Abdominal Pain (Case 1)

NGN Case — Abdominal Pain (EMR Tabs)

The following scenario applies to the next 6 items.

Item 1 of 6

The nurse is caring for a client in the emergency department.

Emergency Department

1100: Client reports nausea, loss of appetite, vomiting, fever, and constipation for 2 weeks. Abdominal pain 7/10 for 1 week, began after trauma (child kicked abdomen). BMI 32. Drinks alcohol occasionally, smokes socially. No significant past medical history.

1130: Provider notified of client status. Awaiting orders.

1230: Client transported for abdominal CT scan.

1245: Peripheral IV inserted. 0.9% NS at 75 mL/hr.

1400: Client reports sudden relief of abdominal pain. Temp 102.5°F.

1415: Provider notified. Order for repeat abdominal CT scan.

History & Physical

No chronic conditions reported; no recent sick contacts.
Recent minor trauma: child kicked abdomen 1 week ago.
Social: occasional alcohol; smokes socially.

Vital Signs

1100 → T 103.4°F, P 92, RR 22, BP 130/86, SpO₂ 98%
1400 → T 102.5°F, P 110, RR 20, BP 125/86

Diagnostic Results

CT (initial): Inflammation in right lower quadrant, possible appendicitis.

CT (repeat): Free air in peritoneal cavity (suggestive of perforation).

Provider Orders

NPO (nothing by mouth)
IV fluids: 0.9% NS at 75 mL/hr
Broad-spectrum IV antibiotics
Type & crossmatch for surgery
Prepare for emergency appendectomy

NGN QBank | Liver Cirrhosis – Assessment Follow-up (SATA)

Which assessment findings require follow-up?

Select all that apply • Scoring: Plus–Minus (+/−) • Minimum total = 0

Instructions

Plus–Minus rule: +1 for each correct option you select, −1 for each incorrect option you select. Leaving an option unselected does not affect your score. The minimum score for this item is 0.

Assessment findings (client with known liver cirrhosis)

Rationale

✅ Correct Answers

Correct Labored breathing, Respiratory rate, and Oral temperature require follow-up.

Step 1 – Identify the Core of the Question

For a client with liver cirrhosis, identify findings that signal acute deterioration or serious complication requiring prompt evaluation.

Step 2 – Apply NCLEX Framework

ABC priority: Airway/Breathing before Circulation.
Physiological Adaptation: Cirrhosis with ascites predisposes to respiratory compromise and infection.
Safety/Surveillance: Fever or tachypnea may indicate sepsis/SBP or respiratory distress.

Step 3 – Option Analysis

Follow-up Labored breathing → respiratory distress; ascites can limit diaphragmatic excursion.
Follow-up Respiratory rate → tachypnea may reflect hypoxemia, sepsis, pain, or metabolic acidosis.
Follow-up Oral temperature → fever in cirrhosis/ascites raises concern for spontaneous bacterial peritonitis (SBP) or other infection.
Not immediate Jaundice → common in chronic liver disease; monitor trend unless acutely worsening.
Not immediate Yellow sclera → expected with hyperbilirubinemia; reassess if sudden change.
Context-dependent Hypoactive bowel sounds → note and trend; prioritize only with severe distension, pain, or suspected ileus/obstruction.

NCLEX Coaching (Bilingual)

1️⃣ Nursing Principle: Prioritize signs of respiratory compromise and infection in cirrhosis to prevent decompensation (e.g., SBP, respiratory failure).

2️⃣ Where It’s Taught: Med-Surg (Hepatic Disorders): assessment & complications of cirrhosis.

3️⃣ NCLEX Lens: Physiological Integrity → Reduction of Risk Potential & Physiological Adaptation.

ES: Prioriza trabajo respiratorio ↑, taquipnea y fiebre en cirrosis con ascitis por alto riesgo de PBE y descompensación.

Feedback

NCLEX NGN Drop-Down Question

The most likely diagnosis is: