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A nurse is reviewing admission assessment and plan of care for a client who has Crohn's disease. Admission Assessment
A 20-year-old admitted through emergency department who is experiencing an exacerbation of previously diagnosed Crohn's disease. Client has lost 6.8 kg (15 lb) over the past week and is too nauseated to keep anything down today. They noticed blood in their stool three days ago. Repeatedly stated to staff, "I do not want to live like this. I am totally frustrated with all you medical people."
Assessment:
Right lower quadrant abdominal pain, abdominal bloating, diarrhea (mucus and blood present), perianal abscess.
Vital Signs:
Temperature 37.5° C (99.5° F)
Heart rate 78/min
Respiratory rate 20/min
Blood pressure 102/54 mm/Hg
Provider Prescriptions
Medical management
CBC, CMP. ESR (erythrocyte sedimentary rate)
MRE (magnetic resonance enterography) of pelvis and abdomen
Corticosteroids for clinical finding management. Taper dose as indicated.
Gastrointestinal evaluation
Nutritional screening and management
Screen for depression
Smoking cessation program
Follow CDC recommended immunizations for those on immunosuppressive therapies.
Evaluate for possible surgical management.
Which members of the interdisciplinary team should the nurse anticipate being included the plan of care? Select all that apply.

Occupations Therapist

General Surgeon

Physical Therapist

Radiologist

Registered Dietitian

Gastroenterologist

Speech Therapist

Pharmacist

Social Worker

Answer and Explanation

Correct Answer : B,D,E,F,H,I

Rationale:

A. Typically involved in helping clients with activities of daily living due to physical or cognitive impairments, which is not the primary focus in this scenario.

B. May be involved if there is a need for possible surgical management due to complications or disease progression. Surgical intervention can be necessary for Crohn's disease, particularly if there are abscesses, strictures, or fistulas.

C. While important in general rehabilitation, physical therapy is not specifically indicated in this case unless there are complications affecting physical mobility.

D. The provider ordered Magnetic Resonance Enterography (MRE) to evaluate the small intestines and pelvis. A radiologist will interpret imaging studies to assess disease severity, fistulas, strictures, or abscesses.

E. Essential for managing nutritional needs, especially given the client's weight loss and inability to keep food down. A dietitian can help develop a plan to address nutritional deficiencies and manage symptoms through diet.

F. A specialist in gastrointestinal diseases who will likely be a key member of the team for managing and evaluating the client's Crohn's disease, overseeing medical and therapeutic interventions.

G. Generally involved if there are issues with swallowing or speech, which is not indicated here.

H. The client is on corticosteroids and may need immunosuppressive therapy, which requires medication management. A pharmacist ensures the correct dosage, drug interactions, and education on potential side effects.

I. Important for addressing psychosocial issues, such as the client's frustration and possible depression. They can assist with coping strategies, support services, and facilitating access to community resources.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

A. Nonmaleficence: By completing a critical care and emergency nursing course before transferring to the ICU, the nurse is ensuring they are adequately prepared to care for critically ill clients. This action minimizes the risk of harm caused by a lack of knowledge or skill, demonstrating adherence to the principle of nonmaleficence.

B. Veracity: Veracity refers to truthfulness and honesty in interactions with clients and colleagues. While important, this scenario does not focus on providing truthful information.

C. Autonomy: Autonomy refers to respecting a client's right to make decisions about their care. This scenario does not involve supporting or promoting client decision-making.

D. Fidelity: Fidelity refers to being faithful to commitments and promises made to clients or the profession. While the nurse is demonstrating professional responsibility, this scenario aligns more closely with nonmaleficence than fidelity.

A. A client who has a red rash over his abdomen B. A client who reports severe flank pain radiating to the groin C. A client who has multiple fractures D. A client who has a punctured femoral artery

Correct Answer is D

Explanation

Rationale:

A. A red rash is concerning but not typically an immediate life-threatening condition compared to other options.

B. Severe flank pain may indicate a serious condition but is not as immediately critical as a life-threatening injury.

C. Multiple fractures can be serious but are generally less urgent compared to critical injuries involving major arteries.

D. A punctured femoral artery is a life-threatening emergency requiring immediate intervention to prevent massive blood loss and ensure survival.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse on a medical-surgical unit has accepted a transfer to the Intensive care unit (ICU). Prior to transfer to the ICU, the nurse completes an online critical care and emergency nursing course. The nurse is demonstrating which of the following ethical principles?

Correct Answer is A

Explanation

A nurse in the emergency department is triaging clients following a mass casualty event. The nurse should identify which of the following clients as emergent?

Correct Answer is D

Explanation

A nurse enters a client's room and finds the client pulseless. The family has requested a do-not-resuscitate (DNR) order from the provider, but he has not written the order yet. Which of the following actions should the nurse take?

A nurse manager is providing an inservice program about delegation to assistive personnel (AP) with staff nurses on the unit. Which of the following statements by a staff nurse indicates an understanding of the teaching?

A nurse is caring for a client who falls in his room. After the nurse assesses the client, notifies the client's provider, and completes an incident report, which of the following actions should the nurse take?

A nurse is caring for four postoperative clients. The nurse can delegate obtaining vital signs to an assistive personnel (AP) for which of the following clients?

An assistive personnel (AP) comes to work with a new set of artificial nails. The nurse takes the AP to a private location to discuss the issue. Which of the following statements by the nurse is appropriate?

A nurse is discussing emergency response with a newly licensed nurse. The nurse should identify which of the following as a triage officer during the time of a disaster?

A nurse is obtaining informed consent from a client who is preoperative. Which of the following actions should the nurse take? (Select all that apply.)