A 45-year-old female patient is admitted to the emergency department with severe abdominal pain, fever, and nausea. She reports that the pain started suddenly and has progressively worsened. The healthcare provider suspects peritonitis and orders immediate interventions.

Physical examination

On examination, the patient has a distended abdomen, guarding, and rebound tenderness.

Her vital signs are as follows:

Temperature 102.4°F (39.1°C), Heart rate 120 bpm, Blood pressure 90/60 mmHg, and Respiratory rate 24 breaths per minute.

Which of the following complications is the nurse's highest priority to monitor for in this patient?

Intestinal obstruction

Hypovolemic shock

Electrolyte imbalance

Sepsis

Answer and Explanation

The Correct Answer is B

A. Intestinal obstruction: While peritonitis can lead to intestinal obstruction, it is not the most immediate life-threatening complication compared to hypovolemic shock or sepsis.

B. Hypovolemic shock: This is a critical condition that can occur due to severe fluid loss, which might be a concern in peritonitis due to fluid shifts into the abdominal cavity. However, the patient’s signs of systemic infection (fever, elevated heart rate, low blood pressure) suggest that sepsis is a more imminent threat.

C. Electrolyte imbalance: Electrolyte imbalances are possible due to fluid loss, but they would be secondary to the more urgent concern of hypovolemic shock.

D. Sepsis: Sepsis is the highest priority due to the patient’s vital signs and symptoms indicating a systemic infection. Early recognition and treatment of sepsis are crucial to prevent organ failure and other severe complications.

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Correct Answer is A

Explanation

A. Laxatives are contraindicated in clients who have a small bowel obstruction. Laxatives such as senna are contraindicated in bowel obstructions because they can increase peristalsis and exacerbate the blockage, leading to complications like bowel perforation or ischemia.

B. Bulk-forming laxatives such as psyllium should be substituted for this client: Bulk-forming laxatives like psyllium would not be appropriate either because they rely on bowel movement for efficacy. They could worsen the obstruction by adding bulk.

C. An osmotic laxative, such as magnesium citrate, should be substituted in this client: Osmotic laxatives, like magnesium citrate, are also contraindicated in bowel obstruction because they draw water into the bowel, which can worsen distension and pressure on the obstructed area.

D. The prescribed medication should be administered via NG route rather than the oral route for this client: While NG tubes may be used to decompress the bowel in cases of obstruction, administering a laxative through an NG tube would still be contraindicated, as laxatives increase the risk of further complications in bowel obstruction.

A. I should eat only plant-based proteins to manage my symptoms. B. I should avoid all sources of protein to prevent flare-ups. C. I should follow a low-protein diet to reduce intestinal inflammation. D. I should include high-protein foods like chicken and fish in my diet.

Correct Answer is D

Explanation

A. I should eat only plant-based proteins to manage my symptoms: While plant-based proteins may be a part of the diet, limiting protein intake solely to plant-based sources is not necessary, and animal proteins like chicken and fish are recommended for tissue repair.

B. I should avoid all sources of protein to prevent flare-ups: Protein is necessary for healing and should not be completely avoided.

C. I should follow a low-protein diet to reduce intestinal inflammation: There is no evidence that a low-protein diet helps reduce inflammation in Crohn's disease. High-protein intake is beneficial.

D. I should include high-protein foods like chicken and fish in my diet. During active inflammation in Crohn's disease, a high-protein diet is important for healing and maintaining muscle mass, especially since malabsorption can be a concern.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing medications for a client who has just been diagnosed with a small bowel obstruction. The nurse should withhold senna prescribed orally based on understanding of which of the following?

Correct Answer is A

Explanation

A patient with Crohn's disease is being discharged from the hospital. The nurse is providing dietary teaching to the patient. Which of the following statements by the patient indicates a correct understanding of the dietary recommendations?

Correct Answer is D

Explanation

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