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A nurse is caring for a 52-year-old male client in the emergency department. It’s now 0800hrs. The client reports worsening mid- abdominal pain, rating it as 8 on a scale of 0 to 10. He states, “I haven’t had a bowel movement in 5 days now.” He also mentions that he has vomited twice since the last assessment.

Exhibits

For each finding, specify if the finding is consistent with small bowel obstruction or acute pancreatitis. Each finding may support more than one disease process.

Abdominal Pain

No Bowel Movement for 5 days

Vomiting

Abdominal Distention

Increased Heart Rate

Elevated Temperature

Distention with fluid and gas in the small bowel (CT Scan)

Sodium: 130 mEq/L

Potassium: 3.3 mEq/L

WBC count: 10,000/mm

Answer and Explanation

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Abdominal Pain: Common in both small bowel obstruction and acute pancreatitis.
No Bowel Movement for 5 days: More indicative of small bowel obstruction.
Vomiting: Can occur in both conditions.
Abdominal Distention: Seen in both small bowel obstruction and acute pancreatitis.

Increased Heart Rate: Can be a response to pain or infection in both conditions.
Elevated Temperature: Can occur in both conditions due to inflammation or infection.
Distention with fluid and gas in the small bowel (CT Scan): Specific to small bowel obstruction.
Sodium: 130 mEq/L: Hyponatremia can be seen in both conditions.
Potassium: 3.3 mEq/L: Hypokalemia can be seen in both conditions.
WBC count: 10,000/mm: Leukocytosis can be seen in both conditions due to inflammation.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A rationale

Glaucoma is a contraindication for taking propranolol. Propranolol is a non-selective beta- blocker that can decrease intraocular pressure, which could worsen glaucoma.

Choice B rationale

DeBou syndrome is not a recognized medical condition and therefore cannot be a contraindication for taking propranolol.

Choice C rationale

Migraine headaches are not a contraindication for taking propranolol. In fact, propranolol is often used in the prevention of migraines.

Choice D rationale

A history of kidney stones is not a contraindication for taking propranolol. Propranolol does not affect kidney stone formation or exacerbate this condition.

A. Consume the medication in its entirety. B. Keep the medication in a cool place. C. Accompany the medication with grapefruit juice. D. Administer the medication during meals.

Correct Answer is A

Explanation

Choice A rationale

Diltiazem is a calcium channel blocker used to treat high blood pressure and prevent chest pain (angina). It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart. The sustained-release tablets are designed to release the medication slowly in the body. Therefore, patients are advised to consume the medication in its entirety. Crushing, chewing, or breaking the tablet would cause too much of the drug to be released at one time.

Choice B rationale

While it’s generally a good idea to store medications in a cool, dry place, specific storage instructions for diltiazem sustained-release tablets are not typically emphasized. The focus is more on the method of consumption.

Choice C rationale

Grapefruit and grapefruit juice may interact with diltiazem and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Therefore, it’s not advisable to accompany the medication with grapefruit juice.

Choice D rationale

Diltiazem can be taken with or without food. If it upsets the patient’s stomach, it can be taken with food. However, it’s not a mandatory instruction that the medication must be administered during meals.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a patient who has hypertension and a new prescription for propranolol. What findings should the nurse identify as a contraindication for taking propranolol?

Correct Answer is A

Explanation

A nurse is providing instructions to a patient who has been prescribed diltiazem sustained-release tablets for hypertension.Which of the following instructions should the nurse include?

Correct Answer is A

Explanation

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