The nurse is caring for an older adult in the medical-surgical unit:

84-year-old female was admitted to the medical-surgical unit with a three-day history of abdominal pain, distention, nausea, and persistent vomiting. She reports that she has not had a bowel movement in five days and has no appetite.

Exhibits

Which of the following findings are consistent with a small bowel obstruction: Select all that apply.

Right lower quadrant abdominal pain

Fever

Nausea and vomiting

Unable to pass stool

distended abdomen

Answer and Explanation

Correct Answer : C,D,E

Choice A rationale: Small bowel obstructions typically present with diffuse, crampy abdominal pain rather than localized pain in the right lower quadrant.

Choice B rationale: While fever can be present in some cases, it's not a consistent finding with small bowel obstruction unless there's perforation.

Choice C rationale: Common symptoms of small bowel obstruction due to the buildup of contents proximal to the obstruction.

Choice D rationale: A key feature of small bowel obstruction due to the blockage preventing normal bowel movements.

Choice E rationale: Accumulation of gas and fluid above the obstruction causes abdominal distention.

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Correct Answer is A

Explanation

Choice A rationale: These lab findings, particularly concentrated urine (high specific gravity) and hyponatremia, are consistent with SIADH, where excessive ADH secretion leads to water retention and dilutional hyponatremia.

Choice B rationale: While it can affect sodium levels, Cushing's syndrome typically results in hypernatremia or normal sodium levels rather than hyponatremia.

Choice C rationale: Usually presents with hyponatremia but not specifically with high urine specific gravity or hematocrit.

Choice D rationale: DI is associated with high serum sodium and low urine specific gravity due to excessive excretion of dilute urine.

A. Stomatitis and Diarrhea B. Dyspnea and Anuria C. Confusion and Vomiting D. Nocturia and Oliguria

Correct Answer is D

Explanation

Choice A rationale: These are symptoms of advance renal failure. Stomatitis and diarrhea are signs of uremia, which is the accumulation of waste products in the blood.

Choice B rationale: Dyspnea and anuria are signs of fluid overload and kidney shutdown and indicate advanced renal failure.

Choice C rationale: Confusion and vomiting are signs of acidosis and electrolyte disturbances and occur in advanced stages of renal failure.

Choice D rationale: One of the early symptoms of renal insufficiency is nocturia, which is the need to urinate frequently at night. This occurs because the kidneys are unable to concentrate urine during the day and produce more urine at night. Another early symptom is oliguria, which is the production of less than 400 mL of urine per day. This occurs because the kidneys are unable to excrete enough urine to maintain fluid balance.

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The nurse is caring for a client suspected of having an endocrine disorder. Exhibits Based on the client's laboratory data, the client is at the highest risk for which condition?

Correct Answer is A

Explanation

A client with a 16-year history of diabetes mellitus is having renal function tests because of recent fatigue, weakness, elevated blood urea nitrogen, and serum creatinine levels. Which finding should the nurse conclude as an early symptom of renal insufficiency?

Correct Answer is D

Explanation

Polystyrene sulfonate (Kayexalate) is used in renal failure to:

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