A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric region along with a rigid, board-like abdomen. These clinical manifestations are most likely indicative of which of the following?

The esophagus has become inflamed

An intestinal obstruction has developed

Additional ulcers have developed

The ulcer has perforated

Answer and Explanation

The Correct Answer is D

A. Inflammation of the esophagus (esophagitis) may cause symptoms like heartburn or dysphagia, but it would not explain the sudden, sharp pain or rigid abdomen seen with a perforated ulcer.
B. An intestinal obstruction can cause abdominal pain and distension, but the rigid, board-like abdomen is more characteristic of peritonitis from a perforated ulcer, not an obstruction.
C. Additional ulcers could cause pain and bleeding, but they would not explain the sudden, sharp pain and rigid abdomen that typically result from perforation.
D. The sudden onset of sharp, severe pain in the mid epigastric area, along with a rigid, board-like abdomen, are hallmark signs of a perforated ulcer, which causes peritonitis. This is a medical emergency, as the perforation allows gastric contents to leak into the peritoneal cavity, leading to widespread infection.

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Correct Answer is B

Explanation

A. Fever and chills are often indicative of infection, which may be a concern with TPN, but they are not typically the immediate concern if the TPN solution is not infusing.
B. Shakiness and diaphoresis (sweating) can occur due to hypoglycemia, which is a potential consequence of an interrupted TPN infusion. TPN provides glucose to the client, and a disruption in the infusion could cause a drop in blood sugar, leading to shakiness and diaphoresis.
C. Excessive thirst and urination are common symptoms of hyperglycemia or diabetes, but they are not typically seen with an interrupted TPN infusion.
D. Hypertension and crackles are more related to fluid overload or heart failure, which would not be an immediate concern in the case of an infusion pump malfunction for TPN.

A. Change the IV tubing every 24 hr. B. Change the IV site dressing every 4 days. C. Weigh the client every other day. D. Obtain the client's blood glucose every 12 hr.

Correct Answer is A

Explanation

A. The IV tubing for TPN should be changed every 24 hours to prevent infection, as TPN is a high-risk solution for bacterial growth due to its high glucose content. Regular changes help reduce the risk of contamination and complications such as bloodstream infections.
B. The IV site dressing should be changed at least every 48 to 72 hours (or per institutional policy) to maintain aseptic technique and minimize infection risk. Changing the dressing every 4 days may exceed this timeframe and increase the risk of infection.
C. Weighing the client is important to monitor fluid balance, but daily weighing is more typical than every other day for clients receiving TPN. This helps to assess nutritional status and detect potential fluid overload or deficit.
D. Blood glucose levels should be monitored more frequently, typically every 6 hours, because TPN can cause significant fluctuations in blood glucose. Checking every 12 hours would not be adequate for early detection of hyperglycemia or hypoglycemia.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client and discovers the infusion pump with the client's total parenteral nutrition (TPN) solution is not infusing. The nurse should monitor the client for which of the following conditions?

Correct Answer is B

Explanation

A nurse is assessing a client who is receiving total parenteral nutrition (TPN) therapy via an infusion pump. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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