The nurse doesn’t hear any gurgling while listening to bowel sounds. What should be the nurse’s next course of action?

Document the bowel sounds as hypoactive

Administer prescribed drugs for constipation

Review dietary intake for the past 24 hours

Continue to listen for at least another 60 seconds

Answer and Explanation

The Correct Answer is D

Choice A rationale
Documenting the bowel sounds as hypoactive is not the most appropriate action. Hypoactive bowel sounds are fewer than three bowel sound events in a minute or none at all. However, the absence of bowel sounds does not necessarily mean they are hypoactive. It could be due to other reasons such as ileus.
Choice B rationale
Administering prescribed drugs for constipation is not the immediate course of action when the nurse doesn’t hear any gurgling while listening to bowel sounds. Constipation is a condition that can cause hypoactive bowel sounds, but it’s not the only reason for the absence of bowel sounds. The nurse should first confirm the absence of bowel sounds before considering this action.
Choice C rationale

Reviewing dietary intake for the past 24 hours is not the immediate course of action. While diet can affect bowel sounds, it’s not the first step when bowel sounds are not heard. The nurse should first confirm the absence of bowel sounds before considering this action.
Choice D rationale
The correct action when the nurse doesn’t hear any gurgling while listening to bowel sounds is to continue to listen for at least another 60 seconds. Bowel sounds are produced by the movement of fluid, gas, and contents through the intestines. An absence of bowel sounds for greater than two minutes may indicate that there is no peristalsis—which implies an ileus.
Therefore, the nurse should continue to listen for at least another 60 seconds to confirm the absence of bowel sounds.

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Correct Answer is C

Explanation

Choice A rationale
While having a room within view of the nurses’ station can be beneficial for monitoring the patient, it does not specifically address the needs of a patient with active tuberculosis.
Choice B rationale
Placing a patient with active tuberculosis in a room with another non-surgical patient could potentially expose the other patient to the disease. Tuberculosis is an airborne disease and can easily spread to others in close proximity.
Choice C rationale
A room with air exhaust directly to the outdoor environment is the most appropriate choice for a patient with active tuberculosis. This type of room, known as a negative pressure room, helps prevent the spread of airborne diseases like tuberculosis. The air in the room is vented outside, reducing the risk of the disease spreading to other areas of the hospital.
Choice D rationale
While the ICU is equipped to handle severe and critical cases, a patient with active tuberculosis does not necessarily need to be in the ICU unless they are critically ill. Moreover, placing them in the ICU could potentially expose other critically ill patients to tuberculosis.

A. Fecal contamination of food or water B. Sexual intercourse C. Kissing mouth-to-mouth D. Contact with infected blood .

Correct Answer is A

Explanation

Choice A rationale
Hepatitis A is primarily transmitted through fecal contamination of food or water. This can occur when an infected person does not wash their hands properly after going to the bathroom and then touches food or other objects that others then put in their mouths.
Choice B rationale
While sexual intercourse can potentially transmit Hepatitis A, it is not the primary mode of transmission. The risk is higher if the sexual activity involves oral-anal contact.
Choice C rationale
Kissing mouth-to-mouth is not typically a primary mode of Hepatitis A transmission unless fecal particles are somehow involved.
Choice D rationale
Contact with infected blood is not the primary mode of Hepatitis A transmission. Hepatitis A is primarily spread through the fecal-oral route, not through blood.

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The nurse doesn’t hear any gurgling while listening to bowel sounds. What should be the nurse’s next course of action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a patient who has active tuberculosis to a room in a medical-surgical unit. Which of the following room assignments should the nurse make for the patient?

Correct Answer is C

Explanation

A patient diagnosed with Hepatitis A is concerned about the risk of transmission to other family members. What is the primary mode of Hepatitis A transmission that the nurse should mention in the response?

Correct Answer is A

Explanation

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