You are caring for a post-operative cholecystectomy client. What should be reported immediately to the physician?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) The client reports severe RUQ tenderness. This symptom is indicative of a potential complication following a cholecystectomy, as it could suggest issues such as bile duct injury, bile leakage, or even a retained stone. Reporting severe RUQ tenderness immediately is crucial for timely intervention to prevent further complications. Option A) The client cannot void 4 hours post-operatively is not the most urgent concern in this case, as it could be related to anesthesia effects or fluid balance adjustments post-surgery, which can be monitored and managed over time. Option B) The client reports shoulder pain is a common post-operative symptom due to residual CO2 gas irritating the diaphragm, known as referred pain, and usually resolves spontaneously. It is not typically an immediate concern unless it is severe or persistent. Option D) Output does not equal input for the first few hours is a common occurrence post-operatively due to various factors such as fasting before surgery, fluid shifts, and anesthesia effects. It usually normalizes as the client's bowel function returns, and therefore does not require immediate reporting unless it persists. Educationally, understanding the post-operative complications specific to cholecystectomy is essential for nurses to provide safe and effective care. Recognizing the significance of symptoms like severe RUQ tenderness and knowing when to escalate concerns to the healthcare provider can help prevent adverse outcomes and promote optimal patient recovery.

Correct Answer: C

Rationale: In cirrhosis of the liver, the correct physiological change is impaired ability to detoxify chemicals (Option C). This occurs because the liver, which is responsible for detoxifying harmful substances in the body, is damaged and unable to perform this function effectively. As a result, toxins can build up in the body, leading to various complications. Option A, the ability to metabolize hormones, is incorrect because cirrhosis primarily affects the liver's detoxification function, not its ability to metabolize hormones. Option B, absorption of fat-soluble vitamins, is incorrect as cirrhosis typically does not directly impact the absorption of fat-soluble vitamins. Option D, malabsorption of water-soluble vitamins, is also incorrect as cirrhosis primarily affects the liver's detoxification and metabolic functions rather than vitamin absorption. From an educational perspective, understanding the physiological changes in cirrhosis is crucial for healthcare professionals caring for patients with liver disease. It highlights the importance of monitoring and managing complications related to impaired liver function, such as toxin buildup. This knowledge can inform treatment decisions and help prevent further damage to the liver.

Correct Answer: C

Rationale: The correct answer is C) Observation of visible pulsations. When conducting a physical examination of the abdomen, visible pulsations are not a normal finding. This can indicate underlying pathology such as an abdominal aortic aneurysm or other vascular issues. It is important to recognize this abnormal finding as it may warrant further investigation and intervention. A) Auscultation of bruits is not a normal finding but rather suggests a vascular abnormality such as stenosis or aneurysm. It is important to investigate further if bruits are heard during auscultation. B) Percussion of liver dullness in the left midclavicular line is a normal finding indicating the lower border of the liver. This is not an abnormal finding on physical examination. D) Palpation of the spleen 1 to 2 cm below the left costal margin is also a normal finding as the spleen can be palpable in some individuals. However, it is important to note the size and consistency of the spleen as an enlarged spleen can indicate underlying pathology. In an educational context, understanding the normal and abnormal findings on physical examination of the abdomen is crucial for healthcare professionals. This knowledge helps in early detection of potential health issues and guides further diagnostic evaluation and treatment. It is important to emphasize the significance of thorough and accurate physical examination skills in assessing a patient's health status.

Correct Answer: B

Rationale: The correct answer is B) A 56-year-old woman with a BMI of 38 kg/m2, a waist measurement of 38 in (96 cm), and a hip measurement of 36 in (91 cm). This patient is at the highest risk for complications of obesity because she has a high BMI, central adiposity indicated by a high waist-to-hip ratio, and is in an age group where obesity-related comorbidities are more common. Central obesity, as indicated by a high waist circumference, is particularly associated with increased risk of cardiovascular diseases, diabetes, and metabolic syndrome. Option A is less at risk as the patient's weight is within a normal range for her height and the weight distribution is in the thighs, which is generally considered less risky in terms of associated health complications. Option C has a normal weight and waist-to-hip ratio, which lowers the risk compared to option B. Option D has a higher weight but a lower BMI compared to option B, and the waist-to-hip ratio is not as high, reducing the risk of obesity-related complications. In an educational context, understanding the risk factors associated with obesity, such as central adiposity and high BMI, is crucial for healthcare professionals to identify patients at higher risk for complications and provide targeted interventions to prevent or manage obesity-related health issues effectively.

Correct Answer: A

Rationale: The correct answer is A) Formation of abscesses with loosening of teeth. Gingivitis is characterized by inflammation of the gums, leading to redness, swelling, and sometimes bleeding. Formation of abscesses and loosening of teeth are common in severe cases of gingivitis due to the buildup of plaque and bacteria causing damage to the gums and supporting structures. Option B) Caused by upper respiratory tract viral infection is incorrect because gingivitis is primarily caused by poor oral hygiene leading to plaque accumulation and subsequent inflammation, rather than a viral infection. Option C) Shallow, painful vesicular ulcerations of lips and mouth is more indicative of conditions like herpes simplex virus infections or aphthous ulcers, not gingivitis. Option D) Infectious ulcers of mouth and lips as a result of systemic disease does not specifically describe the characteristic features of gingivitis, which primarily involves inflammation and infection of the gums rather than ulcers on the lips and mouth. Educationally, understanding the characteristics of gingivitis is crucial for dental hygiene and overall health. Proper oral hygiene practices, regular dental check-ups, and early treatment of gingivitis can prevent progression to more severe forms of gum disease like periodontitis, which can lead to tooth loss and systemic health issues.