What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?
Referred back pain.
Abdominal distention.
Projectile vomiting.
Metabolic alkalosis.
The Correct Answer is B
Choice A rationale
Referred back pain is not a hallmark of large bowel obstruction. It typically occurs in conditions with retroperitoneal organ involvement, such as renal or pancreatic pathology. Large bowel obstruction presents primarily with abdominal distention and pain localized to the affected bowel segment due to obstruction-induced pressure and stretching.
Choice B rationale
Abdominal distention is a classic sign of large bowel obstruction. Accumulated gas and stool proximal to the obstruction result in bloating and visible distention. This presentation reflects impaired bowel motility, pressure build-up, and reduced passage of contents, commonly seen in large bowel pathology.
Choice C rationale
Projectile vomiting is more indicative of upper GI obstruction, such as pyloric stenosis, due to immediate pressure effects. Large bowel obstructions manifest with late vomiting as distal obstruction delays content passage. Vomiting in this case is less forceful and often accompanied by fecal material.
Choice D rationale
Metabolic alkalosis is more associated with vomiting-related losses of gastric acid, as seen in upper GI pathology. Large bowel obstruction typically leads to metabolic acidosis from ischemia or bacterial overgrowth, not alkalosis, as the obstruction hampers normal bowel function and circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Insulin glargine (Lantus) is a long-acting insulin used for basal glycemic control in diabetic patients. It has a slow onset and a steady release over approximately 24 hours, mimicking natural insulin secretion to stabilize blood glucose levels and prevent fluctuations.
Choice B rationale
Rapid-acting insulins, such as insulin lispro or aspart, have fast onsets and short durations to manage postprandial glucose spikes. Insulin glargine does not have these properties, as it is used for long-term basal control rather than immediate blood sugar regulation.
Choice C rationale
Intermediate-acting insulins like NPH have a shorter duration and peak effect compared to long-acting insulins. Insulin glargine provides a consistent effect over 24 hours, distinguishing it from intermediate-acting options.
Choice D rationale
Short-acting insulins are designed for pre-meal blood sugar control with a quick onset and limited duration. Insulin glargine does not fit this description due to its long-acting properties.
Correct Answer is F
Explanation
Choice A rationale
Dextrose IVP is unnecessary with hyperglycemia. It increases the glucose level further, risking complications like hyperosmolar hyperglycemic state. This treatment is reserved for severe hypoglycemia.
Choice B rationale
Glucagon raises blood glucose and is contraindicated for hyperglycemia. It is used to treat hypoglycemia, not elevated glucose levels seen here.
Choice C rationale
Holding insulin neglects hyperglycemia management, allowing complications like ketoacidosis or delayed glucose control. Insulin is necessary to address elevated blood sugar.
Choice D rationale
Calling the MD delays hyperglycemia treatment unnecessarily, as nurses can administer insulin per protocols in cases like this.
Choice E rationale
Administering 15 units of Humalog risks inducing hypoglycemia. It is an excessive dose given the glucose level of 243 mg/dL.
Choice F rationale
Administering 4 units of Humalog is an appropriate corrective dose for a pre-meal glucose of 243 mg/dL. Rapid-acting insulin efficiently reduces glucose to safer levels, aligning with treatment protocols.
Choice G rationale
Administering 9 units of Humalog risks overcorrecting hyperglycemia, potentially causing hypoglycemia, as it exceeds typical sliding scale guidelines for this glucose level.
Choice H rationale
Administering 5 units of Humalog could be reasonable for slight hyperglycemia, but it is not specifically aligned with the sliding scale dose appropriate for 243 mg/dL.
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