You promote hemodynamic stability in a patient with upper GI bleeding by:

Correct Answer: D

Rationale: In managing a patient with upper GI bleeding, promoting hemodynamic stability is crucial to prevent further complications. The correct answer, "D) Giving blood, electrolyte, and fluid replacement," is the most appropriate action to address the underlying issue of blood loss and maintain hemodynamic stability. Blood transfusion helps replenish lost blood volume, ensuring adequate tissue perfusion and oxygen delivery. Electrolyte and fluid replacement are essential to maintain intravascular volume and electrolyte balance, supporting cardiovascular function. Option A, "Encouraging oral fluid intake," is incorrect as it may worsen the bleeding and lead to further hemodynamic instability. Option B, "Monitoring central venous pressure," while important in some cases, does not directly address the immediate need to replace lost blood and fluids. Option C, "Monitoring laboratory test results and vital signs," is a general nursing intervention and does not specifically target hemodynamic stability in a patient with active GI bleeding. In an educational context, understanding the rationale behind managing upper GI bleeding is essential for nurses caring for these patients. By selecting the correct answer, nurses demonstrate their ability to prioritize interventions that directly impact patient outcomes and prevent complications associated with hemorrhage. This question highlights the critical thinking skills required in medical-surgical nursing to provide safe and effective care to patients experiencing GI bleeding.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Bowel perforation. Christopher's presentation with severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output is concerning for a bowel perforation. A bowel perforation is a serious complication of ulcerative colitis where there is a hole in the wall of the intestine. This leads to leakage of bowel contents into the abdominal cavity, causing severe pain, tenderness, fever, and signs of peritonitis like rebound tenderness. The decreased urine output may indicate hypovolemia due to fluid shifting into the peritoneal cavity. Option A) Fistula is incorrect as fistulas are abnormal connections between organs or vessels, not indicative of a bowel perforation in this context. Option C) Bowel obstruction typically presents with different signs and symptoms such as abdominal distension, constipation, and vomiting, which are not prominent in this case. Option D) Abscess would present with localized pain, swelling, and possibly a palpable mass, which are not described in Christopher's case. Educationally, understanding the complications of ulcerative colitis is crucial for nurses to provide timely and appropriate interventions to prevent further deterioration in patients like Christopher. Recognizing the signs and symptoms of bowel perforation can help nurses advocate for prompt medical attention and potentially life-saving interventions.

Correct Answer: C

Rationale: In the context of a severe exacerbation of ulcerative colitis, the correct long-term medication choice is corticosteroids (Option C). Here's a detailed rationale: Corticosteroids are commonly used in ulcerative colitis to reduce inflammation and suppress the immune response in the colon. They help in inducing and maintaining remission in patients with severe disease activity. Antacids (Option A) are primarily used for conditions such as acid reflux and peptic ulcers, not for ulcerative colitis. Antibiotics (Option B) may be used in cases of infection but are not the mainstay of treatment for ulcerative colitis. Histamine2-receptor blockers (Option D) are used for conditions like GERD and peptic ulcers, not for inflammatory bowel diseases like ulcerative colitis. In an educational context, it's crucial for nursing students to understand the rationale behind medication choices in gastrointestinal disorders like ulcerative colitis. Knowing the appropriate pharmacological interventions based on the underlying pathophysiology and severity of the condition is essential for providing safe and effective patient care. This question highlights the importance of selecting the right medications tailored to the specific disease process.

Correct Answer: A

Rationale: In the context of a patient with liver failure, limiting meats and beans (Option A) in the diet is crucial due to their high protein content. The liver is responsible for metabolizing proteins, and in liver failure, the organ's ability to process protein is compromised, leading to ammonia buildup and potential encephalopathy. By reducing protein intake, the workload on the liver is decreased, helping to manage symptoms and prevent further damage. Butter and gravies (Option B) are high in fats, which can worsen liver function as the liver struggles to process them. Excessive fat consumption can lead to fatty liver disease and exacerbate the patient's condition. Potatoes and pastas (Option C) are sources of carbohydrates and are generally acceptable in moderation for a patient with liver failure unless they have other comorbid conditions like diabetes or obesity. Carbohydrates provide energy and are not as directly taxing on the liver as proteins and fats. Cakes and pastries (Option D) are high in sugars and unhealthy fats, which can contribute to weight gain and fatty liver disease. These should be limited in a patient with liver failure to prevent further stress on the liver. Educationally, understanding dietary restrictions in liver failure is essential for patient care. Teaching families about appropriate food choices helps them support the patient's health and recovery. It also highlights the importance of individualized care based on the patient's specific condition to optimize outcomes.

Correct Answer: B

Rationale: The correct response, B) Stop the feeding, and clamp the NG tube, is based on the principle of patient safety and preventing complications. Aspirating 220ml of gastric residual suggests poor gastric emptying and potential risk for aspiration, which can lead to respiratory compromise. By stopping the feeding and clamping the NG tube, you are preventing the patient from receiving more feedings that could potentially exacerbate the situation. Option A) Notify the doctor immediately is not the first response because immediate action is needed to address the risk of aspiration. Waiting for a physician's response could delay necessary interventions. Option C) Discard the 220ml, and clamp the NG tube is incorrect because discarding the aspirate without taking action to prevent further feeding could still lead to complications. Option D) Give a prescribed GI stimulant such as metoclopramide (Reglan) is not appropriate in this situation as the priority is to address the immediate risk of aspiration rather than promoting gastric motility. In an educational context, understanding the significance of gastric residuals in enteral feedings is crucial for nurses caring for patients with NG tubes. Prompt recognition of abnormal findings and appropriate actions can prevent serious complications and promote patient safety in medical-surgical settings.