A client with peptic ulcer disease (PUD) is admitted to the emergency room complaining of sudden severe upper abdominal pain. Assessment indicates an extremely tender and rigid abdomen, blood pressure 90/60 mmHg, and pulse of 110 beats/minute. Which procedure should the emergency department nurse plan for immediate implementation?

Nasogastric tube insertion.

Iced saline lavage.

Administration pantoprazole (Protonix) IV, a proton pump inhibitor.

Emergency abdominal surgery.

Answer and Explanation

The Correct Answer is D

Choice A: Nasogastric tube insertion may be indicated in the management of a client with peptic ulcer disease (PUD) to assess bleeding, relieve gastric distention, or administer medications. However, in this scenario, the client's presentation with sudden severe upper abdominal pain, a tender and rigid abdomen, hypotension, and tachycardia suggests a potentially life-threatening condition that requires immediate intervention beyond nasogastric tube insertion.

Choice B: Iced saline lavage is not a standard procedure for managing peptic ulcer disease (PUD) or its complications. It is not the immediate intervention required for the client's presentation.

Choice C: Administration of pantoprazole (Protonix) IV, a proton pump inhibitor, is a relevant intervention for managing peptic ulcer disease (PUD), but it may not be the most immediate action needed for a client with sudden severe abdominal pain, hypotension, and tachycardia. More urgent interventions are required.

Choice D: Emergency abdominal surgery is the most appropriate and immediate intervention for a client with sudden severe upper abdominal pain, a tender and rigid abdomen, hypotension, and tachycardia. These signs and symptoms may indicate a perforated peptic ulcer, which is a surgical emergency requiring prompt exploration and repair of the perforation to prevent peritonitis and sepsis.

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Correct Answer is D

Explanation

A. Serum protein is an indicator of the client’s overall nutritional status, but it is not as immediately critical to monitor as glucose levels in clients receiving TPN. Protein levels change more slowly over time and are not an acute concern.

B. While serum osmolarity is important in evaluating hydration status and electrolyte balance, it is not the primary lab to monitor during TPN administration. Glucose fluctuations are more likely to cause immediate complications.

C. Urinary ketones are typically monitored in clients with diabetic ketoacidosis (DKA), not in clients receiving TPN. Ketones are a byproduct of fat metabolism and are not a priority in TPN management.

D. Capillary glucose is the most important lab to monitor in clients on TPN because TPN solutions contain high amounts of glucose, which can lead to hyperglycemia. Monitoring glucose levels helps prevent complications such as hyperglycemia or hypoglycemia and is critical in managing the client's metabolic response to TPN.

A. Permanent life-style changes need to be made to promote safety in the home. B. Muscle tension is decreased with fine motor skill projects, so these activities should be encouraged C. Consistent discipline is needed to help the child control the movements. D. The chorea or movements are temporary and will eventually disappear.

Correct Answer is D

Explanation

Choice A: Permanent lifestyle changes may not be necessary for a child with rheumatic fever and associated chorea. Rheumatic fever is typically treated with antibiotics to clear the streptococcal infection and prevent further complications.

Choice B: Muscle tension is not typically decreased with fine motor skill projects, and encouraging such activities may not directly address the symptoms of chorea. Fine motor activities can be pursued if they are enjoyable for the child but should not be presented as a primary treatment.

Choice C: Consistent discipline is important for children but may not be the primary focus when addressing chorea associated with rheumatic fever. Discipline should be appropriate and consistent but should not be the primary intervention for chorea.

Choice D: The chorea or movements are temporary and will eventually disappear. This is the most accurate and reassuring information to provide to the parents. Chorea associated with rheumatic fever typically resolves over time with appropriate treatment, and the child is expected to recover fully.

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Explanation

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Correct Answer is D

Explanation

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