Correct Answer: D

Rationale: Abdominal cramping can occur with various gastrointestinal conditions, including peritonitis. However, it is not specific to peritonitis and may also be present in conditions like gastroenteritis or bowel obstruction. Profuse diarrhea is typically associated with gastrointestinal infections or inflammatory bowel diseases rather than peritonitis. In fact, peritonitis often leads to reduced bowel activity, potentially resulting in constipation rather than diarrhea. Hyperactive bowel sounds can occur in early stages of peritonitis but are not a classic finding. In many cases of peritonitis, bowel sounds may be diminished or absent due to the body’s response to inflammation. A hard, rigid abdomen indicates muscle guarding, which is the body’s response to inflammation and irritation of the peritoneum. This rigidity is often referred to as 'board-like' and is a key indicator of peritonitis.

Correct Answer: C

Rationale: Constipation can be uncomfortable and may require management, but it is not typically a direct complication of peptic ulcer disease. While it is important to address, it does not pose an immediate threat to the client’s health. Epigastric discomfort is a common symptom of peptic ulcer disease and can indicate that the ulcer is active or that the patient is experiencing gastric distress. However, it does not indicate a severe or life-threatening condition and should be managed but is not a priority finding. Hematemesis, or vomiting blood, is a serious symptom that indicates possible bleeding from the ulcer. This is a potentially life-threatening condition that requires immediate medical intervention, as it can lead to significant blood loss and complications such as shock. Dyspepsia refers to general digestive discomfort, which may include symptoms like bloating, nausea, and heartburn. While it is a common symptom in peptic ulcer disease, it does not indicate an urgent medical condition.

Correct Answer: C

Rationale: Elevating the head of the bed is a recommended practice for individuals with GERD, as it helps prevent stomach acid from flowing back into the esophagus during sleep. This shows the patient is taking proactive steps to manage their condition. Using antacids can provide symptomatic relief from heartburn and discomfort associated with GERD. Taking them between meals and at bedtime can help neutralize stomach acid, which is a common practice for managing GERD symptoms. Eating large meals, especially rich or fatty foods, and snacking before bedtime can exacerbate GERD symptoms by increasing stomach pressure and acid production. Patients with GERD are typically advised to eat smaller meals and avoid eating close to bedtime to reduce reflux episodes. Chewing gum can actually be beneficial for some GERD patients as it stimulates saliva production, which can help neutralize stomach acid.

Correct Answer: 2.5 ml/min

Rationale: Rate (ml/min) =
Total Volume (ml) / Time (min). The total volume of the pantoprazole IV is 10 ml, and the time frame for administration is 4 minutes.
Therefore, the calculation would be: Rate = 10 ml / 4 min, which equals 2.5 ml per minute. So, the nurse should administer 2.5 ml of pantoprazole IV per minute to deliver a total of 40 mg over the 4-minute period.

Correct Answer: D

Rationale:
Total bilirubin levels are primarily associated with liver function and hemolysis. While malnutrition can impact liver function, total bilirubin is not a direct indicator of nutritional status or malnutrition. Creatine kinase (CK) is an enzyme found in the heart, brain, and skeletal muscles. Its levels are typically associated with muscle damage or myocardial infarction. While malnutrition can impact muscle mass, CK is not specifically altered due to malnutrition alone. Troponin is a protein released when the heart muscle is damaged. It is primarily used as a biomarker for myocardial injury. Malnutrition does not directly affect troponin levels, so this is not a relevant finding in the context of malnutrition. Albumin is a protein produced by the liver and is a key indicator of nutritional status. Low albumin levels can indicate malnutrition, particularly protein deficiency. In cases of anorexia and malnutrition, albumin levels are often decreased due to inadequate protein intake and poor nutritional status.