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A 56-year-old woman presents to discuss the results of her recent upper endoscopy. She was having some mild abdominal pain, so she underwent the procedure, which revealed an ulcer in the antrum of the stomach. Biopsy of the lesion revealed the presence of H. pylori. All of the following statements regarding her condition are correct except
- A. H. pylori has been associated with gastric MALT (mucosa-associated lymphoid tissue)
- B. Reinfection is rare despite adequate treatment
- C. Triple drug therapy has been shown to be more effective than dual drug therapy
- D. If her H. pylori IgG antibody titer was elevated prior to therapy, it can be used to monitor treatment efficacy
Correct Answer: B
Rationale: The correct answer is B: Reinfection is rare despite adequate treatment. H. pylori reinfection can occur, especially in high-prevalence areas or due to poor hygiene. A: Correct - H. pylori is associated with gastric MALT lymphoma. C: Correct - Triple therapy (usually with a proton pump inhibitor, clarithromycin, and amoxicillin) is more effective than dual therapy. D: Correct - H. pylori IgG antibody titer can be used to assess treatment response. Reinfection is not rare and can happen, making option B incorrect.
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The healthcare provider is preparing to administer a blood transfusion. Which action is most important to ensure client safety?
- A. Check the client's vital signs before starting the transfusion.
- B. Verify the client's identity and blood compatibility.
- C. Administer the blood with normal saline.
- D. Monitor the client for the first 15 minutes of the transfusion.
Correct Answer: B
Rationale: The correct answer is B: Verify the client's identity and blood compatibility. This step is crucial to prevent transfusion reactions due to compatibility issues. By confirming the client's identity and ensuring that the blood type matches, the healthcare provider minimizes the risk of adverse reactions such as hemolytic transfusion reactions. Checking vital signs (A) is important but ensuring blood compatibility takes precedence. Administering blood with normal saline (C) is incorrect as blood should be infused with the appropriate blood administration set. Monitoring the client for the first 15 minutes (D) is essential but verification of identity and blood compatibility is the primary step to prioritize safety.
A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?
- A. Peptic stricture
- B. Esophageal cancer
- C. Achalasia
- D. Esophageal spasm
Correct Answer: B
Rationale: The correct answer is B: Esophageal cancer. Given the patient's age, symptoms of difficulty swallowing and weight loss, along with a history of chronic heartburn not responding to proton-pump inhibitors, esophageal cancer is the most likely diagnosis. Esophageal cancer commonly presents with dysphagia, weight loss, and a history of chronic reflux. Peptic stricture (A) typically presents with dysphagia but is less likely given the worsening symptoms despite treatment. Achalasia (C) presents with dysphagia and regurgitation, but not typically with weight loss. Esophageal spasm (D) presents with chest pain and dysphagia, but not typically with weight loss or chronic heartburn.
When teaching a client postoperative breathing techniques with an incentive spirometer (IS), what should the nurse encourage the client to do to maintain sustained maximal inspiration?
- A. Exhale forcefully into the tubing for 3 to 5 seconds.
- B. Inspire deeply and slowly over 3 to 5 seconds.
- C. Breathe into the spirometer using normal breath volumes.
- D. Perform IS breathing exercises every 6 hours.
Correct Answer: B
Rationale: The correct answer is B: Inspire deeply and slowly over 3 to 5 seconds. This technique is recommended for using an incentive spirometer (IS) to maintain sustained maximal inspiration. Slow, deep inhalation helps fully expand the lungs and improve lung function postoperatively.
A: Exhaling forcefully into the tubing is incorrect because the purpose of using an IS is to promote deep inhalation, not forceful exhalation.
C: Breathing into the spirometer using normal breath volumes is incorrect as it does not promote maximal inspiration and may not fully expand the lungs.
D: Performing IS breathing exercises every 6 hours is incorrect as regular, consistent practice throughout the day is recommended for optimal lung recovery.
A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
- A. Upper endoscopy
- B. Chest/abdominal CT scan
- C. Barium swallow
- D. Esophageal manometry
Correct Answer: C
Rationale: The correct answer is C: Barium swallow. In this case, the patient's symptoms suggest a possible esophageal disorder affecting solid food ingestion. Barium swallow is a non-invasive test that can detect structural abnormalities in the esophagus, such as strictures or tumors, that may be causing dysphagia. It is the best initial test to evaluate the patient's symptoms as it provides a detailed visualization of the esophagus and can identify the cause of dysphagia. Upper endoscopy (choice A) would be appropriate if structural abnormalities are suspected. Chest/abdominal CT scan (choice B) may not provide as detailed information about esophageal function. Esophageal manometry (choice D) is more useful for evaluating motor function of the esophagus, which is not the primary concern in this case.
A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: B
Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate an overactive thyroid gland, leading to symptoms like fatigue, weight gain, and constipation. The low TSH is due to negative feedback as the high free T4 suppresses TSH production. Hyperthyroidism fits this clinical picture, as opposed to hypothyroidism (choice A) which would have high TSH and low free T4 levels. Thyroiditis (choice C) typically presents with symptoms of both hyperthyroidism and hypothyroidism and is usually transient. Thyroid cancer (choice D) is less likely given the presentation of symptoms and specific lab results.