Diverticulitis Leik

Question 1

506. A 70-year-old woman complains of left lower quadrant abdominal pain and fever for 2 days. Her blood pressure of 130/80 mmHg, pulse is 90 beats/min, respirations are 14 breaths/min, and temperature is 100.5°F. During the abdominal exam, the left lower quadrant of the abdomen is tender to palpation. The nurse practitioner (NP) does not palpate a mass; neither is there guarding or rigidity. Rovsing’s sign is negative. Bowel sounds are present in all quadrants. The NP is familiar with the
     patient, who is alert and is asking appropriate questions about her condition.

The nurse practitioner suspects that the patient has acute diverticulitis. Which of the following treatment plans is appropriate for this patient?

A) The patient should be referred to the physician as soon as possible
B) The patient has a mild case of acute diverticulitis and can be treated with
antibiotics in the outpatient setting with close follow-up
C) This patient has a moderate to severe case of acute diverticulitis and needs to be admitted to the hospital for IV antibiotics
D) The patient should be referred to the emergency department as soon as possible

Answer 1

B) The patient has a mild case of acute diverticulitis and can be treated with
antibiotics in the outpatient setting with close follow-up

The patient has a mild
case of acute diverticulitis and can be treated as an outpatient with antibiotics and a clear fluid diet. If outpatient treatment is selected, close follow-up (within 24–48
hours) is very important. Instruct patients to go to the hospital if symptoms get
worse, if fever increases, if unable to tolerate PO treatment, and if pain worsens.
Order a complete blood count (to check for leukocytosis, neutrophils, and possible
shift to the left), chemistry profile, and urinalysis (to rule out renal causes).

Question 2

527. A 74-year-old man presents with recurrent abdominal cramping and pain
     associated with diarrhea that occurs from four to five times per day. He reports that
     currently he is having an exacerbation. The stools are bloody with mucus and pus.
     The patient reports that he has lost weight and is always fatigued. The patient denies recent travel or outdoor camping. Which of the following conditions is most likely?

A) Giardiasis
B) Irritable bowel syndrome (IBS)
C) Diverticulitis
D) Ulcerative colitis
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Answer 2

D) Ulcerative colitis The most important clue for ulcerative colitis is bloody
stools that are covered with mucus and pus along with the systemic symptoms
(fatigue, low-grade fever).

Question 3

598. An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft
     pulsatile mass just above the umbilicus as she palpates this area with her hand.
     Which of the following conditions is most likely?
     A) Abdominal aortic aneurysm
     B) Cauda equina syndrome
     C) Acute diverticulitis
     D) Adenocarcinoma of the colon

Answer 3

A) Abdominal aortic aneurysm Elderly males who are ex-smokers are at higher
risk for abdominal aortic aneurysm. The aneurysm is usually asymptomatic and is
discovered incidentally during a routine chest x-ray or abdominal ultrasound.
Although small aneurysms are usually not detectable during abdominal exams, the
larger aneurysms may be palpable during an abdominal exam, but abdominal obesity
will obscure the findings. The symptoms in this case point toward a rapidly
dissecting aneurysm. The best action is to call 911 stat.