Nokea
The nurse has educated a client scheduled to have an endoscopic retrograde cholangiopancreatography (ERCP). Which of the following client statements would indicate the need for additional teaching by the nurse? Select all that apply.
- A. I will not be able to eat or drink anything for six to eight hours before this procedure.
- B. I will have to do a bowel prep before this procedure.
- C. Someone will have to drive me home after this procedure.
- D. I should notify my physician if I have abdominal pain and distention for one or two days following this procedure.
- E. I can expect to have white stools one to two days following this procedure.
Correct Answer: B,D,E
Rationale: Bowel prep (B) is not typically required for ERCP. Persistent pain and distention (D) post-ERCP require immediate notification, not delayed. White stools (E) are not expected post-ERCP. Fasting (A) and needing a driver (C) are correct.
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The nurse is admitting a client newly diagnosed with acute pancreatitis. The nurse should anticipate a prescription for which medication?
- A. 3% saline infusion
- B. Fentanyl
- C. Diphenoxylate-atropine
- D. Sucralfate
Correct Answer: B
Rationale: Fentanyl is used for pain management in acute pancreatitis, which is often severe. 3% saline is not standard, diphenoxylate-atropine treats diarrhea (not a primary symptom), and sucralfate is for ulcers, not pancreatitis.
The nurse is caring for a client who is diagnosed with acute appendicitis. After several hours of pain, the client suddenly states a relief in his pain. What is the initial action of the nurse?
- A. Notify the physician
- B. Document the finding
- C. Insert an IV cannula
- D. Administer a laxative
Correct Answer: A
Rationale: Sudden pain relief in appendicitis (A) may indicate appendix rupture, a medical emergency requiring immediate physician notification.
The following scenario applies to the next 1 items
The nurse in the physician's office cares for a client looking to establish care
Item 1 of 1
Nurses' Notes
1709: 58-year-old African American male presents to the office looking to establish primary care. The client has not had a primary healthcare provider in over eleven years. The client requests a physical examination. The client reports that two months ago, he started noticing changes in his bowel habits, which alternate between diarrhea and constipation. The symptoms are accompanied by occasional dark, tarry stools. This past week, he has had constant abdominal pain that has ranged from a 5/10 to a 7/10 on the Numerical Rating Scale. He describes the pain as 'dull.' He reports that his diet has not changed, and he primarily eats red meat and sandwiches made with luncheon meats and occasionally vegetables. Currently, the client takes a daily aspirin and a multivitamin. He reports a medical history of oral herpes simplex and high blood pressure. He is overweight. He smokes cigarettes daily. On assessment, the client is alert and fully oriented, skin is warm and dry. Lung sounds are clear; the apical pulse is regular. Bowel sounds are active in all quadrants, with no abdominal distention. Capillary refill less than 3 seconds. Peripheral pulses palpable, 2+. Vital signs: T 97.5° F (36.4° C), P 97, RR 18, BP 161/92, pulse oximetry reading 96% on room air.
Orders
1719:
• Point of care (POC) hemoglobin and hematocrit
• Guaiac-based fecal occult blood test (gFOBT)
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. Obtain an order for serum type and screen, obtain an order for a colonoscopy, educate the client on adopting a high fiber diet, request a prescription for an oral corticosteroid.
- B. Bowel obstruction, ulcerative colitis, colon cancer, peptic ulcer disease.
- C. Pain level, serum glucose level, bowel elimination pattern or habits, white blood cell (WBC) count.
Correct Answer: B: Colon cancer; A: Obtain an order for a colonoscopy, educate the client on adopting a high fiber diet; C: Pain level, bowel elimination pattern or habits
Rationale: Dark, tarry stools, changing bowel habits, and abdominal pain suggest colon cancer (B). Ordering a colonoscopy and promoting a high-fiber diet (A) aid diagnosis and management. Monitoring pain and bowel patterns (C) tracks progress.
The nurse is caring for a client with appendicitis experiencing pain. Which pain relief method would be inappropriate for this client?
- A. Applying ice packs to the abdomen
- B. Practicing breathing exercises with the patient
- C. Using a heating pad on the abdomen
- D. Encouraging rest
Correct Answer: C
Rationale: Using a heating pad on the abdomen is inappropriate for a client with appendicitis as it may increase inflammation or risk perforation of the appendix. Ice packs, breathing exercises, and rest are safer and more appropriate for pain management.
The nurse is caring for a client with diverticulosis who reports difficulty getting enough dietary fiber. The nurse should anticipate the primary healthcare provider (PHCP) will prescribe
- A. Psyllium
- B. Oil-retention enema
- C. Codeine
- D. Bisacodyl
Correct Answer: A
Rationale: Psyllium, a bulk-forming laxative, increases fiber intake, promoting regular bowel movements in diverticulosis. Enemas, codeine (which slows motility), and bisacodyl (a stimulant laxative) are not appropriate for increasing dietary fiber.