A nurse is caring for a 50-year-old male client in the emergency department.
Which finding is most consistent with the client's condition?
Hypoglycemia.
Pancreatitis.
Myocardial infarction.
Gastroenteritis.
The Correct Answer is B
Choice A rationale: Hypoglycemia typically presents with symptoms such as sweating, shakiness, confusion, and palpitations. The client's severe abdominal pain, nausea, vomiting, and jaundice are not consistent with hypoglycemia.
Choice B rationale: Pancreatitis is characterized by severe abdominal pain, nausea, vomiting, fever, and jaundice. The client's symptoms, including severe abdominal pain, nausea, vomiting, and faint yellow hue to sclera, are consistent with pancreatitis2.
Choice C rationale: Myocardial infarction usually presents with chest pain, shortness of breath, sweating, and nausea. The client's primary symptom is severe abdominal pain, which is not typical for myocardial infarction4.
Choice D rationale: Gastroenteritis typically presents with symptoms such as diarrhea, nausea, vomiting, and abdominal cramps. The client's severe abdominal pain, jaundice, and fever are more indicative of pancreatitis than gastroenteritis6.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Soft stools do not directly indicate enteral feeding intolerance, as this consistency is a normal variation in stool formation and does not signify gastrointestinal complications like vomiting, nausea, or diarrhea.
Choice B rationale
A urine output of 40 mL/hr signifies oliguria, potentially due to dehydration or renal impairment, but is unrelated to enteral feeding tolerance. Enteral feedings mainly affect gastrointestinal parameters.
Choice C rationale
Headache is a nonspecific symptom influenced by multiple factors, such as hydration status or systemic illnesses, rather than indicating enteral feeding intolerance directly.
Choice D rationale
A residual volume greater than 250 mL suggests delayed gastric emptying, increasing the risk of aspiration. This finding is a key indicator of enteral feeding intolerance requiring intervention.
Correct Answer is B
Explanation
Choice A rationale
Exercising close to bedtime increases adrenaline and body temperature, which interfere with sleep initiation. Studies recommend ceasing vigorous activity at least 3-4 hours before bedtime to optimize sleep quality.
Choice B rationale
Reducing fluid intake before bed minimizes nocturia, a common sleep disturbance. This aligns with promoting uninterrupted sleep and improving overall sleep hygiene and quality for individuals with insomnia.
Choice C rationale
Taking daytime naps, especially longer than 30 minutes, disrupts circadian rhythms and sleep drive, contributing to difficulty initiating and maintaining sleep during regular hours.
Choice D rationale
Eating a large meal before bedtime delays gastric emptying and may cause discomfort or reflux, both of which interfere with falling asleep. Light snacks are recommended if needed, but not heavy meals.
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