A nurse is assessing a patient who has peritonitis.
Which of the following findings should the nurse expect?
Rigid abdomen.
Increased urinary output.
Frequent bowel movements.
Hyperactive bowel sounds.
The Correct Answer is A
Choice A rationale
A rigid abdomen is a classic finding in peritonitis, an inflammation of the peritoneum. The inflammation causes the abdominal muscles to become tense and board-like as a protective mechanism. This rigidity is often accompanied by severe abdominal pain that is exacerbated by movement or palpation.
Choice B rationale
Increased urinary output is not a typical finding in peritonitis. In fact, due to fluid shifts and potential dehydration from the inflammatory process and decreased oral intake, urinary output may be decreased. Normal adult urinary output is generally considered to be at least 0.5 mL/kg/hour.
Choice C rationale
Frequent bowel movements are not characteristic of peritonitis. Peritonitis often leads to decreased bowel motility and potentially ileus due to the inflammation affecting the gastrointestinal tract. Bowel sounds may be diminished or absent rather than frequent.
Choice D rationale
Hyperactive bowel sounds are not typically associated with peritonitis. Initially, bowel sounds might be present, but as the inflammation progresses and ileus develops, bowel sounds usually become hypoactive or absent. Hyperactive bowel sounds are more commonly associated with early bowel obstruction or gastroenteritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Decreased range of motion in a single joint, such as the right knee in a 77-year-old patient, can be attributed to various age-related changes like osteoarthritis or previous injury. While it warrants assessment, a recent loss of balance and fall is a more acute and potentially serious finding that requires immediate attention due to the increased risk of injury.
Choice B rationale
A history of recent loss of balance and a fall in an elderly patient is a significant finding that requires immediate further nursing assessment and intervention. Falls can lead to serious injuries, such as fractures, and may indicate underlying medical conditions, medication side effects, or environmental hazards that need to be addressed to prevent future falls.
Choice C rationale
Symmetric joint swelling of the fingers in a 77-year-old patient could be indicative of rheumatoid arthritis, an autoimmune condition more common in older adults. While it requires further assessment and diagnosis, it is generally a chronic condition and less immediately life-threatening than a recent fall.
Choice D rationale
A report of left hip aching when jogging in a 77-year-old patient could be related to musculoskeletal issues like arthritis or muscle strain. While it warrants assessment and management to improve comfort and mobility, it is less concerning in the immediate term compared to a recent loss of balance and fall, which poses a higher risk of acute injury. .
Correct Answer is A
Explanation
Choice A rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandins, which play a protective role in the gastric mucosa by promoting mucus and bicarbonate secretion, maintaining mucosal blood flow, and inhibiting acid secretion. Chronic NSAID use can disrupt these protective mechanisms, leading to mucosal damage and increasing the risk of peptic ulcer formation.
Choice B rationale
Bulimia nervosa is an eating disorder characterized by cycles of binge eating followed by compensatory behaviors such as vomiting. While vomiting can cause esophageal damage and dental erosion due to stomach acid exposure, it is not a direct risk factor for peptic ulcer disease.
Choice C rationale
Moderate alcohol consumption, such as a glass of wine with dinner, has not been consistently shown to be a significant risk factor for peptic ulcer disease. While excessive alcohol intake can irritate the gastric mucosa, moderate consumption is generally not considered a primary cause.
Choice D rationale
Green tea contains antioxidants and has some anti-inflammatory properties. Studies have not shown a link between green tea consumption and an increased risk of peptic ulcer disease; in fact, some research suggests potential protective effects on the gastric mucosa. .
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