A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?

Correct Answer: B

Rationale: The correct answer is B) Deficient knowledge related to unfamiliarity with significant signs and symptoms. This nursing diagnosis is appropriate because the client's lack of reporting black stools to the physician indicates a deficiency in knowledge regarding the significance of this symptom in peptic ulcer disease. Option A) Ineffective coping related to fear of diagnosis of chronic illness is not the most appropriate choice in this scenario as the client's behavior is more indicative of a lack of knowledge rather than coping issues. Option C) Constipation related to decreased gastric motility is not relevant to the client's presentation of black stools, which is more suggestive of upper gastrointestinal bleeding rather than constipation. Option D) Imbalanced nutrition: Less than body requirements due to gastric bleeding is not the best choice because the client has not reported gastric bleeding, but rather black stools, which may indicate bleeding from the upper gastrointestinal tract. Educationally, this question highlights the importance of recognizing and addressing patients' lack of knowledge about their health conditions and symptoms. It emphasizes the crucial role of nurses in patient education and empowerment to improve health outcomes. By selecting the correct nursing diagnosis, nurses can intervene appropriately to educate the client on the significance of black stools and the importance of prompt reporting to the healthcare provider.

Correct Answer: C

Rationale: In the context of medical surgical nursing, it is crucial for nurses to educate clients on the proper administration of medications to ensure optimal therapeutic outcomes. In the case of ranitidine, which is a histamine-2 receptor antagonist used to treat peptic ulcers by reducing stomach acid production, taking it at bedtime is the most appropriate time. The correct answer, option C, is right because ranitidine is most effective when taken at bedtime due to its mechanism of action in inhibiting nocturnal acid secretion when the stomach is most active. This timing helps in providing sustained acid suppression throughout the night, which is beneficial for ulcer healing and symptom relief. Option A (before meals) and option B (with meals) are incorrect because ranitidine does not need to be timed with meals for effectiveness. Taking it before or with meals may not align with the physiological basis of the drug's action in reducing nocturnal acid production. Option D (when pain occurs) is also incorrect as ranitidine is not a rescue medication for immediate pain relief. It is intended for prevention and maintenance therapy in the treatment of peptic ulcers. In an educational context, understanding the rationale behind the timing of medication administration is essential for nurses to teach clients to optimize treatment outcomes. By explaining the pharmacological principles underlying the timing of ranitidine administration, nurses can empower clients to adhere to the prescribed regimen effectively.

Correct Answer: C

Rationale: The correct answer is C) The client is experiencing a side effect of the aluminum hydroxide. Rationale: Aluminum hydroxide is an antacid commonly used to treat peptic ulcers. One of its common side effects is constipation. Aluminum-based antacids can lead to constipation due to their ability to absorb water in the gastrointestinal tract, which can result in decreased bowel motility and difficulty passing stool. Option A) The client has not been including enough fiber in his diet: While fiber intake can impact bowel movements, in this case, the primary reason for constipation is the side effect of the medication, not solely a lack of dietary fiber. Option B) The client needs to increase his daily exercise: While exercise can promote bowel regularity, the client's constipation in this scenario is more likely related to the medication side effect rather than lack of exercise. Option D) The client has developed a gastrointestinal obstruction: This option is less likely as a cause of constipation in this case, as the client's history of aluminum hydroxide use and the duration of constipation make medication side effects a more probable cause. Educational Context: Understanding common side effects of medications used in gastrointestinal disorders is crucial for nurses caring for clients with peptic ulcers. Recognizing the effects of aluminum hydroxide on bowel function can help nurses anticipate and manage constipation in patients taking this medication, ensuring optimal patient outcomes. Nurses should educate clients on potential side effects of medications and encourage open communication about any changes in bowel habits to provide timely interventions.

Correct Answer: D

Rationale: In the context of medical surgical nursing, understanding the correct administration of medications is crucial for client care. The correct answer, option D, "It is best for me to take my antacid 1 to 3 hours after meals," is the most appropriate because antacids work by neutralizing gastric acid, thereby providing relief from symptoms of peptic ulcers. Taking antacids after meals ensures that there is food in the stomach to buffer the acid, maximizing the effectiveness of the medication. Option A is incorrect because antacids should not be taken simultaneously with other medications to avoid potential drug interactions. Option B is incorrect as adequate fluid intake is necessary to help the antacid dissolve and be effective. Option C is incorrect as antacids are preventive rather than reactive medications; they should be taken as a regular part of the treatment regimen, not just when symptoms occur. Educationally, this question highlights the importance of proper medication administration in the management of gastrointestinal disorders. Nurses must educate clients on the correct timing and administration of antacids to optimize their therapeutic effects and promote positive outcomes in the management of peptic ulcers.

Correct Answer: B

Rationale: In caring for a client with chronic gastritis, it is crucial to understand the potential complications and deficiencies that may arise. The correct answer is B) Vitamin B12. Clients with chronic gastritis are at risk for decreased intrinsic factor production, which impairs the absorption of Vitamin B12 in the stomach. This can lead to Vitamin B12 deficiency, causing symptoms like anemia and neurological issues. Option A) Vitamin A deficiency is not typically associated with chronic gastritis but is more commonly linked to malabsorption disorders or inadequate dietary intake. Option C) Vitamin C deficiency is usually related to inadequate dietary intake or conditions like scurvy, not specifically chronic gastritis. Option D) Vitamin E deficiency is more commonly seen in conditions that cause fat malabsorption, like cystic fibrosis or cholestatic liver disease, rather than chronic gastritis. Understanding these specific risks in clients with chronic gastritis is vital for nurses to provide appropriate care, monitor for potential deficiencies, and intervene promptly to prevent further complications. This knowledge enhances the nurse's ability to promote optimal outcomes for their patients with gastrointestinal issues.