A patient with gastroesophageal reflux disease (GERD) is being managed with a proton pump inhibitor (PPI). During a follow-up visit, the patient reports new- onset diarrhea and abdominal pain. What is the nurse's priority action in this scenario?
Advise the patient to use an over-the-counter antidiarrheal medication.
Assess the patient for signs of Clostridium difficile infection
Instruct the patient to discontinue the PPI immediately.
Recommend increasing fiber intake to manage diarrhea symptoms.
The Correct Answer is B
Rationale:
A. Advising the patient to use over-the-counter antidiarrheal medication may mask symptoms but does not address the underlying cause. If the diarrhea is due to an infection, particularly Clostridium difficile, using antidiarrheals could worsen the condition by retaining toxins in the colon.
B. Assessing the patient for signs of Clostridium difficile (C. difficile) infection is the priority. PPIs reduce gastric acidity, which can alter gut flora and increase susceptibility to C. difficile overgrowth, especially in patients with new-onset diarrhea and abdominal pain. Early recognition is critical to prevent severe colitis, dehydration, sepsis, or toxic megacolon. The nurse should monitor for frequent watery stools, fever, abdominal tenderness, and laboratory confirmation through stool testing.
C. Instructing the patient to discontinue the PPI immediately is not recommended without provider guidance. Abrupt cessation may worsen GERD symptoms, and the underlying cause of diarrhea must first be evaluated.
D. Recommending increased fiber intake may help manage some types of diarrhea, but in the presence of possible C. difficile infection, this approach is not appropriate and could exacerbate discomfort or bloating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Subcutaneous nodules on the ulnar side of the arm are characteristic of rheumatoid arthritis, not systemic lupus erythematosus. Rheumatoid nodules typically occur over pressure points and are associated with long-standing, seropositive rheumatoid arthritis rather than SLE.
B. A dry, red rash across the bridge of the nose and cheeks is the classic malar (butterfly) rash, a hallmark finding in systemic lupus erythematosus. This rash often spares the nasolabial folds and may worsen with sun exposure (photosensitivity). Its presence supports the diagnosis of SLE and is an expected assessment finding.
C. A grey-colored, non-purpuric papular rash is not typical of SLE. Cutaneous manifestations of SLE most commonly include the malar rash, discoid lesions, and photosensitive rashes rather than grey papular eruptions.
D. Pitting edema of the hands and fingers is not a classic early finding of SLE. While edema may occur secondary to renal involvement (lupus nephritis), it is more commonly seen in the lower extremities and is not a defining or expected primary assessment finding.
Correct Answer is D
Explanation
Rationale:
A. Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and sleep disturbances, but it is not directly associated with the autoimmune manifestations of rheumatoid arthritis or the presence of dry eyes and mouth.
B. Raynaud’s phenomenon involves episodic vasospasm of the fingers and toes, causing color changes and discomfort with cold exposure. While it can occur in autoimmune conditions, it does not explain the hallmark symptoms of dry eyes and dry mouth.
C. Osteoporosis is a skeletal complication that may develop in rheumatoid arthritis patients due to chronic inflammation, corticosteroid use, or decreased mobility. However, it does not present with sicca symptoms (dry eyes and mouth).
D. Sjogren’s syndrome is an autoimmune disorder that often occurs secondary to rheumatoid arthritis. It is characterized by exocrine gland dysfunction, leading to dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Early recognition is important to prevent dental caries, oral infections, and ocular complications, and to manage systemic involvement appropriately.
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