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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 A

Explanation

Rationale:

A. Performing blood glucose monitoring before breakfast is crucial for timely insulin administration and managing diabetes effectively.

B. Applying a condom catheter is important but can generally be done after more urgent tasks.

C. Delivering a clean urine specimen is important but less time-sensitive compared to blood glucose monitoring.

D. Feeding a client is important but may not be as urgent as tasks directly affecting medical management.

A. Keeping an appointment with a client B. Allowing a new mother to hold her stillborn infant C. Confirming that a client going for surgery has signed a consent form D. Refusing to disclose information about a client to the media

Correct Answer is A

Explanation

Rationale:

A. Keeping an appointment with a client demonstrates fidelity by honoring commitments and ensuring reliability in care.

B. Allowing a new mother to hold her stillborn infant is compassionate care but relates more to the ethical principle of beneficence.

C. Confirming that a client going for surgery has signed a consent form is related to the principle of autonomy and informed consent.

D. Refusing to disclose information about a client to the media is related to confidentiality, not fidelity.

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Naxlex Comprehensive Predictor Exams

A nurse has received change-of-shift report and is delegating tasks to the assistive personnel (AP). The nurse should tell the AP to complete which of the following tasks first?

Correct Answer is A

Explanation

A nurse is caring for a group of clients. The nurse demonstrates adherence to the ethical principle of fidelity by doing which of the following?

Correct Answer is A

Explanation

A nurse is triaging clients in an urgent care clinic. Which of the following clients should the nurse have the provider care for immediately?

A charge nurse is making assignments for nursing personnel who will be caring for clients during the oncoming shift. Which of the following factors should the charge nurse consider?

A nurse is caring for a client who is dying. The nurse should incorporate the principle of nonmaleficence into practice by taking which of the following actions?

An assistive personnel (AP) comes to work with a new set of artificial nails. The nurse takes the AP to a private location to discuss the issue. Which of the following statements by the nurse is appropriate?

A nurse manager has received information from the facility's risk management department that a former client is pursuing a lawsuit. The nurse manager should anticipate a deposition will be required during which phase of the legal process?

A charge nurse is observing a nurse Insert an indwelling urinary catheter into a female client. For which of the following actions by the nurse should the charge nurse intervene?

A nurse in an acute care setting is planning care for a group of clients at the beginning of the shift. Which of the following tasks should the nurse assign to the assistive personnel (AP)?