Gastrointestinal Disorders NCLEX RN Related

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

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.

The following scenario applies to the next 1 items
The nurse is caring for an older adult in the medical-surgical unit
Item 1 of 1
Health History
84-year-old female was admitted to the medical-surgical unit with a three-day history of abdominal pain, distention, nausea, and persistent vomiting. She reports that she has not had a bowel movement in five days and has no appetite.

Vital Signs
Oral temperature 101.1° F (38.3° C)
Pulse 108/minute
Respirations 22/minute
Blood pressure 100/64 mm Hg
Oxygen saturation 96% on room air.

The nurse reviews the client's health history and vital signs. Click to specify if the findings are consistent with a small bowel obstruction or appendicitis. Each row must have at least one but may have more than one response option selected.

• A. Unable to pass stool
• B. Fever
• C. Distended abdomen
• D. Right lower quadrant abdominal pain
• E. Nausea and vomiting

The emergency department (ED) nurse is caring for a 45-year-old male client.
Item 3 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 client is at risk for developing........... and .......

• A. Cholelithiasis
• B. Pulmonary edema
• C. Gastrointestinal bleeding
• D. Intestinal obstruction
• E. Diabetic ketoacidosis (DKA)
• F. Hypovolemia
• G. Pulmonary embolism

The following scenario applies to the next 1 items
The nurse is caring for a client immediately following an abdominal paracentesis
Item 1 of 1
Procedure Note
1845 - Emergency ultrasound-guided abdominal paracentesis was performed because the client presented with labored respirations, dyspnea, abdominal cramping, and overall discomfort. Informed consent was obtained, and the client agreed to the procedure. Prior to the procedure, the client emptied their bladder. The site was cleaned and numbed with 1% lidocaine, and using an aseptic technique and an ultrasound; a 14-gauge catheter was inserted to remove 10 mL of clear ascitic fluid. Subsequently, the fluid was drained via tubing. 6 liters of fluid were removed. The client tolerated the procedure well and reported immediate relief in the dyspnea and abdominal cramping following the procedure.

Immediately following this procedure, the nurse should monitor the client's ............. because the client has the risk of ........... If the client should experience this immediate post-procedure complication, the nurse should anticipate a prescription for ........

• A. Blood pressure
• B. Urinary output
• C. Hypotension
• D. Peritonitis
• E. Albumin
• F. Ceftriaxone