Nokea
The nurse determines that the client with gastroesophageal reflux disease (GERD) needs further teaching regarding diet if which statement is made?
- A. I need to avoid coffee, tea, and chocolate.
- B. I should eat four to six small meals a day.
- C. It is important that I drink extra fluids during meals.
- D. I need to avoid snacking for 2 to 3 hours before bedtime.
Correct Answer: C
Rationale: Gastroesophageal reflux disease (GERD) is the backflow of gastric and duodenal contents into the esophagus. Fluids must be taken between meals rather than with meals to prevent the overdistention that leads to reflux. Coffee, tea, cola, and chocolate are eliminated from the diet because they decrease lower esophageal sphincter pressure and can potentiate reflux. Four to six smaller meals per day will help to prevent gastric overdistention. One of the primary factors in GERD is an incompetent lower esophageal sphincter. Adequate time needs to pass after snacking and before bedtime to decrease the risk for the reflux of gastric contents.
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The nurse is caring for a client who is a survivor of a disaster event. The client begins to display behaviors not demonstrated before. Which manifestations should indicate to the nurse that the client may be experiencing post-traumatic stress disorder (PTSD)? Select all that apply.
- A. Irritability and sleep disturbances
- B. Flashbacks or recollections of the disaster
- C. Regression to an earlier developmental stage
- D. A feeling of estrangement or detachment from others
- E. Consistent discussion and rationalizing as to why the disaster occurred
- F. Repression or the inability to remember an important aspect associated with the disaster
Correct Answer: A,B,D,F
Rationale: PTSD involves recurrent flashbacks, irritability, sleep disturbances, estrangement, and repression of trauma-related memories. Regression and rationalizing the event's cause are not typical PTSD symptoms. These manifestations indicate a sustained maladaptive response to the traumatic event, often with avoidance of trauma-related stimuli and psychological distress.
A nurse is caring for a client with dumping syndrome. Which statement by the client indicates a need for further teaching?
- A. I should lie down after I eat my meals.
- B. I may experience weakness and dizziness.
- C. I should eat a low-fat, high-protein, low-carbohydrate diet.
- D. I should eat small meals and avoid drinking fluids with my meals.
Correct Answer: C
Rationale: Dumping syndrome requires a high-fat, low-carbohydrate diet to slow gastric emptying. Other statements are correct.
The nurse is participating in a free community health screening with a group of student nurses. Which statement by a student nurse requires further teaching by the licensed nurse?
- A. Colorectal cancer screening should begin at age 50.
- B. Men should have a prostate-specific antigen test starting at age 55.
- C. High-density lipoprotein should be greater than 50 mg/dL for women.
- D. Risk factors for hypertension include being over age 60 and leading a sedentary lifestyle.
Correct Answer: B
Rationale: Prostate-specific antigen testing typically starts at age 50, not 55, for average-risk men. Other statements are accurate.
The nurse is planning dietary counseling for the client with chronic heart failure taking triamterene. The nurse plans to include which item in a list of foods that are acceptable?
- A. Bananas
- B. Oranges
- C. Baked potato
- D. Canned pears
Correct Answer: D
Rationale: Triamterene is a potassium-retaining diuretic, so high-potassium foods like bananas, oranges, and potatoes should be avoided. Canned pears are lower in potassium, making them acceptable.
A postpartum client recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. What action should the nurse encourage the client to avoid?
- A. Brushing her teeth
- B. Taking acetylsalicylic acid (aspirin)
- C. Walking long distances and climbing stairs
- D. All activities because bruising injuries can occur
Correct Answer: B
Rationale: Aspirin is an antiplatelet medication and can interact with the anticoagulant medication and increase the clotting time beyond therapeutic ranges, so avoiding aspirin is a priority. The client does not need to avoid brushing her teeth, but she should be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided.