The nurse is reviewing the following laboratory results on the chart below of a client diagnosed with a small bowel obstruction. Based on the results, the nurse interprets that the client is experiencing which clinical problem?

Laboratory Results:

WBC

8.5

Hemoglobin

17g/dL

Hematocrit

54%

BUN

28mg/dL

Creatinine

1.1 mg/dL

Potassium

4.9 mEq/L

Dehydration

Infection

Renal insufficiency

internal bleeding

Answer and Explanation

The Correct Answer is A

A. Dehydration: The elevated hemoglobin (17 g/dL) and hematocrit (54%), along with an increased BUN (28 mg/dL) and normal creatinine, suggest hemoconcentration, a key indicator of dehydration. Small bowel obstruction often leads to fluid loss through vomiting and third spacing into the bowel, contributing to this condition.

B. Infection: The WBC count is normal at 8.5, which does not support an active infection. Infections typically result in leukocytosis (WBC >10.5), especially in acute abdominal conditions.

C. Renal insufficiency: Although BUN is elevated, creatinine remains normal (1.1 mg/dL). This pattern, particularly with hemoconcentration, supports pre-renal azotemia due to dehydration, not intrinsic renal insufficiency.

D. Internal bleeding: Internal bleeding typically causes a decrease in hemoglobin and hematocrit due to blood loss. The elevated values in this case rule out active bleeding and instead indicate fluid volume deficit.

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Correct Answer is D

Explanation

A. "The diaphragmatic nerve overdrives the rapid rhythm:" The phrenic (diaphragmatic) nerve controls the diaphragm for breathing and plays no role in cardiac rhythm regulation. It is unrelated to the autonomic control of heart rate or supraventricular tachycardia (SVT) management.

B. "Vagal stimulation decreases peripheral vascular resistance:" Vagal stimulation primarily affects the heart by decreasing the rate and conduction through the AV node. Its effect on vascular resistance is minimal, making this explanation inaccurate in the context of SVT treatment.

C. "The vagus nerve increases the heart rate, overdriving the rhythm:" The vagus nerve has a parasympathetic effect, slowing down the heart rate, not increasing it. Overdrive pacing is a different concept and not related to vagal maneuvers like carotid massage.

D. "The vagus nerve slows the heart rate": The carotid sinuses in the neck contain baroreceptors that are sensitive to pressure. Massaging these sinuses stimulates the vagus nerve to release acetylcholine, which in turn slows conduction through the AV node and may terminate episodes of SVT. This response demonstrates an accurate understanding of the purpose of the procedure.

A. contact the prescriber to decrease the rate of the D51/2 NS during the blood transfusion B. stop the D51/2NS, check the client's vitals & notify the prescriber. C. Fluids cannot be given through a CVC. D. Insert a 22 gauge peripheral IV to administer the transfusion E. transfuse the unit of packed red blood cells through a separate lumen of the CVC

Correct Answer is E

Explanation

A. contact the prescriber to decrease the rate of the D51/2NS during the blood transfusion: There's no need to alter the rate of maintenance fluids unless there's a fluid volume concern. Additionally, decreasing the rate would not address the need for a dedicated blood transfusion line if another lumen is available.

B. stop the D51/2NS, check the client's vitals & notify the prescriber: Stopping necessary fluids without cause may compromise fluid balance. Unless there's a compatibility issue or no other lumen, stopping the infusion is not the safest or most efficient action.

C. Fluids cannot be given through a CVC: Central venous catheters are routinely used for administering fluids, medications, and blood products, especially in critical care settings.

D. Insert a 22 gauge peripheral IV to administer the transfusion: While blood can be given through a peripheral IV, using an existing central venous catheter is safer and more efficient, especially when multiple lumens are available. Inserting a new IV unnecessarily increases infection and complication risks.

E. transfuse the unit of packed red blood cells through a separate lumen of the CVC: This is the safest and most appropriate action. Triple-lumen CVCs allow for simultaneous infusions through separate channels without mixing. Blood should be transfused through a dedicated lumen to avoid incompatibility or dilution by other fluids.

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WBC	8.5
Hemoglobin	17g/dL
Hematocrit	54%
BUN	28mg/dL
Creatinine	1.1 mg/dL
Potassium	4.9 mEq/L

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Naxlex Comprehensive Predictor Exams

A client with paroxysmal supraventricular tachycardia asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective?

Correct Answer is D

Explanation

A client has a triple lumen subclavian central venous catheter (CVC) with D51/2NS infusing through one lumen (port) at 75 mL per hour. The nurse has an order to transfuse one unit of packed red blood cells (PRBCs). The nurse's safest action is to:

Correct Answer is E

Explanation

A client is to receive an intravenous dose of adenosine. What immediate response to this medication should the nurse expect?

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