A client with peptic ulcer disease (PUD) is admitted to the emergency room complaining of sudden severe upper abdominal pain. Assessment indicates an extremely tender and rigid abdomen, blood pressure 90/60 mmHg, and pulse of 110 beats/minute. Which procedure should the emergency department nurse plan for immediate implementation?

Nasogastric tube insertion.

Iced saline lavage.

Administration pantoprazole (Protonix) IV, a proton pump inhibitor.

Emergency abdominal surgery.

Answer and Explanation

The Correct Answer is D

Choice A: Nasogastric tube insertion may be indicated in the management of a client with peptic ulcer disease (PUD) to assess bleeding, relieve gastric distention, or administer medications. However, in this scenario, the client's presentation with sudden severe upper abdominal pain, a tender and rigid abdomen, hypotension, and tachycardia suggests a potentially life-threatening condition that requires immediate intervention beyond nasogastric tube insertion.

Choice B: Iced saline lavage is not a standard procedure for managing peptic ulcer disease (PUD) or its complications. It is not the immediate intervention required for the client's presentation.

Choice C: Administration of pantoprazole (Protonix) IV, a proton pump inhibitor, is a relevant intervention for managing peptic ulcer disease (PUD), but it may not be the most immediate action needed for a client with sudden severe abdominal pain, hypotension, and tachycardia. More urgent interventions are required.

Choice D: Emergency abdominal surgery is the most appropriate and immediate intervention for a client with sudden severe upper abdominal pain, a tender and rigid abdomen, hypotension, and tachycardia. These signs and symptoms may indicate a perforated peptic ulcer, which is a surgical emergency requiring prompt exploration and repair of the perforation to prevent peritonitis and sepsis.

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Correct Answer is D

Explanation

A. Serum protein is an indicator of the client’s overall nutritional status, but it is not as immediately critical to monitor as glucose levels in clients receiving TPN. Protein levels change more slowly over time and are not an acute concern.

B. While serum osmolarity is important in evaluating hydration status and electrolyte balance, it is not the primary lab to monitor during TPN administration. Glucose fluctuations are more likely to cause immediate complications.

C. Urinary ketones are typically monitored in clients with diabetic ketoacidosis (DKA), not in clients receiving TPN. Ketones are a byproduct of fat metabolism and are not a priority in TPN management.

D. Capillary glucose is the most important lab to monitor in clients on TPN because TPN solutions contain high amounts of glucose, which can lead to hyperglycemia. Monitoring glucose levels helps prevent complications such as hyperglycemia or hypoglycemia and is critical in managing the client's metabolic response to TPN.

A. Introduce non-pharmacologic strategies for pain reduction. B. Allow adequate privacy and time for the client's phone call. C. Document the concern of incongruent pain rating and behavior. D. Administer pain medication per the healthcare provider's orders.

Correct Answer is B

Explanation

Choice A: Introducing non-pharmacologic strategies for pain reduction is a valid intervention for managing pain in a client with sickle cell anemia. However, in this scenario, the client's laughter on the phone call may not necessarily indicate that the pain level is accurately reflected by the numerical rating. It is essential to consider the client's overall well-being and pain management plan.

Choice B: Allowing adequate privacy and time for the client's phone call is a considerate and appropriate action. It acknowledges the client's need for communication and emotional support, which can be important in managing pain.

Choice C: Documenting the concern of incongruent pain rating and behavior is a necessary step for the nurse to record the observation. However, it should not be the only action taken in response to the situation.

Choice D: Administering pain medication should be based on a comprehensive assessment of the client's pain and the healthcare provider's orders. While pain medication may be indicated for this client, it should not be administered solely based on the numerical pain rating without further assessment and consideration of the client's overall condition.

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Naxlex Comprehensive Predictor Exams

While caring for a client receiving total parenteral nutrition (TPN), it is most important for the nurse to monitor which of the client's lab values?

Correct Answer is D

Explanation

An adolescent hospitalized with sickle cell anemia reports to the nurse of experiencing a pain level of 10 on a 0 to 10 numerical scale. The nurse observes the adolescent on a phone call laughing. Which action should the nurse take?

Correct Answer is B

Explanation

A middle-aged client newly diagnosed with cholelithiasis is choosing the evening meal.What food choice should the nurse encourage the client to omit?

Before administering a parenteral nutrition solution through a central vein, the nurse should confirm information from which sources? (Select all that apply)

A client expresses an interest in reducing intake of saturated fats and plans to stop eating hamburgers at lunch. Which menu item should the nurse suggest as an alternative source of protein?

After administering an injection, the nurse observes bleeding at the site. In what sequence should the nurse perform these actions? (Arrange with the first step on top and the last step on the bottom.)

When conducting diet teaching for a client diagnosed with hypokalemia, which foods should the nurse encourage the client to eat?

Which client is at greatest risk for aspiration?