The client with a duodenal ulcer may exhibit which of the following findings on assessment?

Correct Answer: C

Rationale: In a client with a duodenal ulcer, the presence of melena (option C) is a common finding on assessment. Melena refers to black, tarry stools caused by upper gastrointestinal bleeding. This occurs because the blood is partially digested as it passes through the gastrointestinal tract. Detecting melena indicates active bleeding and is a crucial sign in assessing the severity of the ulcer and the need for intervention. Option A, hematemesis, is vomiting of blood and is more commonly associated with gastric ulcers. Option B, malnourishment, can be a consequence of chronic gastrointestinal issues like ulcers, but it is not a direct finding on assessment for a duodenal ulcer. Option D, pain with eating, is a common symptom of duodenal ulcers but is not specific to their assessment findings. Educationally, understanding these assessment findings is crucial for nurses caring for patients with gastrointestinal issues. Recognizing the specific signs and symptoms associated with duodenal ulcers helps in prompt diagnosis, appropriate interventions, and effective patient care. It also highlights the importance of differentiating between various gastrointestinal conditions based on assessment findings for accurate treatment and management.

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.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Cancer of the stomach. This is because the client's symptoms of gnawing epigastric pain after meals, along with severe pain and vomiting, are indicative of more serious underlying issues beyond common gastrointestinal problems. Cancer of the stomach can manifest with these symptoms, especially when the tumor obstructs the gastric outlet, leading to postprandial pain and vomiting. Option B) Peptic ulcer disease typically presents with burning epigastric pain that improves with food or antacids, rather than worsening after meals. Chronic gastritis (Option C) is characterized by dull, aching pain and is not usually associated with severe pain and vomiting after meals. Pylorospasm (Option D) presents with intermittent episodes of epigastric pain but is not typically associated with severe pain and vomiting after meals. Educationally, understanding the specific manifestations of different gastrointestinal pathologies is crucial for nurses to provide accurate assessments and interventions. This rationale highlights the importance of recognizing the unique symptomatology of stomach cancer in contrast to other common gastrointestinal disorders, emphasizing the need for timely and appropriate diagnostic testing in clinical practice.