A 50-year-old woman presents with nocturnal pruritus, an elevated alkaline phosphatase of 284 U/L, and normal bilirubin and aminotransferases. She is on no medications and has a normal physical examination. Ultrasound of the liver reveals no ductal abnormalities and no gallstones. What should be the next step?

Correct Answer: D

Rationale: The correct answer is D: Check antimitochondrial antibodies. Rationale: 1. The patient's presentation of elevated alkaline phosphatase without bilirubin or aminotransferase elevation suggests a cholestatic pattern of liver injury. 2. Cholestatic pattern with elevated alkaline phosphatase in the setting of a normal physical exam and ultrasound with no ductal abnormalities points towards primary biliary cholangitis (PBC). 3. Antimitochondrial antibodies are highly specific for PBC and should be checked to confirm the diagnosis. 4. Requesting an ERCP is invasive and not indicated at this point. CT scan may not provide relevant information for this specific presentation. Checking viral serologies is not indicated based on the clinical presentation. Summary: A: Requesting an ERCP is not the next step. B: Obtaining a CT scan may not provide relevant information. C: Checking viral serologies is not indicated at this point.

Correct Answer: C

Rationale: The primary symptom of a peptic ulcer is abdominal pain. Peptic ulcers are sores that develop on the lining of the stomach, small intestine, or esophagus, causing a dull or burning pain in the stomach area. This pain typically occurs when the stomach is empty and can be relieved by eating or taking antacids. Nausea (choice A) and vomiting (choice D) can occur but are not typically the primary symptoms of a peptic ulcer. Heartburn (choice B) is more commonly associated with gastroesophageal reflux disease (GERD) rather than peptic ulcers.

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.