Which patient is at highest risk for having a gastric ulcer?

Correct Answer: A

Rationale: The correct answer is A because a 55-year-old female who is a smoker and experiencing symptoms of nausea and vomiting has multiple risk factors for developing a gastric ulcer. Smoking and older age are established risk factors for gastric ulcers. Nausea and vomiting can be indicative of underlying gastrointestinal issues. Choice B is less likely as illicit drug use typically does not directly increase the risk of gastric ulcers. Choice C is less likely as the male falling while looking for a job does not directly relate to gastric ulcer development. Choice D is less likely as divorce and back pain are not direct risk factors for gastric ulcers.

Correct Answer: D

Rationale: The correct answer is D because in the event of leakage from the pouch, it is important to promptly remove it, clean the skin, and apply a new pouch to prevent skin irritation and infection. This step is crucial for maintaining skin integrity and preventing complications. Choice A is incorrect as ileostomy pouches typically need to be changed more frequently, usually every 3-7 days, to prevent skin breakdown and odor. Choice B is incorrect because decreasing fluid intake can lead to dehydration and electrolyte imbalances, which are especially risky for ileostomy patients who have increased fluid losses. Choice C is incorrect because the pouch should not be removed until the stoma and bowel movements have been evaluated and regulated to ensure proper functioning.

Correct Answer: D

Rationale: The correct answer is D because HBV DNA quantitation measures the amount of HBV genetic material in the blood, reflecting viral replication. This helps monitor the effectiveness of therapy in chronic HBV patients. Choice A is incorrect as the test does not specifically indicate ongoing infection. Choice B is incorrect as it refers to co-infection with HDV, which is not the purpose of HBV DNA quantitation. Choice C is incorrect as the test does not differentiate between previous infection and ongoing viral replication, which is crucial in managing chronic HBV.

Correct Answer: D

Rationale: The correct answer is D because patients who undergo liver transplant are put on immunosuppressive medication to prevent rejection. This medication weakens the immune system, making the patient more susceptible to infections. Monitoring closely for signs of infection is crucial to prevent complications. Choice A is incorrect because alcohol intake is not recommended after a liver transplant as it can further damage the new liver. Choice B is incorrect because HBIG (Hepatitis B Immunoglobulin) is typically given to prevent hepatitis B recurrence, not rejection. Choice C is incorrect as elevating the head has no direct correlation with post-liver transplant care.

Correct Answer: C

Rationale: The correct answer is C: Report any bile-colored or purulent drainage from the incisions. This is important because it could indicate infection or bile leak, which are complications that need immediate medical attention. A is incorrect because incision areas should be kept clean and dry, but typically for 48 hours, not a week. B is incorrect as shoulder pain is a common referred pain after laparoscopic cholecystectomy and not necessarily an immediate concern. D is incorrect because while some nausea and vomiting can be expected, it should not be considered normal for days postoperatively.