A nurse is caring for a 43-year-old female client who reports abdominal pain.
For each potential provider's order, click to specify if the potential order is anticipated or contraindicated for this client.
Begin broad spectrum IV antibiotics.
Transfuse 1 unit of packed red blood cells.
Prepare client for endoscopic retrograde cholangiopancreatography.
Administer morphine sulfate IV push for pain.
The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"B"}}
1. Begin Broad Spectrum IV Antibiotics Anticipated
The client's symptoms, including right upper quadrant pain, nausea, vomiting, jaundice, fever, and elevated white blood cell count, suggest a potential infection or inflammation in the abdominal area, possibly related to the biliary system (e.g., cholecystitis or cholangitis). Broad-spectrum antibiotics are commonly used to treat infections that could be causing these symptoms, especially if the exact pathogen is not yet identified. The elevated white blood cell count further supports the likelihood of an infection.
2. Transfuse 1 Unit of Packed Red Blood Cells Contraindicated
There is no indication from the provided information that the client has anemia or a significant drop in hemoglobin that would necessitate a blood transfusion. The hemoglobin level is 15.1 g/dL, which is within normal limits. Blood transfusion would typically be considered if there was evidence of significant blood loss or anemia, neither of which is indicated by the client’s current lab results.
3. Prepare Client for Endoscopic Retrograde Cholangiopancreatography (ERCP) Anticipated
The symptoms described, including right upper quadrant pain radiating to the right shoulder, jaundice, and the dark amber urine, are suggestive of biliary tract involvement, such as gallstones causing obstruction or infection. ERCP is a diagnostic and therapeutic procedure used to visualize and treat conditions of the bile ducts and pancreatic ducts. Given the symptoms and clinical presentation, preparing the client for an ERCP to assess and potentially address issues in the biliary system is appropriate.
4. Administer Morphine Sulfate IV Push for Pain Contraindicated
The client has a documented allergy to morphine. Administering morphine could lead to an allergic reaction and is therefore contraindicated. Alternative pain management options should be considered, such as non-opioid analgesics or other opioid medications that the client is not allergic to.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Increased sensitivity to cold is not typically associated with Bell's Palsy or ptosis but might be a general sensation change related to nerve involvement.
B. Drooling from the corner of the mouth is a result of facial weakness affecting the muscles responsible for controlling saliva and mouth closure. While drooling is a common symptom of Bell's Palsy due to impaired muscle control, it is not a description of ptosis. Ptosis specifically refers to the drooping of the upper eyelid.
C. Ringing in the ear, or tinnitus, is not a direct symptom of ptosis. Tinnitus might be associated with various conditions affecting the ear or cranial nerves but is not specifically indicative of ptosis, which is related to eyelid drooping.
D. Ptosis refers to the drooping or sagging of the upper eyelid. In the context of Bell's Palsy, this drooping occurs on the affected side due to weakness or paralysis of the muscles that normally help elevate the eyelid.
Correct Answer is C
Explanation
A. Casts in the urine are typically associated with kidney problems, such as glomerulonephritis or kidney infections, rather than biliary obstruction. Casts are formed from proteins or cells in the renal tubules and are not related to bile duct obstruction or cholelithiasis.
B. Dark, tarry stools are indicative of upper gastrointestinal bleeding and the presence of digested blood in the stool. This condition, known as melena, is not typically associated with obstruction of the common bile duct due to cholelithiasis.
C. Jaundice is a common and significant finding in cases of obstruction of the common bile duct due to cholelithiasis. When the bile duct is obstructed, bilirubin, which is a component of bile, accumulates in the bloodstream because it cannot be properly excreted into the intestine.
D. Pain from cholelithiasis (gallstones) typically occurs in the right upper quadrant, not the left. The right upper quadrant pain is often associated with gallbladder inflammation or bile duct obstruction.
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