Ms. Lieberman is your patient in the

Ms. Lieberman is your patient in the Emergency Department (ED) today. She is a 48-year-old female with a history of Crohn’s Disease, for which she takes Infliximab SC injections once per week. She is a Full Code 4 with no known allergies. Ms. Lieberman was brought to the ED today by her sister after she vomited bright red blood three times in the past 12 hours prior to coming to the ED. She also vomited bright red blood once in the ED (300 mL). She is A/Ox4 when she arrives to the ED, but her speech is slightly slurred. While Ms. Lieberman is with the UAP having vital signs taken, the sister pulls you, the RN, aside and indicates she has concerns about the patient consuming increased amounts of alcohol over the past year since her divorce became finalized. When Ms. Lieberman is questioned regarding use of alcohol, cigarettes, and other recreational substances, she reports having “a few drinks on the weekend” only. Her blood alcohol is obtained, and it is twice the legal limit. Ms. Lieberman reports that her medications include Infliximab (5mg/kg SC every 8 weeks). She reports that she takes acetaminophen for headaches only related to NSAIDS causing increased risk for GI bleeding. Ms. Lieberman reports dizziness when standing quickly from a seated position which has worsened over the past 48 hours. Her skin is pale and dry. Abdomen is slightly distended and tender to palpation. She reports 5/10 epigastric pain. Capillary refill is prolonged. BP is 89/51, pulse 117 bpm, RR is 24 breaths/min, and temperature is 99F (37.2C); Oxygen saturation is 94% on 6L oxymask. What is the priority concern for Ms. Lieberman? Ineffective coping with recent loss of spouse in divorce Risk for aspiration related to upper GI bleeding Hypovolemia related to vomiting blood Noncompliance with prescribed medication regimen Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: Which of the following actions would be appropriate in the care of Ms. Lieberman? Select all that apply Initiate strict input and output monitoring Administer IVP Ketorolac for epigastric pain Insert 2 large bore peripheral IV catheters Monitor hemoglobin and hematocrit levels every 6 hours Place the patient in reverse Trendelenburg position Circle Answer(s) Above and Include Rationales for Correct and Incorrect Options: You are performing head-to-toe assessment and obtaining admission history from Ms. Lieberman. Which finding should you immediately report to the physician? Recent use of naproxen Rigid, board-like abdomen Melena stools Recent history of shingles Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: Ms. Lieberman’s hemoglobin lab value just results at 7.1 g/dL. Her HCP orders 2 units of packet red blood cells (PRBCs) to be administered STAT. After completing the blood consent with Ms. Lieberman and preparing the necessary supplies, the blood begins to infuse. Within 15 minutes of receiving the blood, Ms. Lieberman is complaining of chills, headache, and new onset of anxiety. Her oral temperature is up to 101.4F from 99F (prior to blood administration). What is your priority action at this time? Encourage oral intake of fluids Stop the blood transfusion Maintain bedrest in the supine position Administer 50mg IVP Diphenhydramine Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: After Ms. Lieberman finishes receiving the prescribed 2 units of PRBCs, she reports feeling nauseated. The client is prescribed Metoclopramide. Which of the following side/adverse effect must you teach Ms. Lieberman to report immediately to either you or the HCP while receiving this medication? Dry mouth Headache Excessive blinking Paresthesia Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: During this hospitalization, Ms. Lieberman experiences an exacerbation of her inflammatory bowel disease. She is prescribed Methotrexate. Which findings would require priority follow-up by the nurse? Elevated erythrocyte sedimentation rate Hemoglobin of 10.7 g/dL Mucositis of the mouth Uric acid level of 14.5 mg/dL Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: During this hospitalization, it is determined that Ms. Lieberman drinks, on average, 4 alcoholic beverages per day. HCPs decide to evaluate her liver function and determines that she is at high risk for liver cirrhosis. Based on this diagnosis, the nurse anticipates which assessment findings? Select all that apply. Asterixis Bruising Constipation Ascites Steatorrhea Circle Answer(s) Above and Include Rationales for Correct and Incorrect Options: Ms. Lieberman is started on IV Vancomycin as part of her Crohn’s Disease treatment. She suddenly develops generalized urticaria and angioedema. Which of the following actions should the nurse take? Continue to monitor Apply supplemental oxygen Obtain Vancomycin trough level Administer Diphenhydramine 50mg IVP Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: To investigate Ms. Lieberman’s liver function further, a number of labs are drawn. Her albumin level is determined to be critically low. Which characteristic finding associated with hypoalbuminemia should the nurse anticipate assessing? Altered mental status Loss of body hair Hypertension Pitting edema Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: Ms. Lieberman’s Crohn’s Disease gets progressively worse, requiring a small bowel resection. After the surgery she develops an ileus. She reports nausea, vomiting bile, and abdominal discomfort. Which prescription does the nurse ? Hydrocodone 5mg PO every 4 hours PRN for moderate pain Increase continuous IV normal saline rate from 75 to 100 mL/hr Insert nasogastric tube and connect to low intermittent suction Ondansetron 4mg IVP every 4 hours PRN for nausea Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: please can you explain the answer? I want to know what answer is right and why the other is incorrect SCIENCE HEALTH SCIENCE NURSING NURS 398

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