Nokea
The patient described in the preceding questions has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
- A. She is at high risk for reinfection with H. pylori.
- B. A positive serum IgG indicates that eradication of H. pylori was unsuccessful.
- C. The urease breath test is an ideal test to document failure of eradication.
- D. Dyspepsia usually improves with H. pylori eradication.
Correct Answer: C
Rationale: Step 1: The patient has a positive H. pylori antibody blood test, indicating exposure to the bacteria.
Step 2: Compliance with medical regimen suggests treatment for H. pylori infection.
Step 3: Persistence of symptoms after treatment indicates possible treatment failure.
Step 4: The urease breath test is ideal for detecting treatment failure as it directly measures the presence of H. pylori.
Step 5: Therefore, choice C is correct as it identifies the appropriate test for confirming eradication failure.
Summary:
- Choice A is incorrect as reinfection risk is not the immediate concern.
- Choice B is incorrect as a positive serum IgG doesn't definitively indicate eradication failure.
- Choice D is incorrect as not all dyspepsia cases improve with H. pylori eradication.
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A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be
- A. Liver biopsy
- B. Magnetic resonance cholangiopancreatography
- C. Hepatitis B surface antigen and hepatitis C RNA assay
- D. Colonoscopy with biopsies
Correct Answer: B
Rationale: The correct answer is B: Magnetic resonance cholangiopancreatography (MRCP). Given the patient's clinical presentation of right upper quadrant pain, fever, jaundice, and abnormal liver function tests, MRCP is the next diagnostic test of choice to evaluate the biliary tree and pancreatic ducts for possible obstruction or structural abnormalities. This would help identify the cause of the patient's symptoms, such as biliary obstruction or choledocholithiasis.
Choice A: Liver biopsy is not the next step in this scenario as the patient's symptoms are suggestive of a biliary or pancreatic etiology rather than a primary liver pathology.
Choice C: Hepatitis B surface antigen and hepatitis C RNA assay may be relevant for evaluating viral hepatitis, but in this case, the patient's symptoms and lab results are more indicative of a biliary or pancreatic issue.
Choice D: Colonoscopy with biopsies is not the next appropriate step as the patient's symptoms and lab results are not
The client with newly diagnosed hypertension is being taught about lifestyle modifications. Which recommendation should be made?
- A. Increase your intake of saturated fats.
- B. Limit your alcohol intake to two drinks per day.
- C. Engage in at least 150 minutes of moderate exercise per week.
- D. Use table salt liberally to season your food.
Correct Answer: C
Rationale: The correct answer is C, engaging in at least 150 minutes of moderate exercise per week. Regular exercise helps lower blood pressure by strengthening the heart, improving blood flow, and reducing stress. It also helps with weight management, which is crucial for hypertension. Choice A is incorrect because saturated fats can increase the risk of heart disease and worsen hypertension. Choice B is incorrect because excessive alcohol intake can raise blood pressure. Choice D is incorrect because excessive salt intake can lead to high blood pressure. Overall, regular exercise is a key lifestyle modification for managing hypertension.
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.
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
- A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
- B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
- C. Sucralfate is not the drug of choice for prophylaxis in this patient.
- D. H. pylori infection can alter the risk for an NSAID-induced ulcer.
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity.
Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity.
Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action.
Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?
- A. He should be treated with a low-protein diet and lactulose
- B. Lorazepam is not the drug of choice to control his behavior
- C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
- D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used
Correct Answer: A
Rationale: The correct answer is A: He should be treated with a low-protein diet and lactulose. This patient is presenting with hepatic encephalopathy, as evidenced by his altered mental status, ataxia, slurred speech, hyperreflexia, and normal ammonia level. The management of hepatic encephalopathy involves reducing the production of ammonia in the gut. Lactulose is a non-absorbable disaccharide that helps trap ammonia in the gut and promote its excretion in the feces. A low-protein diet is also recommended to decrease ammonia production.
Option B is incorrect because lorazepam is not the drug of choice for managing hepatic encephalopathy; it can worsen the condition. Option C is incorrect because gentamicin is not indicated in this scenario. Option D is incorrect because acetaminophen should be avoided in patients with liver disease due to the risk of hepatotoxicity; nonsteroidal anti-inflammatory drugs