A 68-year-old female client is being seen for follow-up wound care on her right lower leg. During her visit, the client states she hasn't had a bowel movement since her last visit a week ago. The client states she hasn't had much of an appetite in the past few days and says, "l figure I don't have anything in there to come out." The nurse auscultates the client's abdomen and hears hyperactive high-pitched bowel sounds in the upper left quadrant and hypoactive bowel sounds in the lower left quadrant. The nurse collaborates with the primary health care provider and the client is directly admitted to the hospital for possible intestinal obstruction. Before going to the hospital, the client asks the nurse what to expect. Which of these statements by the nurse (is) most likely accurate?
Select all that apply.
You should drink lots of water to help move the stool out of your body.
Surgery will be necessary to remove any Obstruction.
A nasogastric (NG) tube will be placed to relieve distention.
An abdominal CT will determine if you have an intestinal obstruction.
Correct Answer : C,D
Option A is not the best advice because drinking lots of water alone may not be enough to relieve constipation, especially if there is an obstruction.
Option B is also not accurate because not all intestinal obstructions require surgery, and the treatment approach will depend on the cause and severity of the obstruction.
Option C is accurate because a nasogastric tube can help relieve any distention caused by the obstruction by removing any gas or fluids that may have accumulated in the stomach and small intestine.
Option D is also accurate because an abdominal CT is one of the diagnostic tests that can help confirm the presence of intestinal obstruction and provide information about the location and cause of the obstruction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The nurse should quickly assess the patient's vital signs to check for signs of shock and instability. If the vital signs are unstable, the nurse should initiate appropriate interventions to stabilize the patient, such as administering oxygen, starting IV fluids, and providing continuous cardiac monitoring. Based on the sudden onset of severe upper abdominal pain, diaphoresis, and a firm abdomen, the nurse should suspect a possible perforation or bleeding related to the peptic ulcer. This is a medical emergency that requires immediate intervention. Therefore, the nurse should prioritize notifying the healthcare provider and preparing the patient for urgent medical evaluation.
Option A, irrigating the NG tube, is not appropriate in this situation and may further exacerbate the patient's condition if the ulcer has perforated.
Option B, elevating the foot of the bed, is also not appropriate as it does not address the patient's current symptoms.
Option C, giving the ordered antacid, may not be effective in addressing the severity of the patient's symptoms and should be postponed until the healthcare provider has evaluated the patient.
Correct Answer is D
Explanation
Therefore, the correct option is d. Glyburide is a sulfonylurea medication used to treat type 2 diabetes. It works by stimulating the beta cells in the pancreas to produce and release more insulin, which helps to lower blood glucose levels.
Option A is incorrect because glyburide does not affect glucagon secretion from the pancreas. Glucagon is a hormone that raises blood glucose levels by promoting the breakdown of glycogen in the liver.
Option b is incorrect because glyburide should not be taken if the morning blood glucose level is less than 70 mg/dL, as this may increase the risk of hypoglycemia.
Option c is incorrect because glyburide does not interact with IV contrast media. However, some types of IV contrast media can cause kidney damage in patients with diabetes, and the use of glyburide should be temporarily discontinued if a patient is undergoing a procedure that involves the use of contrast media.
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