A 72-year-old patient was admitted with epigastric pain caused by a peptic ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

Chest pain relieved with eating or drinking water

Burning epigastric pain 90 minutes after breakfast

Back pain three or four hours after eating a meal

Rigid abdomen and vomiting following indigestion

Answer and Explanation

The Correct Answer is D

Choice A rationale
Chest pain that is relieved with eating or drinking water is not typically indicative of a complication from a peptic ulcer. This symptom may be related to conditions like gastroesophageal reflux disease (GERD).

Choice B rationale
Burning epigastric pain after eating is a common symptom of a peptic ulcer and, while uncomfortable, does not usually require an urgent change in the plan of care unless it significantly worsens or is accompanied by other concerning symptoms.

Choice C rationale
Back pain after eating can be associated with a peptic ulcer if the ulcer is located at the back of the stomach or the pain radiates; however, it does not typically warrant an urgent change in care without other symptoms.

Choice D rationale
A rigid abdomen and vomiting following indigestion can indicate a perforated ulcer, which is a medical emergency. This requires immediate intervention and possibly surgical consultation, thus warranting an urgent change in the nursing plan of care.

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Correct Answer is ["C","D","E"]

Explanation

Choice A rationale
Applying a new patch at the onset of anginal pain is not recommended for transdermal nitroglycerin. This medication is used for long-term prevention of angina, not for immediate relief.

Choice B rationale
Covering the patch with plastic wrap is not necessary and is not a standard instruction for the use of transdermal nitroglycerin patches.

Choice C rationale
Applying a new patch each morning ensures that the medication is delivered consistently throughout the day, which is important for the management of stable angina.

Choice D rationale
Removing the patch for 10 to 12 hours daily, typically at night, helps prevent tolerance to the medication, ensuring its effectiveness.

Choice E rationale
Applying the patch to a hairless area and rotating sites helps to prevent skin irritation and ensures better adherence of the patch to the skin.

A. Tell the patient to clean the urethral area, void a small amount into the toilet, then void directly into a sterile container. B. Have the patient empty the bladder completely; then obtain the next urine specimen that the patient is able to void. C. Clean the area around the patient's meatus with a povidone-iodine (Betadine) swab and then have the patient void into a sterile specimen cup. D. Insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen.

Correct Answer is A

Explanation

Choice A rationale
This method is the standard procedure for obtaining a clean-catch midstream urine specimen. The initial voiding washes away organisms near the meatus, and the midstream urine is less likely to be contaminated by bacteria from the skin or urethral area, providing a sample that more accurately represents the bacteria in the bladder.

Choice B rationale
Having the patient empty the bladder completely and then obtaining the next specimen does not ensure a clean-catch sample. This method could lead to contamination of the specimen with bacteria from the skin or urethral area.

Choice C rationale
Cleaning the area with povidone-iodine is not recommended for routine urine culture as it may kill some of the bacteria, leading to a false-negative result. The standard practice is to clean the area with mild soap and water.

Choice D rationale
Inserting a catheter is an invasive procedure and is not the first choice for obtaining a urine specimen. It is used when a patient is unable to provide a clean-catch specimen or if there are specific medical indications.

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A 72-year-old patient was admitted with epigastric pain caused by a peptic ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.)

Correct Answer is ["C","D","E"]

Explanation

A female patient with a suspected urinary tract infection is to provide a clean-catch midstream urine specimen for culture and sensitivity testing. What should the nurse do to obtain the specimen?

Correct Answer is A

Explanation

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