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The nurse is assessing a client with ulcerative colitis. Which of the following would be an expected finding?
- A. Projectile vomiting
- B. Frequent bloody stools
- C. Absent bowel sounds
- D. Periumbilical bruising
Correct Answer: B
Rationale: Frequent bloody stools (B) are a hallmark of ulcerative colitis due to mucosal inflammation. Projectile vomiting (A), absent bowel sounds (C), and periumbilical bruising (D) are not typically associated with UC.
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The nurse is teaching a client about peptic ulcer disease. Which of the following statements should the nurse include?
- A. You should take aspirin if you have mild aches or pains.
- B. You will need to consume liquids one hour after each meal.
- C. It will be important to reduce the stress in your life.
- D. Take your prescribed omeprazole with food.
Correct Answer: C
Rationale: Stress reduction (C) helps manage peptic ulcer disease by reducing acid secretion. Aspirin (A) worsens ulcers, liquids with meals (B) are not restricted, and omeprazole (D) is taken before meals.
The nurse is caring for a client with advanced liver cirrhosis receiving prescribed medications. Which medications would the nurse clarify with the primary healthcare provider (PHCP)? Select all that apply.
- A. Isoniazid
- B. Valproic Acid
- C. Amiodarone
- D. Lithium
- E. Thiamine
Correct Answer: A,B,C
Rationale: Isoniazid, valproic acid, and amiodarone are hepatotoxic and can exacerbate liver damage in cirrhosis, requiring clarification with the PHCP. Lithium is not primarily hepatotoxic, and thiamine is often beneficial in cirrhosis to prevent Wernicke’s encephalopathy.
The emergency department (ED) nurse is caring for a 45-year-old male client.
Item 4 of 6
Orders
0600
• Cardiac monitoring
• NPO
• CBC
• CMP
• LFTs
• Amylase
• Lipase
• CT abdomen with contrast
Nurses’ Notes
0600: The client reports sudden, severe epigastric pain. He has a history of chronic alcohol use disorder (30+ years), GERD, and hypertension. His home medications include pantoprazole and lisinopril. Upon assessment, the client is noted to be alert and oriented x4. He is mildly diaphoretic, with pulses 2+ and regular. Abdomen is distended, guarding on palpation, diminished bowel sounds, and no stool in the last 24 hours. He reports nausea and vomiting, and his pain is worse after eating fatty foods, rated 7/10 and radiating to his back. Breath sounds slightly diminished bilaterally, no adventitious sounds, denies cough or dyspnea. He reports heavy alcohol intake two days ago. Fingerstick glucose is 145 mg/dL (8.06 mmol/L) [70-110 mg/dL; 4-6 mmol/L]. Temperature is 101.3°F (38.5°C), heart rate of 112 bpm, respiratory rate of 24 breaths/min, blood pressure of 98/64 mmHg, and oxygen saturation of 95% on room air.
0630: Physician confirmed the diagnosis of acute pancreatitis based on clinical presentation, laboratory findings, and imaging studies.
Laboratory & Imaging Results
0630
Exam: CT Abdomen and Pelvis with IV Contrast
Indication: Acute onset of epigastric abdominal pain, nausea, vomiting.
Findings:
Pancreas: Diffuse enlargement of the pancreas with heterogeneous enhancement. Peripancreatic fat stranding and inflammatory changes are present, most pronounced around the pancreatic head and body. No evidence of necrosis at this time. No discrete mass or cystic lesion noted. Biliary system: Gallbladder is distended with no wall thickening or pericholecystic fluid. No gallstones visualized. Common bile duct is normal in caliber (~5 mm). Liver, spleen, kidneys, and adrenal glands: Normal in appearance. No focal lesions. Bowel: No obstruction or bowel wall thickening noted.
Impression:
Imaging findings are consistent with acute interstitial edematous pancreatitis.
No evidence of pancreatic necrosis or pseudocyst formation at this time.
The nurse anticipates an order to administer intravenous ..................in order to............
- A. Plasma colloid expander
- B. Hypertonic saline
- C. Isotonic crystalloid
- D. Reduce pulmonary edema
- E. Decrease electrolyte toxicity
- F. Replace fluid loss from third spacing
Correct Answer: C,F
Rationale: Isotonic crystalloid (C), such as Lactated Ringer's, is used to replace fluid loss from third spacing (F) in acute pancreatitis, addressing hypovolemia due to inflammation and fluid shifts.
A client with peptic ulcer disease from chronic nonsteroidal anti-inflammatory drug (NSAID) use is prescribed misoprostol. The nurse would be correct in informing the client that this medication does which of the following?
- A. Decreases gas formation
- B. Increases the speed of gastric emptying
- C. Lines the stomach for protection
- D. Increases the lower esophageal sphincter pressure
Correct Answer: C
Rationale: Misoprostol (C) protects the stomach by increasing mucus production and reducing acid secretion, helping to heal NSAID-induced ulcers.
The nurse is caring for a postoperative client who underwent abdominal surgery and is receiving patient-controlled analgesia (PCA) with morphine for pain management. The nurse notes that the client is sedated but still complaining of severe pain. What is the most appropriate action for the nurse to take?
- A. Increase the PCA dosage
- B. Administer a non-opioid analgesic
- C. Discontinue PCA and Administer Intramuscular (IM) Morphine
- D. Notify the healthcare provider
Correct Answer: D
Rationale: Notifying the provider (D) is appropriate when the client is sedated yet in severe pain, indicating potential PCA inadequacy or complications requiring reassessment.