Nokea
You are caring for a client with peptic ulcer disease. Which assessment finding is the most serious?
- A. Projectile vomiting
- B. Burning sensation 2 hours after eating
- C. Coffee-ground emesis
- D. Board-like abdomen with shoulder pain
Correct Answer: D
Rationale: The correct answer is D. A board-like abdomen with shoulder pain indicates a perforated ulcer, a medical emergency requiring immediate intervention. A perforation can lead to peritonitis and septic shock. Choice A, projectile vomiting, may indicate a gastric outlet obstruction but is not as immediately life-threatening as a perforation. Choice B, burning sensation 2 hours after eating, is a common symptom of peptic ulcer disease and does not indicate a complication. Choice C, coffee-ground emesis, may indicate bleeding but is not as severe as a perforation.
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The hepatic sinusoids receive oxygenated and unoxygenated blood. The blood vessels that provide mixed blood to the sinusoids are the
- A. hepatic artery and hepatic vein.
- B. hepatic vein and hepatic portal vein.
- C. hepatic portal artery and hepatic portal vein.
- D. hepatic artery and hepatic portal vein.
Correct Answer: D
Rationale: Rationale:
1. The hepatic artery carries oxygenated blood to the liver.
2. The hepatic portal vein carries nutrient-rich but deoxygenated blood from the digestive system.
3. The hepatic sinusoids receive blood from both the hepatic artery and portal vein, creating a mix of oxygenated and nutrient-rich blood.
4. Choice D (hepatic artery and hepatic portal vein) is correct as it accurately reflects the blood vessels providing mixed blood to the hepatic sinusoids.
Summary:
- Choice A (hepatic artery and hepatic vein) is incorrect as the hepatic vein carries deoxygenated blood.
- Choice B (hepatic vein and hepatic portal vein) is incorrect as it does not include the artery supplying oxygenated blood.
- Choice C (hepatic portal artery and hepatic portal vein) is incorrect as there is no such thing as a hepatic portal artery.
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
- A. A sedentary lifestyle and smoking.
- B. A history of hemorrhoids and smoking.
- C. Alcohol abuse and a history of acute renal failure.
- D. Alcohol abuse and smoking.
Correct Answer: D
Rationale: The correct answer is D: Alcohol abuse and smoking. Both alcohol abuse and smoking are well-established risk factors for peptic ulcers. Alcohol can irritate and damage the stomach lining, while smoking can increase stomach acid production and weaken the stomach lining. These factors can contribute to the development of peptic ulcers.
Choice A (A sedentary lifestyle and smoking) is incorrect because while smoking is a risk factor, a sedentary lifestyle is not directly linked to the development of peptic ulcers.
Choice B (A history of hemorrhoids and smoking) is incorrect because hemorrhoids are not a known risk factor for peptic ulcers.
Choice C (Alcohol abuse and a history of acute renal failure) is incorrect because acute renal failure is not typically associated with an increased risk of peptic ulcers, unlike alcohol abuse.
Gastric secretions:
- A. Decrease when a person thinks of food.
- B. Contain a substance which is essential for absorption of vitamin B12 from terminal ileum.
- C. Contain HCL secreted by chief cells.
- D. Are essential for fat digestion and absorption.
Correct Answer: B
Rationale: Step-by-step rationale:
1. Gastric secretions contain intrinsic factor, essential for vitamin B12 absorption from the terminal ileum.
2. Intrinsic factor binds to vitamin B12 to facilitate its absorption.
3. Without intrinsic factor, vitamin B12 absorption is impaired, leading to pernicious anemia.
4. Therefore, choice B is correct.
Summary:
- Choice A is incorrect as gastric secretions increase, not decrease, when a person thinks of food.
- Choice C is incorrect as hydrochloric acid (HCl) is secreted by parietal cells, not chief cells.
- Choice D is incorrect as fat digestion primarily occurs in the small intestine with the help of pancreatic enzymes, not gastric secretions.
What is the most common cause of secondary protein-calorie malnutrition in the United States?
- A. The unavailability of foods high in protein
- B. A lack of knowledge about nutritional needs
- C. A lack of money to purchase high-protein foods
- D. An alteration in ingestion absorption or metabolism
Correct Answer: D
Rationale: The correct answer is D because an alteration in ingestion, absorption, or metabolism can lead to secondary protein-calorie malnutrition. This can occur due to various medical conditions affecting the digestive system, such as malabsorption syndromes or metabolic disorders. The other choices are incorrect because the primary cause of secondary protein-calorie malnutrition in the US is not the unavailability of high-protein foods, lack of knowledge about nutritional needs, or lack of money to purchase such foods. These factors may contribute to malnutrition but are not the most common cause in this context.
The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
- A. Turn the patient every 3 hours.
- B. Encourage increasing ambulation.
- C. Assist the patient to the bathroom.
- D. Prevent constipation to reduce ammonia production.
Correct Answer: D
Rationale: The correct answer is D: Prevent constipation to reduce ammonia production. In hepatic encephalopathy, the liver is unable to metabolize ammonia, leading to its accumulation and brain dysfunction. Preventing constipation helps reduce the production of ammonia by promoting regular bowel movements. This is crucial in managing hepatic encephalopathy to prevent worsening of symptoms and improve patient safety.
A: Turning the patient every 3 hours is important for preventing pressure ulcers but is not directly related to managing hepatic encephalopathy.
B: Encouraging increasing ambulation may be beneficial for overall patient health but does not directly address the priority of reducing ammonia production in hepatic encephalopathy.
C: Assisting the patient to the bathroom is important for maintaining hygiene and comfort but does not address the underlying issue of reducing ammonia production in hepatic encephalopathy.