A nurse in a provider's office is caring for a client who has a medical history of rheumatoid arthritis and psoriasis, and a family history of heart disease and arthritis. The client has a 60-year smoking history and denies alcohol or other substance use. They are positive for Helicobacter pylori and are on medication for peptic ulcer disease (PUD). Which three findings from the client's medical record increase their risk for peptic ulcer disease?

Choice A rationale
This method is the standard procedure for obtaining a clean-catch midstream urine specimen. The initial voiding washes away organisms near the meatus, and the midstream urine is less likely to be contaminated by bacteria from the skin or urethral area, providing a sample that more accurately represents the bacteria in the bladder.

Choice B rationale
Having the patient empty the bladder completely and then obtaining the next specimen does not ensure a clean-catch sample. This method could lead to contamination of the specimen with bacteria from the skin or urethral area.

Choice C rationale
Cleaning the area with povidone-iodine is not recommended for routine urine culture as it may kill some of the bacteria, leading to a false-negative result. The standard practice is to clean the area with mild soap and water.

Choice D rationale
Inserting a catheter is an invasive procedure and is not the first choice for obtaining a urine specimen. It is used when a patient is unable to provide a clean-catch specimen or if there are specific medical indications.

Choice A reason: An increasing hemoglobin level does not indicate the resolution of acute pancreatitis. Hemoglobin levels can fluctuate due to various factors, including hydration status and blood loss, but are not directly related to the resolution of pancreatitis.

Choice B reason:A decreasing serum amylase level is indicative of the resolution of acute pancreatitis. Amylase is an enzyme that helps digest carbohydrates and is released in large amounts when the pancreas is inflamed. As the inflammation resolves, amylase levels decrease.

Choice C reason: A falling serum bilirubin level may indicate improvement in liver function but is not a specific indicator of the resolution of acute pancreatitis. Bilirubin levels can be affected by conditions other than pancreatitis, such as bile duct obstruction or liver disease.

Choice D reason:An increasing serum alkaline phosphatase level is generally associated with bile duct obstruction or bone disease and does not indicate the resolution of acute pancreatitis. This enzyme is found in several tissues throughout the body, including the liver and bones.