Priority Decision: Before selecting a weight reduction plan with an obese patient

Correct Answer: D

Rationale: In the context of selecting a weight reduction plan with an obese patient, the correct answer is D) Whether financial considerations will affect the patient's choices. This is the priority decision because the patient's financial situation can significantly impact their ability to access and sustain a weight reduction plan. Considering financial constraints allows healthcare providers to tailor recommendations that are feasible and sustainable for the patient. Option A) What is most important for the nurse to first assess is not the most critical in this scenario because financial considerations can have a more immediate impact on the patient's ability to engage in a weight reduction plan. Option B) The patient's motivation to lose weight is important but assessing financial considerations should come first as it can influence the patient's motivation and ability to follow through with a plan. Option C) The length of time that the patient has been obese is relevant for understanding their health history but does not take precedence over addressing financial factors that may affect their current and future weight reduction efforts. In an educational context, understanding the influence of social determinants of health, such as financial constraints, is crucial for providing patient-centered care. By prioritizing the assessment of financial considerations, healthcare providers can work collaboratively with patients to develop realistic and sustainable weight reduction plans that align with their individual needs and circumstances.

Correct Answer: B

Rationale: In teaching patients at risk for upper GI bleeding to prevent bleeding episodes, it is crucial for the nurse to emphasize that the use of over-the-counter (OTC) medications of any kind should be avoided (Option B). This is the correct answer because many OTC medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and certain supplements, can increase the risk of GI bleeding by irritating the stomach lining or interfering with blood clotting. Option A, testing all stools and vomitus for blood, although important for monitoring, does not address prevention strategies. Option C, taking antacids with prescribed medications, is not a universal preventive measure for upper GI bleeding. Option D, using misoprostol (Cytotec), is a treatment option for protecting the gastric mucosa in certain cases but is not a primary prevention strategy. Educationally, it is essential to teach patients about the potential risks associated with OTC medications and the importance of consulting healthcare providers before taking any new medication, especially if they are at risk for upper GI bleeding. Emphasizing lifestyle modifications, medication management, and regular monitoring can empower patients to take an active role in their health and prevent complications like GI bleeding.

Correct Answer: B

Rationale: In the postoperative assessment of a patient who has undergone the first phase of a total proctocolectomy with ileal pouch and anal anastomosis for ulcerative colitis, the nurse should expect to find a loop ileostomy with a plastic rod to hold it in place. This is because after this surgical procedure, a loop ileostomy is often created temporarily to divert fecal flow while the newly created ileal pouch heals. The plastic rod is used to prevent the stoma from retracting into the abdomen. Option A (rectal tube set to low continuous suction) is incorrect because in this surgical procedure, the colon and rectum are usually removed, so there is no need for a rectal tube. Option C (a colostomy stoma with an NG tube in place to provide pouch irrigations) is incorrect because in this procedure, an ileal pouch is created, not a colostomy stoma. Additionally, irrigations are not typically done in the immediate postoperative period. Option D (a permanent ileostomy stoma in the right lower quadrant of the abdomen) is incorrect because the first phase of a total proctocolectomy with ileal pouch and anal anastomosis does not involve the creation of a permanent ileostomy. Educationally, understanding the postoperative care and expected findings following specific surgical procedures is crucial for nurses caring for patients with gastrointestinal conditions. This knowledge ensures appropriate assessment, intervention, and patient education to promote optimal recovery and outcomes.

Correct Answer: B

Rationale: Short bowel syndrome (SBS) is a condition characterized by malabsorption due to a significant portion of the small intestine being removed or non-functional. The most likely patient to be diagnosed with SBS is the one who had extensive resection of the ileum (Option B) because the ileum is the last part of the small intestine where most nutrient absorption occurs. Removal or dysfunction of a large part of the ileum can lead to malabsorption issues seen in SBS. Option A, a history of ulcerative colitis, is incorrect because ulcerative colitis primarily affects the large intestine and does not directly result in SBS. Option C, irritable bowel syndrome, is a functional disorder and does not involve structural changes in the intestine like SBS. Option D, having a colectomy for bowel cancer, involves the removal of the colon (large intestine), not the small intestine where SBS typically occurs. In an educational context, understanding the specific anatomical and functional roles of different parts of the gastrointestinal tract is essential in diagnosing and managing conditions like short bowel syndrome. It highlights the importance of considering surgical history and its potential impact on nutrient absorption and overall gastrointestinal health.

Correct Answer: C

Rationale: In the context of Wilson's disease, D-penicillamine is used as a chelating agent to help remove excess copper from the body. Corneal Fleischer rings are a classic sign of Wilson's disease and are caused by copper deposition in Descemet's membrane of the cornea. Therefore, the correct answer is C. Pruritus (A) is not typically associated with Wilson's disease or D-penicillamine use. Acute kidney injury (B) is not a common assessment finding related to D-penicillamine use in Wilson's disease. Elevated serum iron levels (D) are not expected in Wilson's disease as it is a disorder of copper metabolism. In an educational context, understanding the expected assessment findings in Wilson's disease and the appropriate medication management is crucial for nurses caring for patients with this condition. Recognizing Corneal Fleischer rings can aid in early diagnosis and appropriate treatment initiation for Wilson's disease, highlighting the importance of accurate assessment skills in nursing practice.