The nurse continues to assist with the care of the client.

Exhibits

Which of the following findings indicates that the client's condition has improved?

Select all that apply.

Fluid intake

Temperature

Wound findings

Pain level

Report of nausea

Bowel sounds

Answer and Explanation

Correct Answer : D,E,F

A. Fluid intake: While fluid balance is important, there is no specific information indicating that changes in fluid intake are an indicator of the client’s condition improving in this context.
B. Temperature: The client's temperature has increased from 38.3°C (101°F) on Day 1 to 39.2°C (102.5°F) on Day 4. An increase in temperature indicates a possible infection or ongoing inflammation and does not suggest an improvement in the client’s condition.
C. Wound findings: There are no documented wound findings in the given notes. Thus, wound findings are not applicable in determining whether the client’s condition has improved in this scenario.
D. Pain level: The client's pain level has decreased from 7 to 3, indicating improvement.
E. Report of nausea: The client reports feeling less nauseous and has not vomited since yesterday, which is a sign of improvement.
F. Bowel sounds: The bowel sounds are more regular and less high-pitched, suggesting improvement in gastrointestinal function.

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Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

Pain level:

Small bowel obstruction: The client reports mid-abdominal pain, which is characteristic of small bowel obstruction as the pain is often crampy and located around the abdomen.
Acute pancreatitis: Abdominal pain is also a common symptom of acute pancreatitis, typically described as severe and persistent.

Social history:

Small bowel obstruction: Alcohol consumption is not a typical cause of obstruction.
Acute pancreatitis: Chronic alcohol use is a major risk factor for acute pancreatitis.

Skin findings:

Small bowel obstruction: Skin findings are usually unaffected.
Acute pancreatitis: In severe cases, pancreatic enzymes can leak into the skin, leading to ecchymosis (e.g., Grey Turner's or Cullen's sign). While jaundice can occur in acute pancreatitis due to bile duct obstruction, its absence does not rule out the condition.

Lipase level:

Small bowel obstruction: Lipase is generally normal.
Acute pancreatitis: Elevated lipase levels are highly indicative of acute pancreatitis.

WBC count:

Small bowel obstruction: A mild increase in WBC may occur due to bowel distension. The client’s WBC count is 9,000/mm³, which is within the normal range.
Acute pancreatitis: WBC levels are often elevated due to inflammation.

Abdominal findings:

Small bowel obstruction: Tenderness and high-pitched bowel sounds are typical signs.
Acute pancreatitis: Abdominal tenderness can also be present in acute pancreatitis, but high-pitched bowel sounds are more specific to small bowel obstruction.

A. Current medication prescriptions B. Primary health problem C. Number of family members who have visited D. Admission vital signs from 1 week ago E. Scheduled times for dressing changes

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

Explanation

A. Current medication prescriptions: Ensures continuity of care and proper medication administration in the ICU.
B. Primary health problem: Provides the ICU team with context about the client’s current condition and reason for transfer.
C. Number of family members who have visited: This is not clinically relevant to the client's care.
D. Admission vital signs from 1 week ago: Historical vitals are not as critical as current or recent findings.
E. Scheduled times for dressing changes: Provides critical information about ongoing wound care needs.

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The nurse continues to assist with the care of the client. Exhibits Which of the following findings indicates that the client's condition has improved? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assisting with the care of a client. Exhibits For each finding, click to specify if the finding is consistent with small bowel obstruction or acute pancreatitis. Each finding may support more than 1 disease process.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

A nurse is assisting with the transfer of a client from a medical-surgical unit to an intensive care unit following a change in status. Which of the following information should the nurse include in the transfer documentation? (Select all that apply.)

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

Explanation

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The nurse continues to assist with the care of the client.

Exhibits

Which of the following findings indicates that the client's condition has improved?

Select all that apply.