NP125 Med Surg Exam | Nurselytic

Correct Answer: A

Rationale: Fractures caused by disease processes are termed pathological fractures. Diseases like osteoporosis weaken bones, increasing susceptibility to fractures. Conditions like cancer can invade bone tissue, causing structural fragility. Pathological fractures occur without significant trauma, distinguishing them from those caused by external injuries, which require high-impact forces to break otherwise healthy bones. Traumatic fractures stem from external forces, not from disease processes. This assertion neglects the reality of pathological fractures, which result from diseases undermining the bone's natural strength. Healthy bones typically endure significant stress before fracturing, and the absence of disease makes fractures from minimal trauma highly unlikely. This reasoning excludes pathological fractures caused by internal illnesses or conditions weakening bone structures.

Correct Answer: B

Rationale: While alcohol is a known irritant to the gastric lining, it is not the primary cause of peptic ulcer disease. Excessive alcohol consumption contributes to mucosal damage but lacks the direct causative action of Helicobacter pylori, which colonizes the stomach lining and interferes with protective mechanisms, leading to ulcer formation. Alcohol merely exacerbates existing risk factors rather than initiating disease. Helicobacter pylori is the most common cause of peptic ulcer disease globally. Its mechanism involves producing urease, neutralizing stomach acid and enabling bacterial survival. It induces inflammation and mucosal damage, compromising the stomach's protective lining. Persistent infection leads to ulcer formation. This bacterial colonization is implicated in up to 90% of duodenal ulcers, making it the key pathogenic factor in PUD. Smoking is a risk factor for peptic ulcer disease but functions more as an aggravating agent than the primary cause.
Tobacco use increases gastric acid secretion and decreases bicarbonate production, weakening mucosal defenses. It also reduces the efficacy of Helicobacter pylori eradication therapy, prolonging ulcer disease. However, it does not directly induce the condition independently, highlighting its secondary role in PUD pathology. Stress is associated with peptic ulcer disease but is not a primary causative factor. Psychological stress can lead to hypersecretion of gastric acid, aggravating mucosal vulnerability in susceptible individuals. However, its role is predominantly indirect, amplifying existing risk factors like Helicobacter pylori infection. Stress-induced ulcers are typically seen in critical illnesses or severe physiological stress conditions, differing from PUD pathogenesis.

Correct Answer: A

Rationale: Appendicitis is the leading cause of emergency abdominal surgeries, accounting for a significant percentage globally. It results from inflammation of the appendix, often due to obstruction by fecalith or lymphoid hyperplasia. This condition progresses to localized infection, abscess formation, and potential rupture, requiring urgent surgical intervention to prevent life-threatening complications. The assertion that appendicitis is not the most common reason for emergency abdominal surgery contradicts epidemiological data. Diseases like cholecystitis or bowel obstructions occur less frequently and often have alternate non-surgical management options. Appendicitis's acute presentation and high risk of complications necessitate surgery, maintaining its predominance in emergency settings.

Correct Answer: B

Rationale: Referred back pain is not a hallmark of large bowel obstruction. It typically occurs in conditions with retroperitoneal organ involvement, such as renal or pancreatic pathology. Large bowel obstruction presents primarily with abdominal distention and pain localized to the affected bowel segment due to obstruction-induced pressure and stretching. Abdominal distention is a classic sign of large bowel obstruction. Accumulated gas and stool proximal to the obstruction result in bloating and visible distention. This presentation reflects impaired bowel motility, pressure build-up, and reduced passage of contents, commonly seen in large bowel pathology. Projectile vomiting is more indicative of upper GI obstruction, such as pyloric stenosis, due to immediate pressure effects. Large bowel obstructions manifest with late vomiting as distal obstruction delays content passage. Vomiting in this case is less forceful and often accompanied by fecal material. Metabolic alkalosis is more associated with vomiting-related losses of gastric acid, as seen in upper GI pathology. Large bowel obstruction typically leads to metabolic acidosis from ischemia or bacterial overgrowth, not alkalosis, as the obstruction hampers normal bowel function and circulation.

Correct Answer: C

Rationale: Incisions into the renal pelvis for stone removal describe open surgical methods, not ultrasonic lithotripsy. This invasive approach is reserved for cases where less invasive techniques fail or stones are inaccessible through standard methods. Lithotripsy avoids direct incisions, utilizing external energy for stone fragmentation. Kidney incisions for stone removal align with nephrolithotomy procedures rather than ultrasonic lithotripsy. This alternative represents open surgical intervention, distinct from non-invasive lithotripsy technologies. Lithotripsy eliminates stones using sound waves or lasers, reducing surgical risks and recovery times. Ultrasonic lithotripsy employs high-frequency sound waves to break stones into small fragments. This minimally invasive method allows natural passage through the urinary tract or facilitates removal via catheterization. It reduces complications compared to invasive surgeries and is highly effective for calculi management. Laser fragmentation techniques differ from ultrasonic lithotripsy, involving concentrated light energy to break stones. While both are minimally invasive, ultrasonic methods utilize sound waves rather than light energy for disintegration. This technical distinction outlines lithotripsy's use of external sound waves for stone management.