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The client had a large, loose stool.

Vital signs: Temperature 98.7°F (37°C) orally. Heart rate 73 beats/minute.

Blood pressure 144/82 mm Hg. The client had a large, loose stool. The client had a large, loose stool.

Place the client on contact precautions.

Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take, and two parameters to assess the client’s progress.

Answer and Explanation

The Correct Answer is []

The correct answer is Potential Condition:

A. Secretory diarrhea.

Actions to Take:

A. Collect stool for culture.

D. Make the client NPO.

Parameters to Monitor:

A. Heart rate.

B. Serum potassium.

Potential Condition A rationale:

Secretory diarrhea is characterized by large volumes of watery stool and can be caused by infections, toxins, or certain medications. It is important to identify the underlying cause to provide appropriate treatment. Potential Condition B rationale:

Steatorrhea is characterized by fatty stools and is typically associated with malabsorption syndromes. The client’s symptoms do not suggest this condition. Potential Condition C rationale:

Motility diarrhea is caused by rapid transit of stool through the intestines, often due to conditions like irritable bowel syndrome. The client’s symptoms are more consistent with secretory diarrhea. Potential Condition D rationale:

Osmotic diarrhea occurs when non-absorbable substances draw water into the intestines. The client’s symptoms are more indicative of secretory diarrhea. Action A rationale:

Collecting stool for culture helps identify any infectious agents that may be causing the diarrhea, allowing for targeted treatment. Action B rationale:

Starting a high-fiber diet is not appropriate for a client with acute diarrhea, as it may exacerbate symptoms. Action C rationale:

Administering an oral steroid is not indicated for the treatment of secretory diarrhea and may worsen the condition. Action D rationale:

Making the client NPO (nothing by mouth) helps to rest the gastrointestinal tract and reduce the severity of diarrhea. Parameter A rationale:

Monitoring heart rate is important as dehydration from diarrhea can lead to tachycardia. Parameter B rationale:

Monitoring serum potassium is crucial as diarrhea can lead to significant electrolyte imbalances, including hypokalemia. Parameter C rationale:

Monitoring respiratory rate is not directly related to the management of diarrhea. Parameter D rationale:

Monitoring urine sodium is not directly related to the management of diarrhea.

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Correct Answer is ["5"]

Explanation

Step 1: Calculate the volume to administer. 200 mg ÷ (1000 mg ÷ 25 mL) = 200 mg ÷ 40 mg/mL = 5 mL The nurse should administer 5 mL.

A. Provide a numeric pain scale. B. Ask the client to describe the pain. C. Observe body language and movement. D. Identify effective pain relief measures.

Correct Answer is B

Explanation

Choice A rationale
Providing a numeric pain scale helps quantify the intensity of pain but does not assess the quality of the pain. Quality refers to the characteristics and nature of the pain, which cannot be captured by a numeric scale alone.
Choice B rationale
Asking the client to describe the pain is the best approach to assess the quality of the pain. This allows the client to provide detailed information about the pain’s characteristics, such as its nature, location, and any associated symptoms.
Choice C rationale
Observing body language and movement can provide clues about pain but does not give a comprehensive understanding of the pain’s quality. Nonverbal cues are helpful but should be supplemented with the client’s verbal description.
Choice D rationale
Identifying effective pain relief measures is important for pain management but does not directly assess the quality of the pain. This step comes after understanding the pain’s characteristics.

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Naxlex Comprehensive Predictor Exams

The healthcare provider prescribes streptomycin 200 mg IM every 12 hours. The vial is labeled, “Streptomycin 1 gram/25.”. How many milliliters should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

Correct Answer is ["5"]

Explanation

To assess the quality of the client’s abdominal pain, which approach should the nurse use?

Correct Answer is B

Explanation

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