The nurse is caring for a client who had a cholecystectomy two days ago. The client is febrile, reporting upper abdominal pain radiating to the back and has had three episodes of vomiting in the last 8 hours. The nurse reviews the client's serum amylase and lipase level results which are twice the normal value. Based on these findings, the nurse should recognize the client is exhibiting symptoms of which condition?
Hepatorenal failure.
Acute pancreatitis.
Surgical site infection.
Biliary duct obstruction.
The Correct Answer is B
Choice A reason: This is incorrect because hepatorenal failure is a condition that involves both liver and kidney dysfunction, usually as a complication of cirrhosis or portal hypertension. The symptoms of hepatorenal failure may include jaundice, ascites, edema, oliguria, or encephalopathy. However, these are not consistent with the client's presentation of fever, abdominal pain, vomiting, and elevated amylase and lipase levels.
Choice B reason: This is correct because acute pancreatitis is an inflammation of the pancreas that can be caused by gallstones, alcohol abuse, trauma, infection, or drugs. The symptoms of acute pancreatitis may include fever, upper abdominal pain that radiates to the back, nausea, vomiting, and elevated amylase and lipase levels. These are consistent with the client's presentation and suggest that the cholecystectomy may have triggered an attack of acute pancreatitis.
Choice C reason: This is incorrect because surgical site infection is an infection that occurs at or near the incision site after surgery. The symptoms of surgical site infection may include redness, swelling, warmth, pus drainage, or pain at the wound site. However, these are not consistent with the client's presentation of fever, abdominal pain radiating to the back, vomiting, and elevated amylase and lipase levels.
Choice D reason: This is incorrect because biliary duct obstruction is a blockage of the bile ducts that carry bile from the liver and gallbladder to the intestine. The causes of biliary duct obstruction may include gallstones, tumors, inflammation, or scarring. The symptoms of biliary duct obstruction may include jaundice, dark urine, pale stools, itching, or abdominal pain. However, these are not consistent with the client's presentation of fever, abdominal pain radiating to the back, vomiting, and elevated amylase and lipase levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This is incorrect because consuming a high protein diet is not a recommended strategy to reduce risk factors for BPH. In fact, some studies have suggested that a high protein intake may increase the risk of BPH by stimulating the production of insulin-like growth factor-1 (IGF-1), which may promote prostate growth.
Choice B reason: This is incorrect because obtaining a prostate-specific antigen blood level test is not a preventive measure for BPH, but rather a diagnostic tool to detect prostate cancer or monitor its treatment. Prostate-specific antigen (PSA) is a protein produced by the prostate gland that can be elevated in both BPH and prostate cancer. However, PSA levels alone cannot distinguish between these two conditions and need to be interpreted along with other factors, such as age, race, family history, and digital rectal examination.
Choice C reason: This is incorrect because taking vitamin supplements is not a proven method to reduce risk factors for BPH. While some vitamins, such as vitamin D and vitamin E, may have some beneficial effects on prostate health, there is not enough evidence to support their use as preventive agents for BPH. Moreover, some vitamins, such as vitamin A and vitamin B6, may have adverse effects on prostate health and increase the risk of BPH or prostate cancer.
Choice D reason: This is correct because increasing physical activity is a helpful way to reduce risk factors for BPH. Physical activity can help maintain a healthy weight, lower blood pressure, improve blood circulation, reduce inflammation, and regulate hormone levels. All of these factors can contribute to preventing or delaying the development of BPH.
Correct Answer is C
Explanation
Choice A reason: Redness and edema noted at the incision site are signs of inflammation, which are normal in the early stages of wound healing. The nurse should monitor the site for signs of infection, such as purulent drainage, increased pain, or fever.
Choice B reason: Apical heart rate of 100 to 110 beats/minute is a sign of tachycardia, which may be caused by pain, anxiety, dehydration, or blood loss. The nurse should assess the client's vital signs, fluid status, and hemoglobin level, and administer pain medication as prescribed.
Choice C reason: High-pitched sound heard upon inspiration is a sign of stridor, which is a life-threatening emergency that indicates airway obstruction. The nurse should call for help, administer oxygen, and prepare for intubation or tracheostomy.
Choice D reason: Pain rating of 8 on a scale of 0 to 10 is a sign of severe pain, which may impair the client's recovery and increase the risk of complications. The nurse should administer pain medication as prescribed and use non-pharmacological methods to relieve pain, such as positioning, distraction, or relaxation techniques.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.