The nurse is assessing a client who has a large bowel obstruction. Which late clinical finding would the nurse expect?

Loops of large bowel become visibly outlined through the abdominal wall

Intense thirst, parched tongue and dry mucous membranes

Vomiting of bile-stained gastric contents

High-pitched, frequent bowel sounds

Answer and Explanation

The Correct Answer is A

A. Loops of large bowel become visibly outlined through the abdominal wall is a typical late clinical finding of a large bowel obstruction. In fact, visible loops of bowel through the abdominal wall may be observed in cases of a severe bowel obstruction, but it is not typically considered a late finding.

B. Intense thirst, parched tongue, and dry mucous membranes suggest dehydration, which can occur as a result of vomiting, decreased fluid intake, or fluid loss due to the obstruction. However, dehydration may occur earlier in the course of a bowel obstruction and may not be considered a late finding.
C. Vomiting in large bowel obstruction is commonly of fecal contents.
D. High-pitched, frequent bowel sounds is not a typical late clinical finding of a large bowel obstruction. Instead, bowel sounds are usually diminished or absent in cases of bowel obstruction due to decreased peristalsis beyond the site of obstruction.

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Correct Answer is A

Explanation

A. Sit the client up and provide supplemental oxygen is the correct priority intervention. Chest pain and shortness of breath can be indicative of pulmonary embolism or other respiratory complications, which require immediate attention. Sitting the client up helps improve respiratory mechanics, and providing supplemental oxygen can support oxygenation while further assessments are conducted.
B. While contacting the physician and obtaining an arterial blood gas may be necessary to assess respiratory status and oxygenation, it is not the immediate priority. The client's symptoms require immediate intervention to ensure adequate oxygenation and prevent further deterioration.
C. Chest pain and shortness of breath are not typically expected findings after bariatric surgery and could indicate serious complications. It is essential not to dismiss the client's symptoms but to take them seriously and initiate appropriate interventions.
D. While the use of an incentive spirometer is important for preventing respiratory complications after surgery, it is not the priority intervention in this situation. The client's current symptoms require immediate attention to address potential respiratory distress or other serious complications.

A. keeping the client NPO. B. measuring abdominal girth. C. relieving pain with opioid narcotics. D. administering fluid replacement therapy. E. preparing the client for radiologic studies.

Correct Answer is ["A","B","D","E"]

Explanation

A. Keeping the client NPO (nothing by mouth) helps to rest the gastrointestinal tract, reduces the risk of further obstruction, and prevents exacerbation of symptoms such as vomiting.
B. Measuring abdominal girth is an important nursing assessment for a client with a possible small bowel obstruction. An increase in abdominal girth can indicate abdominal distension, which is a common sign of bowel obstruction.
C. Severe abdominal pain is a common symptom of bowel obstruction, and opioids may be necessary to manage pain effectively. However, opioids should be used cautiously due to the risk of exacerbating bowel obstruction by reducing bowel motility.
D. Fluid replacement therapy is important for clients with small bowel obstruction, especially if they are vomiting or have fluid loss due to intestinal secretions. Intravenous fluids may be administered to maintain hydration, correct electrolyte imbalances, and prevent dehydration.
E. Radiologic studies, such as abdominal X-rays or computed tomography (CT) scans, are often used to confirm the diagnosis of small bowel obstruction and assess its severity.

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The nurse is assessing a client who has a large bowel obstruction. Which late clinical finding would the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a client after bariatric surgery. The client complains of chest pain and shortness of breath. What is the priority nursing Intervention at this time?

Correct Answer is A

Explanation

A client is admitted with a possible small bowel obstruction. The nurse anticipates that the client's care will include: (SELECT ALL THAT APPLY)

Correct Answer is ["A","B","D","E"]

Explanation

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