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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Encouraging coughing and deep breathing is important for promoting the clearance of respiratory secretions. However, while it aids in mobilizing secretions, it does not directly thin the mucus.
B. Frequent ambulation helps to improve overall lung function and prevent complications like pneumonia, but it does not specifically thin respiratory secretions.
C. Increasing fluid intake helps thin the respiratory secretions by providing hydration, making it easier for the body to expel mucus through coughing. Hydration is critical for reducing the viscosity of sputum, thus promoting its removal.
D. Regular use of the incentive spirometer helps prevent atelectasis and improve lung expansion but does not directly affect the thinning of respiratory secretions.
Correct Answer is B
Explanation
A. Administering anticoagulant medications is contraindicated in patients with bleeding esophageal varices. Anticoagulants could worsen bleeding and complicate the condition further. The goal in managing esophageal varices is to control the bleeding, not to increase the risk of bleeding.
B. Monitoring vital signs frequently is critical in patients with bleeding esophageal varices, as they are at risk for hypovolemic shock. Vital signs should be monitored closely to assess for signs of bleeding, hemodynamic instability, and response to interventions. Typically, more frequent monitoring (every 15 minutes initially, then every hour) is indicated, not just every 4 hours.
C. A high-fiber diet is not appropriate for patients with bleeding esophageal varices. This can increase intra-abdominal pressure and may worsen bleeding. The diet should be tailored to the patient's needs, typically involving low-residue or soft foods depending on their condition.
D. Assisting with the insertion and removal of the balloon tamponade device should be done by a skilled provider, not the nurse. The nurse's role involves monitoring for complications, ensuring proper positioning, and assessing the patient's response to treatment.
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