Which patient is at highest risk for complications of obesity?

Correct Answer: B

Rationale: The correct answer is B) A 56-year-old woman with a BMI of 38 kg/m2, a waist measurement of 38 in (96 cm), and a hip measurement of 36 in (91 cm). This patient is at the highest risk for complications of obesity because she has a high BMI, central adiposity indicated by a high waist-to-hip ratio, and is in an age group where obesity-related comorbidities are more common. Central obesity, as indicated by a high waist circumference, is particularly associated with increased risk of cardiovascular diseases, diabetes, and metabolic syndrome. Option A is less at risk as the patient's weight is within a normal range for her height and the weight distribution is in the thighs, which is generally considered less risky in terms of associated health complications. Option C has a normal weight and waist-to-hip ratio, which lowers the risk compared to option B. Option D has a higher weight but a lower BMI compared to option B, and the waist-to-hip ratio is not as high, reducing the risk of obesity-related complications. In an educational context, understanding the risk factors associated with obesity, such as central adiposity and high BMI, is crucial for healthcare professionals to identify patients at higher risk for complications and provide targeted interventions to prevent or manage obesity-related health issues effectively.

Correct Answer: A

Rationale: In the context of peptic ulcer disease, a patient with a slow upper GI source of bleeding will typically present with melena. Melena refers to the passage of black, tarry stools due to the digestion of blood in the gastrointestinal tract. This occurs because the blood has time to be partially digested as it travels through the intestines, resulting in the characteristic dark color. Option A, melena, is the correct answer because it aligns with the typical presentation of slow upper GI bleeding. Melena is a key indicator of bleeding from the upper gastrointestinal tract, such as from a peptic ulcer. Option B, occult blood, typically refers to blood that is not visible to the naked eye and is detected through special tests. While occult blood can be present in peptic ulcer disease, it is not the characteristic presentation for slow upper GI bleeding. Option C, coffee-ground emesis, is more commonly associated with a faster upper GI bleed, where the blood is partially digested in the stomach and appears like coffee grounds when vomited. This is not typically seen in slow upper GI bleeding scenarios. Option D, profuse bright-red hematemesis, is more indicative of a rapid and significant upper GI bleed, often seen in conditions like esophageal varices. It is not typically associated with the slow bleeding seen in peptic ulcer disease. Understanding the different presentations of GI bleeding is crucial in clinical practice to guide appropriate management and treatment decisions. Identifying the specific characteristics of bleeding can help healthcare providers determine the location and severity of the bleed, leading to better patient outcomes.

Correct Answer: C

Rationale: In the context of inflammatory bowel disease (IBD), the rationale for prescribing cobalamin (Vitamin B12) and iron injections is primarily to correct malnutrition (Option C). IBD, which includes conditions like Crohn's disease and ulcerative colitis, often leads to malabsorption of essential nutrients due to chronic inflammation and damage to the gastrointestinal tract. This can result in deficiencies in vitamins and minerals, including cobalamin and iron. Cobalamin is essential for the production of red blood cells and proper neurological function, while iron is crucial for oxygen transport in the blood. Supplementing these nutrients via injections helps address deficiencies that can arise in IBD patients, thereby improving their overall nutritional status and health outcomes. Option A, alleviating stress, is not directly related to the nutritional deficiencies commonly seen in IBD. While stress management is important for overall well-being, it is not the primary reason for prescribing cobalamin and iron injections in this context. Option B, combating infection, is also not the main purpose of these specific medications in IBD treatment. While IBD does involve chronic inflammation, the focus of cobalamin and iron injections is on addressing malnutrition rather than directly targeting infections. Option D, improving quality of life, is a broad goal of managing IBD, but the specific use of cobalamin and iron injections is more targeted at addressing nutrient deficiencies and related complications rather than solely aiming to improve quality of life. Educationally, understanding the rationale behind prescribing specific medications in IBD is crucial for healthcare providers to provide effective care to patients. By addressing nutritional deficiencies with appropriate interventions like cobalamin and iron injections, healthcare professionals can help manage IBD symptoms and improve the overall health outcomes of patients.

Correct Answer: D

Rationale: The correct answer is D) Avoidance of gluten found in wheat, barley, oats, and rye. The most common form of malabsorption syndrome is Celiac disease, which is an autoimmune disorder triggered by the ingestion of gluten. When individuals with Celiac disease consume gluten-containing foods, their immune system attacks the lining of the small intestine, leading to malabsorption of nutrients. Therefore, the primary treatment for Celiac disease is strict adherence to a gluten-free diet. Option A) Administration of antibiotics is not the standard treatment for malabsorption syndromes like Celiac disease. Antibiotics are typically used to treat bacterial infections, not autoimmune conditions. Option B) Avoidance of milk and milk products is a strategy for managing lactose intolerance, not malabsorption syndromes related to gluten intolerance like Celiac disease. Option C) Supplementation with pancreatic enzymes is more commonly associated with conditions like pancreatic insufficiency, where the pancreas does not produce enough digestive enzymes. While this may help with digestion, it is not the primary treatment for malabsorption due to Celiac disease. Educational Context: It is essential for healthcare providers and individuals with malabsorption syndromes to understand the importance of correctly identifying and managing the underlying cause of malabsorption. In the case of Celiac disease, strict adherence to a gluten-free diet is crucial for symptom management and preventing long-term complications. Education on reading food labels, identifying hidden sources of gluten, and working with a dietitian can greatly support individuals in successfully managing their condition and improving their quality of life.

Correct Answer: A

Rationale: In the context of caring for a patient with viral hepatitis, providing adequate nutritional intake (Option A) is one of the most challenging nursing interventions to promote healing. This is because hepatitis can lead to poor appetite, nausea, and malabsorption, making it difficult for patients to meet their nutritional needs. Adequate nutrition is crucial for liver function and overall healing, so ensuring the patient receives the necessary nutrients is essential. Promoting strict bed rest during the icteric phase (Option B) is not recommended as prolonged bed rest can lead to muscle deconditioning and increase the risk of complications like deep vein thrombosis. Patients with hepatitis should be encouraged to engage in light physical activity as tolerated. Providing pain relief without using liver-metabolized drugs (Option C) is important due to the impaired liver function in hepatitis patients. However, while pain management is essential, it is not the most challenging nursing intervention in this context. Providing quiet diversional activities during periods of fatigue (Option D) can be helpful in managing symptoms, but it is not as critical to promoting healing in viral hepatitis as ensuring adequate nutritional intake. Educationally, understanding the rationale behind each option helps nurses prioritize interventions based on their impact on the patient's healing process. By focusing on nutritional support, nurses can significantly contribute to the patient's recovery from viral hepatitis.