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 D
Explanation
Choice A rationale
Cucumbers are a good source of hydration due to their high water content, but they are not particularly high in potassium.
Choice B rationale
Corn is a versatile vegetable that provides a good source of fiber, but it is not particularly high in potassium.
Choice C rationale
Asparagus is a nutrient-rich vegetable known for its diuretic properties, but it is not particularly high in potassium.
Choice D rationale
Avocados are a nutrient-dense fruit that is high in healthy fats and also a good source of potassium. They are a great food choice for a client at risk for hypokalemia.
Correct Answer is B
Explanation
Choice A rationale
Carrying a patient’s soiled linens out of the room in a mesh linen bag is not the most effective way to prevent the spread of infection. While it’s important to handle soiled linens properly to avoid contaminating oneself or the environment, this action alone does not have a significant impact on preventing the spread of infection among a group of patients.
Choice B rationale
Placing a patient who has tuberculosis in a room with negative-pressure airflow is a key measure in preventing the spread of this airborne infection. Negative-pressure rooms prevent
contaminated air from escaping the room and spreading to other areas, thereby protecting other patients and healthcare workers.
Choice C rationale
Providing disposable plates and utensils for a patient who is HIV-positive is not necessary for preventing the spread of infection. HIV is not transmitted through casual contact or through sharing food or utensils.
Choice D rationale
Disposing of a patient’s blood-saturated dressing in a trash bag inside a second trash bag is a good practice for handling biohazardous waste, but it is not the most effective measure for preventing the spread of infection among a group of patients.
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