Nokea
The nurse plans a staff developmental conference on total parenteral nutrition (TPN). It would be appropriate for the nurse to identify which indications for using TPN?
- A. Appendicitis
- B. Gastroesophageal reflux disease (GERD)
- C. Diverticulosis
- D. Pancreatitis
Correct Answer: D
Rationale: TPN is indicated for pancreatitis when oral intake is not possible due to severe inflammation. Appendicitis, GERD, and diverticulosis typically do not require TPN, as oral or enteral nutrition is often feasible.
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The nurse is teaching a client about prescribed metronidazole. Which of the following statements by the client indicates effective teaching?
- A. I should not drink alcohol while I’m taking metronidazole.
- B. It is okay for me to be in the sun while I’m taking this medicine.
- C. I should take the medicine until my stomach stops hurting, then stop.
- D. I should take the medicine on an empty stomach.
Correct Answer: A
Rationale: Metronidazole can cause a disulfiram-like reaction with alcohol, so avoiding alcohol is correct. Sun exposure is not a major concern, stopping early risks incomplete treatment, and metronidazole can be taken with food.
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.
The nurse is teaching a client about their newly established colostomy. Which of the following statements by the client would require follow-up?
- A. I will call my primary healthcare provider (PHCP) immediately if my stoma becomes bluish.
- B. I should slowly introduce high-fiber foods in my diet.
- C. I must always wear a pouch over my stoma.
- D. I should clean the skin around my stoma with rubbing alcohol.
Correct Answer: D
Rationale: Using rubbing alcohol (D) can irritate the skin around the stoma. Options A, B, and C are appropriate for colostomy care.
A nurse is caring for a client diagnosed with a duodenal ulcer. Which medication facilitates healing by forming a protective lining over the client's ulcer?
- A. Famotidine
- B. Omeprazole
- C. Sucralfate
- D. Cimetidine
Correct Answer: C
Rationale: Sucralfate (C) forms a protective barrier over the ulcer, promoting healing by shielding it from stomach acid. Famotidine (A) and cimetidine (D) are H2 blockers, and omeprazole (B) is a proton pump inhibitor, which reduce acid but do not form a physical barrier.
The nurse assesses a client receiving total parenteral nutrition (TPN) and fat emulsions. The nurse observes that the fat emulsion infusion is one hour behind schedule. The nurse should take which action?
- A. Adjust the infusion rate to make up the difference over the next hour, then revert the infusion rate back to the prescribed rate.
- B. Increase the infusion rate to ensure that the infusion finishes at the correct time.
- C. Ensure the fat emulsion infusion rate is infusing at the prescribed rate and maintain the rate at the prescribed rate.
- D. Stop the infusion and inform the primary health care provider (PHCP).
Correct Answer: C
Rationale: Fat emulsions must be infused at a steady, prescribed rate to prevent complications like fat overload syndrome. Adjusting or increasing the rate can be dangerous, and stopping the infusion is unnecessary unless there’s a specific issue.