A nurse in a long-term care facility is providing care for a client who has gastroesophageal reflux (GERD). Which of the following interventions should the nurse implement?

A. Isolate the client in their room.

Encourage the client to ambulate with a staff member.

Administer a prescribed oral dose of trazodone to the client.

Apply bilateral wrist restraints to the client.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Isolating the client in their room is not necessary for managing GERD. Isolation measures are typically used for contagious diseases, not for GERD, which is a non-infectious condition.

Choice B rationale

Encouraging the client to ambulate with a staff member helps promote gastrointestinal motility and reduce the risk of reflux. Physical activity can aid in digestion and reduce GERD symptoms.

Choice C rationale

Trazodone is an antidepressant and is not typically prescribed for managing GERD. It is not relevant to the care plan for a client with GERD.

Choice D rationale

Applying bilateral wrist restraints is not indicated for GERD management. Restraints are used for patients who pose a risk to themselves or others, not for those with GERD. .

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Correct Answer is D

Explanation

Choice A rationale

Clients with an ileostomy will not have normal bowel movements, as the stool is typically liquid or pasty. This statement reflects a lack of understanding of the ileostomy and indicates denial.

Choice B rationale

This statement reflects a sense of loss and difficulty adjusting to the changes in body image and sexual function, indicating poor acceptance of the ileostomy.

Choice C rationale

Having a partner empty the bag to avoid looking at it suggests avoidance and denial rather than acceptance of the ileostomy.

Choice D rationale

Attending a support group to handle difficulties reflects a proactive approach to coping with the changes brought by the ileostomy, indicating acceptance and adjustment.

A. Advise the client about increased dry mouth. B. Check the client for increased hypopigmentation under the patch. C. Inform the client of the adverse effect of diarrhea. D. Monitor the client for weight loss.

Correct Answer is A

Explanation

Choice A rationale

Clonidine can cause dry mouth, which is a common side effect of the medication.

Choice B rationale

Hypopigmentation under the patch is not a common side effect of clonidine and does not need to be monitored.

Choice C rationale

Diarrhea is not a common adverse effect of clonidine. It is not typically associated with the medication.

Choice D rationale

Clonidine is not known to cause weight loss. Monitoring for this is unnecessary. .

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A nurse in a long-term care facility is providing care for a client who has gastroesophageal reflux (GERD). Which of the following interventions should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is evaluating a client's acceptance of having a new ileostomy.Which of the following statements by the client indicates acceptance?

Correct Answer is D

Explanation

A nurse is assisting with the plan of care for an older adult client who has a new prescription for transdermal clonidine.Which of the following information should the nurse include in the plan of care?

Correct Answer is A

Explanation

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