The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?

Prone

Semi-Fowler

Recumbent

Supine

Answer and Explanation

The Correct Answer is B

Large bowel obstruction (LBO) causes significant abdominal distention as gas and fecal material accumulate proximal to the blockage. This distention increases intra-abdominal pressure, which pushes the diaphragm upward into the thoracic cavity. This mechanical elevation limits lung expansion and reduces tidal volume, making the patient highly susceptible to respiratory distress and atelectasis if they are not positioned to optimize diaphragmatic descent.

Rationale:

A. The prone position, where the patient lies on their stomach, is contraindicated in large bowel obstruction. This position would place direct pressure on the already distended abdomen, further increasing intra-abdominal pressure and severely restricting the movement of the diaphragm. It would lead to immediate respiratory compromise and significant pain for a patient with a fecal impaction.

B. The Semi-Fowler position is the most appropriate because it uses gravity to pull the abdominal organs downward, away from the diaphragm. This facilitates maximal lung expansion and eases the work of breathing, which is often compromised by severe abdominal distention. Elevating the head of the bed to 30 to 45 degrees significantly improves gas exchange efficiency.

C. A recumbent or side-lying position does not provide the same respiratory benefits as an upright position. While it may be more comfortable for some patients than lying flat, it does not adequately relieve the pressure on the diaphragm caused by the distended bowel. To prioritize the patient's airway and breathing, an elevated head position is clinically superior.

D. The supine position, or lying flat on the back, is inappropriate for a patient with a large bowel obstruction. In this position, the distended abdominal contents exert maximum pressure against the diaphragm, making it difficult for the patient to take deep breaths. This increases the risk of hypoventilation and the development of secondary pulmonary complications like pneumonia.

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Correct Answer is C

Explanation

Intravenous insulin therapyrequires precise calculation to maintain glycemic control and prevent complications like hypoglycemia or diabetic ketoacidosis. Regular insulin is the only type used for IV infusion due to its predictable pharmacokinetics. Calculating the infusion durationis essential for pharmacy coordination and ensuring continuous delivery of this high-alert medication to the patient through an infusion pump.

Rationale:

A.8 hours is an incorrect calculation based on the provided dosage and volume. If the bag lasted only 8 hours at 4 units per hour, the total units delivered would be only 32 units. This does not account for the 100 units contained in the supplied 100 mL IV bag, leading to a significant error in estimating the duration of the medication supply.

B.10 hours 15 minutes is mathematically incorrect for this scenario. This figure does not correspond to any standard calculation using the 100 unit/100 mL concentration provided in the order. Accurate medication timing is vital for nursing staff to ensure that a new bag is ready before the current one is depleted, preventing interruptions in insulin delivery.

C.25 hours is the correct duration for the infusion. Calculation: Step 1: Determine the concentration of the bag, which is 100 units / 100 mL = 1 unit per mL. Step 2: Determine the hourly volume to be infused: 4 units per hour / 1 unit per mL = 4 mL per hour. Step 3: Calculate the total time: 100 mL total volume / 4 mL per hour = 25 hours.

D.29 hours is an incorrect result and does not reflect the units-to-volume ratio provided in the order. Inaccurately calculating the infusion time can lead to poor planning in the clinical setting. The simple 1:1 ratio of units to milliliters in this specific IV bag clearly indicates that at 4 units per hour, the 100 mL bag will last exactly 25 hours.

A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis

Correct Answer is A

Explanation

The stomach acts as a reservoir for gastric juice, which contains a high concentration of hydrochloric acid(HCl). When profuse vomiting occurs, there is a massive loss of hydrogen ions and chloride from the body. This results in a relative excess of bicarbonate in the extracellular fluid, triggering a significant shift in the blood's pH and electrolyte balance.

Rationale:

A.Metabolic alkalosisis expected because vomiting causes the loss of gastric hydrochloric acid. As hydrogen ions are depleted, the serum pH rises above 7.45. The body attempts to compensate by retaining carbon dioxide through hypoventilation, but the primary cause remains the loss of acid and the subsequent elevation of systemic bicarbonate levels.

B.Metabolic acidosis would be expected in cases of severe diarrhea rather than vomiting. Diarrhea causes the loss of alkaline intestinal secretions and bicarbonate. In contrast, vomiting specifically targets the acidic environment of the stomach, making the blood more basic (alkaline) rather than acidic, provided there is no concomitant underlying renal failure.

C.Respiratory alkalosis is caused by hyperventilation, which leads to the excessive "blowing off" of carbon dioxide. While a patient in pain may breathe faster, the primary and most significant imbalance in a patient who has been vomiting profusely is metabolic in nature, driven by the direct chemical loss of gastric acid through the esophagus.

D.Respiratory acidosis occurs when there is inadequate alveolar ventilation leading to the retention of carbon dioxide. This is typically seen in patients with respiratory failure or obstructive lung diseases. It is not a direct consequence of vomiting, which is a metabolic process involving the gastrointestinal tract and the loss of specific electrolytes and acids.

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The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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