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 B

Explanation

A. An intolerance to the feedings might cause discomfort, but it would not typically cause increasing pain, fever, and dyspnea. These symptoms are more indicative of a serious complication.
B. Esophageal perforation with fistula formation into the lung is the most likely cause of these symptoms. A perforation can lead to leakage of gastric contents into the pleural space or mediastinum, causing fever, pain, and respiratory distress. The formation of a fistula between the esophagus and the lung would lead to dyspnea.
C. Extension of the tumor into the aorta is a rare complication that would typically manifest with symptoms related to cardiovascular issues, not gastrointestinal symptoms like fever and dyspnea.
D. Leakage of fluids into the mediastinum is a possible cause of the symptoms, but esophageal perforation with a fistula into the lung is more directly linked to these specific symptoms, especially dyspnea.

A. Hypermagnesemia B. Hyponatremia C. Hypophosphatemia D. Hyperkalemia

Correct Answer is C

Explanation

A. Hypermagnesemia is not typically associated with refeeding syndrome. In fact, hypomagnesemia is more common due to the rapid shift of electrolytes and the body's increased demand during refeeding.
B. Hyponatremia is not a hallmark of refeeding syndrome. This condition more commonly leads to electrolyte imbalances like hypophosphatemia, hypokalemia, and hypomagnesemia rather than low sodium levels.
C. Hypophosphatemia is a hallmark finding in refeeding syndrome. As the body shifts from catabolic to anabolic states during refeeding, phosphorus is rapidly used in cellular processes, and its levels drop, which can lead to muscle weakness, respiratory failure, and other complications.
D. Hyperkalemia is not typically associated with refeeding syndrome. The condition is more likely to cause hypokalemia due to the shift of potassium into cells during the anabolic process after refeeding.

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Naxlex Comprehensive Predictor Exams

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of:

Correct Answer is B

Explanation

A nurse is caring for a client who is receiving total parenteral nutrition and develops refeeding syndrome. The nurse should expect which of the following laboratory findings?

Correct Answer is C

Explanation

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 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?

A nurse is caring for a client in the primary care office who has a recent diagnosis of a hiatal hernia. Which of the following new information will be beneficial for the nurse to relay to the client?

A nurse is assessing a client who is receiving total parenteral nutrition (TPN) therapy via an infusion pump. Which of the following actions should the nurse take?

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment is effective?

A 36-year-old patient with suspected gastrointestinal (GI) bleeding undergoes a diagnostic endoscopy which determines the site of bleeding is a duodenal ulcer. The nurse explains to the patient that bleeding ulcers are commonly related to which of the following:

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?