Which of the following patients is at greatest risk for developing pressure ulcers?

Correct Answer: B

Rationale: The correct answer is B. An elderly patient who is incontinent, bedridden, and suffering from a serious illness like gastric cancer is at the highest risk for developing pressure ulcers. Being bedridden and incontinent increases the pressure on certain areas of the body, leading to tissue damage and the development of pressure ulcers. Additionally, the patient's age and underlying health condition further contribute to their risk. It is crucial to identify and address such risk factors promptly to prevent the occurrence of pressure ulcers in vulnerable patients.

Correct Answer: A

Rationale: Thiamine deficiency, also known as Vitamin B1 deficiency, is the most common vitamin deficiency seen in individuals with alcohol use disorder. Chronic alcohol consumption can lead to decreased thiamine absorption and utilization, as well as poor dietary intake. Thiamine deficiency can result in serious neurological complications, such as Wernicke-Korsakoff syndrome, making it essential to address thiamine supplementation in individuals with alcohol use disorder.

Correct Answer: C

Rationale: The incorrect statement is that 'The patient should always feed himself.' Patients with dysphagia may require assistance with feeding due to difficulty in swallowing safely. It is essential to provide appropriate support and supervision during meal times to prevent complications such as aspiration or inadequate nutrition intake.

Correct Answer: A

Rationale: Notifying the physician is necessary when the urine output is less than 30 ml/hour as it indicates impaired kidney function. Adequate urine output is essential for monitoring kidney function, and a urine output less than 30 ml/hour could suggest potential renal issues that require medical attention.

Correct Answer: A

Rationale: Caffeine-containing drinks like coffee and cola (Option A) act as diuretics, substances that promote diuresis—the increased production of urine. Caffeine inhibits the action of antidiuretic hormone (ADH), also called vasopressin, which normally signals the kidneys to reabsorb water and concentrate urine. By blocking ADH, caffeine reduces water reabsorption in the renal tubules, leading to higher urine output. Additionally, caffeine increases blood flow to the kidneys by dilating afferent arterioles, further enhancing filtration rates. This physiological mechanism is well-documented and explains why beverages containing caffeine are associated with frequent urination. Beets (Option B) do not increase urine production. While they contain nitrates and betalains, which may have vasodilatory or antioxidant effects, they lack diuretic properties. Beets can temporarily discolor urine (a harmless condition called beeturia) due to their pigments, but this does not correlate with increased urine volume. Their primary metabolic byproducts are excreted without altering kidney filtration or water reabsorption pathways. Urinary analgesics (Option C), such as phenazopyridine, are medications used to relieve pain, burning, or discomfort in the urinary tract. These drugs work by locally numbing the mucosa of the urinary tract, not by modifying kidney function. They do not influence urine volume, glomerular filtration rate, or ADH secretion. Their mechanism of action is entirely distinct from diuretics, making this option incorrect in the context of increasing urine output. Kaolin with pectin (Option D), commonly sold as Kaopectate, is an antidiarrheal agent. It works by adsorbing toxins and fluids in the gastrointestinal tract, reducing stool frequency and liquidity. While it affects fluid balance in the gut, it has no direct action on renal function. If anything, by reducing fluid loss through diarrhea, it may indirectly decrease the need for compensatory diuresis. Its mechanism is orthogonal to diuresis, rendering this choice irrelevant to the question. Thus, the only substance among the options that directly and significantly increases urine production is caffeine, due to its well-established diuretic effects mediated through ADH inhibition and renal vasodilation. The other choices either lack diuretic properties or function through unrelated mechanisms.