Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?

Correct Answer: B

Rationale: In the case of a client hospitalized for cholecystitis, the main focus of nursing management should be on option B) Assessment for complications. This is the correct answer because cholecystitis involves inflammation of the gallbladder, which can lead to serious complications such as infection, abscess formation, or even perforation of the gallbladder. Therefore, closely monitoring the client for any signs of worsening condition or complications is crucial for timely intervention and optimal patient outcomes. Option A) Administration of antibiotics may be a component of the treatment for cholecystitis, especially if it is caused by an infectious process. However, the primary focus should be on assessing for complications to prevent deterioration of the client's condition. Option C) Preparation for lithotripsy is not typically indicated for cholecystitis. Lithotripsy is a procedure used to break down gallstones, which may be a consideration for clients with gallstones but not necessarily for those with cholecystitis. Option D) Preparation for surgery may be necessary in some cases of cholecystitis, particularly if complications arise or if conservative management is not effective. However, the immediate priority is to assess for complications and stabilize the client's condition before considering surgical intervention. In an educational context, understanding the priority of nursing management in conditions like cholecystitis is essential for providing safe and effective care to patients. By focusing on assessing for complications, nurses can intervene promptly and prevent potential adverse outcomes, ultimately promoting the best possible patient care and recovery.

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: D

Rationale: In distinguishing between the pain associated with duodenal and gastric ulcers, it is crucial to understand the pathophysiology of each condition. The correct answer, "D) Pain on an empty stomach," is indicative of a duodenal ulcer. This pain worsens when the stomach is empty due to the exposure of the ulcer to gastric acid during fasting periods. The presence of pain at night or in between meals is a classic symptom of a duodenal ulcer. Option A, "Early satiety," is more commonly associated with gastric ulcers. Gastric ulcers tend to cause pain or discomfort shortly after eating, leading to early satiety as a result of the irritation in the stomach lining postprandially. Option B, "Pain on eating," is not a typical characteristic of either duodenal or gastric ulcers. Pain that worsens with eating is more indicative of esophageal or gastric conditions such as gastritis. Option C, "Dull upper epigastric pain," is a general symptom that can be present in both duodenal and gastric ulcers. However, the specific characteristic that distinguishes duodenal ulcers is the relief of pain with food intake due to neutralization of stomach acid. Understanding these distinctions is vital in clinical practice as it guides healthcare providers in making accurate diagnoses and implementing appropriate treatment plans for patients with gastrointestinal ulcers.

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.