The majority of liver infections are viral in nature. Hepatitis A, hepatitis B, and hepatitis C are the most frequent agents of infection, with hepatitis C being the leading cause of liver transplants. Bacterial infections in the liver most commonly take the form of an abscess. Fungal hepatitis and prion infection of the liver are not generally seen.

Helicobacter pylori or H. pylori is the bacterial cause of peptic ulcers. Staphylococcus aureus is a bacteria that frequently causes skin infections along with other conditions such as toxic shock syndrome. Streptococcus faecalis is responsible for many urinary tract infections and contracting Viridans streptococci may result in endocarditis. Treponema pallidum bacteria cause syphilis.

The correct answer in this question is "Insert two large-bore peripheral IV's."

This is the correct answer because this patient is suffering from a suspected gastrointestinal bleed and based upon the report of the vital signs, he is hemodynamically unstable. In evaluating an emergency/trauma patient, the "ABC's" must be assessed (A= airway, B= breathing, C= circulation). In this patient's case, it is stated that he is responsive and breathing without any issues, indicating that his airway and breathing are both satisfactory. The next issue is his circulation. Given that he has a suspected bleed, and is tachycardic and hypotensive, it is likely that he is losing a significant amount of blood from his bleeding viscera. As such, he may need emergent, rapid fluid and/or blood product resuscitation. The best way to prepare for this immediately is to place two large bore peripheral IV lines, such that resuscitation can be provided through these lines while the rest of the workup and treatment continues. Any delay in placing these lines delays the fluid/blood resuscitation of the patient, which can be dangerous.

At this point, given that the patient has a protected airway and is breathing without issue, intubation would not be indicated. Should his airway or breathing status change, the need can be reassessed.

Administering hydromorphone, a potent opioid, may be necessary if the patient is in a significant amount of pain, but that would not be the most pressing initial concern given that he is hemodynamically unstable.

Administering warfarin, an anticoagulant, would be highly contraindicated in this patient, as he likely has an active gastrointestinal bleed and is hemodynamically unstable.

Administering lorazepam, a benzodiazepine, is not indicated in this hemodynamically unstable patient with a suspected gastrointestinal bleed. After stabilization and continued demonstration of airway protection, if the patient is anxious, this need can be reassessed.

Celiac disease is an autoimmune condition that is triggered by ingestion of gluten, a protein found in wheat, barley, and rye. A wheat-free diet is not sufficient for a patient with Celiac disease, as many other products contain elements of barley or rye and thus also contain gluten.

Oat, while often avoided by individuals with Celiac disease due to cross-contamination during processing, does not contain gluten. Whole dairy products are also generally gluten-free and considered safe for patients with Celiac disease.

Multiple therapies are required to treat Helicobacter Pylori infections. Colestipol is a bile acid sequestrant used to lower blood cholesterol, which is not used to treat Helicobacter Pylori infections ( a bacterium that colonizes the human stomach).

The correct answer is "ondansetron." This is the correct answer because this patient, who is actively being treated with chemotherapy and experiencing severe nausea, is most likely suffering from chemotherapy-induced nausea. The most appropriate first-line treatment for chemotherapy-induced nausea in a patient with a normal QTc interval is ondansetron (also known as Zofran). Ondansetron is a serotonin 5HT-3 receptor antagonist, likely accounting for its anti-nausea properties. A side effect is QTc interval prolongation, and as such, careful consideration as to whether or not to prescribe ondansetron should be given for patients with baseline prolonged QTc intervals.

Acetaminophen, an analgesic, would not treat nausea, nor would ibuprofen, meloxicam, or ketorolac (all NSAID medications).

The correct recommendation is "Eat your last meal at least 3 hours prior to going to bed, and sleep as upright as possible, with multiple pillows." This is correct because this recommendation involves fairly simple lifestyle changes that have the potential to greatly decrease the patient's symptom burden. Heartburn symptoms can be exacerbated in patients who eat spicy foods (at any time), who drink coffee, and/or who eat meals shortly prior to going to bed (since the food can physically reflux back to the distal esophagus from the stomach prior to being digested more completely). Thus, any of those recommendations would be inappropriate. Further, in a patient who is acutely experiencing acid reflux symptoms, it is typically appropriate for them to take calcium carbonate to neutralize the acid and relieve symptoms. As such, advising the patient to not eat immediately prior to going to bed, and to remain upright (to physically minimize reflux of contents) would be the most appropriate recommendation.

Calcium carbonate preparation is rapid-acting, releasing carbon dioxide in the stomach, causing belching and flatulence. Calcium carbonate is an antacid which reacts quicly with HCl to form CaCL2 and carbon dioxide.

It is possible that this patient is suffering from a Clostridium difficile infection caused by bacteria. The presence of an underlying condition, increasing age, and antibiotic use are all risk factors for contracting Clostridium difficile. A stool sample is commonly used to test for the bacteria. Until the results are available, Carrie should place the patient under proper C. difficile contact precautions.

Magnesium hydroxide is a strong base. It works by neutralizing the acid in the stomach, forming water and magnesium chloride. All other listed medications work to prevent the stomach from over-producing acid, rather than neutralizing the existing acid in the stomach.