1 :

0700 hrs

• The client has a history of diverticulitis and is allergic to penicillin. The client states that the pain started yesterday and has been worsening. He also reports nausea and vomiting, and he is unable to eat or drink anything without vomiting.

• Client presents with left lower quadrant (LLQ) pain, rated 9 on a 0 to 10 pain scale.

• Client is nauseous and has vomited twice since arrival.

• Client states he has not had a bowel movement in two days.

• Abdomen is distended and tender to palpation in the LLQ.

• Bowel sounds are hypoactive in all four quadrants.

• Client is oriented to person, place, and time.

• Client is able to move all extremities without difficulty.


0700 hrs

•    Temperature: 37.4°C (99.3°F

•    Heart rate: 100/min

•    Respiratory rate: 20/min

•    Blood pressure: 148/76 mm Hg

•    Oxygen saturation: 97% on room air

 0715 hrs

•    Sodium: 140 mEq/L (136-145 mEq/L)

•    Potassium: 3.5 mEq/L (3.5-5.0 mEq/L)

•    BUN: 19 mg/dL (10-20 mg/dL)

•    Creatinine: 1.1 mg/dL (0.6-1.3 mg/dL)

•    White Blood Cell Count: 28,000/mm³ (5,000-10,000/mm³)

•    Red Blood Cell Count: 4.8 million/mm³ (4.7-6.1 million/mm³)

•    Hemoglobin: 12 g/dL (14-18 g/dL)

•    Hematocrit: 37% (42%-52%)

•    Platelet Count: 230,000/mm³ (150,000-400,000/mm³)

•    Stool for Occult Blood: positive


Based on the information provided, which of the following provider’s prescriptions are anticipated, nonessential, or contraindicated for the client? Select one response per row.


options Anticipated Nonessential Contraindicated
Increase fiber intake
CT of the abdomen with contrast
Flexible sigmoidoscopy
Change IV fluids to 0.9% sodium chloride with KCl
Type and crossmatch blood
Administer IV piperacillin-tazobactam

Hint : 🔷 Avoid penicillin + prep for imaging

Correct Answers

  • Increase fiber intake [ Nonessential ]
  • CT of the abdomen with contrast [ Anticipated ]
  • Flexible sigmoidoscopy [ Anticipated ]
  • Change IV fluids to 0.9% sodium chloride with KCl [ Anticipated ]
  • Type and crossmatch blood [ Anticipated ]
  • Administer IV piperacillin-tazobactam [ Contraindicated ]

Rationale :

🔷 CT and sigmoidoscopy assess severity and location of diverticulitis.

🔷 KCl IV fluids address dehydration and borderline potassium levels.

🔷 Type/crossmatch indicated for possible GI bleeding (positive occult blood).

🔷 Piperacillin-tazobactam is contraindicated due to penicillin allergy.

🔷 High-fiber is nonessential during acute inflammation phase.


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2 :

Hint : 🟢Fecal-oral spread = Hep A

Correct Answers:

  • Hepatitis A


Rationale :

🟢 Hepatitis A is transmitted via fecal-oral route through contaminated food or water.

🟢 It often spreads in outbreaks related to poor sanitation or infected food handlers.

🟢 It differs from Hep B, C, D which are bloodborne pathogens.

🟢 Hep A is typically acute, self-limiting, and does not lead to chronic disease.

🟢 Prevention includes hand hygiene and vaccination.


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3 :

Hint : 🔴Support gut + lungs post-op

Correct Answers:

  • Maintain bed rest for 48 hr following surgery.
  • Irrigate the nasogastric tube every 4 to 8 hr.
  • Encourage hourly use of an incentive spirometer while awake.


Rationale :

🔴 Bed rest allows GI recovery and pain control after obstruction surgery.

🔴 NG tube irrigation ensures tube patency and decompression.

🔴 Incentive spirometry helps prevent atelectasis or pneumonia.

🔴 Leg exercises not specifically prioritized in this post-op scenario.

🔴 Nursing care targets GI healing and pulmonary support.


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4 :

Hint : 🟡NPO = IV fluids + oral care

Correct Answers:

  • Observe mucous membranes for dryness
  • Provide frequent oral care with moist swabs
  • Increase the rate of intravenous (IV) fluids


Rationale :

🟡 Mucous membranes offer a clear sign of hydration status.

🟡 Moist swabs relieve discomfort from NPO restrictions.

🟡 IV fluid adjustment helps maintain fluid balance.

🟡 Oral water intake is not allowed under NPO orders.

🟡 Preventing dehydration requires non-oral methods.


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5 :

Hint : 🔵Dark stoma = emergency

Correct Answers:

  • Bluish-Purplish colored stoma


Rationale :

🔵 A purplish stoma suggests poor perfusion or ischemia, a surgical emergency.

🔵 Report immediately to prevent necrosis or stomal failure.

🔵 Edema and slight bleeding are expected in immediate postop phase.

🔵 No stool is not unusual at 12 hr post-op.

🔵 Stoma viability is assessed by color, moisture, and bleeding.


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6 :

Hint : 🟣Family history = screen early

Correct Answers:

  • 32-year-old who has a sister who died of colon cancer


Rationale :

🟣 Family history is a major risk factor for colorectal cancer.

🟣 Colonoscopy is the gold standard for early detection and prevention.

🟣 Start screening earlier for those with first-degree relatives affected.

🟣 Clostridium difficile and constipation don’t warrant screening unless chronic.

🟣 Follow current screening guidelines for high-risk individuals.


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7 :

Hint : ⚫Abdomen = inspect first

Correct Answers:

  • Inspection


Rationale :

⚫ Abdominal assessment always begins with visual inspection.

⚫ Assess for distension, discoloration, scars, or visible peristalsis.

⚫ Auscultation follows — palpation/percussion may alter bowel sounds.

⚫ Palpation is always done last to avoid pain or gas movement.

⚫ Accurate sequence ensures valid findings.


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8 :

Hint : 🔶PPI use = less acid pain

Correct Answers:

  • Acid indigestion


Rationale :

🔶 Omeprazole is a proton pump inhibitor that reduces gastric acid.

🔶 Effective for treating GERD, ulcers, dyspepsia.

🔶 Relief of acid indigestion = desired outcome.

🔶 Nausea or diarrhea are side effects, not efficacy markers.

🔶 Long-term use needs vitamin B12 monitoring.


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9 :

Hint : 🟢Gastritis = no alcohol

Correct Answers:

  • “I’m going for a drink with my coworkers.”.


Rationale :

🟢 Alcohol irritates gastric mucosa and worsens gastritis.

🟢 It’s a known trigger for acute gastritis flare-ups.

🟢 Nurse should clarify the need for alcohol avoidance.

🟢 Small meals, bland diet, antacids are supportive treatments.

🟢 Education reduces recurrence and complications.


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10 :

Hint : 🔴EGD = assess gag first

Correct Answers:

  • Gag reflex


Rationale :

🔴 Post-EGD, monitor gag reflex to prevent aspiration.

🔴 Local anesthetic impairs swallowing — wait for reflex return.

🔴 Sore throat and bloating are expected but non-urgent.

🔴 Ensures safe resumption of fluids or diet.

🔴 Assess before allowing oral intake.


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Total Questions: 10

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