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An 82-year-old man is admitted with an acute attack of diverticulitis. What should the nurse include in his care?
- A. Monitor for signs of peritonitis.
- B. Treat with daily medicated enemas.
- C. Prepare for surgery to resect the involved colon.
- D. Provide a heating pad to apply to the left lower quadrant.
Correct Answer: A
Rationale: The correct answer is A: Monitor for signs of peritonitis. Peritonitis is a serious complication of diverticulitis that can result from a rupture of inflamed diverticula leading to abdominal infection. Monitoring for signs such as severe abdominal pain, rigidity, and fever is crucial for early detection and prompt intervention. Option B is incorrect as daily medicated enemas are not the standard treatment for diverticulitis. Option C is also incorrect as surgery is usually reserved for complicated cases or recurrent attacks. Option D is incorrect because applying a heating pad may exacerbate inflammation and is not recommended in diverticulitis management.
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What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy?
- A. Constipation
- B. Dehydration
- C. Elevated total serum cholesterol
- D. Cobalamin (vitamin B ) deficiency
Correct Answer: D
Rationale: The correct answer is D: Cobalamin (vitamin B12) deficiency. After a total gastrectomy, the patient lacks the intrinsic factor needed for vitamin B12 absorption in the ileum, leading to deficiency. This can result in megaloblastic anemia, neurological symptoms, and fatigue.
A: Constipation is not typically associated with total gastrectomy.
B: Dehydration may occur postoperatively but is not a specific consequence of total gastrectomy.
C: Elevated total serum cholesterol is not a direct effect of total gastrectomy.
Where does the digestion of proteins begin?
- A. Mouth
- B. Stomach
- C. Small intestine
- D. Large intestine
Correct Answer: B
Rationale: The correct answer is B: Stomach. Protein digestion begins in the stomach where the enzyme pepsin is secreted. Pepsin breaks down proteins into smaller peptides. This process is aided by the acidic environment of the stomach. In contrast, the mouth primarily starts the digestion of carbohydrates through the enzyme salivary amylase. The small intestine is where further breakdown and absorption of nutrients occur, not the initial digestion of proteins. The large intestine is mainly responsible for absorbing water and electrolytes, not digestion.
The liver combines a toxic by-product of amino acid metabolism, ammonia, with another waste product, carbon dioxide, to form the water-soluble ______, which is excreted in the kidneys.
- A. cholesterol
- B. bilirubin
- C. urea
- D. uric acid
Correct Answer: C
Rationale: Rationale: The correct answer is C: urea. Ammonia is toxic and needs to be converted into a less toxic form for excretion. The liver combines ammonia with carbon dioxide to form urea through the urea cycle. Urea is water-soluble and is excreted by the kidneys in urine. Cholesterol (A) is a lipid molecule, bilirubin (B) is a by-product of heme metabolism, and uric acid (D) is a by-product of purine metabolism. These molecules are not formed from the combination of ammonia and carbon dioxide and are not excreted in the kidneys.
Treatment of the patient with appendicitis includes:
- A. Transfusion to replace blood loss.
- B. Bowel prep for cleansing.
- C. Surgical removal of appendix.
- D. Medications to lower pH within the stomach.
Correct Answer: C
Rationale: The correct answer is C: Surgical removal of appendix. Appendicitis is inflammation of the appendix, which requires surgical intervention (appendectomy) to prevent rupture and potential life-threatening complications. Transfusion (A) is not a standard treatment for appendicitis unless severe bleeding occurs post-surgery. Bowel prep (B) is unnecessary for appendicitis treatment as it is not related to colon cleansing. Medications to lower stomach pH (D) are used to treat conditions like acid reflux, not appendicitis. In summary, surgical removal of the inflamed appendix is the definitive treatment for appendicitis to prevent complications.
A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment
- A. what should the nurse expect the patient to report?
- B. Vomiting of bright-red blood
- C. Projectile vomiting of undigested food
- D. Sudden, severe upper abdominal pain and back pain
Correct Answer: C
Rationale: The correct answer is C: Projectile vomiting of undigested food. In a patient with a perforated peptic ulcer, the sudden opening in the stomach lining allows food to pass into the abdominal cavity, leading to projectile vomiting of undigested food. This symptom is a classic sign of a perforation and requires immediate medical attention. Choice A is incorrect because vomiting of bright-red blood is more indicative of upper gastrointestinal bleeding, not a perforation. Choice B is incorrect as vomiting undigested food is more common in conditions like gastroparesis, not perforated ulcers. Choice D is incorrect as severe upper abdominal pain and back pain are symptoms of a perforation but not as specific as projectile vomiting of undigested food.