A 16-year-old woman with no significant medical history presents with quickly progressing encephalopathy and jaundice. A friend feels she may have taken a bottle of acetaminophen tablets one day prior to admission. Her bilirubin is 2.4 mg/dL, alkaline phosphatase 240 U/L, AST 2400 U/L, ALT 3200 U/L, creatinine 2.7, arterial pH 7.2, INR 6.6, and acetaminophen level 60. Which of the following is false?

Correct Answer: C

Rationale: The correct answer is C because the patient should be transferred to a transplant center immediately due to the severity of her condition, not only if she does not awaken with lactulose therapy. The patient's rapidly progressing encephalopathy, significant liver enzyme elevations, high INR, and metabolic acidosis indicate severe hepatotoxicity from acetaminophen overdose. Prompt evaluation by a transplant center is essential for potential liver transplant candidacy. Choices A, B, and D are incorrect because: A - She may indeed need a liver transplant due to the severity of her liver injury. B - Intubation and hyperventilation may be necessary for respiratory support in severe cases of acetaminophen overdose. D - N-acetylcysteine is the standard treatment for acetaminophen overdose to prevent liver damage.

Correct Answer: A

Rationale: The correct answer is A: Avoid spicy foods. Spicy foods can irritate the stomach lining and exacerbate symptoms of peptic ulcer disease (PUD). By avoiding spicy foods, the patient can reduce the risk of worsening their condition. B: Increasing caffeine intake can stimulate acid production in the stomach, which can aggravate PUD symptoms. C: Limiting fluid intake is not recommended as staying hydrated is important for overall health and can help with digestion. D: Eating three large meals per day can put a strain on the stomach and increase acid production, potentially worsening PUD symptoms. It is better to eat smaller, more frequent meals to help manage PUD.

Correct Answer: B

Rationale: The primary goal of nursing care for a patient with a bleeding peptic ulcer is to manage and prevent shock (Choice B). This is because bleeding from the ulcer can lead to hypovolemic shock, a life-threatening condition. Nursing interventions focus on stabilizing the patient's condition by monitoring vital signs, administering IV fluids, and preparing for potential blood transfusions. Decreasing pain (Choice A) is important but not the primary goal in this emergency situation. Similarly, reducing anxiety (Choice C) and educating about dietary restrictions (Choice D) are important aspects of care but are not the immediate priority when the patient is at risk of shock.

Correct Answer: B

Rationale: The correct answer is B: Caffeinated beverages. Caffeine can stimulate acid production in the stomach, leading to increased irritation and worsening of symptoms in patients with peptic ulcer disease (PUD). Avoiding caffeinated beverages helps reduce gastric acid secretion, promoting healing and symptom relief. Incorrect choices: A: Whole grains - Whole grains are generally recommended for PUD patients as they provide fiber and nutrients without irritating the stomach. C: Fresh fruits - Fresh fruits are typically well-tolerated by PUD patients and provide essential vitamins and minerals. D: Lean meats - Lean meats are a good source of protein and are generally safe for PUD patients, as long as they are not fried or heavily seasoned.

Correct Answer: B

Rationale: The correct answer is B: To create a protective barrier in the stomach. Bismuth subsalicylate forms a protective coating on the stomach lining, acting as a barrier to protect against stomach acid and irritants, promoting healing of peptic ulcers. A: To reduce acid production - While some medications like proton pump inhibitors reduce acid production, bismuth subsalicylate does not primarily function in this manner for PUD treatment. C: To increase mucus secretion - Bismuth subsalicylate does not directly increase mucus secretion, although it may indirectly support mucosal protection. D: To eradicate H. pylori - Bismuth subsalicylate does not directly target H. pylori bacteria, which is typically addressed with antibiotics in PUD treatment.