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Which instruction should be discussed with the client diagnosed with gastroesophageal reflux disease (GERD)?
- A. Eat a low-carbohydrate, low-sodium diet.
- B. Lie down for 30 minutes after eating.
- C. Do not eat spicy foods or acidic foods.
- D. Drink two (2) glasses of water before bedtime.
Correct Answer: C
Rationale: Avoiding spicy and acidic foods reduces esophageal irritation, a key instruction for managing GERD. Low-carb/sodium diets are not specific, lying down after eating worsens reflux, and water before bedtime is irrelevant.
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The nurse caring for a client one (1) day postoperative sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention should the nurse implement first?
- A. Mark the drainage on the dressing with the time and date.
- B. Change the dressing immediately using sterile technique.
- C. Notify the health-care provider immediately.
- D. Reinforce the dressing with a sterile gauze pad.
Correct Answer: C
Rationale: Dark reddish brown drainage one day post-surgery suggests possible bleeding or dehiscence, warranting immediate notification of the HCP for evaluation. Marking or reinforcing the dressing delays action, and changing the dressing is secondary.
The charge nurse has just received the shift report. Which client should the nurse see first?
- A. The client diagnosed with Crohn's disease who had two (2) semiformed stools on the previous shift.
- B. The elderly client admitted from another facility who is complaining of constipation.
- C. The client diagnosed with AIDS who had a 200-mL diarrhea stool and has elastic skin tissue turgor.
- D. The client diagnosed with hemorrhoids who had some spotting of bright red blood on the toilet tissue.
Correct Answer: C
Rationale: The AIDS client with diarrhea and elastic turgor may still be dehydrated, requiring immediate assessment for electrolyte imbalances. Crohn’s stools, constipation, and hemorrhoid bleeding are less urgent.
The client diagnosed with liver failure is experiencing pruritus secondary to severe jaundice. Which action by the unlicensed assistive personnel (UAP) warrants intervention by the nurse?
- A. The UAP is assisting the client to take a hot, soapy shower.
- B. The UAP applies an emollient to the client's legs and back.
- C. The UAP puts mittens on both hands of the client.
- D. The UAP pats the client's skin dry with a clean towel.
Correct Answer: A
Rationale: Hot, soapy showers can worsen pruritus by drying the skin, requiring intervention. Emollients, mittens (to prevent scratching), and patting dry are appropriate.
The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD?
- A. Pyrosis, water brash, and flatulence.
- B. Weight loss, dysarthria, and diarrhea.
- C. Decreased abdominal fat, proteinuria, and constipation.
- D. Midepigastric pain, positive H. pylori test, and melena.
Correct Answer: A
Rationale: Pyrosis (heartburn), water brash (regurgitation of sour fluid), and flatulence are classic symptoms of GERD due to acid reflux and gas buildup. The other options include symptoms more associated with other conditions like peptic ulcer disease or systemic disorders.
The client is complaining of painful swallowing secondary to mouth ulcers. Which statement indicates the nurse's teaching is effective?
- A. I will brush my teeth with a soft-bristle toothbrush.
- B. I will rinse my mouth with Listerine mouthwash.
- C. I will swish with antifungal solution and then swallow.
- D. I will avoid spicy foods, tobacco, and alcohol.
Correct Answer: D
Rationale: Avoiding spicy foods, tobacco, and alcohol reduces irritation of mouth ulcers, indicating effective teaching. Soft brushes help, Listerine may irritate, and antifungal solutions are for candidiasis.