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An adult who has a hiatal hernia is seen in clinic. The nurse is reviewing her care with her. Which comment by the client indicates a need for more teaching about managing her condition?
- A. I sit up for an hour after eating.
- B. I miss drinking soda, but I know it is not good for me.
- C. I like to go swimming every day.
- D. I drink hot chocolate instead of coffee.
Correct Answer: D
Rationale: Hot chocolate contains caffeine, which can relax the lower esophageal sphincter, worsening hiatal hernia symptoms. Sitting up, avoiding soda, and swimming are appropriate for management.
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A client with hyperthyroidism.
Which of the following actions, if taken by the nurse, is BEST?
- A. Provide the client with extra blankets.
- B. Instill artificial tears prn.
- C. Offer the client reading material.
- D. Offer frequent low-calorie snacks.
Correct Answer: B
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) client is usually sensitive to heat (2) correct-clients with hyperthyroidism frequently exhibit exophthalmos, which requires ophthalmic drops on a regular basis (3) should provide a calm, restful environment with low levels of sensory stimulation, protecting eyes from injury takes priority (4) frequent snacks should be high-calorie
The nurse checks for placement of a nasogastric (NG) tube before beginning a tube feeding for a client.
Which of the following results would indicate to the nurse that the tube feeding can begin?
- A. A small amount of white mucus is aspirated from the NG tube.
- B. The pH of the contents removed from the NG tube is 3.
- C. No bubbles are seen when the nurse inverts the NG tube in water.
- D. The client says he can feel the NG tube in the back of his throat.
Correct Answer: B
Rationale: Strategy: Determine how the answers relate to a tube feeding. (1) mucus may be from lungs (2) correct-stomach contents are acidic (3) not a safe way to check placement (4) not a reliable indication
After receiving an annual influenza immunization, a client develops symptoms suggestive of Guillain-Barré syndrome. Which symptom is associated with Guillain-Barré syndrome?
- A. Paresthesia and weakness of the lower extremities
- B. Hyperactive deep tendon reflexes
- C. Emotional lability
- D. Flapping tremors of the hand and feet
Correct Answer: A
Rationale: Guillain-Barré syndrome causes paresthesia and weakness in the lower extremities , progressing upward. Reflexes are hypoactive (B is incorrect). Emotional lability and tremors are not typical.
A client weighing 76 kg is admitted at 0600 with a TBSA burn of 40%. Using the Parkland formula, the client's 24-hour intravenous fluid replacement should be:
- A. 6,080 ml
- B. 9,120 ml
- C. 12,160 ml
- D. 15,180 ml
Correct Answer: C
Rationale: The Parkland formula is 4 ml × kg × TBSA = 24-hour fluid requirement, or 4 × 76 × 40 = 12,160 ml. Answer A is the fluid requirement for the first 8 hours after burn injury, so it's incorrect. Answer B is incorrect because it's the fluid requirement for 16 hours after burn injury. Answer D is an excessive amount given the client's weight and TBSA, so it's incorrect.
The nurse is caring for a client with a history of depression.
- A. Which client statement indicates a positive response to antidepressant therapy?
- B. I feel like my old self again.'
- C. I don’t need to take the medication anymore.'
- D. I’m sleeping more than usual.'
- E. I still feel sad most of the time.'
Correct Answer: A
Rationale: Feeling like their old self indicates improved mood and function, a positive response to antidepressants. Stopping medication prematurely, excessive sleep, or persistent sadness suggest inadequate response or side effects.