Exam 5 Evolve Questions- Elimination, reproductive, infection

The nurse is providing pre-procedure education to a 55-year-old client who is scheduled for an initial screening colonoscopy in one week. The electronic health record indicates a personal history of Crohn's disease and a family history of colon cancer. The client does not wish to go through the preparation process for a traditional colonoscopy and voices a preference to have a home screening test performed. 1. What assessment information in this client situation is the most important and immediate concern for the nurse? (Hint: Identify the relevant information first to determine what is most important.) 2. What client conditions are consistent with the most relevant information? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)

1. It is important to recognize that this is the client's first screening and the client is in a higher-risk category based upon the personal and family history. The personal history of Crohn's disease and family history of colon cancer indicate that client is not an ideal candidate for home screening for colon cancer. This should alert the nurse to provide further education about the need for, and benefits of, a traditional colonoscopy. 2. The client condition of Crohn's disease, and the client's family history of colon cancer, are particularly relevant to the need to have a traditional colonoscopy versus using a home screening test. Both of these factors place the client at higher risk of developing colon cancer. The nurse will provide education as regarding the fact that home screening tests are not the preferred method of testing for clients at higher risk, and that a traditional colonoscopy is the recommended test for at-risk clients.

The nurse is using a bladder scanner on a female client to estimate bladder volume. Which action will the nurse take? (Select all that apply.) A. Aim the scanner toward the client's coccyx to visualize the bladder. B. Select the female icon since the client has had a hysterectomy. C. Two readings should be completed for best accuracy. D. Gently insert the scanner probe into the vagina. E. Place a gel pad over the client's pubic area.

A. Aim the scanner toward the client's coccyx to visualize the bladder. C. Two readings should be completed for best accuracy. D. Gently insert the scanner probe into the vagina.

1. Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? A. An 80-year-old man who has benign prostatic hyperplasia B. A 62-year-old woman with a known allergy to contrast media C. A 48-year-old woman with established urinary incontinence D. A 45-year-old man receiving oral and intravenous fluid therapy

A. An 80-year-old man who has benign prostatic hyperplasia

Which teaching will the nurse include when educating a client who is scheduled to have an Esophagogastroduodenoscopy (EGD)? Select all that apply. A. "Anesthesia will be used for sedation." B. "The procedure takes about 20-30 minutes to complete." C. "Informed consent will be needed prior to the procedure." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6-8 hours before the EGD."

A. "Anesthesia will be used for sedation." B. "The procedure takes about 20-30 minutes to complete." D. "A separate test will be required to obtain any needed biopsies." E. "You will need to refrain from eating for at least 6-8 hours before the EGD." Rationale: The nurse will teach the patient undergoing an EGD that informed consent is required; anesthesia will be used for purposes of sedation during the procedure; the procedure lasts 20-30 minutes; and to refrain from eating 6-8 hours before the procedure. Specimens for biopsy and cell studies can be obtained through the endoscope, so a separate procedure is not needed.

The nurse is conducting a reproductive assessment of a young adult client. What assessment question will the nurse ask? (Select all that apply.) A. "Have you had any sexually transmitted infections?" B. "What changes would you like to see in your appearance?" C. "If you engage in sexual activities, do you practice 'safe' sex?" D. "Are you currently experiencing any reproductive concerns?" E. "When did you first start menstruating?"

A. "Have you had any sexually transmitted infections?" C. "If you engage in sexual activities, do you practice 'safe' sex?" D. "Are you currently experiencing any reproductive concerns?" E. "When did you first start menstruating?"

Which assessment finding would require the nurse to take immediate action in a client who is one hour post kidney biopsy? Select all that apply. A. Pink-tinged urine B. Nausea and vomiting C. Increased bowel sounds D. Reports of flank pain E. The patient is ambulating to the bathroom

A. Pink-tinged urine Rationale: Hemorrhage is a major complication of renal biopsy. The biopsy site and urine need to be closely monitored in addition to the hemoglobin. A fall in hemoglobin may indicate internal bleeding. Pain lasting more than 12 hours may indicate a ureteral obstruction.

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the best nursing response? A. "Have you tried using the toilet every couple of hours?" B. "How does that make you feel?" C. "We can fix that." D. "That happens when we get older."

A. "Have you tried using the toilet every couple of hours?" The nurse's best response to a client who states, "I feel like a child who sometimes pees her pants," is to ask the client if she uses the toilet at least every couple of hours. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.The client has already stated how she feels. Asking her again does not address her concern, nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for any client teaching.

Which statements by unlicensed assistive personnel indicate understanding regarding infection control measures needed to care for a client who has possible Clostridium difficile? Select all that apply. A. "I'll wear an isolation gown when providing direct care." B. "I'll wear gloves when providing direct care." C. "I'll wear a mask each time I enter the client's room." D. "I'll use a hand sanitizer when I can't wash my hands." E. "I'll wear goggles to protect my eyes."

A. "I'll wear an isolation gown when providing direct care." B. "I'll wear gloves when providing direct care." D. "I'll use a hand sanitizer when I can't wash my hands." The client requires contact precautions because C. difficile is transmitted by direct contact with stool. Therefore, a gown, gloves, and meticulous hand hygiene is required. A mask (Choice C) is not required because the client does not have an infection transmitted via the respiratory tract. Choice E (goggles) would only be needed if body fluids are splashed and could be transmitted via mucous membranes.

The health care provider has completed a cervical biopsy on a client. Which post-procedure teaching will the nurse provide? A. "Use the antiseptic solution rinses to clean your perineum." B. "Abstain from intercourse for 24 hours after the procedure." C. "Rest for at least 12 hours after the procedure." D. "There is no limit on activity or weight-lifting."

A. "Use the antiseptic solution rinses to clean your perineum." The client must keep the perineum clean and dry by using antiseptic solution rinses as directed by the primary health care provider, and needs to change pads frequently. The client is told not have intercourse or lift heavy objects for about 2 weeks after the procedure. The client also needs to rest for 24 hours after the procedure.

While working in the outpatient procedure unit, the RN is assigned to four clients. Which client will the nurse assess first? A. A 51 year old who just had an endoscopic retrograde cholangiopancreatography (ERCP). B. A 58 year old who has just arrived for a sigmoidoscopy. C. A 60 year old with questions about an endoscopic ultrasound examination. D. A 54 year old who is ready for discharge following a colonoscopy.

A. A 51-year-old who just had an endoscopic retrograde cholangiopancreatography (ERCP). ERCP requires conscious sedation, so the client needs immediate assessment of respiratory and cardiovascular status. The endoscopic procedure and nursing care for a client having an ERCP are similar to those for the EGD procedure, except that the endoscope is advanced farther into the duodenum and into the biliary tract.A 54-year-old client being discharged after a colonoscopy, a 58-year-old client who is going to have a sigmoidoscopy, and a 60-year-old client with questions about an endoscopic ultrasound examination are not at risk for depressed respiratory status. They can all be seen following the client who just had an ERCP.

Which client is at the greatest risk of developing an infection? A. A 65-year-old woman who had heart surgery 4 days ago B. A 54-year-old man with hypertension C. A 21-year-old woman with a fractured tibia in a cast D. A 71-year-old man in a nursing home

A. A 65-year-old woman who had heart surgery 4 days ago Older clients such as the 65-year-old woman with compromised skin (surgical incision) are at the highest risk for infection.No coexisting conditions are present for the client with hypertension to be at risk for infection. The 71-year-old client in a nursing home is not at highest risk because no coexisting conditions make this client most vulnerable to infection.

The human papillomavirus (HPV) test may be collected at the same time as the Papanicolaou (Pap) test for screening. Which finding indicates the highest risk for the development of cervical cancer? A. Abnormal Pap results and positive HPV test B. Normal Pap results and no HPV infection C. Abnormal Pap results and no HPV infection D. Normal Pap results and positive HPV results

A. Abnormal Pap results and positive HPV test If not treated, women with abnormal Pap results and a positive HPV test have the highest risk for developing cervical cancer. Women who have normal Pap test results and no HPV infection are at the lowest risk for developing cervical cancer.

A client is preparing to give a client an antipyretic drug for a temperature of 101° F (38.3° C). What drug would be the most appropriate for the nurse to administer? A. Acetaminophen B. Aspirin C. Doxycycline D. Ibuprofen

A. Acetaminophen

The nurse is assessing an alert client who had abdominal surgery yesterday. Which assessment method will the nurse use to most accurately determine whether peristalsis has resumed? A. Ask if the client has passed flatus (gas) within the previous 12 to 24 hours. B. Perform auscultation with the diaphragm of the stethoscope. C. Listen for bowel sounds in all abdominal quadrants. D. Count the number of bowel sounds in each abdominal quadrant over 1 minute.

A. Ask if the client has passed flatus (gas) within the previous 12 to 24 hours. The best and most reliable method for assessing the return of peristalsis following abdominal surgery is the client's report of passing flatus within the past 8 hours or stool within the past 12 hours. Although auscultation and counting the number of sounds can help to assess bowel activity, it is not the most reliable method.

The nurse is caring for the following clients who are scheduled for a computed tomography (CT) scan with contrast. For which clients will the nurse communicate safety concerns to the health care provider (HCP)? (Select all that apply.) A. Client who took metformin 4 hours ago B. Client with an allergy to shrimp C. Client who requests morphine sulfate every 3 hours D. Client with a history of asthma E. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L)

A. Client who took metformin 4 hours ago B. Client with an allergy to shrimp D. Client with a history of asthma E. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L)

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? A. Client with polycystic kidney disease who is having a kidney ultrasound. B. Client with glomerulonephritis who is having a kidney biopsy. C. Client who is going for a cystoscopy and cystourethroscopy. D. Client who has just returned from having a kidney artery angioplasty.

A. Client with polycystic kidney disease who is having a kidney ultrasound. The best client to assign to an LPN/LVN is the client with polycystic kidney disease who is having a kidney ultrasound. Kidney ultrasounds are noninvasive procedures without complications, and the LPN/LVN can provide this care.A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage. A registered nurse is needed for this client. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients must be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client would also be assigned to RN staff members.

Which laboratory test will the nurse assess as the best indicator of kidney function? A. Creatinine B. Blood urea nitrogen (BUN) C. Aspartate aminotransferase (AST) D. Alkaline phosphatase

A. Creatinine The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.

When obtaining a health history and physical assessment from a 68-year-old male client who has a history of an enlarged prostate, which finding does the nurse consider significant? Select all that apply? A. Distended bladder B. Absence of a bruit C. Frequency of urination D. Dribbling urine after voiding E. Chemical exposure in the workplace

A. Distended bladder C. Frequency of urination D. Dribbling urine after voiding A distended bladder, urinary frequency, and dribbling urine after voiding are significant findings for a client with an enlarged prostate. The nurse would expect the absence of bruit- as a bruit is considered an abnormal finding. Although chemical exposure in the workplace may cause kidney damage, it is not associated with an enlarged prostate.

The nurse is caring for a client who underwent a hysterosalpingogram earlier in the day. Which assessment finding will the nurse immediately report to the healthcare provider? Select all that apply. A. Fever and chills B. Heart rate 120 bpm C. Bloody vaginal discharge D. Pain in the lower quadrant E. Discomfort in the shoulder

A. Fever and chills B. Heart rate 120 bpm D. Pain in the lower quadrant Rationale: The nurse will report fever and chills, tachycardia, and pain in the lower quadrant to the healthcare provider, as these can be signs of an adverse outcome associated with hysterosalpingogram. Bloody vaginal discharge is expected for up to 4 days. Discomfort in the shoulder is associated with irritation of the phrenic nerve, and is expected to resolve in a few days.

The nurse is teaching a group of senior citizens about recommended immunizations. What immunizations would the nurse include? (Select all that apply.) A. Herpes Zoster vaccine B. Pneumococcal Vaccine polyvalent vaccine C. Adult Tdap with Td booster every 10 years D. Annual influenza vaccine E. Pneumococcal 13-valent conjugate vaccine

A. Herpes Zoster vaccine B. Pneumococcal Vaccine polyvalent vaccine C. Adult Tdap with Td booster every 10 years D. Annual influenza vaccine E. Pneumococcal 13-valent conjugate vaccine

Which nursing intervention is essential? A. Hold the metformin 24 hours before and on the day of the procedure. B. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values. C. Report the blood urea nitrogen (BUN) and creatinine. D. Obtain a thyroid-stimulating hormone (TSH) level.

A. Hold the metformin 24 hours before and on the day of the procedure. The essential intervention for the nurse to perform is to withhold metformin at least 24 hours before the time of a contrast media study and for at least 48 hours after the procedure because metformin may cause lactic acidosis.The focus of this scenario is the client with polycystic kidneys. A TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HgbA1c is in an appropriate range.

The nurse recognizes that handwashing is the best method for preventing infection. Which action(s) by the Centers for Disease Control (CDC) about hand hygiene are recommended? (Select all that apply.) A. If hands are not visibly soiled, use an alcohol-based hand rub. B. Wash hands before and after wearing gloves C. If hands are visibly soiled, was them with soap and water D. Use only soap and water E. Wash hands before performing any invasive client procedure

A. If hands are not visibly soiled, use an alcohol-based hand rub. B. Wash hands before and after wearing gloves C. If hands are visibly soiled, was them with soap and water E. Wash hands before performing any invasive client procedure

Which client assessment data indicates to the nurse that the client has a potential need for fluids? A. Increased blood urea nitrogen B. Increased creatinine C. Decreased sodium D. Pale-colored urine

A. Increased blood urea nitrogen Potential for increased fluids are needed for a client with increased blood urea nitrogen. Increased blood urea nitrogen can indicate dehydration.Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

The nurse is caring for a client with uremia. What assessment data will the nurse anticipate? A. Nausea and vomiting B. Insomnia C. Cyanosis of the skin D. Tenderness at the costovertebral angle (CVA)

A. Nausea and vomiting The signs and symptoms the nurse needs to assess for are nausea and vomiting. Other manifestations of uremia include anorexia, nausea, vomiting, muscle cramps, pruritus, fatigue, and lethargy.CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action will the nurse take? A. Notifies the department and the HCP. B. Asks the client's spouse to sign the form. C. Cancels the procedure. D. Asks the client to sign the informed consent.

A. Notifies the department and the HCP. The nurse notifies both the HCP and the department to ensure effective communication across the continuum of care. This nursing action makes it less likely that essential information will be omitted. The client may be asked to sign the consent form in the department. The HCP gives the client a complete description of and reasons for the procedure and explains complications. The nurse reinforces this information. The procedure would not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent and that the spouse needs to sign the form.

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? A. Promoting fluid intake B. Medicating for pain C. Monitoring for hematuria D. Maintaining bedrest

A. Promoting fluid intake The priority nursing intervention for this client is to promote fluid intake. The nurse must ensure that the client has adequate hydration to dilute and excrete the contrast media. The nurse urges the client to take oral fluid or, if needed, administers IV fluids to the client. Hydration reduces the risk for kidney damage.Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

A client who is scheduled for a Pap smear reports having sexual intercourse this morning and douching afterward. What is the appropriate nursing action? A. Reschedule the Pap smear for another week B. Delay the procedure until later in the afternoon C. Help the client prepare for the procedure at this time D. Hold the procedure until the client's next menstrual cycle

A. Reschedule the Pap smear for another week Rationale: The nurse will reschedule the Pap smear for another week. Women are not to douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours prior to the test, as these can interfere with test results.

Which factor does the nurse identify that places a client at risk for gastrointestinal (GI) problems? (Select all that apply.) A. Smoking a half-pack of cigarettes per day B. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) C. Financial concerns D. Eating a high-fiber diet E. Use of herbal preparations

A. Smoking a half-pack of cigarettes per day B. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) C. Financial concerns E. Use of herbal preparations Smoking or any tobacco use places a client in a higher-risk category for GI problems. Financial concerns can also influence the risk for GI problems; clients may not be able to afford to seek care or treatment and may put off seeking help. Some herbal preparations contribute to GI problems, such as Ayurvedic herbs, which can affect appetite, absorption, and elimination. NSAIDs can predispose clients to peptic ulcer disease or GI bleeding. High-fiber diets are generally believed to be healthy for most clients.

A client with pelvic pain is admitted to the same-day surgery unit for a laparoscopic procedure. Which nursing action will the RN delegate to assistive personnel (AP)? A. Taking admission blood pressure and heart rate B. Educating about analgesic use for referred pain C. Teaching about postoperative activity restrictions D. Inserting a retention catheter using sterile technique

A. Taking admission blood pressure and heart rate Although most of the admission assessment and history will be completed by the RN, the admission vital signs can be delegated to a AP.Client education and teaching is a higher-level skill and must be done by the RN. Catheter insertion is also a higher-level skill and would be done by the RN.

A client who was treated last month for a severe respiratory infection reports many of the same symptoms today. Which factor in the client's use of antibiotic therapy most likely caused the client's relapse? A. Taking the antibiotic most days B. Taking the antibiotic as prescribed C. Taking the antibiotic before jogging 2 miles daily D. Taking the antibiotic with a full glass of water

A. Taking the antibiotic most days Antibiotics not taken as prescribed can result in recurring symptoms, as well as the development of drug-resistant infections and other emerging infections. Taking the antibiotic before jogging is not a contributing factor to the client's relapse. The client who is taking antibiotics as prescribed is not likely to develop recurring symptoms. Taking antibiotics with a full glass of water is a positive action and neither hinders nor promotes antimicrobial therapy.

The nurse is caring for client who has just returned from the operating room for cystoscopy performed under conscious sedation. Which assessment finding requires immediate nursing action? A. Temperature of 100.8° F (38.2° C) B. Lethargy C. Pink-tinged urine D. Urinary frequency

A. Temperature of 100.8° F (38.2° C) The nurse is immediately concerned when a postoperative cystoscopy client who had conscious sedation returns to the unit with a temperature of 100.8° F (38.2° C). Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure. The provider must be notified immediately. Pink-tinged urine is expected after a cystoscopy. Frequency may be noted as a result of irritation of the bladder. Gross hematuria would require notification of the surgeon. If sedation or anesthesia was used, lethargy is an expected effect.

While in the hospital, a client developed a methicillin-resistant infection in an open foot ulcer. Which nursing action would be appropriate for this client? A. Wear a gown and gloves to prevent contact with the client or client-contaminated items B. Have the client wear a surgical mask when being transported out of the room. C. Wear a mask when working within 3 feet (91 cm) of the client. D. Assign the client to a private room with a negative airflow.

A. Wear a gown and gloves to prevent contact with the client or client-contaminated items. Caregivers should wear a gown and gloves to prevent contact with the client or contaminated items when caring for a client with this infection. This is the best way to prevent the spread of infection. Gloves should also be worn when entering the room.The client does not require a private room or respiratory isolation, and does not need to wear a surgical mask when being transported out of the room because the infection is not airborne. Use of a mask is not the best way to prevent the spread of this infection.

Which nursing actions aid in the prevention and early detection of infection in a client at risk? (Select all that apply.) A. obtain cultures as needed B. Remove unnecessary medical devices C. Monitor the red blood cell (RBC) count D. Inspect the skin for coolness E. Promote sufficient nutritional intake

A. obtain cultures as needed B. Remove unnecessary medical devices E. Promote sufficient nutritional intake

The nurse takes a history for a client admitted to the hospital. Which factors in the nursing history indicate that the client is at risk for infection? Select all that apply. A. Diabetes mellitus Type 2 for 20 years. B. 52-pack year history of cigarette smoking C. Admitted from a long term care facility D. Has a history of multiple urinary tract infections E. Is 84 years of age

Answer: A, B, C, D, E Rationale: All choices place the client at a risk for infection because each factor can impair the client's immune status.

While performing an abdominal assessment on a client, the nurse notes a bruit over the aorta. What is the appropriate nursing action? A. Consult another nurse to verify the bruit B. Auscultate each quadrant for 5 minutes each C. Notify the health care provider of the findings D. Perform light palpation to further assess the pulsation

Answer: C C. Notify the health care provider of the findings* Rationale: A bruit (a "swooshing" sounds) over the abdominal aorta usually indicates the presence of an aneurysm. If this sound is heard, the nurse should stop the assessment, and refrain from percussing or palpating the abdomen. It is not necessary to consult another nurse to verify the findings. It is of critical importance to notify the healthcare provider immediately of the finding

Which daily behavior of a client with GI problems requires further nursing assessment? Select all that apply. A. Smokes a pack of cigarettes* B. Uses Fleet's enemas frequently to assist with bowel movements* C. Practices intentional relaxation D. Eats multiple servings of fruits E. Takes 325 mg of aspirin at night for arthritic pain* F. Exercises at 30 minutes three times weekly G. Travels extensively across the world*

Answers: A, B, E, G A. Smokes a pack of cigarettes* B. Uses Fleet's enemas frequently to assist with bowel movements* E. Takes 325 mg of aspirin at night for arthritic pain* G. Travels extensively across the world* Rationale: Smoking has been linked with an increased risk for most GI cancers; the nurse will need to obtain a full smoking history. If a client must use an enema frequently to assist with having bowel movements, further assessment is indicated. Aspirin and NSAID use can contribute to rectal bleeding, so this should be further assessed. Water and food variations from around the globe can impact GI health; therefore, the nurse will need to further assess the client's travel and nutrition history. Client behaviors of practicing intentional relaxation, eating multiple servings of fruit, and exercising are healthy behaviors that do not require further assessment.

Which teaching will the nurse provide to a community group about early detection of colorectal cancer? Select all that apply. A. Home testing kits are available with a prescription. B. A sigmoidoscopy should be performed every 10 years. C. Individuals over 40 years old should be testing for colon cancer. D. Bowel preparation is necessary prior to performance of a colonscopy E. Virtual colonoscopies (CT colonography) can be performed every 5 years

Answers: A, D, E A. Home testing kits are available with a prescription. D. Bowel preparation is necessary prior to performance of a colonoscopy E. Virtual colonoscopies (CT colonography) can be performed every 5 years Rationale: The nurse will teach that (1) home testing kits are available with a prescription, (2) bowel preparation is necessary prior to undergo a traditional colonoscopy to ensure precise visualization of the colon; and (3) virtual colonoscopies (CT colonography) can be performed every 5 years, per the American Cancer Society (2019). Sigmoidoscopies should be performed every 5 years, and individuals over the age of 45 should be tested for colon cancer.

The nurse is assessing a young adult client who missed multiple work days this winter due to having pneumonia or other respiratory infection four times. What question would be most appropriate for the nurse to ask as part of the health interview? A. "Have you received your pneumonia vaccines?" B. "Do you have any environmental concerns at work?" C. "Did you have the flu before developing pneumonia?" D. "Do you travel out of the country a lot?"

B. "Do you have any environmental concerns at work?" The client may be exposed to inanimate substances in the work environment, such as mold, toxic metals, or asbestos. This particulate matter exposure can cause respiratory infections and allergies. Traveling can also predispose a client to infections, but this factor is less likely to be a major risk factor. Pneumonia vaccines are usually given for clients who are over 65 years of age. Having influenza can lead to pneumonia is the client has a depressed immune system or does not take care of him- or herself.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which client statement indicates that teaching was effective? A. "I will have to drink 2 L of fluid before providing the sample." B. "I'll start to urinate in the toilet, stop, and then urinate into the cup." C. "It is best to provide the sample while I am bathing." D. "I must clean with the wipes and then urinate directly into the cup."

B. "I'll start to urinate in the toilet, stop, and then urinate into the cup." Teaching is demonstrated to be effective when the client says, "I'll start to urinate in the toilet, stop, and then urinate into the cup." A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra.Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 L of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

A client is preparing to undergo a stool DNA (sDNA) test to screen for colon cancer. What preprocedure teaching does the nurse provide? A. "Do not eat or drink anything for 12 hours before the test." B. "No special preparation is needed prior to completing this test." C. "Give yourself tap water enemas until the fluid returns are clear." D. "Begin a clear liquid diet at least 24 hours before the test."

B. "No special preparation is needed prior to completing this test." The nurse will teach the client that no special preparation is needed prior to completing the Cologuard test. Cologuard is a home screening test that the client can perform at any time, with no traditional bowel cleaning preparation or fasting necessary.

An older adult client reports uncomfortable sexual intercourse associated with vaginal dryness. Which nursing response is appropriate? A. "You may need to have additional pelvic examinations." B. "Products such as water-soluble lubricants may be helpful." C. "Be sure to tell your primary health care provider about this." D. "Let me teach you how to do Kegel exercises."

B. "Products such as water-soluble lubricants may be helpful." Information about vaginal estrogen therapy and water-soluble lubricants needs to be provided to the older adult client with vaginal dryness. There is no need to inform the primary health care provider because vaginal dryness is a normal change associated with aging. Additional pelvic examinations are not indicated for this client. Kegel exercises are used for clients with incontinence.

What teaching does the nurse provide to a client prior to a mammogram? A. "Do not eat anything for 12 hours before having a mammogram." B. "You must not wear deodorant the day of your mammogram." C. "You will not feel any discomfort during the mammography procedure." D. "A mammogram will x-ray the hard tissue of your breasts."

B. "You must not wear deodorant the day of your mammogram." Remind the client not to use creams, lotions, powders, or deodorant on the breasts or underarms before the mammogram, because these products may be visible on the mammogram and lead to misdiagnosis.Mammography is an x-ray of the soft tissue of the breast. Dietary restrictions are not necessary before a mammogram. The client may experience some temporary discomfort when the breast is compressed during positioning and the test itself.

Which statement does the nurse identify as accurate regarding the prostate-specific antigen (PSA) test? A. Elevated PSA levels are specific only to prostate cancer. B. African-American men may benefit from starting PSA screening at age 40. C. Health care providers may interpret the results of the PSA test differently. D. The PSA test can be used to monitor the disease course after treatment. E. PSA levels less than 7.5 ng/mL (7.5 mcg/L) may be considered normal.

B. African-American men may benefit from starting PSA screening at age 40. C. Health care providers may interpret the results of the PSA test differently. D. The PSA test can be used to monitor the disease course after treatment.

A client scheduled for a hysterosalpingogram is interviewed by the nurse. What interview information is critical for the nurse to report to the primary health care provider before the procedure? A. Administration of a rectal suppository 4 hours ago B. Allergy to shellfish C. Menstrual period that ended 3 days ago D. Abortion 2 months ago

B. Allergy to shellfish The contrast medium used during hysterosalpingography is iodine-based, so the primary health care provider will need to know if the client is allergic to shellfish. Obstetric history, menstrual history, and recent medications are communicated to the primary health care provider but do not require any change in the procedure. Two months between abortion and this procedure is adequate. This test is done just at the completion of menses so that it would not interrupt a pregnancy in the uterus or the fallopian tube.

1. Which lab finding is indicative of renal function alterations and not dehydration? Select all that apply. A. BUN 20 ml/dL B. Creatinine 2.3 ml/dL C. Hemoglobin 14 g/dL D. Cystatin-c 105 mg/mL E. BUN - creatinine ratio 10 F. Creatinine clearance 175 ml/min

B. Creatinine 2.3 ml/dL D. Cystatin-c 105 mg/mL F. Creatinine clearance 175 ml/min

The nurse is teaching an older adult client. Which gastrointestinal problem does the nurse discuss that takes place during the normal aging process? A. Increased peristalsis B. Decreased hydrochloric acid levels C. Increased liver size D. Excess lipase production

B. Decreased hydrochloric acid levels In older adults, decreased hydrochloric acid levels (hypochlorhydria) results from atrophy of the gastric mucosa. A decrease in lipase production results from calcification of pancreatic vessels. A decrease in the number and size of hepatic cells leads to decreased liver weight and mass. Peristalsis decreases, and nerve impulses are dulled.

The nurse is teaching a class about kidney and urinary changes that occur with age. What teaching will the nurse include? (Select all that apply.) A. Drug clearance is often increased which produces more drug reactions. B. Glomerular filtration rate decreases which increases the risk for fluid overload. C. Urinary sphincters lose tone and weaken with age. D. Blood flow to the kidneys increases promoting nocturia. E. The ability to concentrate urine decreases which creates urgency.

B. Glomerular filtration rate decreases which increases the risk for fluid overload. C. Urinary sphincters lose tone and weaken with age. E. The ability to concentrate urine decreases which creates urgency.

The nurse is teaching a group of young women. Which factor does the nurse teach increases a women's risk for the development of cervical cancer? A. Having more than six pregnancies B. Having sexual intercourse at a very early age C. Using a diaphragm with spermicidal jelly for contraception D. Eating a diet that is high in fat content

B. Having sexual intercourse at a very early age Having intercourse at a very early age and/or multiple sex partners places a woman at high risk for the development of cervical cancer. Eating a diet that is high in fat content, the number of pregnancies, and using a diaphragm have not been identified as increasing the risk for cervical cancer.

The nurse and health care provider are discussing a client who has pernicious anemia. The nurse anticipates that the client has which deficiency? A. Hydrochloric acid B. Intrinsic factor C. Glucagon D. Pepsinogen

B. Intrinsic factor Intrinsic cells are produced by the parietal cells in the stomach. This substance facilitates the absorption of vitamin B12. The absence of intrinsic factors causes pernicious anemia. Glucagon, which is produced by the alpha cells in the pancreas, is essential for the regulation of metabolism. Parietal cells secrete hydrochloric acid, but this does not facilitate the absorption of vitamin B12. Pepsinogen is secreted by the chief cells; pepsinogen is a precursor to pepsin, a digestive enzyme.

The nurse is admitting a client undergoing a CT scan with contrast. Which finding does the nurse report as a possible immediate hypersensitivity reaction? Select all that apply. A. Nausea B. Pruritis C. Urticaria D. Laryngeal stridor E. Flushing of the skin

B. Pruritis C. Urticaria D. Laryngeal stridor E. Flushing of the skin Signs and symptoms of a hypersensitivity (allergic) reaction include: itching (pruritis), urticaria (hives or wheals), erythema (redness), stridor, hoarseness, bronchospasm and anaphylactic shock (hypotension, tachycardia).

A client is being observed after a routine sigmoidoscopy with a tissue biopsy. Which assessment finding will the nurse report to the health care provider? A. Flatulence B. Rectal bleeding C. Mild abdominal pain D. Borborygmi

B. Rectal bleeding Bleeding is a possible complication following a sigmoidoscopy. It must be reported immediately to the health care provider.Mild abdominal pain (usually gas pain) and flatulence are expected findings after a sigmoidoscopy. Borborygmi may be heard, especially if the client is hungry if they have followed a clear liquid diet prep before the procedure.

A client is on a 24-hour urine collection. At midpoint during the collection, the client tells the nurse that some of the urine was discarded. What action will the nurse take? Select all that apply. A. No action is required. B. Reinforce client education C. Notify the laboratory staff D. Restart the urine collection E. Document the discarded urine F. Notify the healthcare provider

B. Reinforce client education C. Notify the laboratory staff E. Document the discarded urine F. Notify the healthcare provider Rationale: Reinforcing patient education is important to ensure all urine is collected for the 24-hour urine test. Notifying the laboratory staff is essential in determining next steps and whether the urine collection must be restarted. Document the discarded urine as part of the 24-hour urine collection and notify the healthcare provider of the discarded urine for further instructions

1. Which client assessment data is essential for the nurse to report to the healthcare provider before a renal scan is performed? A. Pink-tinged urine B. Reports pregnancy C. Reports claustrophobia D. History of an aneurysm clip

B. Reports pregnancy

The nurse is educating a 22-year-old female about the Papanicolaou (Pap) test. Which client statement indicates that further teaching is needed? (Select all that apply.) A. "The specimen will be sent to a laboratory for evaluation." B. "I need to have yearly Pap tests until I am 30 years old." C. "I can have sexual intercourse the night before the test." D. "Pap smears help detect precancerous and cancerous cells." E. "I will douche the morning before I have the Pap test performed."

C. "I can have sexual intercourse the night before the test." The client must not have sexual intercourse, douche, or use vaginal medications or deodorants for at least 24 hours before the test. These all may interfere with test interpretation; therefore, these misconceptions require further nursing teaching. The other client statements are accurate, and do not require further nursing teaching. Annual screening is recommended to 30 years of age with the conventional Pap test. The Pap smear is a cytologic study that is effective in detecting precancerous and cancerous cells in the cervix. The specimen-containing slides from a Pap smear are sent to a laboratory for evaluation.

A 68-year-old client who has had normal Pap results for 10 years and no history of cancer asks about scheduling a Pap smear. What is the appropriate nursing response? A. "You will need a Pap test this year." B. "You aren't due for a Pap test until next year." C. "You do not need to have further Pap tests at this time." D. "You do not need a Pap tests unless you are sexually active."

C. "You do not need to have further Pap tests at this time." Rationale: The American Cancer Society recommends that women who are older than 65 years old who have had regular cervical cancer testing with normal results in the past decade, and no serious cancers in the past 20 years, do not need further Pap testing.

Immediately following a colonoscopy, which client behavior will the nurse report to the health care provider? Select all that apply. A. Passing of flatus B. Blood pressure 128/80 C. Abdominal guarding D. Change in mental status E. Report of mild abdominal cramping

C. Abdominal guarding D. Change in mental status Rationale: The nurse will report abdominal guarding, as this can be a sign of bowel perforation. The nurse will also report any changes in mental status, as this can be a sign of hypovolemic shock. In older adults, this is often the first sign. A blood pressure of 128/80, and reports of mild abdominal cramping, are considered normal findings that do not require the nurse to notify the healthcare provider.

The nurse is preparing to obtain a sterile urine specimen from a client with a Foley catheter. What technique will the nurse use? A. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. B. Use a sterile syringe to withdraw urine from the urine collection bag. C. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. D. Remove the existing catheter and obtain a sample during the process of inserting a new Foley.

C. Clamp the tubing, attach a syringe to the specimen and withdraw at least 5 mL of urine. The nurse will employ the technique of clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine when obtaining a sterile urine specimen from a client with a Foley catheter. Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter would not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a sterile urine specimen.

The nurse is caring for an older hospitalized client. Which physiologic age-related change(s) increase(s) the client's risk for infection? (Select all that apply.) A. Increased cough and gag reflexes B. Urinary incontinence C. Decreased intestinal motility D. Decreased immune response E. Thinning skin

C. Decreased intestinal motility D. Decreased immune response E. Thinning skin

A client has been scheduled for a transvaginal ultrasound. Which allergy does the nurse identify that should be immediately reported to the healthcare provider? A. Eggs B. Corn C. Latex D. Iodine

C. Latex Rationale: For an internal transvaginal or transrectal scan, the transducer is covered with a condom-like sac onto which transmission gel has been placed. Because this condom-like sac is often made of latex, it is important to assess whether a patient has a latex allergy prior to the procedure.

The nurse is assessing a very thin client who has come to the emergency department with acute abdominal pain. Upon assessment, visible peristaltic movements are noted. What is the appropriate nursing action? A. Prepare to administer antibiotics as prescribed. B. Report finding to the health care provider. C. Monitor laboratory values for possible pancreatitis. D. Toilet quickly as diarrhea is imminent.

C. Monitor laboratory values for possible pancreatitis The nurse will report the finding to the health care provider, as it is possible that the client has an obstruction. Peristaltic movements are rarely seen except in thin clients.Acute diarrhea does not cause visible peristaltic movements. Pancreatitis is not characterized by visible peristaltic movement. The client likely has an obstruction, not an infection.

Which information does the nurse include when teaching a client about antibiotic therapy for infection? A. Take antibiotics until symptoms subside, and then stop taking the drugs B. Share antibiotics with family members who develop the same infection C. Take all antibiotics as prescribed, unless adverse effects develop. D. Take antibiotics when symptoms of infection develop.

C. Take all antibiotics as prescribed, unless adverse effects develop. Antibiotics should be taken as prescribed until they are gone. Teach the client about possible side effects and allergic manifestations. The primary health care provider must be contacted immediately if any adverse effects develop. Antibiotics must be taken until they are gone, even if the client feels better or when symptoms of infection appear. They should be taken only by the person for whom they are prescribed and not shared with anyone else.

A hospitalized client with ongoing abdominal tenderness reports an increase in generalized abdominal pain today. Which assessment technique will the nurse perform? (Select all that apply.) A. Percuss to determine size of liver and spleen. B. Auscultate beginning in the RLQ. C. Visually observe for contour and symmetry. D. Ask for a pain scale rating on a scale of 0-10. E. Deeply palpate the area of tenderness.

C. Visually observe for contour and symmetry. D. Ask for a pain scale rating on a scale of 0-10. The abdominal assessment is performed in the order of inspection, auscultation, percussion, and palpation. The nurse will visually observe the abdomen for contour and symmetry, auscultate beginning in the RUQ (not the RLQ), lightly palpate for any large masses or areas of tenderness, ask the client to rate the pain level on a 0-10 scale, and document the findings. The nurse will not perform deep palpation nor percussion, as the health care provider conducts this portion of the examination.

Which precaution is appropriate for the nurse to take to prevent the transmission of Clostridium difficile infection? A. Carefully wash hands that are visibly soiled. B. Wear a mask with eye protection and perform proper handwashing. C. Wear gloves when in contact with the client's body secretions or fluids. D. Wear a mask and gloves when in contact with the client.

C. Wear gloves when in contact with the client's body secretions or fluids. The nurse must wear gloves and wash hands before and after potential exposure to the client's body secretions or fluids. C. difficile infection requires Contact Precautions. Hands must be properly washed before and after any contact with the client with C. difficile infection. Alcohol-based hand rubs are not effective for hand hygiene in the care of clients with C. difficile. Hands must be washed even if not visibly soiled. It is not necessary to wear a mask when caring for clients with C. difficile infection. A mask and eye protection are not necessary to prevent the transmission of C. difficile.

Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? A. A 40 year old who needs administration of IV midazolam hydrochloride during an upper endoscopy. B. A 36 year old who needs teaching about an endoscopic retrograde cholangiopancreatography. C. A 46 year old who is admitted with abdominal cramping and diarrhea of unknown causes. D. A 32 year old with constipation who has received a laxative.

D. A 32-year-old with constipation who has received a laxative. The LPN/LVN can best assist the RN by monitoring the client with constipation who has received a laxative. Assessment, IV hypnotic medication administration, and client teaching must be done by an RN

What teaching will the nurse provide to a client who has just been fitted for new hearing aids? A. Leave the hearing aid on, even if not wearing it B. Immerse the ear mold in alcohol to fully clean it C. Store the hearing aid in a warm, humid bathroom when not in use D. Avoid using hair spray, makeup, and personal care products around the device

D. Avoid using hair spray, makeup, and personal care products around the device Rationale: The nurse will teach the client who has just been fitted for new hearing aids to avoid using hair spray, makeup, and personal care products around the device. These can compromise the integrity of the hearing aid. The hearing aid should be turned off when not in use as this preserves the battery. The ear mold should be cleaned with soap and water, and never immersed. The hearing aid should be kept in a clean area free from temperature extremes when not in use.

Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) clinic? A. Client admitted with nausea, abdominal pain, and abdominal distention. B. Client who needs discharge teaching after an endoscopic retrograde cholangiopancreatography (ERCP). C. Client with epigastric pain who needs conscious sedation during endoscopy. D. Client who has had laxatives administered and needs monitoring before a colonoscopy.

D. Client who has had laxatives administered and needs monitoring before a colonoscopy. The client who needs laxatives administered and effectiveness monitored before a colonoscopy is the least complicated client. This client would be assigned to the float nurse who would have the experience and education to adequately care for this client.Discharge instructions following an ERCP, assessment of an admitted acutely ill client, and monitoring a client who is receiving conscious sedation is accomplished best by a nurse with experience in caring for adults with acute GI problems.

Which client will the nurse encourage to consume 2 to 3 L of fluid each day? A. Client with heart failure B. Client with chronic kidney disease C. Client with complete bowel obstruction D. Client with hyperparathyroidism

D. Client with hyperparathyroidism The nurse encourages the client with hyperparathyroidism to drink 2 to 3 L of fluid each day. A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones. This client must remain hydrated. A client with chronic kidney disease would not consume 2 to 3 L of water because the kidneys are not functioning properly. Consuming that much fluid could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and would be NPO.

A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? A. Has the client lie in a supine position with legs straight and arms above the head. B. Assesses the following sequence: inspection, palpation, percussion, auscultation. C. Palpates any bulging mass very gently and documents findings. D. Examines the RUQ of the abdomen last following all other assessment techniques.

D. Examines the RUQ of the abdomen last following all other assessment techniques. If the client reports pain in the RUQ, the nurse examines this area last. This sequence prevents the client from tensing abdominal muscles because of the pain, which would make the assessment difficult.The sequence for examining the abdomen is inspection, auscultation, percussion, and then palpation. This sequence prevents the increase in intestinal activity and bowel sounds caused by palpation and percussion. The client would be positioned supine with the knees bent while keeping the arms at the sides to prevent tensing of the abdominal muscles. If a bulging, pulsating mass is present during assessment of the abdomen, the nurse must never touch the area because the client may have an abdominal aortic aneurysm, a life-threatening problem. The nurse would notify the health care provider of this finding immediately!

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention will the nurse implement first? A. Administer captopril. B. Request a breakfast tray for the client. C. Administer lispro (Humalog) insulin, 10 units subcutaneously. D. Infuse 0.45% normal saline at 125 mL/hr.

D. Infuse 0.45% normal saline at 125 mL/hr. After a diabetic client returns to the unit after a CT scan, the first intervention implemented by the nurse is to infuse 0.45% normal saline at 125 mL/hr. Fluids are needed because the iodinated dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure.Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse needs to monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

The nurse assesses blood clots in a client's urinary catheter after a cystoscopy. What initial nursing intervention is appropriate? A. Administer heparin intravenously. B. Remove the urinary catheter. C. Irrigate the catheter with sterile saline. D. Notify the health care provider (HCP).

D. Notify the health care provider (HCP). The nurse first notifies the HCP after visualizing a blood clot in a postoperative cystoscopy client's urinary catheter. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. In addition, the nurse must monitor urine output and notify the HCP of obvious blood clots or a decreased or absent urine output.Heparin would not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and would not be removed at this time. The Foley catheter may be irrigated with sterile saline if prescribed by the HCP.

A client has undergone a prostate biopsy. Which post procedure symptom will the nurse teach the client to report immediately to the primary health care provider? A. Discoloration of the semen 5 days after biopsy B. Light rectal bleeding 2 days after procedure C. Tenderness at the site 1 day after biopsy D. Pain upon urination 3 days after procedure

D. Pain upon urination 3 days after procedure Rationale: The nurse will teach the client report pain upon urination 3 days after the procedure to the healthcare provider, as this can be a sign of an adverse outcome associated with the prostate biopsy. Discoloration of the semen is expected for up to several weeks, as is light rectal bleeding two days post-procedure, and tenderness at the site 1 day post-procedure.

The nurse is obtaining a personal health history of a 21-year-old male. How does the nurse approach questions about his sexual practices? A. Ask if the client wants to have his partner present for the health history. B. Defer questions about his sexual practices to the health care provider. C. Skip questions about sexual practices as he is unlikely to be sexually active. D. Respect the client's choice to answer or not answer questions about sexual practices.

D. Respect the client's choice to answer or not answer questions about sexual practices. Respecting the client's choice to answer or not answer questions about sexual practices is an important part of the process of taking the sexual history of any client. Deferring questions about sexual practices to the primary health care provider or skipping questions is inappropriate, as important health information may be missed. All adult clients should be offered the opportunity to discuss sexual practices as these relate to patient-centered care.

A 68-year-old client has recently undergone a prostate biopsy. Which assessment finding will the nurse report to the health care provider? A. Rust-colored semen B. Slight rectal bleeding C. Mild pain and soreness at the site D. The temperature of 101.6° F (38.7° C)

D. Temperature of 101.6° F (38.7° C) Rarely, sepsis can develop after a prostate biopsy. However, clients need to be told to contact their primary health care provider immediately if they experience fever, pain when urinating, or penile discharge. Expected findings after a prostate biopsy may include slight soreness, light rectal bleeding, and blood in the urine or stools for a few days. Semen may be red or rust-colored for several weeks.

The nurse is reviewing a laboratory report that indicates a decrease in a client's estradiol level. How does the nurse interpret this information? A. The client is experiencing a normal pregnancy. B. The client may have a malignant tumor. C. The client may be in menopause. D. The client may be pregnant with twins.

D. The client may be pregnant with twins. Decreased levels of estradiol in a client may indicate menopause, hypopituitarism, anorexia nervosa, or a possible pregnancy concern. This laboratory finding does not indicate a normal pregnancy, pregnancy with twins, or the presence of a malignant tumor.

1. Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? A. The client experiences nausea and vomiting after drinking juice. B. The biopsy site is tender to light palpation. C. The abdomen is distended and the client reports abdominal discomfort. D. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

D. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.