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 B

Explanation

B. Changing the IV tubing every 24 hours helps prevent the accumulation of bacteria and other contaminants within the tubing, reducing the risk of infection. This practice is particularly important for clients receiving TPN, as they are at higher risk of infection due to the direct infusion of nutrients into the bloodstream.
A. It is essential to maintain the integrity of the IV site to prevent infection and ensure proper TPN delivery. Changing the IV site dressing every 24 hours helps minimize the risk of contamination and infection at the insertion site.
C. Regular monitoring of the client's weight is not necessary.
D. While monitoring blood glucose levels is important for clients at risk of hyperglycemia or hypoglycemia, the frequency of monitoring should be individualized based on the client's clinical condition and risk factors.

A. Notify the physician immediately. B. Notify the pharmacy when the bag is empty C. Decrease the rate to 27.1 mL/hr until the new bag is brought to the unit D. Hang a bag of D10W at the current rate until the new bag arrives

Correct Answer is C

Explanation

C. Decrease the rate to 27.1 mL/hr until the new bag is brought to the unit: This option is a suitable approach to conserve the remaining TPN solution until the new bag arrives. By halving the infusion rate, the remaining volume of TPN will last longer, ensuring the client continues to receive some nutrition and fluid support while awaiting the delivery of the new bag.
A. While it's important to inform the healthcare team about the low volume of TPN remaining, it may not require immediate physician intervention unless the situation worsens or alternative actions need to be taken.
B. Notifying the pharmacy when the bag is empty is a reasonable action, as they can prepare and deliver the next infusion bag promptly. However, it does not address the immediate need for fluid and nutrition replacement.
D. D10W (dextrose 10% in water) can help prevent hypoglycemia and provide some energy, but it does not provide the full nutritional support that TPN does. However, it can be a reasonable short- term measure while waiting for the replacement TPN bag.

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

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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