The emergency room nurse is caring for a client just diagnosed with a bowel obstruction secondary to adhesions. Which of the following orders should the nurse complete first?

Hang IV fluids of CSNS with 20 mEq of potassium chloride at 125 ml/hr

Insert a nasogastric tube

Draw a basic metabolic panel

Ambulate in the hallway

Answer and Explanation

The Correct Answer is B

A. Hang IV fluids of CSNS with 20 mEq of potassium chloride at 125 ml/hr: Fluid resuscitation is important, but potassium should not be administered until electrolyte levels are assessed. Also, potassium administration in a client with a bowel obstruction requires caution due to the risk of hyperkalemia if renal function is impaired.

B. Insert a nasogastric tube: A nasogastric (NG) tube is essential in managing bowel obstruction as it helps decompress the stomach, relieve pressure, and prevent aspiration. This should be done first to stabilize the client.

C. Draw a basic metabolic panel: Checking electrolyte imbalances is important but should be done after stabilizing the client with NG tube insertion.

D. Ambulate in the hallway: Ambulation is contraindicated in acute bowel obstruction due to the risk of worsening symptoms such as nausea, vomiting, and severe pain.

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Correct Answer is ["A","B","C"]

Explanation

A. Avoid drawing blood from the affected extremity: Blood draws, IVs, and BP measurements should never be done on the fistula arm to prevent damage and thrombosis.

B. Auscultate the fistula for the sound of a bruit: A bruit (whooshing sound) confirms blood flow through the fistula, indicating patency.

C. Palpate the site to identify the presence of a thrill: A thrill (vibration) should be felt over the fistula. Absence may indicate clotting or failure.

D. Irrigate the fistula with saline to maintain patency: A fistula is never irrigated. Only dialysis staff should access it.

E. Keep the fistula clamped until ready to perform dialysis: AV fistulas are not clamped. Clamping could obstruct blood flow.

A. Obstruction of the bile duct B. Hepatitis C C. Hepatotoxic medications D. Excessive alcohol consumption

Correct Answer is A

Explanation

A. Obstruction of the bile duct: Biliary cirrhosis (now called primary or secondary biliary cholangitis) can occur due to prolonged bile duct obstruction, leading to liver damage and cirrhosis.

B. Hepatitis C: Hepatitis C can cause cirrhosis, but it is not a direct cause of biliary cirrhosis. Instead, it leads to post-viral cirrhosis.

C. Hepatotoxic medications: Certain medications (e.g., acetaminophen overdose) can cause liver damage, but they do not specifically cause biliary cirrhosis.

D. Excessive alcohol consumption: Alcohol abuse can cause alcoholic cirrhosis, but not biliary cirrhosis.

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