Mr. Garcia, a 41-year old chronic alcohol drinker is admitted to the hospital after vomiting bright red blood. He was diagnosed to have a bleeding gastric ulcer and suddenly develops sudden sharp pain in the midepigastric region with a rigid boardlike abdomen. This likely indicates:

Correct Answer: C

Rationale: The sudden sharp pain in the midepigastric region with a rigid boardlike abdomen in a patient with a bleeding gastric ulcer, especially in the setting of chronic alcohol use, is indicative of a perforation of the ulcer. Perforation occurs when the ulcer penetrates through the wall of the stomach or duodenum, leading to the leakage of gastric contents into the peritoneal cavity. This results in peritonitis, causing severe abdominal pain and rigidity. Perforation of the ulcer is a surgical emergency requiring immediate intervention to repair the perforation, control the infection, and prevent further complications like sepsis. It is a life-threatening condition that necessitates prompt diagnosis and management.

Correct Answer: C

Rationale: Clients with cirrhosis, which is a serious liver condition, should avoid or limit their alcohol intake. Alcohol can worsen liver damage and lead to further complications such as liver failure. Nurse Dennis is correct in advising clients with cirrhosis to adhere to this measure in order to promote their health and reduce the progression of the disease. Taking daily multivitamins can be beneficial for some individuals, but limiting alcohol intake is crucial for those with cirrhosis. Taking sleeping pills at home without medical supervision can also be dangerous, as it may interact with other medications and worsen liver function. Limiting contact at all times is not relevant to managing cirrhosis.

Correct Answer: C

Rationale: The best statement explaining why the nurse should instruct the client to take prednisone (Deltasone) in the morning is that morning administration mimics the body's natural corticosteroid secretion pattern. Cortisol, a natural corticosteroid, is highest in the morning and decreases throughout the day. By taking prednisone in the morning, the client aligns the medication's peak effects with the body's natural cortisol levels, which can help reduce the risk of disrupting the body's internal rhythm and minimize potential side effects. This timing also helps achieve optimal therapeutic effects while minimizing the risk of adrenal suppression and other adverse effects associated with corticosteroid use.

Correct Answer: A

Rationale: The statement "Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites" is accurate and supported by data. Studies have shown that diabetes mellitus, particularly type 2 diabetes, is more prevalent among Hispanic populations compared to Black or White populations. Factors such as genetic predisposition, lifestyle choices, and socioeconomic status can contribute to this disparity. It is important for healthcare providers to be aware of these trends to provide appropriate and culturally sensitive care to individuals at higher risk for diabetes.

Correct Answer: D

Rationale: The correct statement to include during preoperative teaching for a client undergoing subtotal thyroidectomy is "You must avoid hyperextending your neck after surgery." This is important because hyperextending the neck can put strain on the suture line and may lead to dehiscence (wound opening). It is crucial for the client to avoid any activities or positions that could compromise the surgical site and hinder proper healing.