A male client is admitted to the emergency department (ED) while vomiting dark brown, foul-smelling emesis. He reports having a surgical repair of a recurrent inguinal hernia a week ago and is troubled by intense abdominal pain. After finding that his bowel sounds are hyperactive, which prescription should the nurse implement first?
Place an indwelling urinary catheter and attach a bedside drainage unit.
Give a prescribed analgesic for temperature above 101°F (38.3°C), orally.
Send the client to x-ray for a flat plate of the abdomen.
Insert a nasogastric tube (NGT) and attach to low intermittent suction (LIS).
The Correct Answer is D
Choice A reason: Placing an indwelling urinary catheter is not immediately relevant to the client's symptoms.
Choice B reason: Giving an analgesic for a fever does not address the underlying issue of bowel obstruction.
Choice C reason: Sending the client to x-ray can help diagnose the issue but is not the first action to relieve symptoms.
Choice D reason:
The correct answer is d) because inserting a nasogastric tube and attaching it to low intermittent suction helps decompress the stomach and relieve symptoms of bowel obstruction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Bile-stained emesis indicates an obstruction, but it is not as immediately critical as a distended, hard, and rigid abdomen.
Choice B reason: Clay-colored stool is a sign of bile duct obstruction but is not as urgent as the abdomen findings.
Choice C reason:
The correct answer is c) because a distended, hard, and rigid abdomen suggests peritonitis or a perforated organ, which requires immediate medical intervention.
Choice D reason: Radiating, sharp pain in the right shoulder is common in gallbladder issues but is not as immediately life-threatening as a distended, hard, and rigid abdomen.
Correct Answer is B
Explanation
Choice A reason: Arthritic joint changes and chronic pain are not related to an ABO incompatibility reaction.
Choice B reason:
The correct answer is b) because lower back pain and hypotension are signs of a hemolytic transfusion reaction, which requires immediate intervention.
Choice C reason: Acute rhinitis and nasal stuffiness are not related to an ABO incompatibility reaction.
Choice D reason: Delayed painful rash with urticaria can indicate an allergic reaction but is not specific to a hemolytic transfusion reaction.
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