After an initial assessment, a nurse documents that a patient, admitted for abdominal pain, has hyperactive bowel sounds. As a result, the nurse could expect the patient's bowel movements to be

In range from 530 bowel sounds per minute

Less than 5 bowel sounds per minute

Absent bowel sounds

Over 30 bowel sounds per minute

Answer and Explanation

The Correct Answer is D

Choice A This range of bowel sounds is considered normal. Hyperactive bowel sounds refer to an increased frequency and intensity of bowel sounds, exceeding the upper limit of the normal range.

Choice B Bowel sounds less than the normal range might indicate decreased bowel motility but are not associated with hyperactive bowel sounds.

Choice C Absent bowel sounds would be concerning and may indicate an ileus or other gastrointestinal issue, but it is not associated with hyperactive bowel sounds.

Choice D Hyperactive bowel sounds are characterized by an increased frequency and intensity of bowel sounds, exceeding the normal range, and are likely to be documented in a patient with abdominal pain.

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Correct Answer is C

Explanation

Choice A This change in blood pressure is not alarming and does not require immediate cessation of the procedure.

Choice B A slight increase in temperature is within a normal range and does not indicate an urgent issue related to the stool removal procedure.

Choice C A significant decrease in pulse rate suggests bradycardia, which can be a serious sign and might be caused by the stimulation of the vagus nerve during the procedure. The nurse should stop immediately and take corrective action.

Choice D An increase in respiratory rate may indicate increased anxiety or discomfort, but it is not an immediate cause for stopping the procedure.

A. Take a stool softener or laxative every day until a normal elimination pattern has been reestablished. B. Eat small amounts at meals so less waste will need to be expelled. C. Eat a minimum of 50 g fiber every day and quickly increase the amount until normal defecation becomes routine. D. Drink at least 2000 mL fluid every day, but limit the amount of caffeine to 300 mg. E. None F. None

Correct Answer is D

Explanation

Choice A Depending on laxatives or stool softeners every day may lead to dependence and can be harmful in the long term. It is not a preferred approach for managing constipation.

Choice B While eating smaller, more frequent meals can aid digestion, it is not the primary strategy for preventing constipation.

Choice C : Increasing dietary fiber intake is an effective way to promote regular bowel

movements and prevent constipation. Gradually increasing fiber intake helps the body adjust to the increased fiber load.

Choice D Adequate fluid intake is important for bowel health, but focusing solely on fluid intake may not be as effective as increasing dietary fiber to prevent constipation.

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After an initial assessment, a nurse documents that a patient, admitted for abdominal pain, has hyperactive bowel sounds. As a result, the nurse could expect the patient's bowel movements to be

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Naxlex Comprehensive Predictor Exams

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