What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?
Referred back pain.
Abdominal distention.
Projectile vomiting.
Metabolic alkalosis.
The Correct Answer is B
Choice A rationale
Referred back pain is not a hallmark of large bowel obstruction. It typically occurs in conditions with retroperitoneal organ involvement, such as renal or pancreatic pathology. Large bowel obstruction presents primarily with abdominal distention and pain localized to the affected bowel segment due to obstruction-induced pressure and stretching.
Choice B rationale
Abdominal distention is a classic sign of large bowel obstruction. Accumulated gas and stool proximal to the obstruction result in bloating and visible distention. This presentation reflects impaired bowel motility, pressure build-up, and reduced passage of contents, commonly seen in large bowel pathology.
Choice C rationale
Projectile vomiting is more indicative of upper GI obstruction, such as pyloric stenosis, due to immediate pressure effects. Large bowel obstructions manifest with late vomiting as distal obstruction delays content passage. Vomiting in this case is less forceful and often accompanied by fecal material.
Choice D rationale
Metabolic alkalosis is more associated with vomiting-related losses of gastric acid, as seen in upper GI pathology. Large bowel obstruction typically leads to metabolic acidosis from ischemia or bacterial overgrowth, not alkalosis, as the obstruction hampers normal bowel function and circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While alcohol is a known irritant to the gastric lining, it is not the primary cause of peptic ulcer disease. Excessive alcohol consumption contributes to mucosal damage but lacks the direct causative action of Helicobacter pylori, which colonizes the stomach lining and interferes with protective mechanisms, leading to ulcer formation. Alcohol merely exacerbates existing risk factors rather than initiating disease.
Choice B rationale
Helicobacter pylori is the most common cause of peptic ulcer disease globally. Its mechanism involves producing urease, neutralizing stomach acid and enabling bacterial survival. It induces inflammation and mucosal damage, compromising the stomach's protective lining. Persistent infection leads to ulcer formation. This bacterial colonization is implicated in up to 90% of duodenal ulcers, making it the key pathogenic factor in PUD.
Choice C rationale
Smoking is a risk factor for peptic ulcer disease but functions more as an aggravating agent than the primary cause. Tobacco use increases gastric acid secretion and decreases bicarbonate production, weakening mucosal defenses. It also reduces the efficacy of Helicobacter pylori eradication therapy, prolonging ulcer disease. However, it does not directly induce the condition independently, highlighting its secondary role in PUD pathology.
Choice D rationale
Stress is associated with peptic ulcer disease but is not a primary causative factor. Psychological stress can lead to hypersecretion of gastric acid, aggravating mucosal vulnerability in susceptible individuals. However, its role is predominantly indirect, amplifying existing risk factors like Helicobacter pylori infection. Stress-induced ulcers are typically seen in critical illnesses or severe physiological stress conditions, differing from PUD pathogenesis.
Correct Answer is C
Explanation
Choice A rationale
Glucagon IM is inappropriate for a glucose of 85 mg/dL, which is within normal preprandial ranges of 70-100 mg/dL. It is reserved for severe hypoglycemia with symptoms like unconsciousness.
Choice B rationale
Calling the MD is unnecessary when blood glucose is in the normal range and the patient is symptomatic. Nutritional intake is the next logical step in management.
Choice C rationale
Holding insulin and allowing the patient to eat is appropriate for 85 mg/dL. Nutritional intake stabilizes glucose levels, maintaining euglycemia without risking hypoglycemia from insulin.
Choice D rationale
Administering 10 units of Humalog risks causing hypoglycemia, as this dose is excessive for a glucose level of 85 mg/dL. Insulin use is not indicated here.
Choice E rationale
Administering dextrose IVP unnecessarily increases glucose levels. It is inappropriate unless the patient is symptomatic and glucose levels drop below 70 mg/dL.
Choice F rationale
Administering 7 units of Humalog risks hypoglycemia for a glucose level of 85 mg/dL, as the dose is excessive and unnecessary without elevated glucose.
Choice G rationale
Administering 5 units of Humalog poses a risk for hypoglycemia and is not indicated with normal glucose levels. Nutritional intake alone suffices.
Choice H rationale
Administering 15 units of Humalog is inappropriate and dangerous for a normal glucose level, as it likely induces hypoglycemia. Insulin use should be avoided here. .
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