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 C

Explanation

A. Apply transcutaneous pacemaker pads: While this is a potential intervention for symptomatic or severe bradycardia unresponsive to medications, it is premature as a first step in this scenario. The client is stable with a heart rate of 50 bpm and no mention of hemodynamic compromise.

B. Place the client in Trendelenburg position: This position is used to improve venous return in hypotensive patients, but there is no evidence of hypotension or poor perfusion. It is not an appropriate response to mild bradycardia in this context.

C. Call the doctor for an order to decrease the infusion rate: Diltiazem is a calcium channel blocker that slows AV node conduction, potentially causing bradycardia. Since the heart rate has dropped to 50 bpm, the most appropriate first action is to contact the provider to adjust the infusion rate, which may be too high for the client’s current rhythm.

D. Administer a dose of atropine: Atropine is used for symptomatic bradycardia. If the client is asymptomatic and the bradycardia is mild and medication-induced, adjusting or discontinuing the offending agent should be attempted before administering atropine.

Correct Answer is ["200"]

Explanation

Volume ordered is 1 L.

Convert the total volume to milliliters (mL)

1 L = 1000 mL.

Total volume in mL = 1 L × 1000 mL/L = 1000 mL

Total infusion time = 5 hours

Calculate the infusion rate in milliliters per hour (mL/hr).

Infusion rate (mL/hr) = Total volume (mL) / Total infusion time (hours)

= 1000 mL / 5 hours

= 200

The appropriate setting is 200 mL/hr.

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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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client in the coronary care unit is receiving a diltiazem infusion for atrial fibrillation. The nurse observes on the cardiac monitor that the client's heart rate has converted to sinus bradycardia at a rate of 50 beats/minute. Which nursing action should be performed first?

Correct Answer is C

Explanation

A post-op client is to receive the following: D5%W/0.45% NS 1 L to infuse over 5 hours. What is the appropriate setting on an infusion pump in milliliters per hour? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["200"]

Explanation

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