A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric region along with a rigid, board-like abdomen. These clinical manifestations are most likely indicative of which of the following?

The esophagus has become inflamed

An intestinal obstruction has developed

Additional ulcers have developed

The ulcer has perforated

Answer and Explanation

The Correct Answer is D

A. Inflammation of the esophagus (esophagitis) may cause symptoms like heartburn or dysphagia, but it would not explain the sudden, sharp pain or rigid abdomen seen with a perforated ulcer.
B. An intestinal obstruction can cause abdominal pain and distension, but the rigid, board-like abdomen is more characteristic of peritonitis from a perforated ulcer, not an obstruction.
C. Additional ulcers could cause pain and bleeding, but they would not explain the sudden, sharp pain and rigid abdomen that typically result from perforation.
D. The sudden onset of sharp, severe pain in the mid epigastric area, along with a rigid, board-like abdomen, are hallmark signs of a perforated ulcer, which causes peritonitis. This is a medical emergency, as the perforation allows gastric contents to leak into the peritoneal cavity, leading to widespread infection.

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Correct Answer is A

Explanation

A. Brushing the client's teeth with a suction toothbrush every 12 hours is a key intervention to reduce the risk of ventilator-associated pneumonia (VAP). Oral hygiene helps to decrease the accumulation of bacteria in the mouth, which could potentially be aspirated into the lungs and cause infection. This should be done more frequently, often every 4–6 hours, to reduce bacterial colonization.
B. Providing humidity to the ventilator tubing is necessary to maintain adequate moisture and prevent airway dryness, but it does not directly reduce the risk of VAP. Oral care and head-of-bed positioning are more crucial in preventing infection.
C. The head of the client's bed should be kept elevated, not flat, to reduce the risk of aspiration, which can lead to VAP. Keeping the head of the bed at a 30–45 degree angle is recommended.
D. Turning the client every 4 hours is important for preventing pressure ulcers and promoting circulation but is not the most effective intervention for reducing the risk of VAP. Frequent oral care and appropriate positioning are more important.

A. Total loss of gastric enzymes B. Excess secretion of digestive enzymes in the intestines C. Rapid emptying of stomach contents into the small intestine D. Excess glycogen production by the liver

Correct Answer is C

Explanation

A. Total loss of gastric enzymes is not a primary cause of dumping syndrome. While gastric enzymes may be reduced following gastric surgery, the syndrome is primarily related to the way food moves through the digestive tract.
B. Excess secretion of digestive enzymes in the intestines does not directly cause dumping syndrome. Although enzyme levels can be affected by surgery, dumping syndrome is more about the timing and volume of food delivery to the intestines.
C. Rapid emptying of stomach contents into the small intestine is the primary cause of dumping syndrome. This occurs because the normal regulatory mechanisms of the stomach are bypassed or disrupted after gastric resection, leading to a quick shift of food into the small intestine, which causes symptoms like nausea, diarrhea, and dizziness.
D. Excess glycogen production by the liver is not related to dumping syndrome. This would be more relevant to conditions affecting glucose metabolism, not gastrointestinal emptying.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia?

Correct Answer is A

Explanation

As a result of gastric resection, the client is at risk for developing dumping syndrome. The nurse should prepare a plan of care for this client based on knowledge that this problem stems primarily from which of the following gastrointestinal changes?

Correct Answer is C

Explanation

A nurse is instructing a client who has GERD about positions that can help minimize the effects of reflux during sleep. Which of the following statements indicates to the nurse that the client understands the instructions?

A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia. Which of the following actions should the nurse take?

A nurse is preparing an adolescent client who has pneumonia for percussion, vibration, and postural drainage. Prior to the procedure, which of the following nursing actions should the nurse complete first?

A nurse is discussing good food choices with a client who is recovering from an exacerbation of inflammatory bowel disease and is to start a low-lactose diet. Which of the following foods is the best choice for the client?

A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 6 L/min via nasal cannula. Which of the following actions should the nurse take?

The nurse is changing the subclavian dressing of a client who is receiving total parenteral nutrition. When assessing the catheter insertion site, the nurse noticed the presence of a yellow drainage from around the sutures that are anchoring the catheter. Which actions should the nurse take first?