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Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)?
- A. Limit caffeine intake to two cups of coffee per day.
- B. Do not lie down for 2 hours after eating.
- C. Follow a low-protein diet.
- D. Take medications with milk to decrease irritation.
Correct Answer: B
Rationale: Avoiding lying down for 2 hours after eating prevents reflux of stomach contents into the esophagus, a key strategy for managing GERD. The other options are incorrect or exacerbate symptoms.
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A client is admitted for a revascularization procedure for arteriosclerosis in his left iliac artery. To promote circulation in the extremities, the nurse should:
- A. Position the client on a firm mattress
- B. Keep the involved extremity warm with blankets
- C. Position the left leg at or below the body's horizontal plane
- D. Encourage the client to raise and lower his leg four times every hour
Correct Answer: C
Rationale: Positioning the left leg at or below the body's horizontal plane promotes arterial blood flow to the extremity in arteriosclerosis, avoiding gravitational resistance. A firm mattress is irrelevant, warmth is beneficial but secondary, and leg raises may not be feasible pre-revascularization.
A client with malignant melanoma asks the nurse about the prognosis. The nurse should base a response that informs the client that the prognosis depends on:
- A. The amount of ulceration of the lesion.
- B. The age of the client.
- C. The location of the lesion on the body.
- D. The thickness of the lesion.
Correct Answer: D
Rationale: Melanoma prognosis primarily depends on lesion thickness (Breslow depth), as thicker lesions indicate deeper invasion and worse outcomes.
The nurse is teaching a client about newly prescribed isoniazid (INH) for pulmonary tuberculosis. Which of the following statements by the client would require follow up?
- A. I will have to take this medication for three months.
- B. I will need to have my blood drawn periodically to see if I am having an adverse effect to this medication.
- C. I will not be considered infectious if I have three consecutive negative sputum samples.
- D. This medication may make my hands and feet have numbness and tingling sensations.
Correct Answer: A
Rationale: Choice A requires follow-up because isoniazid (INH) treatment for pulmonary tuberculosis typically lasts 6-9 months, not 3 months. Choice B is correct; periodic blood tests monitor for hepatotoxicity. Choice C is correct; three consecutive negative sputum samples indicate non-infectiousness. Choice D is correct; INH can cause peripheral neuropathy, manifesting as numbness and tingling.
A client on hemodialysis reports muscle cramps. The nurse should:
- A. Increase dialysate flow.
- B. Check electrolyte levels.
- C. Administer a diuretic.
- D. Encourage ambulation.
Correct Answer: B
Rationale: Muscle cramps may indicate electrolyte imbalances, requiring lab assessment.
Which of the following skin preparations would be best to apply around the client's colostomy?
- A. Karaya.
- B. Petroleum jelly.
- C. Antiseptic cream.
- D. None of the above
Correct Answer: A
Rationale: Karaya is a natural skin barrier that protects the skin around the stoma from irritation and is commonly used in ostomy care. Petroleum jelly is not suitable as it can interfere with adhesion of the ostomy appliance, and antiseptic cream is not typically used for routine skin protection around a stoma. CN: Physiological adaptation; CL: Apply