A nurse is admitting a client from a provider's offic

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A nurse is admitting a client from a provider's office.

Click to highlight the provider prescriptions the nurse should implement first.

Vital signs on admission and every 4 hr NPO

Complete blood count

Basic metabolic profile

Arterial blood gases

Hemoccult stool

Stool culture and sensitivity

Urine culture and sensitivity

Sitz baths up to 3 times daily PRN

Medications:

Dextrose 5% in 0.45% sodium chloride IV at 125 mL/hr

Metoclopramide 10 mg IV every 6 hr PRN nausea/vomiting

Ciprofloxacin 400 mg IV every 12 hr

Basic metabolic profile

Hemoccult stool

Stool culture and sensitivity

Urine culture and sensitivity

Sitz baths up to 3 times daily PRN

Dextrose 5% in 0.45% sodium chloride IV at 125 mL/hr

Ciprofloxacin 400 mg IV every 12 hr

Answer and Explanation

The Correct Answer is ["C","D","F","G"]

Dextrose 5% in 0.45% sodium chloride IV at 125 mL/hr. The client exhibits clinical signs of hypovolemic shock, including a heart rate of 122/min, blood pressure of 96/48 mm Hg, and dark concentrated urine. Restoring intravascular volume is the highest priority to maintain organ perfusion and reverse the 48-hour fluid loss from vomiting and diarrhea. Intravenous rehydration directly addresses the fluid volume deficit identified in the provider's physical assessment. This intervention must be initiated immediately to stabilize the patient's deteriorating hemodynamic status.

Stool culture and sensitivity. In cases of suspected foodborne illness with hematochezia and febrile illness, identifying the specific enteric pathogen is essential for targeted therapy. Obtaining the specimen before the administration of the first dose of antibiotics ensures the diagnostic integrity of the culture results. This diagnostic step allows the healthcare team to differentiate between various bacterial, viral, or parasitic causes of gastroenteritis. The nurse must prioritize collection to guide the transition from empiric to definitive antimicrobial treatment.

Urine culture and sensitivity. The report of dark, concentrated urine and decreased output suggests potential pre-renal azotemia or a concurrent urinary tract infection contributing to the febrile state. Collecting a urine sample before starting systemic antibiotics is a standard nursing priority to ensure accurate identification of any bacteriuria. This data helps the provider rule out systemic complications or alternative sources of infection in a lethargic, febrile patient. Accurate cultures are critical for antimicrobial stewardship and ensuring the most effective treatment plan is followed.

Ciprofloxacin 400 mg IV every 12 hr. Administering empiric antibiotics is a priority for a patient showing signs of systemic infection, including a temperature of 39° C and tachycardia. Ciprofloxacin provides broad-spectrum coverage against common gram-negative enteric pathogens associated with undercooked meat and contaminated food. Rapid initiation of antimicrobial therapy reduces the risk of the infection progressing to bacteremia or septicemia. This intervention should follow the collection of cultures but must not be delayed significantly in a hemodynamically unstable client.

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Correct Answer is ["D","E"]

Explanation

A. The need for frequent visits to the emergency department for bowel management. While Hirschsprung’s disease involves significant intestinal dysfunction, the goal of long-term management is to establish a predictable home routine. Parents are taught to monitor for enterocolitis, a life-threatening complication, which would necessitate emergency care. Routine bowel management is typically handled through specialized outpatient follow-up rather than recurrent emergency department utilization.

B. The importance of maintaining a high-fiber diet. High-fiber intake can exacerbate abdominal distension and obstruction in a child with an aganglionic colon segment. The lack of peristalsis in the affected area means that bulkier stools are more difficult to propel, increasing the risk of impaction. Dietary management usually focuses on low-residue or specialized formulas to facilitate easier passage of stool before surgical correction.

C. Strict adherence to a low-protein diet. Protein intake is essential for the growth and tissue repair of a pediatric patient, especially when preparing for surgical intervention. There is no physiological basis for restricting protein in Hirschsprung’s disease, as it does not affect the aganglionic nature of the bowel. Education should focus on high-calorie, nutritious options that do not contribute to intestinal bulk or obstruction.

D. The need for surgical intervention to correct the condition. Hirschsprung’s disease is caused by the absence of ganglion cells in the distal colon, which can only be resolved by removing the aganglionic segment. Surgical procedures, such as a pull-through operation, are necessary to restore functional bowel motility and prevent chronic obstruction. Parents must understand the surgical timeline and the potential need for a temporary colostomy to allow the bowel to rest.

E. The importance of avoiding medications that can cause constipation. Many common medications, such as certain analgesics or anticholinergics, decrease intestinal motility and can worsen the existing functional obstruction. In a child with impaired colonic transit, these drugs increase the risk of fecal impaction and toxic megacolon. Parents must be educated to screen all over-the-counter and prescribed medications for side effects that impact gastrointestinal motility.

F. The need for frequent enemas to stimulate bowel movements. While enemas are used preoperatively to decompress the bowel, they are not a long-term alternative to surgical correction. Over-reliance on enemas can lead to electrolyte imbalances and potential mucosal injury in a pediatric patient. Education focuses on the temporary nature of these interventions as a bridge to definitive surgical treatment.

G. The need for daily laxative use to promote bowel movements. Laxatives are generally ineffective in Hirschsprung’s disease because the primary issue is a lack of innervation, not slow transit in healthy tissue. Forcing stool into an aganglionic, non-relaxing segment can cause significant pain and increased intraluminal pressure. Management prioritizes surgical resection of the non-functional segment over pharmacological attempts to force bowel movements.

A. Cluster activities in the morning when well rested B. Request a medical prescription for cortisol C. Assess daily weights D. Teach the client to increase fluid intake

Correct Answer is C

Explanation

A. Cluster activities in the morning when well rested. Clients with Cushing's syndrome often suffer from severe muscle wasting and fatigue due to protein catabolism. However, activity should be paced throughout the entire day rather than clustered, which can cause overexertion and cardiovascular strain. Frequent rest periods are necessary to manage the physiological exhaustion associated with chronic hypercortisolism.

B. Request a medical prescription for cortisol. Cushing's syndrome is characterized by an endogenous overproduction of cortisol or exogenous steroid excess. Administering additional cortisol would exacerbate the condition and worsen clinical symptoms such as hypertension and hyperglycemia. The goal of treatment is typically to reduce or block cortisol production rather than increase its systemic levels.

C. Assess daily weights. Hypercortisolism leads to significant sodium and water retention, resulting in edema and weight gain. Monitoring daily weights is a critical nursing intervention to evaluate fluid status and the effectiveness of treatment. This assessment helps the nurse identify rapid fluid accumulation that could lead to congestive heart failure or pulmonary edema in these patients.

D. Teach the client to increase fluid intake. Due to the high risk of fluid volume excess and hypertension, increasing fluid intake is generally contraindicated for clients with Cushing's syndrome. Fluid intake may need to be restricted to prevent worsening edema and cardiovascular complications. The nurse should focus on monitoring intake and output to ensure a balanced fluid volume.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a child diagnosed with Hirschsprung's disease. Which of the following should the nurse include in the education of the child's parents? (Select All that Apply.)

Correct Answer is ["D","E"]

Explanation

The nurse is caring for a client with a medical diagnosis of Cushing's syndrome. What would the nurse include in the plan of care?

Correct Answer is C

Explanation

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