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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
An increasing hemoglobin level does not indicate the resolution of acute pancreatitis. Hemoglobin levels can fluctuate due to various factors, including hydration status and blood loss, but are not directly related to the resolution of pancreatitis.
Choice B rationale
During an episode of acute pancreatitis, serum concentrations of amylase and lipase rise significantly, often within hours of pancreatic injury. These elevated enzyme levels are key components in diagnosing the condition. As the inflammation subsides and the pancreas begins to heal, the levels of these enzymes typically decrease, returning to normal ranges. Therefore, a declining serum amylase level suggests that the acute inflammatory process is resolving.
Choice C rationale
Serum bilirubin levels are indicative of liver function and bile metabolism. Elevated bilirubin may occur if pancreatitis leads to bile duct obstruction or liver involvement. However, a decrease in bilirubin levels addresses biliary system recovery rather than directly reflecting pancreatic inflammation resolution.
Choice D rationale
An increasing serum alkaline phosphatase level is generally associated with bile duct obstruction or bone disease and does not indicate the resolution of acute pancreatitis. This enzyme is found in several tissues throughout the body, including the liver and bones.
Correct Answer is C
Explanation
Choice A rationale
While inflammation can affect the kidneys, the presence of inflammatory cells alone does not typically cause a decrease in GFR. Inflammatory cells invading the kidneys is more associated with conditions like glomerulonephritis rather than acute tubular necrosis.
Choice B rationale
A reduction in blood flow to the kidneys, known as prerenal azotemia, can indeed lead to a decreased GFR. However, in the context of acute tubular necrosis, the primary issue is damage to the renal tubules rather than blood flow.
Choice C rationale
Acute tubular necrosis is characterized by damage to the renal tubular cells, which can lead to a decrease in GFR. This damage impairs the kidney's ability to filter waste products from the blood, resulting in a lower GFR.
Choice D rationale
Obstruction of the urinary tract can lead to postrenal azotemia, which may decrease GFR if severe enough. However, this is not the typical pathophysiological change seen in acute tubular necrosis, which primarily involves tubular cell injury.
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