A nurse is teaching a client who has a new diagnosis of gastroesophageal reflux disease. Which of the following instructions should the nurse include?

"Lie down after meals."

"Elevate the head of the bed while sleeping."

"Eat a snack 1 hour before going to bed."

"Eat three large meals each day."

Answer and Explanation

The Correct Answer is B

Rationale:
A. "Lie down after meals.": Lying down after eating increases the risk of gastric contents refluxing into the esophagus due to gravity. Clients with GERD should remain upright for at least 2 to 3 hours after meals to minimize symptoms.
B. "Elevate the head of the bed while sleeping.": Elevating the head of the bed by 6 to 8 inches helps prevent nighttime reflux by using gravity to reduce backward flow of stomach acid into the esophagus, which is a key strategy in GERD management.
C. "Eat a snack 1 hour before going to bed.": Eating close to bedtime can exacerbate GERD symptoms by increasing gastric volume and acid production, especially when the client lies down soon after eating. A longer gap between the last meal and sleep is advised.
D. "Eat three large meals each day.": Large meals increase gastric pressure and acid production, worsening reflux symptoms. Clients with GERD should eat smaller, more frequent meals to reduce gastric distension and minimize acid reflux episodes.

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Correct Answer is A

Explanation

Rationale:
A. Blurred vision: Ethambutol is known to cause optic neuritis, which can lead to blurred vision, decreased visual acuity, and impaired red-green color discrimination. Clients on ethambutol should be monitored for changes in vision and advised to report any visual disturbances immediately.

B. Tinnitus: Tinnitus is not a typical adverse effect of ethambutol. It is more commonly associated with other anti-tuberculosis drugs such as streptomycin, which can cause ototoxicity, especially affecting the auditory and vestibular systems.

C. Peripheral edema: Peripheral edema is not commonly linked to ethambutol use. It may occur with certain cardiovascular medications or conditions but is not an expected side effect of this antitubercular drug.

D. Bradycardia: Bradycardia is not a recognized adverse effect of ethambutol. This medication primarily affects the eyes rather than the cardiovascular system. Monitoring for vision changes is a higher priority when assessing for side effects.

A. "Use salt substitutes to reduce your sodium intake." B. "Increase your fluid intake to 1,000 mL a day." C. "Include phosphorus-rich foods in your diet." D. "Avoid food products that contain trans-fats."

Correct Answer is D

Explanation

Rationale:
A. "Use salt substitutes to reduce your sodium intake.": Salt substitutes often contain potassium, which can accumulate to dangerous levels in clients with chronic kidney disease. Therefore, they should be avoided rather than recommended.

B. "Increase your fluid intake to 1,000 mL a day.": Clients on hemodialysis typically require fluid restrictions, not increases, to prevent fluid overload between dialysis sessions. Fluid allowances are individualized based on urine output and clinical status.

C. "Include phosphorus-rich foods in your diet.": Phosphorus levels tend to rise in clients with kidney failure, contributing to bone disease. These clients are advised to avoid phosphorus-rich foods like dairy, nuts, and cola beverages.

D. "Avoid food products that contain trans-fats.": Clients with chronic kidney disease are at increased risk for cardiovascular disease. Avoiding trans-fats, which raise LDL cholesterol and promote inflammation, supports heart health and is an appropriate dietary recommendation.

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A nurse is teaching a client who has a new diagnosis of gastroesophageal reflux disease. Which of the following instructions should the nurse include?

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Naxlex Comprehensive Predictor Exams

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Explanation

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