Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

Mr. Peterson, who suffers from constipation, shows symptoms of abdominal distention, no flatus, and an absence of bowel sounds. What is the most likely diagnosis?

1. Volvulus

2. Diverticular disease

3. Bowel ischemia

4. Bowel obstruction

The correct answer is: Bowel obstruction

The presentation of Mr. Peterson's symptoms strongly supports a diagnosis of bowel obstruction. In cases of bowel obstruction, one typically observes signs such as abdominal distention, the absence of flatus, and reduced or absent bowel sounds. The obstruction prevents the normal passage of gas and stool, leading to a buildup of gas in the intestines, which causes distention. Additionally, the absence of bowel sounds indicates that the digestive tract is not functioning properly, as bowel sounds are produced by the movement of the intestines. This situation aligns with the classic signs of bowel obstruction. Bowel ischemia refers to inadequate blood flow to the intestines, which can lead to similar symptoms but usually presents with additional signs like severe pain and may demonstrate some systemic effects such as fever or tachycardia. Diverticular disease can also cause some gastrointestinal symptoms, but it typically does not present with the combination of absent bowel sounds and significant abdominal distention to this degree. Volvulus is a type of bowel obstruction caused by twisting of the intestine; while it can present with similar symptoms, the broader term 'bowel obstruction' encompasses all potential causes of the obstruction, making it the most accurate diagnosis in this case.