A client returns to the clinic reporting frequent diarrhea over the past 2 days. The client describes diarrhea as watery with a foul odor and reports mild to moderate abdominal cramping, nausea, and decreased appetite. The client reports decreased pain in the left leg and wound.
On assessment of the wound, the nurse notes the wound is smaller in measurement, pink around edges with granulation tissue and minimal serous drainage. No odor or swelling is noted and the client reports an increase in energy prior to diarrhea symptoms appearing. The client states, This diarrhea has me stuck at home, I have to go all the time, and I can't really hold it at all. Based on these cues, how should the nurse categorize the bowel movements?
Improvement.
No Change.
Complication.
Expected finding.
The Correct Answer is C
Choice A rationale
Improvement implies that the clinical status of the client is better than the previous assessment. While the wound itself shows signs of healing, the sudden onset of watery, foul-smelling diarrhea and abdominal cramping indicates a new pathological process. This represents a decline in the overall systemic health of the client rather than an improvement, as the gastrointestinal symptoms are acute and disruptive to the client's recovery and daily living.
Choice B rationale
No change is categorized when the client's symptoms or physical findings remain static over a specific timeframe. In this scenario, the client has developed significant new symptoms, including frequent watery diarrhea, nausea, and decreased appetite, which were not present before. These active changes in the client's condition mean that the status is not stable or unchanging, thus making the category of no change inaccurate for the current clinical presentation of the bowel.
Choice C rationale
A complication is an unfavorable evolution of a disease, a health condition, or a medical treatment. The symptoms described, specifically foul-smelling, watery diarrhea following recent wound treatment, are classic indicators of a secondary infection like Clostridioides difficile. This occurs when normal intestinal flora is disrupted, often by antibiotics used for the initial wound. This new morbidity represents a significant complication that requires immediate medical intervention to prevent dehydration and further systemic illness.
Choice D rationale
An expected finding refers to a normal or predictable response during the course of a disease or recovery. Frequent, foul-smelling, watery diarrhea is never a normal or expected outcome of wound healing or standard recovery. While mild fluctuations in bowel habits can occur, the severity and nature of these symptoms point toward a pathological state. Attributing these symptoms to a normal recovery process would ignore a serious clinical development that necessitates specific diagnostic testing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Waiting until after the second voided specimen is collected to start the 24-hour clock would result in an inaccurate total volume and incorrect concentration of solutes. The goal of the 24-hour urine collection is to measure the total excretion of substances like creatinine, protein, or electrolytes over a precise 1440-minute window. Starting at the second void would omit the urine produced between the first and second voids, leading to a significant underestimation of renal clearance.
Choice B rationale
The 24-hour urine collection begins by having the client empty their bladder and discarding that first specimen. This ensures that the urine collected starts from an empty bladder at a specific time. All subsequent urine for the next 24 hours, including the final void at the exact end of the 24-hour period, is saved in the container. This method captures all urine produced by the kidneys during the designated timeframe, providing a reliable measure of renal function.
Choice C rationale
The arrival of equipment does not dictate the start of the biological collection period. The timing must be synchronized with the emptying of the client's bladder to ensure the sample represents a true 24-hour window of renal filtration and excretion. Starting the collection based on equipment arrival rather than the client's voiding schedule would lead to a random timeframe that does not account for urine already present in the bladder from the hours prior to the start.
Choice D rationale
Starting with the last voided specimen of the day is incorrect because it does not allow for a full 24-hour cycle of monitoring. A 24-hour collection must span a complete day-night cycle to account for circadian variations in hormone levels and renal excretion rates. Beginning at the end of the day would be retrospective and logistically impossible for a forward-looking collection. The process must be prospective, starting with an empty bladder and ending exactly 24 hours later.
Correct Answer is C
Explanation
Choice A rationale
Aluminum hydroxide is an antacid commonly used to neutralize gastric acid in patients with heartburn or peptic ulcers. One of its most frequent side effects is constipation. Regarding stool appearance, aluminum hydroxide usually causes the stool to appear white or speckled with white streaks rather than black. It does not contain the metallic components necessary to produce a dark, tarry appearance in the stool.
Choice B rationale
Antibiotics can significantly alter the composition of the normal gut microbiota, which may lead to changes in stool consistency, such as diarrhea. Certain antibiotics might cause greenish or yellowish stools due to rapid transit time and altered bile metabolism. However, antibiotics do not typically cause stool to become black and tarry. That specific discoloration is usually reserved for substances containing bismuth or heavy metals.
Choice C rationale
Iron supplements are well-known for causing stools to become black or dark green. This occurs because unabsorbed iron in the gastrointestinal tract reacts with hydrogen sulfide produced by bacteria, forming iron sulfide. This chemical reaction results in a dark, tarry appearance that can mimic melena. It is a benign side effect, but nurses must distinguish it from true gastrointestinal bleeding through a guaiac fecal occult blood test.
Choice D rationale
Aspirin is a nonsteroidal anti-inflammatory drug that can cause gastrointestinal irritation and bleeding by inhibiting prostaglandin synthesis, which protects the stomach lining. If aspirin causes a black, tarry stool, it is usually because it has induced an actual upper gastrointestinal bleed. Aspirin itself does not possess pigmenting properties that turn stool black without the presence of digested blood, unlike iron or bismuth.
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