Correct Answer: B

Rationale: Endoscopy is a diagnostic procedure used for evaluating persistent or severe symptoms of heartburn, but it is not part of initial treatment. Patient education focuses on symptom relief and management strategies before invasive testing. Proton pump inhibitors reduce gastric acid secretion by irreversibly blocking H+/K+ ATPase in stomach parietal cells. They are first-line medications for heartburn and gastroesophageal reflux disease, effectively relieving symptoms and preventing complications. Radionuclide tests are specialized diagnostic procedures for conditions such as gastric emptying disorders. They are not standard educational topics for new heartburn complaints, as they do not provide immediate symptom relief. A barium swallow is used for imaging structural abnormalities of the esophagus or stomach but is not part of initial management for heartburn. It is a diagnostic tool rather than a first-line treatment or educational focus.

Correct Answer: A

Rationale: Lispro (Humalog) is a rapid-acting insulin analog designed for mealtime glucose control. It begins action within 15 minutes, peaks in 1 hour, and lasts 2 to 4 hours. Its quick onset matches postprandial glucose spikes, enhancing glycemic control during meals and preventing hyperglycemia from carbohydrate intake. Glargine (Lantus) is a long-acting basal insulin with no peak and prolonged action. It does not target mealtime spikes but provides steady glucose control over 24 hours. Its slow onset and constant release profile are unsuitable for immediate postprandial glucose management. Detemir (Levemir) is a long-acting basal insulin, similar to glargine, with extended action for baseline glucose control. It lacks the rapid onset needed for mealtime management, making it inappropriate for postprandial hyperglycemia control, as observed in Lispro efficacy. NPH (Humulin N) is an intermediate-acting insulin with delayed onset and peak activity. It supports baseline glucose regulation but fails to address mealtime glucose control promptly. Its time profile does not align with the immediate needs of postprandial hyperglycemia management.

Correct Answer: A

Rationale: Assisting the patient to the bathroom is within the scope of practice for a Nursing Aide (N
A) and does not require advanced training, making it an appropriate task to delegate while ensuring patient needs are met. Teaching weight-bearing precautions involves patient education, which is the responsibility of the Registered Nurse (RN) due to the need for professional judgment and instruction clarity. Pain level assessment requires critical thinking and professional judgment, which are within the RN's scope of practice. This cannot be delegated to an NA. Instruction on incentive spirometer use requires understanding of therapeutic goals, patient capability, and respiratory assessment, tasks specific to the RN and beyond the scope of an NA.

Correct Answer: B

Rationale: Referred back pain is not a hallmark of large bowel obstruction. It typically occurs in conditions with retroperitoneal organ involvement, such as renal or pancreatic pathology. Large bowel obstruction presents primarily with abdominal distention and pain localized to the affected bowel segment due to obstruction-induced pressure and stretching. Abdominal distention is a classic sign of large bowel obstruction. Accumulated gas and stool proximal to the obstruction result in bloating and visible distention. This presentation reflects impaired bowel motility, pressure build-up, and reduced passage of contents, commonly seen in large bowel pathology. Projectile vomiting is more indicative of upper GI obstruction, such as pyloric stenosis, due to immediate pressure effects. Large bowel obstructions manifest with late vomiting as distal obstruction delays content passage. Vomiting in this case is less forceful and often accompanied by fecal material. Metabolic alkalosis is more associated with vomiting-related losses of gastric acid, as seen in upper GI pathology. Large bowel obstruction typically leads to metabolic acidosis from ischemia or bacterial overgrowth, not alkalosis, as the obstruction hampers normal bowel function and circulation.

Correct Answer: A

Rationale: Fractures caused by disease processes are termed pathological fractures. Diseases like osteoporosis weaken bones, increasing susceptibility to fractures. Conditions like cancer can invade bone tissue, causing structural fragility. Pathological fractures occur without significant trauma, distinguishing them from those caused by external injuries, which require high-impact forces to break otherwise healthy bones. Traumatic fractures stem from external forces, not from disease processes. This assertion neglects the reality of pathological fractures, which result from diseases undermining the bone's natural strength. Healthy bones typically endure significant stress before fracturing, and the absence of disease makes fractures from minimal trauma highly unlikely. This reasoning excludes pathological fractures caused by internal illnesses or conditions weakening bone structures.