A child recovering from Wilms tumor removal develops abdominal pain, distension, absent bowel sounds, and vomiting. Which complication should the nurse suspect?

Intestinal obstruction.

Pyloric stenosis.

Infectious gastritis.

Abdominal peritonitis.

Answer and Explanation

The Correct Answer is A

A. Intestinal obstruction is the most likely complication in a child post-Wilms tumor removal who presents with abdominal pain, distension, absent bowel sounds, and vomiting. Postoperative adhesions, bowel manipulation during surgery, or edema can impair intestinal motility, leading to obstruction. Early recognition and intervention are critical to prevent bowel ischemia or perforation.

B. Pyloric stenosis typically occurs in infants and presents with projectile vomiting, visible peristalsis, and a palpable “olive” in the abdomen. It is not a common postoperative complication in older children after abdominal tumor surgery.

C. Infectious gastritis usually presents with nausea, vomiting, and mild abdominal discomfort, but it does not typically cause absent bowel sounds or significant distension, making it less likely in this scenario.

D. Abdominal peritonitis is an inflammation of the peritoneum, often caused by perforation or infection. While it can cause severe abdominal pain and distension, it is usually associated with fever, rigidity, and severe tenderness. The gradual presentation of absent bowel sounds and vomiting aligns more closely with intestinal obstruction rather than acute peritonitis.

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Correct Answer is ["C","D","E"]

Explanation

A. While knowing allergies is part of a general admission or intake process, it is not a priority diagnostic action for acute confusion. Allergies typically cause respiratory distress or skin reactions (anaphylaxis/urticaria), not sudden cognitive changes or hallucinations.

B. Encouraging increased intake of high-protein foods is not an immediate priority. While nutrition is important for long-term health, it does not address the urgent concern of acute confusion. Immediate assessment for potentially reversible causes takes precedence.

C. Obtaining a tympanic temperature measurement is crucial because infection can present atypically in older adults, sometimes only as confusion or behavioral changes rather than classic symptoms like fever. A urinary tract infection, pneumonia, or other systemic infection could be causing delirium, and detecting fever would guide timely intervention.

D. Determining whether the client has recently experienced a fall is important. Head trauma, even minor, can lead to acute cognitive changes, intracranial bleeding, or other complications. Older adults are particularly vulnerable, and history of falls must be assessed to rule out injury as a cause of confusion.

E. Asking if the client is experiencing pain with urination is important because urinary tract infections (UTIs) are a common cause of delirium in older adults, even when classic urinary symptoms like dysuria or frequency are absent. Early identification allows for rapid treatment and prevention of further complications.

A. If the client was compulsive about food when he was younger, the aging process can magnify this. B. The client probably has an organic brain disease and will likely have Alzheimer's disease within a few years. C. The daughter is under stress and should be encouraged to think about happier times. D. The family needs a social worker to talk to them about how to handle their father when he becomes annoying.

Correct Answer is A

Explanation

A. Personality traits that were present earlier in life, such as compulsiveness or perfectionism, can become more pronounced in older adulthood due to normal aging processes, changes in cognition, or the stress of hospitalization. In this case, the client’s preoccupation with food likely reflects his lifelong habits and professional background as a chef, rather than a new pathological condition. Recognizing this helps the nurse respond with understanding and provide strategies that respect the client’s preferences.

B. While some cognitive decline is common with aging, assuming that the client has an organic brain disease such as Alzheimer’s disease based solely on obsessive behavior is inaccurate. Obsessive tendencies related to personality do not indicate inevitable neurodegenerative disease. Making this assumption could cause unnecessary alarm and misinform the family.

C. Advising the daughter to focus on happier times does not address the underlying behavior or provide practical guidance. It minimizes the client’s current needs and could be dismissive of the family’s concerns. Effective nursing communication should validate the family’s observations while explaining possible reasons for the client’s behavior.

D. Suggesting a social worker to help the family handle the client when he becomes annoying is not appropriate. The behavior is not inherently “annoying” or pathological; it reflects personality traits. The focus should be on understanding and accommodating the client’s lifelong habits rather than labeling them as problems requiring external intervention.

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A child recovering from Wilms tumor removal develops abdominal pain, distension, absent bowel sounds, and vomiting. Which complication should the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older adult client is taken to the clinic by the spouse, who appears extremely worried. The spouse reports to the nurse that the client started to not make any sense and asked to visit a brother that has been dead for many years. Which action(s) should the nurse take? Select all that apply.

Correct Answer is ["C","D","E"]

Explanation

An older adult male client, who is a retired chef, is hospitalized with a diabetic ulcer on his foot. His daughter tells the nurse that her father has become increasingly obsessed with the way his food is prepared in the hospital. The nurse's response should be based on which information?

Correct Answer is A

Explanation

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