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A nurse is caring for an elderly patient with significant ascites due to end-stage liver disease. Which of the following precautions should the nurse include in the patient’s care plan?

“An increased weight in the abdomen can lead to problems with getting comfortable when lying down, therefore, have extra pillows in bed.”.

“Due to the increased weight in the abdomen, it is advised that you do not wear undergarments as they will not fit.”.

“The increased weight in your abdomen will mean that you can no longer exercise due to the strain on your heart.”.

“Due to the increased abdominal weight, take your time with walking as your balance might be affected and cause a fall.”.

Answer and Explanation

The Correct Answer is D

Choice A rationale
While it is true that an increased weight in the abdomen can lead to discomfort when lying down, simply having extra pillows in bed may not be sufficient to address the issue. Ascites, or the accumulation of fluid in the peritoneal cavity, can cause significant discomfort and even

pain. It can also lead to respiratory issues as the fluid puts pressure on the diaphragm, making breathing difficult. Therefore, while extra pillows may help to some extent by allowing the patient to find a more comfortable position, they are not a comprehensive solution.
Choice B rationale
Advising the patient not to wear undergarments because they will not fit due to the increased weight in the abdomen is not a medically sound advice. While it is true that ascites can cause distension of the abdomen, the focus should be on treating the underlying condition and managing the symptoms, rather than on the fit of the patient’s clothing. Moreover, the choice of clothing is a personal decision and may have psychological implications for the patient.
Choice C rationale
The statement that the increased weight in the abdomen means that the patient can no longer exercise due to the strain on the heart is not entirely accurate. While it is true that ascites can put additional strain on the heart and other organs, it does not necessarily mean that all forms of exercise are contraindicated. In fact, gentle forms of exercise may be beneficial for overall health and well-being. However, any exercise regimen should be discussed with and approved by a healthcare provider.
Choice D rationale
This is the correct choice. Due to the increased abdominal weight from ascites, the patient’s balance might indeed be affected, increasing the risk of falls. Therefore, advising the patient to take their time with walking is a valid precaution. Fall prevention is a key aspect of care for patients with ascites due to end-stage liver disease.

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Correct Answer is A

Explanation

Choice A rationale
Gastroesophageal reflux disease (GERD) is a condition where stomach acid frequently flows back into the esophagus, causing discomfort. Certain lifestyle habits and diet can trigger or worsen GERD symptoms. Alcohol and caffeine are among the substances that can aggravate

GERD123. They can relax the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus. Therefore, reducing or avoiding alcohol and caffeine can help manage GERD symptoms.
Choice B rationale
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can cause or worsen GERD symptoms. It can irritate the esophagus and stomach lining, leading to heartburn and other GERD symptoms. Therefore, it’s not advisable to take aspirin if you have GERD12.
Choice C rationale
While it’s important to avoid mercury-containing foods due to their potential health risks, there’s no specific link between these foods and GERD12. GERD is primarily triggered by foods that relax the lower esophageal sphincter, cause stomach distension, or irritate the esophagus. Mercury-containing foods do not fall into these categories.
Choice D rationale
Lying down after eating can indeed increase the onset of GERD123. When you lie down, it’s easier for stomach acid to backflow into the esophagus. This is why it’s recommended to wait at least 2-3 hours after eating before lying down.

A. You can lay down 30 minutes after eating if that will help you feel better. B. It’s important for you to practice good oral hygiene with this disorder. C. A glass of wine per day might help with reducing your stress and improve your GERD. D. Adding more citrus foods in your diet might help with easing the manifestations.

Correct Answer is B

Explanation

Choice A rationale
Laying down 30 minutes after eating can actually worsen GERD symptoms. This is because the position can make it easier for stomach acid to back up into the esophagus.
Choice B rationale
Practicing good oral hygiene is important for everyone, but it doesn’t directly prevent GERD. However, it can help prevent complications of GERD such as tooth decay caused by stomach acid.
Choice C rationale
While moderate alcohol consumption may reduce stress, it can actually worsen GERD. Alcohol can relax the lower esophageal sphincter, allowing stomach acid to reflux into the esophagus. It can also increase stomach acid production.
Choice D rationale

Citrus foods are generally not recommended for people with GERD. They are acidic and can trigger GERD symptoms. Instead, non-citrus fruits like bananas, apples, and pears are better choices.

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A nurse is caring for an elderly patient with significant ascites due to end-stage liver disease. Which of the following precautions should the nurse include in the patient’s care plan?

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