A patient who is visiting the clinic complains of having stomach pains for 2 weeks and describes his stools as being soft and black for approximately the last 10 days. He denies taking any medications. How should the nurse interpret these symptoms?
Absent bile pigment from liver or gallbladder problems
Excessive fat in the stool caused by malabsorption
Increased iron intake, resulting from a change in diet
Occult blood resulting from gastrointestinal bleeding
The Correct Answer is D
Choice A reason: Absent bile pigment causes pale, clay-colored stools due to impaired bile flow from liver or gallbladder issues. Black stools suggest blood or medication effects, not bile absence, making this interpretation inconsistent with the patient’s soft, black stool description.
Choice B reason: Excessive fat in stools (steatorrhea) from malabsorption causes bulky, greasy, foul-smelling stools, typically pale or light-colored, not black. The patient’s black stools point to a different etiology, such as bleeding, making this an incorrect interpretation.
Choice C reason: Increased iron intake, such as from supplements, can cause black stools, but the patient denies medications. Dietary iron alone is unlikely to produce consistently black stools without supplementation, and stomach pain suggests a pathological cause, making this less likely.
Choice D reason: Soft, black stools (melena) typically indicate occult blood from gastrointestinal bleeding, often from the upper GI tract (e.g., stomach or duodenum). Stomach pain supports this, as bleeding from ulcers or gastritis can cause both symptoms, making this the correct interpretation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A complete physical exam is comprehensive but not specific to initial nutritional screening. Height and weight history provide BMI, a quick nutritional indicator, so this is not the first assessment.
Choice B reason: Height and weight history are critical for initial nutritional screening, enabling BMI calculation to assess undernutrition or obesity. This is a standard, quick method, making it the correct first step.
Choice C reason: Calorie counting is detailed and time-consuming, unsuitable for initial screening. Height and weight offer a rapid baseline for nutritional status, so this is incorrect for the first step.
Choice D reason: Leg circumference may assess muscle mass but is not standard for initial nutritional screening. Height and weight are primary for BMI, so this is incorrect for the initial assessment.
Correct Answer is A
Explanation
Choice A reason: Alcohol can interact with medications, altering their metabolism via liver enzymes (e.g., CYP450), and exacerbate conditions like liver disease or hypertension. This information is critical for safe treatment planning, making it the primary reason for inquiry.
Choice B reason: Assessing patient reliability is not the purpose of asking about alcohol use. This question focuses on clinical implications, not trustworthiness, as alcohol’s effects on health and medications are the priority, making this an incorrect rationale.
Choice C reason: Alcohol use is relevant even without an obvious drinking problem, as even moderate consumption can affect medication efficacy or disease progression. Dismissing this question unless a problem is evident overlooks potential risks, making this incorrect.
Choice D reason: Teaching all patients to avoid alcohol is not universally necessary, as moderate use may be safe for some. The inquiry aims to identify specific risks, like drug interactions, not to enforce blanket abstinence, making this an incorrect reason.
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