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 C

Explanation

Choice A rationale

Cabbage is low in potassium, making it a suitable food for clients who need to avoid high-potassium foods. It contains approximately 150 mg of potassium per cup, which is relatively low compared to other vegetables.

Choice B rationale

Watermelon is a fruit with moderate potassium content, containing about 170 mg of potassium per cup. While not extremely high, it is not the best choice for someone seeking to increase potassium intake significantly.

Choice C rationale

A medium potato is high in potassium, with about 900 mg of potassium. Potatoes are an excellent source of potassium, which is essential for maintaining proper muscle and nerve function.

Choice D rationale

An apple is low in potassium, containing around 150 mg per small apple. It is a good option for clients who need to limit their potassium intake, but not for those looking to increase it. .

A. Discuss the possible changes in family roles. B. Encourage the client to verbalize their feelings. C. Determine the client's ability to see the buttons on the call light. D. Assist the client and family in locating a community support group.

Correct Answer is C

Explanation

Choice A rationale

Discussing changes in family roles is important but is not the immediate priority upon admission. This can be addressed once the client's immediate needs are met.

Choice B rationale

Encouraging verbalization of feelings is crucial for mental health support but is not the most urgent action during admission.

Choice C rationale

Determining the client's ability to see the buttons on the call light ensures their immediate safety and ability to call for help, making it the priority.

Choice D rationale

Assisting with locating a community support group is essential for long-term support but is not the first priority upon admission. .

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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

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