A 60-year-old client is experiencing pain that is caused by distention of the veins in their rectum. What health problem is this client most likely experiencing?

Laxative Usage

Paralytic ileus

Diarrhea

Hemorrhoids

Answer and Explanation

The Correct Answer is D

A.   Laxative usage is more likely to cause diarrhea or loose stools rather than rectal pain from distended veins.
B.   Paralytic ileus is characterized by a lack of bowel motility and is not associated with distention of veins in the rectum.
C. Diarrhea is unlikely to cause pain related to distention of rectal veins.
D.   Hemorrhoids are swollen veins in the rectum and anus, causing pain and discomfort, especially during bowel movements.

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Correct Answer is D

Explanation

A. The helping relationship phases and nursing process are not specific communication tools for addressing safety concerns.
B. The nursing process is a systematic approach to patient care but is not a communication tool specifically for addressing safety concerns.
C. SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool commonly used in healthcare settings for reporting and addressing safety concerns.
D. CUS (I am concerned, I feel uncomfortable, this is unsafe) is a communication tool for expressing concerns, for instance, by saying something like this: "I am concerned about the patient's risk for falls. I feel uncomfortable seeing you walk the patient without a gait belt or non-skid socks. This is unsafe for the patient and could cause harm or injury. Please use a gait belt and non-skid socks when walking the patient." This way, the nurse can convey their message in a clear, respectful, and assertive way, and prompt the UAP to take action to ensure the patient's safety.

A. Occlude the Y-port when inserting the catheter B. Limit the application of suction to 20-30 seconds C. Assist the client into a supine position in preparation for suctioning. D. Use sterile saline to moisten the end of the suction catheter

Correct Answer is B

Explanation

A. Occluding the Y-port during insertion is not a standard practice and may impede proper suctioning.
B. Limiting the application of suction to 20-30 seconds helps prevent hypoxia and tissue damage.
C. Assisting the client into a supine position is not a standard practice for endotracheal tube suctioning.
D. Using sterile saline to moisten the end of the suction catheter may introduce unnecessary moisture into the airway.

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A 60-year-old client is experiencing pain that is caused by distention of the veins in their rectum. What health problem is this client most likely experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse has received an order to suction a patient's endotracheal tube. Which action is most appropriate when performing this intervention?

Correct Answer is B

Explanation

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