A client presents to the emergency room with epigastric pain and nausea.

Which prescriptions should the nurse anticipate?

Analgesia, nasogastric tube, intravenous fluids, and total parenteral nutrition,

Analgesia, intravenous fluids, and clear liquids.

intravenous fluids and nasogastric tube.

Analgesia, intravenous fluids, nothing by mouth, and antiemetics

Answer and Explanation

The Correct Answer is D

Rationale:

A. This combination is typically reserved for severe pancreatitis with prolonged ileus or inability to tolerate enteral feeding. In this client, bowel sounds are present and the patient is passing flatus, indicating functional gastrointestinal activity, so total parenteral nutrition (TPN) and an NG tube are not immediately indicated.

B. While clear liquids may be appropriate later, initiating oral intake too early could worsen nausea, vomiting, or abdominal pain in acute pancreatitis. Current assessment indicates the client should not eat until stabilized and nausea controlled.

C. An NG tube is indicated primarily for significant vomiting, gastric outlet obstruction, or ileus. This client has vomited only once and has positive bowel sounds, so routine NG tube placement is unnecessary.

D. The client’s presentation—epigastric pain radiating to the back and left shoulder, bluish umbilical discoloration (Cullen sign), nausea, vomiting, and fever with tachycardia—is consistent with acute pancreatitis. Standard initial management includes: pain control, IV fluid resuscitation, NPO (nothing by mouth) to rest the pancreas, and antiemetics to control nausea. Early supportive care helps stabilize the client and prevent complications.

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Correct Answer is ["B","C","D"]

Explanation

Rationale:

A. Mild to moderate chest pain with deep inspiration is expected after chest tube insertion due to pleural irritation or tissue trauma. Pain should be managed with analgesics, but it does not require immediate provider notification unless accompanied by respiratory distress, hypotension, or other signs of complication.

B. Subcutaneous emphysema (air under the skin, often felt as crepitus) indicates air leaking from the pleural space into surrounding tissue. This may signal tube displacement, a worsening pneumothorax, or a new pleural leak, all of which require urgent provider notification. Severe cases can compromise the airway.

C. The water seal chamber should only bubble intermittently during exhalation or coughing. Continuous or constant bubbling indicates an air leak, suggesting tube malfunction or pleural space compromise. This can prevent proper lung re-expansion and requires prompt provider evaluation.

D. Chest tube eyelets should remain entirely within the pleural cavity. If they are visible, the tube is malpositioned, which can prevent drainage and worsen the pneumothorax or cause tissue damage. This is an urgent finding requiring immediate attention.

E. This is expected behavior for a properly functioning chest tube. Intermittent bubbling with exhalation or coughing shows that the tube is patent and air is being expelled from the pleural space. It does not require provider notification.

A. Nutritional support B. Education C. Pain control D. Fluid resuscitation

Correct Answer is D

Explanation

Rationale:

A. Nutritional support is important in acute pancreatitis, particularly if oral intake is delayed due to NPO status. However, it is not the immediate priority in the initial management of acute pancreatitis.

B. Patient education is essential for long-term management, dietary changes, and prevention of complications, but it is not the priority during the acute phase when the patient is unstable or in severe pain.

C. Pain management is important and should be addressed promptly, but it is secondary to stabilizing vital functions. Severe pain is common in acute pancreatitis, but untreated hypovolemia and shock pose a greater immediate risk to life.

D. Acute pancreatitis often causes third-spacing of fluids, hypovolemia, and risk of shock due to systemic inflammatory response and fluid shifts into the retroperitoneal space. Aggressive intravenous fluid replacement is the priority treatment to maintain perfusion, prevent organ failure, and stabilize the client before other interventions such as pain management or nutrition.

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A client presents to the emergency room with epigastric pain and nausea. Which prescriptions should the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse assesses a client with a pleural chest tube inserted to treat a pneumothorax. Which findings require immediate notification to the provider? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

A nurse assesses a client admitted to the emergency department with acute pancreatitis. Which treatment should the nurse prioritize?

Correct Answer is D

Explanation

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A client presents to the emergency room with epigastric pain and nausea.

Which prescriptions should the nurse anticipate?