A client's morning laboratory test results include hemoglobin 11.0 g/dL (110 g/L) and hematocrit 34% (0.34 volume fraction). Based on these findings, this client is at risk for which pathophysiological findings?

Reference Ranges:

Hemoglobin [14 to 18 g/dL (140 to 180 g/L)]

Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

A) Nerve degeneration due to chronic gastric reflux:

Nerve degeneration due to chronic gastric reflux may lead to conditions such as gastroesophageal reflux disease (GERD) or esophagitis, but it is not directly related to the clinical presentation of intestinal obstruction. Symptoms of GERD or esophagitis typically include heartburn, regurgitation, and dysphagia rather than severe, colicky abdominal pain, nausea, vomiting, and abdominal distention.

B) Volvulus that occurred during an appendectomy:

Correct. Volvulus refers to the twisting of a segment of the intestine around its mesentery, leading to obstruction of the bowel lumen and compromising blood flow to the affected area. In this scenario, the client's clinical presentation of severe, colicky abdominal pain, nausea, vomiting, and abdominal distention is consistent with symptoms of intestinal obstruction, which can occur secondary to volvulus. Volvulus may result from various factors, including prior abdominal surgeries, such as an appendectomy, leading to abnormal positioning or adhesions within the abdomen.

C) Esophagitis due to reflux of gastric contents:

Esophagitis due to reflux of gastric contents can cause symptoms such as heartburn, chest pain, and difficulty swallowing, but it is not typically associated with severe, colicky abdominal pain, nausea, vomiting, and abdominal distention characteristic of intestinal obstruction.

D) A history of having Helicobacter pylori infection:

Helicobacter pylori infection is associated with conditions such as peptic ulcer disease and gastritis, but it is not directly related to the clinical presentation of intestinal obstruction. Symptoms of H. pylori infection may include abdominal pain, nausea, and vomiting, but they are not typically colicky and severe as those seen in intestinal obstruction.

A) An increase in afterload results in decreased systolic pressure, which creates a decreased cardiac output:

This statement is incorrect. According to the Frank-Starling law, afterload refers to the resistance against which the heart must pump blood during systole. An increase in afterload typically results in increased systolic pressure, not decreased, as the heart works harder to overcome the increased resistance. However, increased afterload can lead to decreased cardiac output due to the increased work of the heart.

B) A decrease in afterload causes the cardiac muscles to hypertrophy, resulting in increased diastolic volume:

This statement is incorrect. A decrease in afterload typically reduces the workload on the heart, which may lead to reverse remodeling and a reduction in cardiac hypertrophy. Increased diastolic volume may occur due to reduced afterload, but it's not the direct result of hypertrophy.

C) An increase in preload results in greater shortening of myocardial fibers, thereby increasing contractility:

Correct. The Frank-Starling law states that an increase in preload (end-diastolic volume or stretch of myocardial fibers) leads to greater overlap of actin and myosin filaments within myocardial fibers during systole. This increased overlap results in stronger myocardial contraction (increased contractility), leading to an increased stroke volume and cardiac output.

D) A decrease in preload results in increasing diastolic muscle fiber length, which impedes contractility:

This statement is incorrect. Preload refers to the degree of stretch of the myocardial fibers at the end of diastole. A decrease in preload would lead to decreased stretch of the myocardial fibers, not increasing diastolic muscle fiber length. Decreased preload typically results in decreased contractility rather than an impediment to contractility due to reduced myocardial stretch.