A nurse is contributing to the plan of care of a client who has a small bowel obstruction. Which of the following interventions should the nurse include?

Provide bulk-forming agent.

Elevate the head of the bed.

Measure abdominal girth daily.

Monitor intake and output every 8 hr.

Answer and Explanation

The Correct Answer is B

Choice A: Provide bulk-forming agent. This is incorrect because bulk-forming agents are used to treat constipation, not bowel obstruction. They can worsen the obstruction by increasing the stool volume and pressure in the bowel.

Choice B: Elevate the head of the bed. Elevating the head of the bed is an important intervention for clients with a small bowel obstruction. It can help reduce abdominal pressure, promote comfort, and facilitate better respiratory function, especially if the client is experiencing any associated nausea or vomiting. This position can also aid in the proper positioning of the intestines, potentially helping with any non-complicated obstructions.

Choice D: Monitor intake and output every 8 hr. This is incorrect because monitoring intake and output is not enough to assess the ﬂuid and electrolyte balance of a client with a bowel obstruction. The nurse should monitor intake and output more frequently, such as every 4 hr or every shift, and report any signs of dehydration or imbalance.

Choice C: Measure abdominal girth daily. While this is an important assessment for monitoring the status of the obstruction, the immediate intervention of elevating the head of the bed can provide immediate comfort and support during the acute phase of the obstruction.

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Correct Answer is A

Explanation

Choice A reason: Phosphate 5.7 mg/dL is an elevated value, as the normal range is 2.5 to 4.5 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood.

Choice B reason: Vitamin D 25 ng/mL is a normal value, as the normal range is 20 to 50 ng/mL. Hypoparathyroidism does not directly aﬀect vitamin D levels, but vitamin D supplements may be given to help increase calcium absorption and lower phosphorus levels in the blood.

Choice C reason: Calcium 9.8 mg/dL is a normal value, as the normal range is 8.6 to 10.2 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood. However, calcium levels may be normal or near- normal in some cases of hypoparathyroidism, especially if the condition is mild or well-controlled with treatment.

Choice D reason: Magnesium 1.8 mEq/L is a normal value, as the normal range is 1.5 to 2.5 mEq/L. Hypoparathyroidism does not directly aﬀect magnesium levels, but magnesium deficiency can cause or worsen hypoparathyroidism, as magnesium is needed for PTH secretion and action. Magnesium supplements may be given to correct magnesium deficiency and improve PTH function.

A. “Both illnesses result in malabsorption of nutrients.” B. “Both illnesses begin in the rectum.” C. “Both illnesses manifest fistula formation.” D. “Both illnesses are inﬂammatory in nature.”

Correct Answer is D

Explanation

Choice A: Both illnesses result in malabsorption of nutrients. This is incorrect because malabsorption of nutrients is more common in Crohn’s disease than in ulcerative colitis. Crohn’s disease can aﬀect any part of the gastrointestinal tract, including the small intestine, where most of the nutrient absorption occurs. Ulcerative colitis mainly aﬀects the colon and rectum, which are responsible for water and electrolyte absorption.

Choice B: Both illnesses begin in the rectum. This is incorrect because ulcerative colitis usually begins in the rectum and spreads proximally to the colon, while Crohn’s disease can begin anywhere in the gastrointestinal tract, from the mouth to the anus.

Choice C: Both illnesses manifest fistula formation. This is incorrect because fistula formation is more common in Crohn’s disease than in ulcerative colitis. Fistulas are abnormal connections between diﬀerent parts of the gastrointestinal tract or other organs, such as the bladder, vagina, or skin. They are caused by inﬂammation, ulceration, and infection that penetrate through the bowel wall.

Choice D: Both illnesses are inﬂammatory in nature. This is correct because both ulcerative colitis and Crohn’s disease are types of inﬂammatory bowel disease (IBD), which are chronic conditions that cause inﬂammation and damage to the gastrointestinal tract. The exact cause of IBD is unknown, but it may involve genetic, immune, environmental, and microbial factors.

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