Three days after a cholecystectomy for cholelithiasis, a female client reports having persistent upper abdominal pain that radiates to her back. She has vomited three times in the last 12 hours and has a temperature of 101.8° F. (38.7° C). Serum amylase and lipase are twice the normal value. Based on these findings, the nurse should observe the client for which pathophysiological condition?

Acute pancreatitis.

Biliary duct obstruction.

Surgical site infection.

Hepatorenal failure.

Answer and Explanation

The Correct Answer is A

A. The symptoms of persistent upper abdominal pain radiating to the back, elevated serum amylase and lipase levels, vomiting, and fever suggest acute pancreatitis, which can occur after cholecystectomy due to potential injury to the pancreas or bile duct obstruction.
B. While biliary duct obstruction can occur postoperatively, the significantly elevated amylase and lipase levels, along with the described symptoms, more strongly indicate pancreatitis.
C. Surgical site infection typically presents with localized symptoms rather than systemic symptoms like elevated amylase and lipase.
D. Hepatorenal failure is unlikely to present with these specific gastrointestinal symptoms and enzyme elevations.

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Correct Answer is ["A","F","G"]

Explanation

A. Enalapril can potentially cause hyperkalemia and hypotension, which could be detrimental to a client with pneumonia. The prescription should be questioned due to these risks.
B. A chest X-ray may be necessary to assess the extent of pneumonia; thus, it is appropriate and should not be questioned.
C. Admission to the medical floor is necessary for monitoring the client's condition due to pneumonia, so this prescription is appropriate.
D. Monitoring vital signs every 4 hours is essential for assessing the client's condition, making this prescription appropriate.
E. Sending blood for a complete blood count and electrolytes is important to evaluate the patient's infection status and metabolic balance, so this is appropriate.
F. Changing the supplemental oxygen from a face mask to a nasal cannula may compromise oxygenation and should be questioned.
G. Administering ibuprofen could mask fever and may not be advisable in the presence of pneumonia, so this prescription should be questioned.
H. Continuous pulse oximetry is crucial for monitoring the patient's oxygen saturation, especially given the pneumonia diagnosis, making this prescription appropriate.

A. Employed as a construction worker. B. Reported history of alcoholism. C. Toenails appear thick and yellow. D. White blood cell count of 8,500/mm3 (8.5 x 10°/L).

Correct Answer is B

Explanation

A. While working as a construction worker may involve exposure to various pathogens, it is not as critical as the client's history of substance use.
B. A reported history of alcoholism is significant because terbinafine is metabolized by the liver, and a history of alcohol use could affect liver function, increasing the risk of liver toxicity. This finding requires further assessment before administration.
C. Thick and yellow toenails indicate a fungal infection, which is the reason for the terbinafine prescription but does not impact the immediate safety of administering the medication.
D. A white blood cell count of 8,500/mm³ is within the normal range and does not indicate an immediate concern related to medication administration.

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Naxlex Comprehensive Predictor Exams

Exhibits Which prescriptions would the nurse question? Select all that apply.

Correct Answer is ["A","F","G"]

Explanation

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

Correct Answer is B

Explanation

A client receives a prescription for ophthalmic ketorolac. Prior to administering the medication, the nurse should review the medical record for which condition?

The antitubercular drug isoniazid is prescribed for a client with active tuberculosis. To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?

A client who is newly diagnosed with erosive esophagitis secondary to gastroesophageal reflux disease (GERD) reports to the home health nurse that there has been only a minimal reduction in symptoms after taking lansoprazole PO for one full week. Which action should the nurse take?

A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which pathophysiological process supports the client's respiratory acidosis?

A client with myasthenia gravis receives a new prescription for pyridostigmine. Which information should the nurse obtain prior to administering the medication?