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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

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A,B"},"D":{"answers":"A,B"},"E":{"answers":"A,B"},"F":{"answers":"A,B"},"G":{"answers":"A"},"H":{"answers":"A,B"},"I":{"answers":"A,B"},"J":{"answers":"A,B"}}

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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Correct Answer is B

Explanation

Choice A rationale

While an antiemetic might help with the vomiting, it would not address the underlying issue of not having a bowel movement for 4 days. Therefore, this choice is incorrect.

Choice B rationale

If the client has a nasogastric tube, checking its position would be a good first step. If the tube is not in the correct position, it could be causing or contributing to the client’s symptoms.

Therefore, this choice is correct.

Choice C rationale

Increasing the suction on a nasogastric tube might help if the tube is functioning correctly and the problem is related to stomach contents not being properly evacuated. However, it would not be the first step before checking the position of the tube. Therefore, this choice is incorrect.

Choice D rationale

Repositioning the nasogastric tube might be necessary if it’s not in the correct position, but this would not be the first step before checking its position. Therefore, this choice is incorrect.

A. Offer snacks that are high in sodium. B. Monitor the patient’s weight once per week. C. Provide rest periods throughout the day. D. Place the head of the patient’s bed flat.

Correct Answer is C

Explanation

Offering snacks that are high in sodium is not recommended for patients with heart failure. Sodium can cause fluid retention and worsen heart failure symptoms.

Choice B rationale

Monitoring the patient’s weight once per week is not sufficient for patients with heart failure. Daily weight monitoring is typically recommended to detect fluid retention early.

Choice C rationale

Providing rest periods throughout the day is recommended for patients with heart failure. Rest can help reduce the workload of the heart and manage symptoms of fatigue.

Choice D rationale

Placing the head of the patient’s bed flat is not recommended for patients with heart failure. This position can make breathing more difficult. Instead, the head of the bed should be elevated.

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Naxlex Comprehensive Predictor Exams

A client reports, “I have not had a bowel movement in 4 days and I have vomited once or twice.”. Given the client’s cardiovascular and gastrointestinal status, and social history, what should the nurse plan to do first?

Correct Answer is B

Explanation

A nurse is assisting with the plan of care for a patient who has heart failure. Which of the following interventions should the nurse recommend?

Correct Answer is C

Explanation

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