Three days after a cholecystectomy for cholelithiasis, a female client reports having persistent upper abdominal pain that radiates to her back. She has vomited three times in the last 12 hours and has a temperature of 101.8° F. (38.7° C). Serum amylase and lipase are twice the normal value. Based on these findings, the nurse should observe the client for which pathophysiological condition?

Acute pancreatitis.

Biliary duct obstruction.

Surgical site infection.

Hepatorenal failure.

Answer and Explanation

The Correct Answer is A

A. The symptoms of persistent upper abdominal pain radiating to the back, elevated serum amylase and lipase levels, vomiting, and fever suggest acute pancreatitis, which can occur after cholecystectomy due to potential injury to the pancreas or bile duct obstruction.
B. While biliary duct obstruction can occur postoperatively, the significantly elevated amylase and lipase levels, along with the described symptoms, more strongly indicate pancreatitis.
C. Surgical site infection typically presents with localized symptoms rather than systemic symptoms like elevated amylase and lipase.
D. Hepatorenal failure is unlikely to present with these specific gastrointestinal symptoms and enzyme elevations.

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Correct Answer is C

Explanation

A. While some clients may need to manage fluid intake based on their symptoms, it is not the primary dietary restriction for Crohn's disease.
B. Clients with Crohn's disease often need to focus on nutrient-rich foods; limiting calcium and iron is not generally advised unless specific deficiencies are present.
C. An elimination diet can help identify trigger foods that exacerbate symptoms, making this response appropriate and beneficial for managing Crohn's disease.
D. Avoiding gluten is specifically related to celiac disease rather than Crohn's disease, as not all individuals with Crohn's need to eliminate gluten unless they have an associated gluten sensitivity.

A. Enalapril 10 mg every morning B. Chest x-ray now C. Admit to the medical floor D. Vital signs every 4 hours E. Send blood for a complete blood count, electrolytes F. Supplemental oxygen 10 L/min via nasal cannula G. Ibuprofen 400 mg every 4 to 6 hours PRN for temperature greater than 100.5° F (38.0° C) H. Continuous pulse oximetry

Correct Answer is ["A","F","G"]

Explanation

A. Enalapril can potentially cause hyperkalemia and hypotension, which could be detrimental to a client with pneumonia. The prescription should be questioned due to these risks.
B. A chest X-ray may be necessary to assess the extent of pneumonia; thus, it is appropriate and should not be questioned.
C. Admission to the medical floor is necessary for monitoring the client's condition due to pneumonia, so this prescription is appropriate.
D. Monitoring vital signs every 4 hours is essential for assessing the client's condition, making this prescription appropriate.
E. Sending blood for a complete blood count and electrolytes is important to evaluate the patient's infection status and metabolic balance, so this is appropriate.
F. Changing the supplemental oxygen from a face mask to a nasal cannula may compromise oxygenation and should be questioned.
G. Administering ibuprofen could mask fever and may not be advisable in the presence of pneumonia, so this prescription should be questioned.
H. Continuous pulse oximetry is crucial for monitoring the patient's oxygen saturation, especially given the pneumonia diagnosis, making this prescription appropriate.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with newly diagnosed Crohn's disease asks the nurse about dietary restrictions. How should the nurse respond?

Correct Answer is C

Explanation

Exhibits Which prescriptions would the nurse question? Select all that apply.

Correct Answer is ["A","F","G"]

Explanation

A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in, "500 mg per 100 mL of dextrose 5% in water." To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

A client with chronic cirrhosis has esophageal varices. It is most important for the nurse to monitor the client for the onset of which problem?

While changing a client's postoperative dressing, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

The healthcare provider prescribes bismuth subsalicylate, metronidazole, tetracycline, and pantoprazole for a client with a Helicobacter pylori (H. pylori) infection. Prior to administering the H. pylori treatment regimen, the nurse should review the electronic medical record for which medication?

An adult client is admitted with AIDS and oral Candida albicans manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide to the UAP?

To assess the quality of an adult client's pain, which approach should the nurse use?

A client with myasthenia gravis receives a new prescription for pyridostigmine. Which information should the nurse obtain prior to administering the medication?

The nurse is caring for a client with emphysema who is mildly dyspneic after ambulation. Which instruction should the nurse provide to the client to improve gas exchange?