A patient reports abdominal pain.
An abdominal x-ray indicates a large amount of fecal material throughout the colon, but no evidence of gastrointestinal obstruction is observed.
Which of the following actions should the nurse take?
Assist the patient to a left side-lying position with the right knee flexed.
Prepare the patient for a chest x-ray.
Administer a cleansing enema.
Perform a manual digital examination of the patient’s rectum.
The Correct Answer is C
Choice A rationale
Assisting the patient to a left side-lying position with the right knee flexed is often used for rectal examinations or administering enemas, but it does not directly address the issue of a large amount of fecal material in the colon.
Choice B rationale
Preparing the patient for a chest x-ray would not be beneficial in this situation. A chest x-ray would not provide further information about the fecal material in the colon.
Choice C rationale
Administering a cleansing enema can help to remove the fecal material from the colon. This is a common treatment for fecal impaction.
Choice D rationale
Performing a manual digital examination of the patient’s rectum can help to assess the amount of fecal material present, but it would not alleviate the patient’s abdominal pain or remove the fecal material.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["8"]
Explanation
Step 1 is: Calculate the total units of heparin in the bag, which is 25,000 units.
Step 2 is: Divide the total units by the total volume to find the units per mL, which is (25,000 units ÷ 250 mL) = 100 units/mL.
Step 3 is: Divide the desired units per hour by the units per mL to find the mL/hr, which is (800 units/hr ÷ 100 units/mL) = 8 mL/hr. So, the infusion pump rate should be set at 8 mL/hr.
Correct Answer is B
Explanation
Choice A rationale
When descending stairs, the crutches and the injured leg should go down first, followed by the good leg31415.
Choice B rationale
Placing crutches 12 inches in front and to the side of each foot is a correct method for using crutches. This provides stability and balance while walking31415.
Choice C rationale
When sitting down, it’s recommended to hold both crutches in one hand on the same side as the injured leg. This allows the other hand to be free to reach for the chair31415.
Choice D rationale
The shoulder rests, or pads, should not be snug against the body. There should be a space of about 1-2 inches between the top of the crutch and the armpit31415.
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