A 57-Year-Old Woman Comes to the Emergency Department Due to Black

question 103

Multiple Choice

A 57-year-old woman comes to the emergency department due to black stools and 2 episodes of hematemesis over the last 24 hours.  Her other medical problems include hypertension, type 2 diabetes mellitus, hypercholesterolemia, and migraine headaches.  Current medications include metformin, glyburide, simvastatin, ramipril, and low-dose aspirin.  The patient has also been taking naproxen for frequent headaches over the last week.  She has smoked a pack of cigarettes per day for 20 years and drinks 1 or 2 cans of beer daily.
Temperature is 36.7 C (98.1 F) , blood pressure is 122/70 mm Hg, pulse is 96/min, and respirations are 16/min.  Examination reveals a soft abdomen that is mildly tender over the epigastrium.  There is no rebound tenderness or rigidity.
Laboratory results are as follows:
After initial fluid resuscitation, the patient undergoes upper gastrointestinal endoscopy in the emergency department; it reveals a 1.5-cm ulcer in the gastric antrum.  There is no active bleeding and the ulcer is covered with an adherent clot.  Endoscopic hemostatic therapy is performed.
Which of the following is the most appropriate course of action for this patient?

• A)Advise the patient to stop naproxen; discharge on oral lansoprazole with close follow-up
• B)Admit the patient, order a regular diet, and observe overnight
• C)Admit the patient to the intensive care unit for octreotide infusion
• D)Admit the patient to the regular medical ward and order a clear liquid diet
• E)Order a blood transfusion and schedule follow-up endoscopy in 24-48 hours

Recognize the focus and significance of positive psychology in human flourishing.

Appreciate the interaction between nature and nurture in human development and behavior.

Acknowledge the global applicability of psychological principles regardless of cultural differences.

Understand the commonalities in psychological processes that underlie cultural differences.

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Definitions:

Oedipus Complex

In psychoanalytic theory, a child's emotions and unconscious desires towards their opposite-sex parent and jealousy and rivalry with their same-sex parent.

Pleasure Principle

A psychoanalytic concept that describes the driving force behind human behavior to seek pleasure and avoid pain.

Psychoanalytic Researchers

Individuals who study the unconscious mind and the theoretical framework developed by Sigmund Freud to understand human behavior and cognition.

Recurrent Dreams

Recurrent dreams are repeated dreams that can be exactly the same each time or have slight variations, often reflecting unresolved conflicts or stressors in one’s waking life.