You are caring for a client with peptic ulcer disease. Which assessment finding is the most serious?

Correct Answer: D

Rationale: The correct answer is D. A board-like abdomen with shoulder pain indicates a perforated ulcer, a medical emergency requiring immediate intervention. A perforation can lead to peritonitis and septic shock. Choice A, projectile vomiting, may indicate a gastric outlet obstruction but is not as immediately life-threatening as a perforation. Choice B, burning sensation 2 hours after eating, is a common symptom of peptic ulcer disease and does not indicate a complication. Choice C, coffee-ground emesis, may indicate bleeding but is not as severe as a perforation.

Correct Answer: D

Rationale: The correct answer is D because smoking can lead to chronic coughing and sneezing, which may increase intra-abdominal pressure. This can be detrimental post-surgery, especially in herniation cases where increased pressure can strain the surgical site, leading to complications like wound dehiscence or hernia recurrence. Choices A and B are incorrect as they do not directly relate to the impact of smoking on intra-abdominal pressure. Choice C is also incorrect as it focuses on medication contraindications rather than the physiological effects of smoking on surgical outcomes.

Correct Answer: B

Rationale: The correct answer is B: Colostomy. A colostomy is an opening in the large bowel created by bringing a section of the large intestine out to the abdomen to form a stoma. This procedure is typically done to divert stool in cases of colorectal diseases or surgeries. A: Continent ileostomy - This choice is incorrect because a continent ileostomy involves creating a pouch inside the body to collect waste, rather than bringing a section of the large intestine out to the abdomen. C: Ileostomy - This choice is incorrect because an ileostomy involves bringing the end of the small intestine out to the abdomen to create a stoma, not a section of the large intestine. D: Ileoanal reservoir - This choice is incorrect as it refers to a surgical procedure where the colon and rectum are removed, and a pouch is created from the small intestine to restore bowel function, not to create a stoma in the large bowel.

Correct Answer: D

Rationale: The correct answer is D because an alteration in ingestion, absorption, or metabolism can lead to secondary protein-calorie malnutrition. This can occur due to various medical conditions affecting the digestive system, such as malabsorption syndromes or metabolic disorders. The other choices are incorrect because the primary cause of secondary protein-calorie malnutrition in the US is not the unavailability of high-protein foods, lack of knowledge about nutritional needs, or lack of money to purchase such foods. These factors may contribute to malnutrition but are not the most common cause in this context.

Correct Answer: B

Rationale: The correct answer is B: Lipectomy. This procedure involves the removal of excess fat tissue, which can help the patient achieve weight loss. In contrast, options C and D are bariatric surgeries, which are not solely focused on fat removal and may not be suitable for this patient given her age and medical history. Option A, a combination of restrictive and malabsorptive surgery, may pose higher risks for complications in a severely obese patient with diabetes. Lipectomy is a more targeted and less invasive approach to weight loss, making it the most appropriate choice in this scenario.