A client comes to the emergency department complaining of abdominal cramping and severe persistent diarrhea. The client has recently traveled outside of the United States to an area that may be prone to water contamination. The physician has written several orders. Which assessment and diagnostic physician order would be the first priority for the nurse to complete based on the patient's symptoms?

Abdominal sounds and colonoscopy.

Bowel sounds and obtain a stool specimen.

Abdominal inspection and kidney, bowel, and ureter x-ray.

Bowel palpation and abdominal x-ray.

Answer and Explanation

The Correct Answer is B

The correct answer is choice B: Bowel sounds and obtain a stool specimen.

When a client presents with abdominal cramping and persistent diarrhea, obtaining a stool specimen is the first priority to determine the cause of the diarrhea. The stool specimen can be sent to the laboratory for analysis to check for the presence of bacteria, viruses, or parasites. The nurse should also assess bowel sounds as part of the client's abdominal assessment to monitor for any changes in bowel motility. The other options listed are not the first priority in this situation and may be ordered after the cause of the diarrhea has been determined.

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Free Nursing Study Resources

Correct Answer is B

Explanation

The correct answer is choice B, Use water and mild soap.

When teaching a patient about ostomy care, the nurse should instruct the patient to clean the area around the ostomy with water and mild soap. Using a whirlpool bath, alcohol-based sanitizer, or chlorhexidine or HCG is not recommended as they can irritate the skin and damage the stoma. Cleansing the ostomy area with water and mild soap is the best way to maintain the skin's integrity and prevent irritation and infection.

A. Act as if you are still taking the radial pulse while assessing respiratory rate so the client does not know you are counting. B. If the respiratory rate is regular, count for 30 seconds and multiply by 2. C. Observe the depth and rhythm of the respirations. D. Count a full respiratory cycle (inhalation and exhalation) E. Count a full respiratory cycle (inhalation and exhalation)

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

Explanation

The correct answer is choices B, C, and D.

When assessing respiratory rate, it is important to count for a full respiratory cycle, which includes both inhalation and exhalation. If the respiratory rate is regular, the nurse can count for 30 seconds and multiply by 2 to obtain the total number of breaths per minute. The nurse should also observe the depth and rhythm of the respirations, noting any abnormalities or changes. It is not recommended to pretend to take the radial pulse while assessing respiratory rate, as this can lead to inaccurate readings and is not a professional approach to care

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Naxlex Comprehensive Predictor Exams

The nurse is teaching a patient with a new ostomy about skin care to preserve tissue integrity. What teaching will the nurse provide about cleansing the ostomy area?

Correct Answer is B

Explanation

A nurse is instructing a group of nursing students in taking vital signs and assessing a client's respiratory status. Which of the following guidelines should the nurse include? Select all that apply.

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

Explanation

The nurse is planning to care for a client with an indwelling catheter. Which of the following measures should the nurse implement when performing hygiene care in regards to the indwelling catheter?

The nurse is inserting an indwelling urinary catheter for a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. When should the nurse inflate the balloon?

A nurse can most accurately assess a client's apical heart rate by which of the following methods?

A nurse is providing education to a client diagnosed with insomnia. What sleeppromoting techniques would the nurse suggest to help the client's condition? Select all that apply.

Which technique should the nurse use to assess the pupillary reaction on a client?

A patient develops food poisoning from contaminated food. The contaminated food would be an example of which part of the infectious cycle?

A new patient is admitted to a medical unit with Clostridium difficile (C-diff). Which type of precautions or isolation should the nurse apply for this patient?

A patient is on a PCA pump following an abdominal surgery. The order states the client can have 0.5mg morphine every 15 minutes as needed. The client pushed the button 10 times in the past 60 minutes. How many doses did the client receive?