Gastrointestinal Disorders NCLEX RN Related

The emergency department (ED) nurse is caring for a 45-year-old male client.
Item 5 of 6
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.

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.
1030: Client receiving LR at 150 mL/hr, calcium replacement completed. Urine output over the last 4 hours is 80 mL of dark amber urine. The client reports increased thirst. The abdomen continues to be distended with diminished bowel sounds. He reports that nausea has improved after receiving PRN medication. Increased edema noted in the lower extremities.

Orders
0630
• Ondansetron 4mg IV q6h PRN
• Calcium gluconate 2g IV over 5-10 minutes
• Lactated Ringer’s solution continuous infusion IV rate of 150mL/hr

The nurse is preparing interventions to address the client's needs. Select the four (4) nursing interventions that should be prioritized based on the client's current condition.

• A. Notify the provider of the client's urine output
• B. Maintain NPO status
• C. Place the client in the Trendelenburg position
• D. Request an order for an indwelling urinary catheter
• E. Begin continuous cardiac monitoring
• F. Insert a nasogastric tube for gastric decompression
• G. Educate the client about initiating a low-fat diet

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

The nurse is assisting in positioning a client for a liver biopsy procedure. Which positioning is most appropriate for the client during the procedure?

• A. Prone position with the arms extended overhead.
• B. Supine position with the right arm abducted and the head turned to the left.
• C. Left lateral decubitus position with the right arm raised above the head.
• D. Trendelenburg position with the legs elevated and the head lowered.

The nurse is caring for a client with suspected bowel perforation. Which of the following would be contraindicated?

• A. Administering gastrografin for an upper GI x-ray.
• B. An exploratory laparotomy procedure.
• C. Administering milk of magnesia following an upper GI study.
• D. An abdominal CT scan.

The nurse is caring for a client who has ulcerative colitis (UC). The nurse should teach the client to [Select all that apply].

• A. Eat consistent amounts of carbohydrates at mealtimes.
• B. Avoid drinking fluids with meals.
• C. Obtain recommended colon cancer screenings.
• D. Avoid taking anti-diarrheal medication.
• E. Increase the intake of non-caffeinated fluids during exacerbations.