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 ["0.5"]

Explanation

Convert milligrams to micrograms.

1 mg = 1000 mcg.

0.05 mg × 1000 mcg/mg = 50 mcg

Desired dose = 25 mcg

Available dose = 50 mcg/tablet

Calculate the number of tablets.

Number of tablets = Desired dose / Available dose per tablet

= 25 mcg / 50 mcg/tablet

= 0.5

The nurse should administer 0.5 tablet.

A. Maintain the infusion because the client had a cardiac arrest. B. Continue to monitor the client's rhythm closely. C. Suggest that the client's medication be changed to norepinephrine. D. Ask the physician if the dose can be decreased.

Correct Answer is D

Explanation

A. Maintain the infusion because the client had a cardiac arrest: While epinephrine is essential during cardiac arrest, continuing a high-dose infusion post-resuscitation without reassessment may lead to complications like tachycardia, hypertension, and increased myocardial oxygen demand.

B. Continue to monitor the client's rhythm closely: Ongoing monitoring is important, but it is a passive intervention. The heart rate of 120 bpm may reflect excessive adrenergic stimulation from epinephrine, and further action is needed to prevent deterioration.

C. Suggest that the client's medication be changed to norepinephrine: Norepinephrine is another vasopressor that has less of a beta-1 adrenergic effect compared to epinephrine. It is primarily used for hypotension and septic shock, not as a direct substitute for epinephrine post-cardiac arrest. Changing to another vasopressor without indication is not the best initial step.

D. Ask the physician if the dose can be decreased: A heart rate of 120 bpm may indicate that the epinephrine dose is too high, causing sympathetic overstimulation. Prolonged or excessive tachycardia increases myocardial oxygen demand, which can be detrimental, especially in a post-arrest heart. Decreasing the dose can help prevent arrhythmias or myocardial ischemia, making this the most appropriate and proactive action.

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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 is to receive Synthroid 25 mcg PO daily. Synthroid unit dose available is 0.05 mg/ tablet. How many tablets (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero)

Correct Answer is ["0.5"]

Explanation

The nurse is caring for a client who has been successfully resuscitated following a cardiac arrest and is now on an IV infusion of epinephrine. The cardiac monitor shows a heart rate of 120 beats/minute. What should be the nurse's best action?

Correct Answer is D

Explanation

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