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Rationale for Correct Answer:

• Patent: The nurse should determine whether the IV line is patent because a patent line ensures that medications flow freely and effectively reach the bloodstream for pain relief.
• Obstruction: The nurse should determine whether the IV line is obstructed because obstruction prevents the flow of medication through the IV line, interfering with the effectiveness of the prescribed medications.
• Medication delivery: The nurse should determine whether the IV line is obstructed because obstruction directly interferes with medication delivery, preventing pain medications from being delivered as intended.

Rationale for Incorrect Choices:

• Properly secured: While it is important for the IV line to be properly secured, this does not affect the ability of the medication to flow or reach the bloodstream. The IV line can still be obstructed even if it is properly secured, which would block medication delivery.
• Malpositioned: If the IV line is malpositioned, this could reduce the flow of medication, but it does not completely prevent medication from being delivered. Obstruction is the primary concern for ensuring the effective delivery of medication.
• Extravasation: Extravasation occurs when IV medication leaks into surrounding tissue, causing tissue damage. While this is a serious issue, it doesn’t directly affect the ability of the medication to reach the bloodstream. Obstruction is a more immediate concern as it prevents medication delivery entirely.
• Infiltration: Infiltration happens when IV medication leaks into surrounding tissues, leading to tissue damage. However, it does not stop the medication from reaching the bloodstream, unlike obstruction, which completely prevents medication delivery.
• Phlebitis: Phlebitis refers to vein inflammation, which could cause tissue damage or discomfort, but it doesn't usually obstruct the IV line completely. Obstruction, however, directly impacts medication delivery and is more critical for this patient.
• Fluid administration: Fluid administration does not directly affect the delivery of pain medications. While fluids may be necessary for hydration, obstruction in the IV line is the primary issue in ensuring the correct pain medications are delivered effectively.
• Tissue damage: Tissue damage caused by extravasation, infiltration, or phlebitis can occur when the IV line is not functioning properly, but this is secondary to the concern of whether the IV line is patent for proper medication delivery.

Rationale for Correct Answer:

• Improve circulation: Ambulating post-operatively helps to promote blood circulation throughout the body. This is important for preventing complications like blood clots and ensuring effective recovery from surgery. Improved circulation supports overall healing and reduces the risk of cardiovascular issues.
• Deep vein thrombosis (DVT): After surgery, especially bariatric surgery, the risk of developing blood clots (DVT) increases due to reduced mobility. Ambulation helps keep blood circulating, preventing the stasis that can lead to clot formation in the veins, particularly in the legs.

Rationale for Incorrect Choices:

• Reduce pain: While ambulation may help with post-operative discomfort by promoting circulation, the primary goal is to reduce the risk of complications like DVT, not necessarily to reduce pain. Pain management strategies like medications are more directly focused on managing pain.
• Increase appetite: Ambulating post-op is important for physical recovery, but it is not aimed at increasing appetite. Appetite can be influenced by other factors like gastrointestinal recovery and the body’s metabolic state after surgery, not by walking.
• Infection: Although ambulation is important for overall recovery, it doesn't directly prevent infection. Infection prevention typically involves good hygiene, wound care, and possibly antibiotics, rather than just physical activity.
• Pressure ulcers: Pressure ulcers are more commonly prevented through repositioning and using pressure-relieving devices, not primarily through ambulation. While moving helps circulation, preventing pressure ulcers involves more targeted interventions like avoiding prolonged pressure on specific body parts.
• Dehydration: Dehydration is prevented through fluid management and proper hydration, not by walking. Dehydration is more directly influenced by fluid intake and output than by physical activity.

Rationale for Correct Answers:

• Paralytic Ileus: The patient's symptoms, such as abdominal pain, nausea, vomiting, hypoactive bowel sounds, absence of gas in the colon, and the CT scan results (fluid and gas in the small intestine), are consistent with paralytic ileus. This condition is often caused by a lack of peristalsis after abdominal surgery, resulting in a functional obstruction.
• Prepare to insert a nasogastric tube: A nasogastric tube can help decompress the stomach, remove excess fluids and gases, and prevent further vomiting and distention, which are common in paralytic ileus.
• Make the client NPO: Keeping the patient NPO (nothing by mouth) prevents the gastrointestinal system from being further stressed and allows it to rest, reducing the risk of worsening the ileus or causing aspiration.
• Serum sodium and potassium: Monitoring electrolytes is essential in paralytic ileus due to the potential for dehydration and electrolyte imbalances from vomiting and the inability to properly absorb fluids and nutrients.
• Pain: Abdominal pain is a key symptom of paralytic ileus, and monitoring pain levels helps assess the severity and effectiveness of the management plan.

Rationale for Incorrect Choices:

• Peptic Ulcer Disease: Peptic ulcers cause upper abdominal pain and may lead to complications like bleeding or perforation. However, the symptoms, combined with CT scan results showing small intestine issues, are more consistent with paralytic ileus than with peptic ulcer disease.
• Cholecystitis: Cholecystitis is characterized by right upper quadrant pain, often related to gallstones, and is usually associated with a positive Murphy's sign. The CT scan did not show gallbladder inflammation, making this diagnosis unlikely.
• Gastroenteritis: Gastroenteritis typically involves symptoms like vomiting and diarrhea, but the lack of bowel movements and the absence of gas in the colon point toward a paralytic ileus rather than an infection like gastroenteritis.
• Administer a proton pump inhibitor: A proton pump inhibitor is used for conditions such as GERD or peptic ulcers, not for paralytic ileus. It doesn't address the underlying issue of bowel motility in this case.
• Administer an NSAID: NSAIDs can worsen gastrointestinal issues by increasing the risk of bleeding, especially after abdominal surgery. They should not be used in paralytic ileus as they may exacerbate the condition.
• Offer the client fluid oral rehydration therapy: Oral rehydration is not appropriate in paralytic ileus, as the digestive system is not functioning properly. Intravenous fluids are more appropriate to prevent dehydration in this condition.
• Yellow skin and mucous membranes: This indicates jaundice, typically associated with liver dysfunction or biliary obstruction. There are no signs in the client's notes or labs to suggest this.
• Hemoglobin and hematocrit: Although important for monitoring bleeding or dehydration, these values are less specific for paralytic ileus and do not directly assess the effectiveness of treatment for this condition.
• Skin: Monitoring the skin for signs of pressure ulcers or other conditions may be important in hospitalized patients, but it is not directly related to managing paralytic ileus, where the priority is gastrointestinal and pain management.