The nurse is performing an assessment on a client who has been diagnosed with severe peritonitis. Which finding would the nurse expect?
Active bowel sounds.
Leukocytosis.
Pain report of "0" on a 0-10 scale.
Undistended abdomen.
The Correct Answer is B
Choice A rationale
Active bowel sounds are indicative of normal or increased gastrointestinal motility, which is not expected in severe peritonitis. Peritonitis typically leads to decreased or absent bowel sounds due to inflammation and paralysis of the intestines.
Choice B rationale
Leukocytosis, an elevated white blood cell count, is a common finding in severe peritonitis. It indicates an immune response to infection or inflammation within the abdominal cavity.
Choice C rationale
A pain report of "0" on a 0-10 scale is highly unlikely in severe peritonitis. This condition causes significant abdominal pain due to widespread inflammation of the peritoneum.
Choice D rationale
An undistended abdomen is not expected in severe peritonitis. The condition often results in abdominal distension due to fluid accumulation, inflammation, and decreased bowel motility.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A rationale
Pyloric obstruction does not cause respiratory acidosis. Instead, it leads to gastrointestinal symptoms due to obstruction of the stomach's outflow.
Choice B rationale
Abdominal pain relieved by belching is a typical symptom of pyloric obstruction, as it can help release some of the gas and pressure build-up in the stomach.
Choice C rationale
Sensation of epigastric fullness is a common symptom of pyloric obstruction due to the blockage preventing stomach contents from passing into the duodenum.
Choice D rationale
Nausea is a frequent symptom of pyloric obstruction because the stomach's inability to empty properly can lead to discomfort and vomiting. .
Correct Answer is C
Explanation
Choice A rationale
Clients with acute appendicitis often lie still in a fetal position to reduce pain caused by movement. The fetal position helps decrease tension on the abdominal muscles, providing relief.
Choice B rationale
Initial pain in appendicitis is often crampy and diffuse but later localizes to the right lower quadrant (McBurney's point). The progression of pain from generalized to localized is typical in appendicitis.
Choice C rationale
Rhinitis (nasal inflammation) and myalgias (muscle pain) are symptoms more associated with viral infections like the flu, not acute appendicitis. These symptoms do not support a diagnosis of appendicitis.
Choice D rationale
A lack of appetite (anorexia) is common in clients with appendicitis due to the discomfort and inflammation in the abdomen, making this a supportive symptom.
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