The nurse suspects that the client, hospitalized with severe ulcerative colitis, is experiencing the complication of toxic megacolon. Which assessment finding would support this suspicion?
Increased passage of gas and stool
Enlarging abdominal girth
Hyperactive bowel sounds
Afebrile
The Correct Answer is B
B. Toxic megacolon is characterized by severe colonic dilation, leading to a significant increase in abdominal girth. As the colon becomes distended, it can cause visible abdominal swelling and bloating, which may be accompanied by tenderness upon palpation.
A. In the context of toxic megacolon, there may be a reduction or cessation of bowel movements due to colonic dilation and paralysis.
C. In toxic megacolon, bowel sounds may initially be hyperactive due to increased peristalsis as the colon attempts to overcome the obstruction. However, as the condition progresses, bowel sounds may diminish or become absent due to colonic dilation and paralysis.
D. While fever can be present in toxic megacolon due to the underlying inflammatory process, it is not universally seen in all cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. Bismuth subsalicylate, one of the medications prescribed for peptic ulcers, can cause blackening of the stools. This discoloration is harmless and temporary but is an important side effect to be aware of.
A. Citrus juices, including orange juice, can exacerbate symptoms of peptic ulcers due to their acidic nature. Therefore, it would not be appropriate for the client to consume orange juice while taking famotidine and bismuth subsalicylate.
C. Osteoporosis is not a known side effect or concern associated with these medications.
D. Constipation and not diarrhea, is a potential side effect of bismuth subsalicylate.
Correct Answer is C
Explanation
A. Emptying the bladder before and after sexual intercourse can help flush out bacteria that may have entered the urethra during sexual activity, reducing the risk of UTIs. Therefore, this statement indicates effective understanding of preventive measures.
B. Regularly emptying the bladder helps prevent the buildup of bacteria in the urinary tract, reducing the risk of UTIs. Therefore, this statement indicates effective understanding of preventive measures.
C. Using vaginal sprays and douches can disrupt the natural balance of bacteria in the vagina and increase the risk of UTIs and other vaginal infections. Therefore, this statement indicates a misunderstanding of preventive measures and could potentially contribute to an increased risk of UTIs.
D. Wiping from front to back after urination helps prevent the spread of bacteria from the anal area to the urethra, reducing the risk of UTIs. Therefore, this statement indicates effective understanding of preventive measures.
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