Nokea
Your client has just undergone a fecal diversion surgery and will be discharged to their home. Which type of social support person or support network is most likely to benefit this client in terms of post-discharge self-care and physical adaptations necessary for this client?
- A. A peer support network like an ostomy group in the community to promote self-care
- B. An emotional support person to help the client cope with the altered bodily image
- C. An instrumental support network to help with activities of daily living (ADLs)
- D. A church group of volunteers who can transport the client to health care provider (HCP) appointments
Correct Answer: A
Rationale: A peer support network like an ostomy group (A) provides practical self-care education and emotional support, critical for adapting to a new colostomy.
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The emergency department (ED) nurse is caring for a 45-year-old male client.
Item 6 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 knows that the client's condition is improving when they report a reduction in [condition].
- A. Urine output
- B. Pain
- C. Muscle strength
- D. None of the above
Correct Answer: B
Rationale: A reduction in pain (B) indicates improvement in acute pancreatitis as inflammation subsides. Reduced urine output (A) or muscle strength (C) would not reflect improvement.
The following scenario applies to the next 1 items
The nurse is caring for a client in the outpatient clinic
Item 1 of 1
Nurses’ Note
35-year-female arrives at the clinic for reported loss of appetite and nausea. The client reports that she is not eating as much because she experiences palpitations, sweating, and dizziness about thirty minutes after she eats. She reports that she has not been adherent to the prescribed diet and her symptoms worsen when she eats something sweet and drinks cola.
Medical History
• Morbid obesity (BMI 42)
• Roux-en-Y procedure eight weeks ago
Complete the following sentence by choosing from the list of options. To prevent.........., the nurse should instruct the client ............. and ...........
- A. Pernicious anemia
- B. Dumping syndrome
- C. Lie down after meals
- D. Exercise after meals
- E. Avoid drinking with meals
- F. Eat food high in carbohydrates
- G. Eat food high in vitamin B12
Correct Answer: B,E
Rationale: Dumping syndrome (B) occurs post-Roux-en-Y due to rapid gastric emptying. Avoiding drinking with meals (E) slows digestion, reducing symptoms. Lying down after meals (C) can worsen symptoms and is not advised.
The nurse is positioning a client following a liver biopsy. Which position is best suited for this client?
- A. On the left side with a pillow under the ribs.
- B. Supine with a pillow under the client's knees.
- C. Face down with a pillow under the hips.
- D. On the right side with a pillow under the biopsy site.
Correct Answer: D
Rationale: The right-side position with a pillow under the biopsy site (D) applies pressure to prevent bleeding post-liver biopsy.
The nurse is caring for a client who has ascites and hepatic encephalopathy. Which of the following prescriptions should the nurse anticipate from the primary healthcare provider (PHCP)? Select all that apply.
- A. Furosemide
- B. Neomycin
- C. Naproxen
- D. Lactulose
- E. Diazepam
Correct Answer: A,B,D
Rationale: Furosemide (A) manages ascites, neomycin (B) reduces gut ammonia production, and lactulose (D) treats hepatic encephalopathy. Naproxen (C) and diazepam (E) can worsen liver dysfunction or encephalopathy.
The nurse is assessing a client with acute cholecystitis. Which of the following physical assessment findings would be expected?
- A. Stools that contain blood and mucus
- B. Pain with urination
- C. Episodic upper abdominal pain
- D. Hypoactive bowel sounds
Correct Answer: C
Rationale: Episodic upper abdominal pain (C), often in the right upper quadrant, is a hallmark of acute cholecystitis due to gallbladder inflammation.