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.

Answer and Explanation

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.

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Correct Answer is ["A","B","C","D"]

Explanation

Choice A rationale

Regular inspection of the cord for frays or tears is crucial to ensure the safe operation of the home oxygen concentrator. A damaged cord can pose a risk of electric shock or fire.

Choice B rationale

Keeping the unit at least 1.2 m (4 ft) away from a gas stove is important because oxygen supports combustion. An oxygen-rich environment can cause materials to ignite more easily and make fires burn at a faster rate.

Choice C rationale

Considering the purchase of a generator for power backup is a good idea. In case of a power outage, a backup power source would ensure the continuous operation of the oxygen concentrator, which is critical for patients who are dependent on supplemental oxygen.

Choice D rationale

Monitoring for signs of hypoxia is essential. Despite receiving oxygen therapy, a patient may still experience hypoxia if the oxygen flow rate is insufficient, or if there are issues with the equipment. Signs of hypoxia include shortness of breath, rapid breathing, restlessness, confusion, and cyanosis (bluish color of the skin, lips, or nails)12.

Choice E rationale

Choosing synthetic clothing and bedding is not recommended. Synthetic materials can build up static electricity, which can spark and cause a fire in an oxygen-enriched environment.

A. Stop the IV infusion. B. Elevate the client’s left arm. C. Apply heat to the client’s left hand. D. Start a new IV in the client’s left hand.

Correct Answer is ["A","B","C"]

Explanation

Choice A rationale

The nurse should stop the IV infusion. The client has manifestations of IV infiltration, which occurs when IV fluid enters the surrounding tissue. Stopping the IV infusion and removing the IV catheter can reduce the risk for further tissue damage.

Choice B rationale

The nurse should elevate the client’s left arm. Elevation can help decrease swelling and reduce the risk for tissue damage.

Choice C rationale

The nurse should apply heat to the client’s left hand. Heat can help reduce swelling and promote comfort.

Choice D rationale

Starting a new IV in the client’s left hand is not recommended at this point. The nurse should first manage the infiltration and then assess the need for a new IV3.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge instructions to a patient who has a new prescription for a home oxygen concentrator. Which of the following instructions should the nurse provide to the patient and their family? (Select all that apply.)

Correct Answer is ["A","B","C","D"]

Explanation

Correct Answer is ["A","B","C"]

Explanation

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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?