A client being treated for chronic cholecystitis should be given which of the following instructions?

Correct Answer: D

Rationale: In the context of a client being treated for chronic cholecystitis, the correct instruction is to use anticholinergics as prescribed (Option D). Anticholinergics help to decrease the spasms in the smooth muscle of the gastrointestinal tract, including the gallbladder, which can be beneficial in managing the symptoms associated with cholecystitis. Option A, increasing rest, while important for overall health, does not directly address the treatment of cholecystitis. Option B, avoiding antacids, is not specifically indicated for cholecystitis treatment and may not have a direct impact on the condition. Option C, increasing protein in the diet, is not the priority in the management of cholecystitis as dietary modifications typically focus on reducing fat intake to decrease gallbladder stimulation. From an educational standpoint, understanding the rationale behind the correct answer helps students grasp the pharmacological management of gastrointestinal conditions. It reinforces the importance of tailored interventions for specific conditions and highlights the role of medications in symptom management. This question also emphasizes the need for critical thinking in selecting the most appropriate intervention based on the client's condition.

Correct Answer: D

Rationale: In distinguishing between the pain associated with duodenal and gastric ulcers, it is crucial to understand the pathophysiology of each condition. The correct answer, "D) Pain on an empty stomach," is indicative of a duodenal ulcer. This pain worsens when the stomach is empty due to the exposure of the ulcer to gastric acid during fasting periods. The presence of pain at night or in between meals is a classic symptom of a duodenal ulcer. Option A, "Early satiety," is more commonly associated with gastric ulcers. Gastric ulcers tend to cause pain or discomfort shortly after eating, leading to early satiety as a result of the irritation in the stomach lining postprandially. Option B, "Pain on eating," is not a typical characteristic of either duodenal or gastric ulcers. Pain that worsens with eating is more indicative of esophageal or gastric conditions such as gastritis. Option C, "Dull upper epigastric pain," is a general symptom that can be present in both duodenal and gastric ulcers. However, the specific characteristic that distinguishes duodenal ulcers is the relief of pain with food intake due to neutralization of stomach acid. Understanding these distinctions is vital in clinical practice as it guides healthcare providers in making accurate diagnoses and implementing appropriate treatment plans for patients with gastrointestinal ulcers.

Correct Answer: A

Rationale: In the context of medical-surgical nursing, the correct answer (A) instructing the client to tilt his head back for insertion in the nostril and then flex his neck for the final insertion is the most appropriate technique for nasogastric (NG) tube insertion. Tilting the head back helps align the nasal passages and facilitates the smooth passage of the tube. Flexing the neck during the final insertion aids in guiding the tube through the nasopharynx into the esophagus. Option B (instructing the client to extend his neck after insertion) is incorrect as extending the neck can obstruct the pathway of the NG tube. Option C (introducing the tube with the client's head tilted back, then keeping the head upright for final insertion) is incorrect as keeping the head upright can hinder the tube's progression. Option D (instructing the client to hold his chin down, then back for insertion) is also incorrect as this position can cause difficulty in advancing the tube through the nasopharynx. Educationally, understanding the correct technique for NG tube insertion is crucial for nurses to ensure patient safety and comfort. Proper positioning of the client facilitates the procedure and reduces the risk of complications such as trauma to the nasal passages or misplacement of the tube. Nurses must be knowledgeable about the anatomical considerations and patient positioning to perform procedures effectively in a clinical setting.

Correct Answer: C

Rationale: In understanding the pathophysiology of esophageal varices, it is crucial to recognize that portal hypertension is the primary factor contributing to their formation. Esophageal varices develop as collateral vessels in response to increased pressure within the portal venous system, typically due to liver cirrhosis. Option A, decreased prothrombin formation, is not directly related to the development of esophageal varices. While clotting factors are important, they do not play a primary role in variceal formation. Option B, decreased albumin formation by the liver, is linked to hypoalbuminemia but is not the key factor leading to esophageal varices. Albumin levels are more closely associated with ascites formation in liver disease. Option D, increased central venous pressure, is not the main pathophysiologic factor contributing to esophageal varices. Although increased central venous pressure can contribute to other conditions like heart failure, it is not the primary mechanism behind variceal formation. Educationally, understanding the relationship between portal hypertension and esophageal varices is essential for nurses caring for patients with liver disease. Recognizing the signs and symptoms of variceal bleeding and managing complications are critical aspects of nursing care in the medical-surgical setting.

Correct Answer: C

Rationale: The correct answer is C) Regularly assess respiratory status. When a client has a Sengstaken-Blakemore tube inserted for esophageal varices, the most critical complication is airway compromise due to tube displacement. Regular assessment of respiratory status is essential to detect early signs of respiratory distress, such as shortness of breath, stridor, or decreased oxygen saturation. Prompt recognition and intervention can prevent serious respiratory complications like asphyxiation. Option A) Checking that the hemostat is on the bedside is important for securing the tube but not as critical as monitoring respiratory status. Option B) Monitoring IV fluids is important for overall fluid balance but not the most critical assessment for a client with a Sengstaken-Blakemore tube. Option D) Checking that the balloon is deflated on a regular basis is essential but does not take precedence over respiratory assessment in terms of immediate risk to the client's airway. In the educational context, understanding the priority assessments for clients with specific interventions like a Sengstaken-Blakemore tube is crucial for nurses caring for patients with gastrointestinal bleeding. Emphasizing the importance of respiratory assessment in high-risk situations can help prevent life-threatening complications and improve patient outcomes.