The nurse is caring for a patient with suspected diverticulitis. The nurse would be most prudent in questioning which of the following diagnostic tests ordered.

Appeared in: DHS 2018 shift 1st

Explanation

A barium enema is strictly contraindicated in patients with suspected acute diverticulitis due to the high risk of bowel perforation.
The pressure used to instill the barium can rupture the inflamed and weakened wall of a diverticulum.
Leakage of barium sulfate into the abdominal cavity causes severe, widespread chemical peritonitis, which has a very high mortality rate and is a surgical emergency.
Therefore, a prudent nurse would immediately question this order to prevent catastrophic patient harm.

Option A: While a colonoscopy also carries a risk of perforation in acute diverticulitis and is generally deferred, it is not considered as dangerous as a barium enema. The pressure can be better controlled, and it is not the most contraindicated procedure.
Option C: A complete blood count (CBC) is a fundamental and necessary blood test, not a risky procedure. It provides crucial information about the presence and severity of infection (leukocytosis).
Option D: A Computed Tomography (CT) scan is the preferred and most appropriate diagnostic imaging study for acute diverticulitis. It is non-invasive in the intraluminal sense and can accurately diagnose diverticulitis and its complications (e.g., abscess, perforation) without the risk of rupture from internal pressure.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Contraindications for diagnostic procedures in acute diverticulitis in acute care settings.
A core nursing responsibility is patient advocacy and safety. This includes critically evaluating medical orders and questioning any that could foreseeably harm the patient, such as a barium enema in this scenario.
Nurses must be vigilant in monitoring patients with diverticulitis for signs of complications like perforation and peritonitis (e.g., sudden increase in pain, rigid abdomen, fever, tachycardia, hypotension), as this is a medical emergency.
What if? If the patient were asymptomatic and undergoing a routine screening for diverticulosis (not acute diverticulitis), a barium enema or colonoscopy would be appropriate and safe diagnostic tools to visualize the colon.

How to Approach the Question

First, identify the key clinical condition in the stem: 'suspected diverticulitis.' This indicates an acute inflammatory process in the colon.
Next, analyze the question's task: determine which diagnostic test the nurse should be 'most prudent in questioning.' This means you are looking for the most dangerous or contraindicated test.
Evaluate each option based on its risk profile in the context of an inflamed bowel.
Recall that procedures involving pressure within the colon (like an enema) are extremely risky when the bowel wall is weak and inflamed.
Compare the risks: A CT scan is non-invasive imaging. A CBC is a blood test. A colonoscopy is invasive but allows for some pressure control. A barium enema forces contrast under pressure, posing the highest risk of rupture.
Conclude that the barium enema is the most hazardous choice and the one a nurse must question to ensure patient safety.

Concept Tested & Keywords

Concept Tested: Contraindications for diagnostic procedures in acute diverticulitis
Stem keywords: suspected diverticulitis, diagnostic tests, questioning
Lead-in keywords: most prudent
Negative lead-in flag: false

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 80-82

E6 Medicine Davidson Principles Practice 24e p. 853-855

E6 Medicine Harrison 22e Part 2 p. 483-485

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.