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A client shares with the nurse concerns of a possible stomach ulcer. The client is experiencing heartburn and a dull gnawing pain that is relieved with eating. Which is the best response by the nurse?

A.

Encourage the client to obtain a complete physical exam, since these symptoms are consistent with an ulcer.

B.

Advise the client that he needs to seek immediate medical evaluation and treatment of these symptoms.

C.

Assure the client that his symptoms may only reflect reflux, since ulcer pain is not relieved with food.

D.

Instruct the client that these mild symptoms can generally be controlled with changes in his diet.

Answer and Explanation

The Correct Answer is A

Rationale:

A. Encourage the client to obtain a complete physical exam, since these symptoms are consistent with an ulcer: The client’s symptoms are typical of a duodenal ulcer. A full evaluation allows for appropriate diagnosis and treatment without causing alarm.

B. Advise the client that he needs to seek immediate medical evaluation and treatment of these symptoms: Immediate evaluation is not warranted unless the client has signs of bleeding, perforation, or severe distress. A timely but routine follow-up is appropriate for stable symptoms.

C. Assure the client that his symptoms may only reflect reflux, since ulcer pain is not relieved with food: Duodenal ulcer pain is classically relieved by eating, while gastric ulcer pain may worsen with food. Dismissing the symptoms as reflux could delay interventions.

D. Instruct the client that these mild symptoms can generally be controlled with changes in his diet: While diet can influence ulcer symptoms, assuming dietary change alone is sufficient may delay proper medical evaluation and necessary pharmacologic treatment.


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Related Questions

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

Explanation

Rationale for Correct Choices:

  • Hyponatremia: The client shows signs of neurological impairment (confusion and altered LOC), which are common symptoms of hyponatremia. The significant, concentrated urine output despite normal IV fluid intake suggests water retention and sodium dilution.
  • Syndrome of inappropriate antidiuretic hormone (SIADH): A hypothalamic tumor can disrupt normal ADH regulation, leading to SIADH. In SIADH, excessive ADH causes water retention without sodium retention, resulting in dilutional hyponatremia. The high urine output relative to intake further supports inappropriate ADH secretion.

Rationale for Incorrect Choices:

  • Hypernatremia: This condition is associated with dehydration, increased serum osmolality, and symptoms like thirst and dry mucous membranes, not confusion with preserved fluid intake and high urine output seen here.
  • Hypokalemia: This typically presents with muscle weakness, cramping, or arrhythmias. It does not account for the client’s confusion or link directly to hypothalamic tumors and fluid imbalance.
  • Diabetes insipidus: Although linked to hypothalamic or pituitary damage, diabetes insipidus causes hypernatremia due to water loss and low urine osmolality, not confusion from fluid retention and hyponatremia.
  • Addison’s disease: Addison’s typically presents with hypotension, hyperkalemia, and fatigue. It is an adrenal insufficiency condition, not primarily linked to hypothalamic tumors or SIADH-like fluid handling.

Correct Answer is D

Explanation

Rationale:

A. A change in the sleep-wake cycle: This is a common and expected effect as ramelteon works by regulating the circadian rhythm through melatonin receptors. It does not typically warrant immediate provider notification.

B. Dizziness reported after initial dose: Dizziness is a known, mild side effect that often resolves with continued use. It should be monitored but does not require urgent reporting unless severe or persistent.

C. Mild sedation: Sedation is an intended pharmacologic effect of ramelteon, helping to induce sleep. Mild sedation is not concerning unless excessive or impairing functioning.

D. Somnambulism: Sleepwalking (somnambulism) is an abnormal and potentially dangerous parasomnia that should be reported immediately. It can result in injury and may indicate the need to discontinue or adjust the medication.

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