A nurse is caring for a patient who the provider suspects might have pernicious anemia. The nurse should expect the provider to prescribe which of the following diagnostic tests?

Choice A reason: Crohn’s disease, an inflammatory bowel condition, typically causes weight loss due to malabsorption, diarrhea, and reduced appetite. It does not lead to secondary obesity, as the chronic inflammation and nutrient loss impair weight gain. Obesity is more associated with metabolic or endocrine disorders, not gastrointestinal diseases like Crohn’s.

Choice B reason: Addison’s disease, or adrenal insufficiency, leads to weight loss due to cortisol deficiency, causing reduced appetite, nausea, and metabolic dysfunction. It does not cause secondary obesity, as the lack of glucocorticoids impairs fat accumulation. Weight gain is more linked to conditions with excess cortisol, not its deficiency.

Choice C reason: Cushing’s disease, caused by excess cortisol from a pituitary tumor, promotes secondary obesity by increasing appetite and fat deposition, particularly in the trunk and face. Cortisol enhances gluconeogenesis and fat storage, leading to weight gain. This endocrine disorder directly causes obesity, making it the most likely condition in this scenario.

Choice D reason: Graves’ disease, a form of hyperthyroidism, causes weight loss due to increased metabolism, despite increased appetite. Elevated thyroid hormones accelerate catabolism, burning calories and preventing fat accumulation. Secondary obesity is not associated with Graves’ disease, as it promotes a hypermetabolic state, not weight gain.

Choice A reason: Obtaining vital signs every hour post-paracentesis monitors for complications like bleeding or hypovolemia, as the procedure removes peritoneal fluid, potentially causing hemodynamic instability. Frequent monitoring ensures early detection of hypotension, tachycardia, or other signs of complications, ensuring patient safety after this invasive procedure targeting spontaneous bacterial peritonitis.

Choice B reason: Having the patient void before paracentesis prevents bladder puncture, as a full bladder elevates the risk during needle insertion into the peritoneal cavity. Emptying the bladder ensures a safer procedure by reducing the risk of organ injury, a critical step in preparing for paracentesis to diagnose spontaneous bacterial peritonitis.

Choice C reason: Checking for a signed consent form is essential, as paracentesis is an invasive procedure requiring informed consent. This ensures the patient understands risks, benefits, and alternatives, adhering to ethical and legal standards. Confirming consent is a critical pre-procedure step to diagnose spontaneous bacterial peritonitis safely and appropriately.

Choice D reason: Encouraging early ambulation post-paracentesis is not standard, as patients may require monitoring for complications like bleeding or hypotension. Rest is typically advised initially to ensure stability. Ambulation may increase intra-abdominal pressure or risk complications, making it inappropriate in the immediate post-procedure care plan for this condition.

Choice E reason: Sending fluid for lab analysis is critical in paracentesis to diagnose spontaneous bacterial peritonitis. The fluid is tested for cell count, bacteria, and protein to confirm infection. This analysis guides antibiotic therapy and management, making it an essential component of the care plan to address the suspected bacterial infection.