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 {"dropdown-group-1":"D","dropdown-group-2":"A"}

Explanation

Rationale:

Hypoxia: The client's decreased oxygen saturation (SaO2) despite oxygen therapy and the presence of respiratory distress (tachypnea, shortness of breath) indicate hypoxia.

Pneumonia: The client's fever, increased respiratory rate, decreased oxygen saturation, and crackles in the lungs are indicative of pneumonia, particularly in the right lower lobe as evidenced by the chest X-ray.

A. "I will try not to gain weight." B. "I will sleep with the head of my bed elevated." C. "I will drink less fluid." D. "I will consume less caffeine and fewer spicy foods." E. "I will lie down for one half hour after meals."

Correct Answer is ["A","B","D"]

Explanation

A. Maintaining a healthy weight is important in managing a hiatal hernia. Excess weight can increase abdominal pressure, which may worsen symptoms of acid reflux.
B. Sleeping with the head of the bed elevated helps prevent acid reflux and symptoms of heartburn associated with a hiatal hernia. Elevation reduces the risk of stomach contents moving into the esophagus during sleep.
C. Drinking less fluid is not a necessary dietary change for hiatal hernia management. However, clients should avoid consuming large amounts of fluid with meals, as this may exacerbate reflux symptoms.
D. Consuming less caffeine and fewer spicy foods is appropriate because both can irritate the esophagus and increase acid reflux. Caffeine and spicy foods are known to trigger symptoms in individuals with a hiatal hernia.
E. Lying down for one-half hour after meals is not recommended for clients with a hiatal hernia, as it can worsen symptoms of reflux. The client should be advised to wait at least 2–3 hours before lying down after eating.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a tracheostomy. Exhibits Drag words from the choices below to fill in each blank in the following sentence. The client has manifestations of dropdownanddropdown

Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}

Explanation

A nurse is teaching a client who has a hiatal hernia about dietary recommendations. Which of the following client statements indicates an understanding of the teaching? (Select all that apply.)

Correct Answer is ["A","B","D"]

Explanation

Which patient should the nurse assess first after receiving a change-of-shift report?

A client is admitted to the nursing unit with a diagnosis of gastric ulcer. Which assessment finding by the nurse supports the client's diagnosis of gastric ulcer?

A nurse in the emergency department is assessing an older adult client who has community-acquired pneumonia. Which of the following findings should the nurse expect?

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The nurse is caring for a client diagnosed with pneumonia. Which interventions should the nurse include in the plan of care? (Select All that Apply.)

A patient has a nasogastric (NG) tube following esophagectomy. Following standards of practice, which of the following postoperative instructions should the nurse question the surgeon about?

A nurse is creating a plan of care to maintain the skin integrity of a client who experiences frequent diarrhea due to ulcerative colitis. Which of the following interventions should the nurse include in the plan?

A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority?