A nurse is attending to a client who has just been admitted due to an acute exacerbation of ulcerative colitis. What should be the nurse’s initial course of action?
Investigate the client’s emotional concerns.
Check the client’s perianal skin integrity.
Obtain a dietary history from the client.
Review the client’s electrolyte values.
The Correct Answer is B
Choice A rationale
While emotional concerns are important to address in a holistic care approach, they are not the initial course of action when a client is admitted due to an acute exacerbation of ulcerative colitis. Emotional concerns are usually addressed once the client’s physical condition is stabilized.
Choice B rationale
Checking the client’s perianal skin integrity is a crucial initial step when a client is admitted due to an acute exacerbation of ulcerative colitis. Ulcerative colitis can cause rectal bleeding and diarrhea, which can lead to skin breakdown in the perianal area. Therefore, assessing for skin integrity helps in early detection and management of potential skin complications.
Choice C rationale
Obtaining a dietary history from the client is important but not the initial course of action in this scenario. Dietary history is usually obtained once the client’s condition is stabilized and when planning for discharge or dietary modifications.
Choice D rationale
Reviewing the client’s electrolyte values is important in managing ulcerative colitis, but it’s not the initial course of action. Electrolyte imbalances can occur due to diarrhea and
malabsorption, which are common in ulcerative colitis. However, this is usually done after initial physical assessments and stabilization of the client.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Increasing daily protein intake is often recommended for clients with chronic pancreatitis. Protein is needed for healing and repairing tissues, and people with chronic pancreatitis may have increased protein needs.
Choice B rationale
Decreasing caloric intake when abdominal pain is present is not typically recommended for clients with chronic pancreatitis. Adequate nutrition, including sufficient calories, is important for managing this condition.
Choice C rationale
Increasing fat intake when experiencing loose stools is not typically recommended for clients with chronic pancreatitis. Fat can be difficult to digest for these clients and can contribute to loose stools.
Choice D rationale
Limiting alcohol intake to 2-3 drinks per week is not typically recommended for clients with chronic pancreatitis. Alcohol can exacerbate pancreatitis and should be avoided.
Correct Answer is C
Explanation
Choice C rationale
In the context of suspected acute pancreatitis, an increase in serum amylase is one of the key laboratory findings. Pancreatitis is associated with inflammation of the pancreas, which can result in the release of digestive enzymes such as amylase and lipase into the bloodstream.
Therefore, elevated levels of these enzymes are often used as markers for acute pancreatitis.
Choice A rationale
Decreased serum lipase is not typically associated with acute pancreatitis. In fact, an increase in serum lipase is more commonly seen in acute pancreatitis. Lipase is a digestive enzyme produced by the pancreas, and its levels in the blood can rise when the pancreas is inflamed.
Choice B rationale
Increased serum calcium is not typically associated with acute pancreatitis. While hypercalcemia, or high calcium levels, can be a cause of pancreatitis, it is not a typical finding in the blood tests of patients with acute pancreatitis.
Choice D rationale
Decreased white blood cell (WBC) count is not typically associated with acute pancreatitis. In fact, an increase in WBC count can sometimes be seen in acute pancreatitis due to the body’s inflammatory response to the condition. Hypothyroidism Explore
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