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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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Correct Answer is B

Explanation

Rationale:

A. A client who has Guillain-Barre syndrome requires close monitoring and specialized care due to progressive weakness and potential respiratory issues. This client's care may involve more complex needs that are beyond the AP's scope.

B. A client who has a lumbosacral spinal tumor is likely to have fewer immediate needs related to eating assistance, making this task appropriate to delegate to the AP. The client’s primary concern may be mobility or pain management, but meal assistance is a routine task.

C. A client who has systemic sclerosis may have issues with gastrointestinal motility and swallowing, requiring more careful feeding assistance and monitoring, which should be performed by the nurse.

D. A client who has amyotrophic lateral sclerosis (ALS) requires specialized care for swallowing difficulties and respiratory issues, making it inappropriate to delegate meal assistance to the AP.

A. Frequent trips to supply room when doing bedside care such as wound care. B. Notes on clients written on multiple small pieces of paper. C. Does not take breaks. D. Coming early and staying late to chart. E. Frequent personal phone calls during shift. F. Covering other nurses' clients for breaks. G. Missed prescriptions in the EHR.

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

Explanation

Time Management: Concerns related to how the nurse manages their time, including the efficiency of their work and how they handle their responsibilities (e.g., frequent trips to the supply room, notes written on small pieces of paper, coming early and staying late to chart).

Delegation: Issues related to the nurse's ability to delegate tasks effectively (e.g., covering other nurses' clients for breaks, which could suggest issues with delegation).

Professional Behavior: Concerns related to the nurse's conduct and adherence to professional standards (e.g., frequent personal phone calls during shifts, not taking breaks, missed prescriptions, covering other nurses' clients without taking breaks).

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse and an assistive personnel (AP) are providing care for four clients who were admitted to the medical-surgical unit on the previous shift. The nurse should delegate meal assistance for which of the following clients to the AP?

Correct Answer is B

Explanation

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

Explanation

A nurse is caring for a client who is postoperative. Exhibits Which of the following should the nurse request as a recommendation in an SBAR report to the provider? Select All That Apply

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A nurse on an obstetrics-gynecology unit is planning care for four clients after receiving change of shift report. Which of the following clients should the nurse assess first?