Nokea
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.
Correct Answer: C
Rationale: Milk of magnesia (C) is contraindicated in suspected bowel perforation as it may worsen the condition by increasing intestinal motility or causing further leakage. Gastrografin (A), laparotomy (B), and CT scans (D) are appropriate diagnostic or therapeutic measures.
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The nurse is caring for a client admitted with an exacerbation of Crohn's disease
Item 1 of 1
• History and Physical
A 25-year-old male has had Crohn's disease for over six years. He is admitted to the hospital for severe diarrhea, abdominal pain, and fatigue. The client will be admitted for fluid replacement, antibiotics, steroids, and pain control.
• Physician Orders
• Admit to the medical-surgical unit
• Nothing by mouth (NPO)
• Gastroenterology consultation
• Lactated Ringers at 80 mL/hr
• Metronidazole 500 mg intravenous piggyback q 8 hours
• Methylprednisolone 125 mg intravenously q 12 hours
Drag the words from the word choices below to fill in each blank of the following sentences: The prescribed------------------------------puts the client at risk for complications such as hyperglycemia. To recognize this complication the nurse should monitor the client’s------------------
- A. metronidazole
- B. lactated ringers
- C. methylprednisolone
- D. nothing by mouth status
- E. capillary blood glucose
- F. hemoglobin A1C
Correct Answer: C,E
Rationale: Methylprednisolone is a corticosteroid that may cause elevated blood glucose and even hyperglycemia (blood glucose 250 mg/dL or greater). This is a common treatment for exacerbations of inflammatory bowel disorders. Hyperglycemia may complicate outcomes by delaying wound healing and increasing the client’s risk for infection. Thus, the nurse should monitor the capillary blood glucose and collaborate with the primary healthcare provider.
Monitoring the hemoglobin A1C is useful for monitoring the clinical progress of a client with chronic diabetes. This value is collected every 90-120 days and would not be useful during this acute course of steroids.
During an exacerbation of Crohn’s disease, it is likely that the client will be prescribed antibiotics such as metronidazole. The client will also have fluid repletion, and isotonic solutions such as lactated ringers may be given to rehydrate the client.
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
Correct Answer: A,C,E
Rationale: Monitor blood pressure (A) for hypotension (C) due to fluid shifts post-paracentesis. Albumin (E) is anticipated to restore intravascular volume if hypotension occurs.
The nurse in the intensive care unit is caring for a client being treated for necrotizing pancreatitis. Which of the following findings would indicate the client is experiencing a complication?
- A. Periumbilical bruising
- B. Abdominal pain rated 5/10 on the numerical rating scale
- C. White blood cell count 13,500 mm3 [5,000-10,000 mm3]
- D. Decreased lung sounds in the left lower lung fields
Correct Answer: D
Rationale: Decreased lung sounds (D) may indicate a complication like pleural effusion or atelectasis in necrotizing pancreatitis, requiring further evaluation.
The nurse is caring for a client who is receiving prescribed dicyclomine. Which of the following client findings would indicate a therapeutic response?
- A. Decreased abdominal cramping
- B. Absence of nausea and vomiting
- C. Decreased urinary retention
- D. Less burning with urination
Correct Answer: A
Rationale: Dicyclomine, an anticholinergic, reduces intestinal spasms, so decreased abdominal cramping indicates a therapeutic response. It is not primarily for nausea, urinary retention, or dysuria.
The nurse prepares a client for a computed tomography (CT) scan of their abdomen and pelvis with intravenous (IV) contrast. The nurse should take which action before the client's exam?
- A. Remove any medicated patches before the exam
- B. Instruct the client to empty their bladder right before the test
- C. Educate the client that they may experience a flushing sensation during the exam
- D. Assess the client for an implantable pacemaker
Correct Answer: C
Rationale: Educating about the flushing sensation (C) prepares the client for the common effect of IV contrast. Patches (A) are not routinely removed, emptying the bladder (B) is not critical, and pacemakers (D) are relevant for MRI, not CT.