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The nurse is caring for a client with suspected appendicitis. Nursing interventions for this client would include: (SELECT ALL THAT APPLY)

Withholding food and fluids until a diagnosis is established.

Administering prophylactic IV antibiotics.

Giving the client a heating pad to place on the abdomen for comfort.

Administering a cleansing enema in preparation for surgery.

Having the client ambulate at least once every hour.

Answer and Explanation

Correct Answer : A,B

Choice A rationale

Withholding food and fluids is essential to prevent complications should surgery be needed.

Choice B rationale

Administering prophylactic IV antibiotics helps prevent infection, which is critical in cases of appendicitis.

Choice C rationale

Applying heat to the abdomen can increase circulation and the risk of rupture in appendicitis.

Choice D rationale

Administering an enema can increase the risk of perforation in appendicitis.

Choice E rationale

Ambulation can exacerbate pain and the risk of rupture in a client with suspected appendicitis.

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Correct Answer is D

Explanation

Choice A rationale

Gloves are often the most contaminated piece of PPE. They should be removed first to prevent contamination of other PPE or areas.

Choice B rationale

The gown should be removed after gloves because it covers the largest surface area and could spread contaminants if removed earlier.

Choice C rationale

Eyewear should be removed before the mask to avoid potential contamination from airborne particles that could remain on the mask.

Choice D rationale

The mask is typically removed last to prevent inhalation of any contaminants that might still be in the air during the removal process.

A. Cell rebuilders. B. Aids to digestion and blood production. C. Prevention to the colonizing of pathogens. D. Managers of fluid balance of the body.

Correct Answer is C

Explanation

Choice A rationale

Normal flora does not function as cell rebuilders. They primarily exist in a symbiotic relationship with the host without directly participating in cell repair processes.

Choice B rationale

While some normal flora aid in digestion, they are not involved in blood production. Blood production is a function of bone marrow and not influenced by normal flora.

Choice C rationale

Normal flora play a crucial role in preventing the colonization of pathogens by competing for nutrients and space, thereby protecting the body from harmful microorganisms.

Choice D rationale

Normal flora do not manage the fluid balance of the body. Fluid balance is regulated by the kidneys and the body's endocrine system, not by the normal flora.

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The nurse is caring for a client with suspected appendicitis. Nursing interventions for this client would include: (SELECT ALL THAT APPLY)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a client who requires isolation has just finished a care procedure. Which of the following pieces of personal protective equipment (PPE) should the nurse remove last?

Correct Answer is D

Explanation

The nurse explains that the body's normal flora serves as:

Correct Answer is C

Explanation

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