A nurse is caring for a 45-year-old male client in the emergency department who reports severe abdominal pain.

Exhibits

Based on the information provided, which of the following provider’s prescriptions are anticipated, nonessential, or contraindicated for the client? Select one response per row.

Increase fiber intake

CT of the abdomen with contrast

Flexible sigmoidoscopy

Change IV fluids to 0.9% sodium chloride with KCl

Type and crossmatch blood

Administer IV piperacillin-tazobactam

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"C"}}

•   Increase fiber intake: This is nonessential at this time. While a high-fiber diet can help prevent future episodes of diverticulitis, it won’t help in the acute phase, especially when the client is unable to eat or drink without vomiting.
•   CT of the abdomen with contrast: This is an anticipated action. A CT scan can help confirm the diagnosis of diverticulitis and assess the severity of the condition.
•   Flexible sigmoidoscopy: This is an anticipated action. A flexible sigmoidoscopy can help visualize the diverticula and assess the extent of the inflammation.

•   Change IV fluids to 0.9% sodium chloride with KCl: This is an anticipated action. The client is likely dehydrated due to vomiting and unable to take oral fluids, so IV hydration is necessary. The client’s potassium level is at the lower end of the normal range, so adding KCl to the IV fluids can help prevent hypokalemia.
•   Type and crossmatch blood: This is an anticipated action. The client has a positive stool occult blood test and a lower than normal hemoglobin and hematocrit, suggesting that he may be experiencing bleeding. It’s important to have blood ready for a transfusion if necessary.
•   Administer IV piperacillin-tazobactam: This is contraindicated. Piperacillin-tazobactam is a penicillin-based antibiotic, and the client has a known allergy to penicillin. Another class of antibiotics should be used. Please note that these are potential actions and the healthcare provider should be informed immediately for further evaluation and management. It’s important to continue following the provider’s prescriptions and closely monitor the client’s condition.

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Correct Answer is C

Explanation

Choice A rationale
Assuring the patient that the problem is temporary may not be accurate. Postoperative dysphagia could indicate a complication from the surgery, such as the stomach fundus being wrapped too tight around the esophagus, causing food obstruction. It’s important to not dismiss the patient’s concerns without proper assessment.
Choice B rationale
Cutting the food into small pieces might help the patient swallow easier, but it does not address the underlying issue. The patient’s difficulty in swallowing could be a sign of a serious problem that needs medical attention.
Choice C rationale
Reporting the observation to the healthcare provider (HCP) is the correct action. After the repair of a paraesophageal hernia, dysphagia should be reported to the HCP. The corrective fundoplication surgery may have the stomach fundus wrapped too tight around the esophagus, causing food obstruction.
Choice D rationale

Offering the patient liquids instead might alleviate the symptom temporarily, but it does not solve the potential problem. The healthcare provider needs to be informed about the dysphagia to assess and treat the possible complication.

A. Taking histamine receptor antagonist medication as prescribed B. Elevating the head of the bed on 6-inch blocks C. Lying down after meals D. Consuming small, frequent, bland meals

Correct Answer is C

Explanation

Choice A rationale
Taking histamine receptor antagonist medication as prescribed can help manage the symptoms of a hiatal hernia by reducing the production of stomach acid. This statement does not require correction.
Choice B rationale
Elevating the head of the bed on 6-inch blocks can help manage the symptoms of a hiatal hernia by using gravity to keep stomach acid from flowing back into the esophagus. This statement does not require correction.
Choice C rationale
Lying down after meals can exacerbate the symptoms of a hiatal hernia by making it easier for stomach acid to flow back into the esophagus. This action should be avoided.
Choice D rationale
Consuming small, frequent, bland meals can help manage the symptoms of a hiatal hernia by reducing the amount of stomach acid produced and preventing the stomach from becoming too full. This statement does not require correction.

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A nurse is caring for a 45-year-old male client in the emergency department who reports severe abdominal pain. Exhibits Based on the information provided, which of the following provider’s prescriptions are anticipated, nonessential, or contraindicated for the client? Select one response per row.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing care for a patient who had surgical repair of a paraesophageal (rolling) hernia. The nurse observes that the patient is having difficulty swallowing during the first postoperative meal.What action should the nurse take?

Correct Answer is C

Explanation

A patient with a chronic hiatal hernia experiences the following. Which action should the nurse advise the patient to avoid?

Correct Answer is C

Explanation

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