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An adult is postoperative on day 2 following bariatric surgery. The nurse's most recent assessment reveals increasing abdominal pain that the client rates at 8 out of 10, a heart rate of 112 beats per minute, and an oral temperature of 38.1°C (100.6°F). What is the nurse's best action?

Communicate the findings to the healthcare provider because the client may have a complication, such as an anastomotic leak.

Slow the client's oral intake in consultation with the dietitian to prevent further dumping syndrome.

Insert a nasogastric tube as prescribed to facilitate STAT gastric decompression

Continue to monitor the client.

Answer and Explanation

The Correct Answer is A

Rationale:
A. Increasing abdominal pain, tachycardia, and a low-grade fever in a postoperative bariatric surgery client may indicate a serious complication such as an anastomotic leak. This requires immediate communication with the healthcare provider.
B. Dumping syndrome typically causes symptoms like dizziness, diarrhea, and sweating after eating—not increasing pain and fever.
C. Nasogastric tube insertion is usually contraindicated after bariatric surgery unless specifically ordered, as it may disrupt surgical sites.
D. These are not mild findings that warrant passive monitoring; prompt intervention is necessary to prevent worsening of a potentially life-threatening complication.

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Correct Answer is A

Explanation

Rationale:
A. Avoiding crowds and contact with sick individuals is essential to reduce infection risk in neutropenic clients. This is an important teaching point.
B. Gardening can expose clients to soil bacteria and fungi, increasing infection risk and should be avoided during neutropenia.
C. Fresh salads and fruit smoothies can harbor bacteria and are generally discouraged during neutropenia unless properly prepared and approved by the healthcare provider.
D. Clients should take their temperature daily and report any fever promptly, as fever can be a sign of serious infection.

A. Review the client's electrolyte values. B. Obtain a dietary history from the client. C. Check the client's perianal skin integrity. D. Investigate the client's emotional concerns.

Correct Answer is A

Explanation

Rationale:
A. Electrolyte imbalances, particularly hypokalemia and hyponatremia, are common during an acute exacerbation of ulcerative colitis due to frequent diarrhea. Reviewing these values is the priority because severe imbalances can lead to life-threatening complications.
B. A dietary history is important but not the immediate priority in an acute situation.
C. Checking skin integrity is necessary to prevent breakdown, but it follows after addressing potential systemic issues.
D. Addressing emotional concerns is important for holistic care but is not urgent in the acute phase of illness.

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An adult is postoperative on day 2 following bariatric surgery. The nurse's most recent assessment reveals increasing abdominal pain that the client rates at 8 out of 10, a heart rate of 112 beats per minute, and an oral temperature of 38.1°C (100.6°F). What is the nurse's best action?

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Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to a client undergoing chemotherapy who has developed neutropenia. Which of the following statements by the nurse is appropriate to include in the teaching?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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