Dark, tarry stools indicate bleeding in which location of the GI tract?

Correct Answer: C

Rationale: In medical-surgical nursing, understanding the significance of stool characteristics is crucial for assessing gastrointestinal (GI) bleeding. Dark, tarry stools, known as melena, indicate the presence of digested blood in the stool. This type of stool typically signals bleeding in the upper GI tract, specifically in the stomach or proximal small intestine. Option A) Upper colon is incorrect because bleeding in the colon usually results in bright red blood in the stool (hematochezia) rather than dark, tarry stools. Option B) Lower colon is incorrect as lower GI bleeding, such as from the colon or rectum, typically presents as bright red blood in the stool, not melena. Option D) Small intestine is incorrect as melena is more commonly associated with upper GI bleeding rather than the small intestine. Educationally, this question highlights the importance of recognizing clinical manifestations associated with GI bleeding and linking them to specific anatomical locations within the GI tract. Nurses need to be adept at interpreting stool characteristics to guide appropriate interventions and improve patient outcomes in acute care settings.

Correct Answer: D

Rationale: In managing a patient with upper GI bleeding, promoting hemodynamic stability is crucial to prevent further complications. The correct answer, "D) Giving blood, electrolyte, and fluid replacement," is the most appropriate action to address the underlying issue of blood loss and maintain hemodynamic stability. Blood transfusion helps replenish lost blood volume, ensuring adequate tissue perfusion and oxygen delivery. Electrolyte and fluid replacement are essential to maintain intravascular volume and electrolyte balance, supporting cardiovascular function. Option A, "Encouraging oral fluid intake," is incorrect as it may worsen the bleeding and lead to further hemodynamic instability. Option B, "Monitoring central venous pressure," while important in some cases, does not directly address the immediate need to replace lost blood and fluids. Option C, "Monitoring laboratory test results and vital signs," is a general nursing intervention and does not specifically target hemodynamic stability in a patient with active GI bleeding. In an educational context, understanding the rationale behind managing upper GI bleeding is essential for nurses caring for these patients. By selecting the correct answer, nurses demonstrate their ability to prioritize interventions that directly impact patient outcomes and prevent complications associated with hemorrhage. This question highlights the critical thinking skills required in medical-surgical nursing to provide safe and effective care to patients experiencing GI bleeding.

Correct Answer: A

Rationale: In preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy, the initial step should be to determine what the patient already knows about colostomies (Option A). This is crucial for assessing the patient's baseline knowledge, addressing any misconceptions, and tailoring education to meet their specific needs and concerns. Option B, showing pictures of colostomies, may be overwhelming for a patient experiencing anxiety and could potentially increase their distress. Option C, arranging for someone with a colostomy to visit the patient, may not always be feasible and might not address the patient's individual questions and fears. Option D, providing written material, may not be effective if the patient is too anxious to read or comprehend the information. In an educational context, effective patient education involves assessing the patient's knowledge, addressing their concerns, and providing information in a way that is tailored to their needs and preferences. By starting with what the patient already knows, healthcare providers can build upon existing knowledge, correct misunderstandings, and ensure that the patient is well-prepared and supported for the upcoming surgery and colostomy.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Bowel perforation. Christopher's presentation with severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output is concerning for a bowel perforation. A bowel perforation is a serious complication of ulcerative colitis where there is a hole in the wall of the intestine. This leads to leakage of bowel contents into the abdominal cavity, causing severe pain, tenderness, fever, and signs of peritonitis like rebound tenderness. The decreased urine output may indicate hypovolemia due to fluid shifting into the peritoneal cavity. Option A) Fistula is incorrect as fistulas are abnormal connections between organs or vessels, not indicative of a bowel perforation in this context. Option C) Bowel obstruction typically presents with different signs and symptoms such as abdominal distension, constipation, and vomiting, which are not prominent in this case. Option D) Abscess would present with localized pain, swelling, and possibly a palpable mass, which are not described in Christopher's case. Educationally, understanding the complications of ulcerative colitis is crucial for nurses to provide timely and appropriate interventions to prevent further deterioration in patients like Christopher. Recognizing the signs and symptoms of bowel perforation can help nurses advocate for prompt medical attention and potentially life-saving interventions.

Correct Answer: C

Rationale: In the context of a severe exacerbation of ulcerative colitis, the correct long-term medication choice is corticosteroids (Option C). Here's a detailed rationale: Corticosteroids are commonly used in ulcerative colitis to reduce inflammation and suppress the immune response in the colon. They help in inducing and maintaining remission in patients with severe disease activity. Antacids (Option A) are primarily used for conditions such as acid reflux and peptic ulcers, not for ulcerative colitis. Antibiotics (Option B) may be used in cases of infection but are not the mainstay of treatment for ulcerative colitis. Histamine2-receptor blockers (Option D) are used for conditions like GERD and peptic ulcers, not for inflammatory bowel diseases like ulcerative colitis. In an educational context, it's crucial for nursing students to understand the rationale behind medication choices in gastrointestinal disorders like ulcerative colitis. Knowing the appropriate pharmacological interventions based on the underlying pathophysiology and severity of the condition is essential for providing safe and effective patient care. This question highlights the importance of selecting the right medications tailored to the specific disease process.