLEX Practice Questions Saunders - GI
System Questions And Answers Rated A+
2024.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis
who
is scheduled for surgery in 2 hours. The client begins to complain of increased
abdominal pain
and begins to vomit. On assessment, the nurse notes that the abdomen is distended
and bowel
sounds are diminished. Which is the most appropriate nursing intervention?

1. Notify the health care provider (HCP).
2. Administer the prescribed pain medication.
3. Call and ask the operating room team to perform the surgery as soon as possible.
4. Reposition the client and apply a heating pad on the warm setting to the client's
abdomen. - correct answer. 1. Notify the health care provider (HCP).

Rationale: On the basis of the signs and symptoms presented in the question, the nurse
should suspect peritonitis and notify the HCP.
Administering pain medication is not an appropriate intervention. Heat should never be
applied to the abdomen of a client with
suspected appendicitis because of the risk of rupture. Scheduling surgical time is not
within the scope of nursing practice, although the
HCP probably would perform the surgery earlier than the prescheduled time.

A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the
nurse
is assessing the client's pain. What type of pain is consistent with this diagnosis?

, 1. Burning and aching, located in the left lower quadrant and radiating to the hip
2. Severe and unrelenting, located in the epigastric area and radiating to the back
3. Burning and aching, located in the epigastric area and radiating to the umbilicus
4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin -
correct answer. 2. Severe and unrelenting, located in the epigastric area and radiating
to the back

Rationale: The pain associated with acute pancreatitis is often severe and unrelenting,
is located in the epigastric region, and radiates
to the back. The other options are incorrect.

The nurse is assessing a client who is experiencing an acute episode of cholecystitis.
Where
should the nurse anticipate the location of the pain?

1. Right lower quadrant, radiating to the back
2. Right lower quadrant, radiating to the umbilicus
3. Right upper quadrant, radiating to the left scapula and shoulder
4. Right upper quadrant, radiating to the right scapula and shoulder - correct answer.
4. Right upper quadrant, radiating to the right scapula and shoulder

Rationale: During an acute episode of cholecystitis, the client may complain of severe
right upper quadrant pain that radiates to the
right scapula and shoulder. This is determined by the pattern of dermatomes in the
body. The other options are incorrect.

A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and
"losing my taste for food." What instruction should the nurse give the client to provide
adequate nutrition?

1. Select foods high in fat.
2. Increase intake of fluids, including juices.
3. Eat a good supper when anorexia is not as severe.
4. Eat less often, preferably only three large meals daily. - correct answer. 2. Increase
intake of fluids, including juices.

Rationale: Although no special diet is required to treat viral hepatitis, it is generally
recommended that clients consume a low-fat diet
as fat may be tolerated poorly because of decreased bile production. Small, frequent
meals are preferable and may even prevent
nausea. Frequently, appetite is better in the morning, so it is easier to eat a good
breakfast. An adequate fluid intake of 2500 to
3000 mL/day that includes nutritional juices is also important.

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