The nurse is reviewing the following laboratory results on the chart below of a client diagnosed with a small bowel obstruction. Based on the results, the nurse interprets that the client is experiencing which clinical problem?

Laboratory Results:

WBC

8.5

Hemoglobin

17g/dL

Hematocrit

54%

BUN

28mg/dL

Creatinine

1.1 mg/dL

Potassium

4.9 mEq/L

Dehydration

Infection

Renal insufficiency

internal bleeding

Answer and Explanation

The Correct Answer is A

A. Dehydration: The elevated hemoglobin (17 g/dL) and hematocrit (54%), along with an increased BUN (28 mg/dL) and normal creatinine, suggest hemoconcentration, a key indicator of dehydration. Small bowel obstruction often leads to fluid loss through vomiting and third spacing into the bowel, contributing to this condition.

B. Infection: The WBC count is normal at 8.5, which does not support an active infection. Infections typically result in leukocytosis (WBC >10.5), especially in acute abdominal conditions.

C. Renal insufficiency: Although BUN is elevated, creatinine remains normal (1.1 mg/dL). This pattern, particularly with hemoconcentration, supports pre-renal azotemia due to dehydration, not intrinsic renal insufficiency.

D. Internal bleeding: Internal bleeding typically causes a decrease in hemoglobin and hematocrit due to blood loss. The elevated values in this case rule out active bleeding and instead indicate fluid volume deficit.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. A 60-year-old woman with cardiac dysrhythmias post myocardial infarction. Her HR is 39 & irregular, BP 147/65: Although her heart rate is low, carvedilol is commonly used post-MI to reduce mortality, especially in patients with dysrhythmias. However, caution is warranted, and dosage adjustments or withholding may be necessary due to bradycardia.

B. A 55-year-old woman with HTN due to renal failure from chronic pyelonephritis. HR 92. BP 145/72: This client has stable vitals, and carvedilol can be safely used to help manage hypertension. Renal impairment requires monitoring, but it is not a contraindication if renal function is closely followed.

C. A 78-year-old man with a history of hyperlipidemia & cardiac dysfunction. He is in 3rd degree heart block. HR 42. BP 92/65: Carvedilol is contraindicated in clients with 2nd or 3rd degree heart block without a functioning pacemaker. It can worsen bradycardia and conduction delays, making its use unsafe in this client without rhythm control support.

D. A 49-year-old male, BMI 36, history of type 2 diabetes & HTN. HR 105, BP 158/92: This client is hypertensive and tachycardic, both of which carvedilol can help manage. Although diabetes requires careful monitoring for hypoglycemia, there is no contraindication in this scenario.

A. contact the prescriber to decrease the rate of the D51/2 NS during the blood transfusion B. stop the D51/2NS, check the client's vitals & notify the prescriber. C. Fluids cannot be given through a CVC. D. Insert a 22 gauge peripheral IV to administer the transfusion E. transfuse the unit of packed red blood cells through a separate lumen of the CVC

Correct Answer is E

Explanation

A. contact the prescriber to decrease the rate of the D51/2NS during the blood transfusion: There's no need to alter the rate of maintenance fluids unless there's a fluid volume concern. Additionally, decreasing the rate would not address the need for a dedicated blood transfusion line if another lumen is available.

B. stop the D51/2NS, check the client's vitals & notify the prescriber: Stopping necessary fluids without cause may compromise fluid balance. Unless there's a compatibility issue or no other lumen, stopping the infusion is not the safest or most efficient action.

C. Fluids cannot be given through a CVC: Central venous catheters are routinely used for administering fluids, medications, and blood products, especially in critical care settings.

D. Insert a 22 gauge peripheral IV to administer the transfusion: While blood can be given through a peripheral IV, using an existing central venous catheter is safer and more efficient, especially when multiple lumens are available. Inserting a new IV unnecessarily increases infection and complication risks.

E. transfuse the unit of packed red blood cells through a separate lumen of the CVC: This is the safest and most appropriate action. Triple-lumen CVCs allow for simultaneous infusions through separate channels without mixing. Blood should be transfused through a dedicated lumen to avoid incompatibility or dilution by other fluids.

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Potassium 2.8 mEq/L
Sodium 133 mEq/L
Chloride 90 mEq/L
Glucose 200 mg/dl
Magnesium 2.5 mg/dL
Calcium 8.0 mg/dL

WBC	8.5
Hemoglobin	17g/dL
Hematocrit	54%
BUN	28mg/dL
Creatinine	1.1 mg/dL
Potassium	4.9 mEq/L

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Naxlex Comprehensive Predictor Exams

The nurse would contact the prescriber for safety concerns about using carvedilol in which of the following clients?

Correct Answer is C

Explanation

A client has a triple lumen subclavian central venous catheter (CVC) with D51/2NS infusing through one lumen (port) at 75 mL per hour. The nurse has an order to transfuse one unit of packed red blood cells (PRBCs). The nurse's safest action is to:

Correct Answer is E

Explanation

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