Priority Decision: In instituting a bowel training program for a patient with fecal incontinence, what should the nurse first plan to do?

Correct Answer: D

Rationale: The correct answer is D because assisting the patient to the bathroom at the time of their normal defecation helps establish a routine for bowel movements, which is crucial in bowel training. This step maximizes the chances of success by utilizing the body's natural cues. Teaching the patient to use a perianal pouch (A) does not address the underlying issue of incontinence. Inserting a rectal suppository (B) may provide temporary relief but does not promote long-term bowel control. Placing the patient on a bedpan (C) at a specific time does not actively involve the patient in the process of bowel training.

Correct Answer: D

Rationale: The correct answer is D. Hemolytic jaundice in a blood transfusion reaction is due to increased breakdown of red blood cells (RBCs) causing elevated serum unconjugated bilirubin. This occurs when the patient's immune system reacts to the transfused blood, leading to destruction of RBCs. The breakdown of these cells releases hemoglobin, which is metabolized into bilirubin. This unconjugated bilirubin then accumulates in the blood, causing jaundice. Choice A is incorrect because hepatocellular disease does not directly cause hemolytic jaundice. Choice B is incorrect as malaria parasite breaking apart RBCs leads to hemolysis, not a blood transfusion reaction. Choice C is incorrect as decreased bile flow through the liver or biliary system typically causes obstructive jaundice, not hemolytic jaundice.

Correct Answer: D

Rationale: The correct answer is D: Is irritable and lethargic. Early signs of hepatic encephalopathy often include behavioral changes like irritability and lethargy due to impaired brain function from liver dysfunction. This is because the liver is unable to properly detoxify ammonia, leading to its accumulation in the bloodstream and affecting brain function. Asterixis, unconsciousness, and oliguria are more severe manifestations seen in later stages of hepatic encephalopathy. Therefore, recognizing irritability and lethargy in a patient would prompt early intervention to prevent further progression of hepatic encephalopathy.

Correct Answer: A

Rationale: The correct answer is A: NPO with NG suction. This treatment prevents further stimulation of the gallbladder by resting the digestive system and reducing the secretion of bile. NPO stands for "nothing by mouth," which reduces gallbladder contractions. NG suction removes stomach contents, preventing bile from reaching the gallbladder. Incisional cholecystectomy is a surgical removal of the gallbladder and not a preventive measure. Antiemetics help control nausea and vomiting but do not directly prevent gallbladder stimulation. Anticholinergics inhibit the parasympathetic nervous system but are not typically used to prevent gallbladder stimulation.