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

Answer and Explanation

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.

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Correct Answer is D

Explanation

D. "You will probably begin to notice changes in how you feel with just a few weeks of diet and exercise.": This statement focuses on short-term benefits of weight loss, such as improvements in energy levels, mood, and overall well-being. Teenagers may be more motivated by immediate or short-term results rather than long-term outcomes. Feeling better quickly can provide positive reinforcement and encouragement to continue with healthy habits.
A. Water weight loss may not lead to significant changes in appearance or health outcomes, which are often key motivators for weight loss.
B. This statement emphasizes the importance of making lasting lifestyle changes for successful weight loss, which is a key concept for long-term success. However, it may sound daunting or overwhelming to a teenager.
C. Connecting weight loss to long-term health outcomes is unlikely to motivate some teenagers. This is because most teenagers feel immune to most chronic illnesses.

A. Urine specific gravity and antigen levels B. Urine characteristics and output C. Appearance of the surgical site D. Results of clean catch urine specimens

Correct Answer is B

Explanation

B. After ESWL for a urinary stone, it is essential to monitor the client's urine characteristics (such as color, clarity, and presence of blood) and output. The presence of hematuria is a common and expected finding after ESWL due to the disruption of tissue and blood vessels during the procedure. Monitoring urine output helps assess renal function and ensures adequate hydration, which is crucial for flushing out stone fragments.
A. While monitoring urine specific gravity can provide information about the concentration of urine, and assessing antigen levels may be relevant in certain contexts, these parameters are not typically the most important information to collect immediately after extracorporeal shock-wave lithotripsy (ESWL) for a urinary stone.
C. While it is important to monitor the surgical site for signs of infection or complications after any procedure, ESWL is a non-invasive procedure performed externally, typically without any incisions.
D. While obtaining clean catch urine specimens for urinalysis and culture may be relevant for assessing urinary tract infection or other urinary abnormalities, it is not typically the most important information to collect immediately after ESWL.

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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?

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Naxlex Comprehensive Predictor Exams

Which statement made by the nurse to a 14-year-old extremely obese teenager is most likely to motivate him to lose weight?

Correct Answer is D

Explanation

A client who has a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock- wave lithotripsy. What Information is most Important for the nurse to collect after lithotripsy?

Correct Answer is B

Explanation

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