Nokea
A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which instruction should the nurse provide?
- A. Avoid green leafy vegetables.
- B. Take aspirin for headaches.
- C. Use a soft-bristled toothbrush.
- D. Limit fluid intake to 1 liter per day.
Correct Answer: C
Rationale: The correct answer is C: Use a soft-bristled toothbrush. Patients on warfarin are at risk for bleeding due to its anticoagulant effect. Using a soft-bristled toothbrush helps prevent gum bleeding and injury to the gums, reducing the risk of bleeding complications. Avoiding green leafy vegetables (choice A) is not necessary, as consistent intake is key for warfarin dosing. Taking aspirin (choice B) can increase the risk of bleeding. Limiting fluid intake (choice D) is not indicated in this case.
You may also like to solve these questions
The client with gastroesophageal reflux disease (GERD) is being taught about dietary modifications by the nurse. Which instruction should the nurse include?
- A. Increase your intake of spicy foods.
- B. Avoid lying down immediately after eating.
- C. Consume a high-fat diet.
- D. Drink caffeinated beverages with meals.
Correct Answer: B
Rationale: The correct answer is B: Avoid lying down immediately after eating. This instruction helps prevent acid reflux by allowing gravity to aid in digestion. Lying down can cause stomach acid to flow back up the esophagus, exacerbating GERD symptoms. Increasing intake of spicy foods (A) can irritate the esophagus, consuming a high-fat diet (C) can delay stomach emptying and worsen symptoms, and drinking caffeinated beverages with meals (D) can relax the lower esophageal sphincter, leading to more reflux.
A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?
- A. Acute pancreatitis
- B. Mesenteric ischemia
- C. Peptic ulcer disease
- D. Diverticulitis
Correct Answer: B
Rationale: The most likely diagnosis in this case is B: Mesenteric ischemia. Given the sudden onset of severe abdominal pain in an elderly patient with atrial fibrillation, mesenteric ischemia is a crucial consideration due to the risk of thromboembolism from the heart condition leading to inadequate blood supply to the intestines. Acute pancreatitis (A) typically presents with epigastric pain radiating to the back and elevated serum amylase/lipase levels. Peptic ulcer disease (C) usually presents with a history of dyspepsia and is less likely to cause sudden severe abdominal pain. Diverticulitis (D) commonly presents with left lower quadrant pain and tenderness, which contrasts with the soft abdomen and minimal tenderness seen in this case.
A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?
- A. Refer her for an exploratory laparotomy
- B. Measure serum gastrin in response to secretin infusion
- C. Treat her for H. pylori
- D. Obtain a dedicated small bowel series
Correct Answer: B
Rationale: The correct answer is B: Measure serum gastrin in response to secretin infusion. This step is necessary to confirm the diagnosis of gastrinoma. Secretin stimulation test is used to differentiate between Zollinger-Ellison syndrome (gastrinoma) and other causes of hypergastrinemia. If serum gastrin levels remain elevated after secretin infusion, it supports the diagnosis of gastrinoma.
Choice A: Refer her for an exploratory laparotomy - This is an invasive procedure and should not be the first step in the investigation of gastrinoma.
Choice C: Treat her for H. pylori - This is not indicated in the management of suspected gastrinoma. H. pylori infection is not a likely cause of the symptoms described.
Choice D: Obtain a dedicated small bowel series - This test is not typically used in the initial evaluation of gastrinoma. The secretin stimulation test is the preferred method for confirming the diagnosis.
Which of the following statements about Helicobacter pylori (H. pylori) is false?
- A. H. pylori does not invade the gastric or duodenal epithelium
- B. H. pylori stimulates gastric acid secretion
- C. Eradication of H. pylori prevents adenocarcinoma of the stomach
- D. H. pylori produces a urease that splits urea into ammonia and CO2
Correct Answer: C
Rationale: Rationale:
C is false because eradication of H. pylori does not completely prevent adenocarcinoma of the stomach, although it reduces the risk. A is true as H. pylori can invade epithelium. B is true as it can stimulate acid secretion. D is true as H. pylori produces urease. Thus, C is the only false statement.
What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?
- A. Acute hepatitis
- B. Acute cholecystitis
- C. Acute cholangitis
- D. Pancreatic cancer
Correct Answer: C
Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a