Question 55 - Coordinated Care Practice Test for the NCLEX-PN Exam

Use the case study information provided to answer this question.

You are called into the client’s room after the doctor notified the client that he will be going to surgery and signed the informed consent with him. To you, the client states, “I don’t understand the risks of this surgery. The doctor was talking so fast and seemed in a hurry to get out of the room. I guess it could kill me, but what other choice do I have?” What would be the best nursing action to take after hearing this from the client?

Intro to Case

A 68-year-old male client was recently admitted to the medical-surgical unit that you work on as an LPN. The client tells you he has not had a bowel movement in seven days, and he states, “I haven’t even been passing gas the last few days.” He states he has not been able to eat in three days because of how uncomfortable he feels. He has only been able to drink sips of water.

Nurse’s Notes

1000: Client is vomiting bile and states his abdominal pain is 8/10. He describes his pain as “cramping.” Client states, “I feel like my stomach is going to explode.” Client is grimacing and holding his abdomen. Client is reluctant to allow assessment on abdomen and states, please don’t push on my belly.” Transport arrived to take client down for CT scan of abdomen.

1045: CT scan completed, and client in room guarding abdomen and complaining of 8/10 cramping pain. NG tube placed without complication to left nostril. 500 ml yellowish-green fluid immediately drained into canister after NG tube placement. NG tube placed on low-intermittent suction as ordered. Peripheral IV placed in left anterior forearm. Educated client that he is on strict NPO status for bowel rest and explained to client what this means. Client states, “I can’t eat or drink anything anyway, so that won’t be a problem.” Continuous IV fluids initiated as ordered. Lactated Ringer’s solution administered at 250 ml/hr. IV Morphine 2 mg administered for abdominal pain, Tylenol suppository given as ordered for fever, and IV Amoxicillin administered as ordered.

1100: The client is resting in bed with eyes closed. He states his pain has decreased to 3/10 after pain medication. MD notified nurse that client will be going to surgery for small bowel obstruction. MD at client’s bedside explaining risks and benefits of bowel surgery and signing surgical consent with client.

Lab Values

Laboratory Tests, Reference
Ranges, and Imaging
1000 1030
Potassium (3.5 - 5.2) 3.3  
Magnesium (1.46 - 2.68) 1.2  
Albumen (3.4 - 5.4) 3.0  
WBC (4,500 - 11,000) 12,000  
CT scan of abdomen   Closed-loop bowel obstruction
noted by radiologist

History and Physical

Body System Findings
Neurological AAOx3, client recently diagnosed
with Parkinson’s disease
Gastrointestinal Distended abd, hyperactive bowel
sounds, vomiting bile, history of
Crohn’s disease for past 10 years
Psychological The client does not have family members
that live close. He has a sister that is the
closest living relative that lives 6 hours
away and hasn’t talked to client in ten years.
Client has a history of alcohol abuse.

Vital Signs

  1000 1100
T 101.5°F 99.3°F
P 121 102
BP 185/98 134/76
RR 22 20
SpO2 96% 95%

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