NCLEX-PN® Prep Course

Multiple myeloma can cause lytic bone lesions and vertebral compression fractures. A report of new, severe back pain, especially when accompanied by new neurologic changes such as leg weakness or numbness, raises concern for vertebral fracture or spinal cord compression and requires prompt assessment and escalation of care. The reports describing short-term diarrhea after a medication change, chronic pill-related swallowing difficulty, or urinary hesitancy after an over-the-counter cold medication are not as directly suggestive of an acute, myeloma-related emergency in this scenario and would generally be evaluated after immediate neurologic and spine concerns are addressed.

Fecal impaction should be suspected when a patient with several days of constipation and rectal fullness suddenly develops watery stools. This pattern can indicate overflow diarrhea, in which liquid stool leaks around a hard stool mass in the rectum. Chronic constipation alone would not typically cause an abrupt onset of watery stools. Gastroenteritis and ulcerative colitis can cause diarrhea, but they do not best fit the combination of several days without a bowel movement followed by sudden watery stool with rectal fullness.

When a home apnea monitor alarms, the priority is to assess the infant first because alarms can be caused by loose leads or movement artifact. The safest initial action is the choice describing a quick visual check of breathing effort, skin color, and activity. If the infant appears apneic, cyanotic, or unresponsive after assessment, the parents should provide stimulation and initiate emergency actions (such as calling for help and beginning CPR as instructed). Turning off the alarm delays assessment, and activating EMS or starting resuscitation without first confirming the infant’s condition is not the best initial step when the alarm may be false.