Paralytic ileus may occur as a postoperative complication. Which of the following patients would cause you the greatest concern about the development of paralytic ileus?

Correct Answer: B

Rationale: In the context of the ATI Medical Surgical Proctored Exam, the greatest concern for the development of paralytic ileus postoperatively would be in a patient who has undergone an open right hemicolectomy, which is option B. Paralytic ileus is a common complication following abdominal surgery, especially procedures involving the gastrointestinal tract like a hemicolectomy. This is due to the disruption of normal bowel function and peristalsis during surgery, leading to a temporary paralysis of the intestines. Option A, Kim, who had a laparoscopic appendectomy, would be less concerning as laparoscopic procedures typically have a lower risk of paralytic ileus due to minimal intra-abdominal manipulation. Option C, Nancy, who had a mediastinoscopy, and option D, John, who had a total joint replacement, are not likely to have paralytic ileus as a complication since these surgeries do not directly involve the gastrointestinal tract. Educationally, understanding the risk factors and common complications associated with different surgical procedures is crucial for nurses and healthcare professionals caring for postoperative patients. Recognizing the signs and symptoms of paralytic ileus and knowing which patients are at higher risk can help in early detection and appropriate management to prevent further complications.

Correct Answer: B

Rationale: In the context of a patient with a second-degree burn, the greater risk for infection (Option B) is the correct answer. Second-degree burns compromise the skin barrier, making the patient more susceptible to bacterial invasion and subsequent infection. The damaged skin is unable to protect against pathogens, increasing the likelihood of infection, which can lead to serious complications like sepsis. Constipation (Option A) is not directly related to the severity of a burn injury. While pain medications or immobility post-burn may contribute to constipation, it is not the primary concern in this scenario. Hypotension (Option C) and hyperglycemia (Option D) are also not typically associated with second-degree burns unless there are underlying conditions or complications present. Educationally, understanding the increased risk of infection in patients with second-degree burns is crucial for providing appropriate care. Proper wound care, infection prevention strategies, and vigilance for signs of infection are essential in managing these patients effectively to prevent further complications and promote optimal healing.

Correct Answer: B

Rationale: In the context of the ATI Medical Surgical Proctored Exam, understanding the symptoms of hypothyroidism is crucial for providing effective care. The correct answer is B) Fatigue and cold intolerance. Hypothyroidism is characterized by an underactive thyroid gland, leading to a decrease in metabolic rate. This results in symptoms such as fatigue, cold intolerance, weight gain, constipation, dry skin, and hair loss. These symptoms are due to the decreased production of thyroid hormones, which play a crucial role in regulating metabolism and energy levels in the body. Option A) Polydipsia and polyphagia are symptoms more commonly associated with conditions like diabetes, where increased thirst and hunger are present due to issues with insulin regulation, not hypothyroidism. Option C) Weight loss and hyperglycemia are also not typical symptoms of hypothyroidism. Weight gain is more commonly seen in hypothyroidism due to the slowed metabolism, and hyperglycemia is usually associated with conditions like diabetes. Option D) Tachycardia and diarrhea are actually symptoms of hyperthyroidism, where the thyroid gland is overactive and producing an excess of thyroid hormones, leading to symptoms such as rapid heart rate and gastrointestinal disturbances. Understanding the specific symptoms of hypothyroidism is essential for nurses to be able to recognize and provide appropriate care for patients with this condition. By knowing the correct symptoms, healthcare providers can initiate timely interventions and improve patient outcomes.

Correct Answer: A

Rationale: In the context of a patient with a history of asthma undergoing an appendectomy, the correct preoperative teaching would include the need to perform postoperative coughing and deep breathing exercises (Option A). This is crucial for the patient with asthma to prevent respiratory complications such as atelectasis and pneumonia, which can be exacerbated by reduced lung expansion post-surgery. Option B, leg exercises, while beneficial for circulation and preventing blood clots, are not directly related to respiratory complications in asthma patients post-appendectomy. Option C, wound dressing changes, is important but not specific to asthma or respiratory care post-surgery. Option D, all of these, is incorrect because leg exercises and wound dressing changes are not directly related to managing respiratory concerns in asthma patients post-appendectomy. Including coughing and deep breathing exercises in preoperative teaching is essential to promote lung expansion, prevent respiratory complications, and support optimal recovery for patients with asthma undergoing surgery. This educational rationale underscores the importance of tailoring preoperative teaching to the specific needs and risks of individual patients to enhance their postoperative outcomes.

Correct Answer: C

Rationale: In rheumatoid arthritis, the correct answer is C) Small joints of hands and feet. This is because rheumatoid arthritis is a systemic autoimmune disorder that primarily affects the synovial joints, leading to inflammation, pain, and joint deformity. The small joints of the hands and feet are commonly involved due to their complex structure and high degree of mobility, making them more susceptible to the inflammatory process seen in rheumatoid arthritis. Option A) Spine, from the sacrum to the cervical spine, is incorrect because rheumatoid arthritis typically does not primarily affect the spine. Option B) Symmetrical involvement of major joints is incorrect as rheumatoid arthritis tends to affect joints bilaterally, but it is not limited to major joints only. Option D) Slightly movable joints of the axial skeleton is incorrect as rheumatoid arthritis predominantly affects synovial joints rather than the less movable joints of the axial skeleton. Educationally, understanding the specific joints commonly involved in rheumatoid arthritis is crucial for healthcare professionals to accurately assess, diagnose, and provide appropriate care for patients with this condition. Recognizing the characteristic joint involvement patterns can aid in early detection and intervention, ultimately improving patient outcomes and quality of life.