The nurse is caring for a client who has a small bowel obstruction. When teaching the student nurse about this condition, the nurse will include which of the following findings that are consistent with the diagnosis? (Select all that apply).
Severe fluid and electrolyte imbalance
Upper abdominal distention
Metabolic acidosis
Projectile vomiting with a fecal odor
Diarrhea or ribbon-like stools
Correct Answer : A,B,D
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
A headache is not typically an indication of an allergy to nitroglycerin. Allergic reactions are more likely to present with symptoms such as rash, itching, or difficulty breathing.
Choice B reason:Headaches are a well-known side effect of nitroglycerin, due to its vasodilating effects, which can cause dilation of cerebral arteries.
Choice C reason:While anxiety can cause headaches, in this context, where the client has taken nitroglycerin, it is more likely that the headache is a side effect of the medication rather than anxiety.
Choice D reason:Tolerance to medication would reduce the effectiveness of the drug, not typically cause a headache. The headache is a common side effect, not an indication of tolerance.
Correct Answer is B
Explanation
Choice A reason: A heart murmur is not a common finding in right-sided heart failure unless there is an associated valvular heart disease.
Choice B reason: Dependent edema is a classic sign of right-sided heart failure due to the accumulation of fluid in the tissues, particularly in the lower extremities.
Choice C reason: Chest pain is more commonly associated with left-sided heart failure or other cardiac conditions such as angina.
Choice D reason: Crackles in the lungs are typically found in left-sided heart failure due to pulmonary congestion, not right-sided heart failure.

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