The nurse is in the G unit is assessing a patient after receiving the change of shift SBAR report. What assessment findings will the nurse report immediately to the provider?

The patient who is having white milky liquid stools immediately after a barium enema.

The patient with irritable bowel syndrome (IBS) who has not had a bowel movement for three days.

The patient diagnosed with ulcerative colitis with a temperature of 101°F and abdominal distention.

The patient receiving Total Parenteral Nutrition (TPN) whose blood glucose level is 225 mg/dL.

Answer and Explanation

The Correct Answer is C

Choice A reason: White milky liquid stools immediately after a barium enema are not uncommon and are typically due to the passage of barium. This finding does not usually require immediate reporting unless there are other concerning symptoms.

Choice B reason: Not having a bowel movement for three days in a patient with irritable bowel syndrome (IBS) can be uncomfortable but is not typically an emergency. Management can be addressed through dietary and medication adjustments rather than immediate reporting.

Choice C reason: A temperature of 101°F and abdominal distention in a patient diagnosed with ulcerative colitis is concerning and should be reported immediately. These symptoms can indicate a serious complication such as toxic megacolon, perforation, or severe infection, which require prompt medical intervention.

Choice D reason: A blood glucose level of 225 mg/dL in a patient receiving Total Parenteral Nutrition (TPN) is elevated but not necessarily an emergency. Elevated blood glucose levels are a common side effect of TPN and can be managed through adjustments in insulin or TPN composition.

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Correct Answer is B

Explanation

Choice A reason: While acute pain is a possibility in peripheral neuropathy, infection poses a more serious risk. The sensory deficits in peripheral neuropathy can lead to unnoticed injuries and subsequent infections, especially in the lower extremities.

Choice B reason: Infection is a major risk in patients with peripheral neuropathy due to the loss of sensation, which can result in unnoticed injuries that can become infected. Additionally, high blood sugar levels in diabetes can impair the immune response, making infections more likely and harder to heal.

A. Administer Hydrochlorothiazide 50 mg orally daily B. Monitor intake and output and daily weights C. Administer Calcitonin 300 International Units (U) intramuscularly every 12 hours D. Prepare the patient for possible hemodialysis

Correct Answer is A

Explanation

Choice A reason: The order to administer Hydrochlorothiazide should be clarified because thiazide diuretics can increase calcium levels, which could worsen hypercalcemia in a patient with a history of hyperparathyroidism.

Choice B reason: Monitoring intake and output and daily weights are essential for managing fluid balance in heart failure patients and do not need clarification.

Choice C reason: Administering Calcitonin helps lower calcium levels, which is appropriate for treating hypercalcemia in a patient with hyperparathyroidism.

Choice D reason: Preparing the patient for possible hemodialysis may be necessary if the patient's kidney function deteriorates, especially with elevated BUN and creatinine levels.

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The nurse is in the G unit is assessing a patient after receiving the change of shift SBAR report. What assessment findings will the nurse report immediately to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with diabetes who is exhibiting signs and symptoms of peripheral neuropathy. What will the nurse identify as a risk for this patient?

Correct Answer is B

Explanation

Correct Answer is A

Explanation

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