Chronic Care Exam 1 (PrepU)

The nurse is caring for an adult paraplegic with an ostomy. Which is an appropriate statement for the nurse to make?

"Do you need assistance managing your ostomy?" -The nurse should ask the client whether he or she needs assistance managing the ostomy. The nurse should not assume that the client is unable to care for it independently and should not refer to the client as "honey." When caring for an adult client with a disability, the nurse should treat the client as an adult and offer assistance, but not insist.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.)

- "You may have ingested some irritating foods." - "It can be caused by ingestion of strong acids." - "Is it possible that you are overusing aspirin."

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Select all that apply.

-Alleviate and manage symptoms -Validate individual self-worth -Validate family functioning

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply.

-Liver -Duodenum -Pancreas

Clients must contend with chronic illness daily. Nurses relate more effectively to clients when they understand the following as characteristics of chronic illness. Choose all that apply.

-The management of chronic conditions is a process of discovery. -Chronic illness affects the entire family. -Managing chronic conditions must be a collaborative process. Management of chronic conditions is a process of discovery. Chronic illness affects the entire family to the point that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. Chronic conditions usually involve many different phases over the course of a person's lifetime. Chronic illness involves not only treating the medical problems but may also include the psychological and social problems.

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15% -Fifteen percent of clients with peptic ulcer experience bleeding.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits. -Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges the client's achievement when she walks to the bedside commode with her walker. -In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin (Glucophage) and exenatide (Byetta) and reports adhering to her diet. The glycohemoglobin is 5.9%. In the stable phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges to the client she is performing satisfactorily. -In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors. The glycohemoglobin is at a level of good control for a client with diabetes. No adjustments needs to be made to the diet or the medications.

An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as

Acquired -An acquired disability results from an acute and sudden injury, such as trauma to the spinal cord. The paralysis may be temporary. It may not be known to be permanent until swelling in the spinal cord has decreased. This may take weeks to months. A developmental disability is one that occurs prior to age 22 years. An age-related disability occurs in the elderly population as a result of the aging process.

A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?

Acquired disability

The client has diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. The nurse assesses that the client is in the phase of the Trajectory Model of Chronic Illness known as

Acute -In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?

Borborygmus -Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she:

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. -The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.

An 80-year-old client with osteoarthritis and osteoporosis has difficulty ambulating and is seeking a prescription for a walker. The nurse assesses the client's type of disability as

Age-associated -Age-associated disabilities in the elderly population result from the aging process. Acquired disabilities may be progression of a chronic disorder, such as multiple sclerosis. Developmental disabilities are those disabilities that occur any time from birth to 22 years and may result in impairment of physical or mental health, cognition, speech, language, or self-care. Sensory disabilities affect hearing or vision.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition?

Anal fissure -Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience?

Attitudinal barrier -Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

The nurse provides corrective instruction to the nursing assistant when the assistant refers to the client as the

Blind diabetic patient -It is important to use "people-first" language, which means referring to the person first. Examples include person who is disabled, man with a stroke, and woman who has multiple sclerosis. Using "blind diabetic patient" conveys that the illness or disability is of greater importance than the person.

In women, which of the following types of cancer exceeds colorectal cancer?

Breast -In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

The instructor provides corrective information to the nursing student when the student refers to the client as the

COPDer in 216

The nurse recognizes which disorder as a developmental disability in a patient?

Cerebral palsy -Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy.

Which is the most common presenting symptom of colon cancer?

Change in bowel habits. -The most common presenting symptom is a change in bowel habits. Fatigue, anorexia, and weight loss may occur but are not the most common presenting symptoms.

Which ulcer is associated with extensive burn injury?

Curling ulcer

A patient sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this patient?

Curling's ulcer -Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

A client who is blind is admitted for treatment of a small bowel obstruction and has been vomitting for days. Which nursing diagnosis takes highest priority for this client?

Deficient fluid volume -Although the client's disability should be considered in the course of assessment and delivery of health and nursing care, it should not become the overriding focus or exclusive focus of the assessment or the care that the client receives. Because the client has been vomitting for days, he is most likely dehydrated; therefore, deficient fluid volume takes highest priority. A sensory deficit such as blindness puts the client at risk for injury from the environment; however, a ptoential problem doesn't take highest priority.

A graduate nurse is assigned to care for a client with an acute exacerbation of chronic obstructive pulmonary disease. The client also has Down syndrome. During the shift, the nurse discovers that the client lives alone and holds a full-time job. Which type of disability would the nurse state the client has?

Developmental

Down syndrome is categorized as a(n)

Developmental disability.

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as

Downward -The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching?

Drink 8 to 10 glasses of fluid daily. -The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan?

Drink at least 8 to 10 large glasses of fluid every day. -The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

Dry skin thoroughly after washing. -The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

Clients with Type O blood are at higher risk for which of the following GI disorders?

Duodenal ulcers -Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases.

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.

End-stage renal disease. -Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist?

Endoscopy -Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

Which medication is classified as a histamine-2 receptor antagonist?

Famotidine -Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

Fecal incontinence -The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

Fissure. -An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?

Gently washing the area surrounding the stoma using a facecloth and mild soap. -For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?

Hemorrhage -Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

High-fiber diet. -A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

Hypokalemia -The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

Hypokalemia. -The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Hypotension. -Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

Which is a cause related to the increasing number of people with chronic conditions?

Improved screening and diagnostic procedures. -The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious disease has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.

The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis?

Left lower quadrant -Rovsing's sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant.

A client has symptoms suggestive of peritonitis. Nursing management would not include:

Limiting analgesics to avoid the formation of paralytic ileus. -Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, input and output are monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Low residue -Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?

Nasogastric tube insertion -The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor?

Obesity -Obesity, caused by an improper diet and physical inactivity, is the major cause of pre-diabetes.

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?

People-first

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?

Peritonitis -The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

Peritonitis -Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to

Plan with the client how to incorporate the regimen into the client's activities of daily living. -The nurse should work with the client and family to identify ways to implement the treatment regimen. The nurse does not tell the client what the client must do. The other options may be appropriate interventions for this client, but these would not be the next step.

Which of the following is the most common symptom of a polyp?

Rectal bleeding -The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Right lower quadrant -The pain of acute appendicitis localizes in the RLQ at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring?

Stable -In the Stable phase, the focus of nursing care is on reinforcing positive behaviors and offering ongoing monitoring. During the Pretrajectory phase, the focus is on referring the person for genetic testing and counseling, if indicated, and providing education about prevention of modifiable risk factors and behaviors. The trajectory onset phase provides explanation of diagnostic tests and procedures and reinforces information and explanation given by the primary health care provider. During the Unstable phase of the Trajectory Model, the focus of nursing care is on providing guidance and support and reinforcing previous teaching.

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?

Stable -The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"?

Stool consistency and client comfort. -Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abdominal pain. -Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?

The client gradually returns back to an acceptable way of life within the limits imposed by the illness.

A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image?

The client touches the altered body part. -By touching the altered body part, the client recognizes the body change and establishes that the change is real. Closing his eyes, not looking at the abdomen when the colostomy is exposed, or avoiding talking about the surgery reflects denial, instead of acceptance of the change. Asking the spouse to leave the room signifies that the client is ashamed of the change and not coping with it.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important?

The consistency of stool and comfort when passing stool. -In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client?

The interpreter may lag a few words behind--especially if names or technical terms are to be fingerspelled.

Which symptom characterizes regional enteritis?

Transmural thickening -Transmural thickening is an early pathologic change of Crohn's disease. Later pathology results in deep, penetrating granulomas. Regional enteritis is characterized by regional discontinuous lesions. Severe diarrhea is characteristic of ulcerative colitis, whereas diarrhea in regional enteritis is less severe. Rectal bleeding is one of the predominant symptoms of ulcerative colitis.

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse

Turns off the television -The nurse minimizes distractions so the client can focus on one thing, such as the physician who may impart important information. Distractions are having the television on, cleaning the room, and talking with someone else in the room. The nurse does not leave the room. The nurse remains so she can repeat information provided by or to the client.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Usual pattern of elimination. -Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

A client has been diagnosed with diabetes and has received instructions about managing the disease. The client has undertaken an activity to improve quality of life and maintain functional status. The nurse recognizes this activity as

Walking at least one mile 5 days each week. -Behaviors, such as exercise or walking, are essential to quality of life and maintaining functional status for a client who has a chronic illness. The other activities, such as ingesting low caloric foods, taking medications, and checking blood glucose level, relate to managing symptoms and avoiding complications.

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred?

Wound dehiscence has occurred. -Any suggestion from the patient that an area of the abdomen is tender or painful or "feels as if something just gave way" must be reported. The sudden occurrence of serosanguineous wound drainage strongly suggests wound dehiscence (see Chapter 19).