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?
Elevated serum potassium levels
Increased white blood cell count
Mid epigastric pain that worsens with eating
Epigastric pain that worsens with eating
The Correct Answer is D
A. Elevated serum potassium levels are not a specific finding related to gastric ulcers. They may be seen with other conditions such as kidney dysfunction or the use of certain medications (e.g., diuretics).
B. An increased white blood cell count is often associated with infection or inflammation but is not specific to gastric ulcers.
C. Mid epigastric pain that worsens with eating is more characteristic of duodenal ulcers, not gastric ulcers.
D. Epigastric pain that worsens with eating is a hallmark symptom of a gastric ulcer. This pain is typically aggravated by food intake due to the increased acid production in the stomach during digestion.
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Related Questions
Correct Answer is C
Explanation
A. While this patient is scheduled for a physical therapy session, it is not an urgent concern that would require immediate attention.
B. A routine follow-up appointment for a non-urgent condition can be managed at a later time and does not take priority over more acute concerns.
C. A patient with altered mental status and confusion should be assessed first. This could indicate a serious underlying issue such as infection, hypoxia, or a neurological condition. Altered mental status in any patient warrants immediate attention to prevent further complications.
D. Although the patient with pleuritis is in pain, moderate pleuritis is typically not an urgent condition, and pain management can be provided after more pressing concerns are addressed.
Correct Answer is D
Explanation
A. Positioning the head of the bed at 10 degrees is not sufficient for optimizing respiratory function. Typically, the head of the bed should be elevated to 30–45 degrees to help with breathing and reduce the risk of aspiration.
B. Encouraging fluid intake of 1500 mL/day may be too low for a client with pneumonia. Adequate hydration is important to thin mucus and help with expectoration, especially in the context of pneumonia. Typically, fluid intake should be higher unless contraindicated.
C. Coughing and deep breathing every 8 hours is insufficient. To prevent atelectasis and promote effective clearance of secretions in clients with pneumonia, coughing and deep breathing should be done more frequently, typically every 2 hours.
D. Obtaining a sputum culture is a priority for determining the specific pathogen causing the pneumonia and guiding antibiotic treatment. A sputum culture helps identify bacterial, viral, or fungal organisms that may be present, which is crucial for managing recurrent pneumonia, especially in an immunocompromised client with AIDS.
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