An obese patient has reflux and asks how being overweight could cause this condition.
Which response by the nurse is best?

Choice A rationale

Acetaminophen is often recommended as a first-line analgesic for managing mild to moderate pain associated with osteoarthritis. It acts centrally to inhibit prostaglandin synthesis in the central nervous system and block pain impulses peripherally. Unlike nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen lacks significant anti-inflammatory properties and does not typically cause gastrointestinal irritation or bleeding, making it a safer initial option for chronic pain management in many individuals.

Choice B rationale

Decreasing foods high in purines is a dietary recommendation for patients with gout, a type of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints. Osteoarthritis, however, is a degenerative joint disease resulting from cartilage breakdown and is not directly linked to purine metabolism or uric acid levels. Therefore, this dietary modification is not relevant to managing osteoarthritis.

Choice C rationale

While elevating an affected joint can help reduce swelling and discomfort, it is generally recommended for acute inflammation or injury rather than the chronic pain of osteoarthritis. Large pillows under the knee or hip for extended periods can actually promote joint flexion contractures and should be avoided. Proper positioning usually involves maintaining joint alignment and avoiding prolonged static positions.

Choice D rationale

Applying heat can provide pain relief and muscle relaxation for osteoarthritis by increasing blood flow to the area and reducing stiffness. However, the temperature should be comfortably warm, not below body temperature, to achieve these therapeutic effects. Heat application typically ranges from 104°F to 113°F (40°C to 45°C) for optimal benefit without causing burns.

Choice A rationale

A client who is ambulatory following a cardiac catheterization 4 hours ago has increased mobility, which reduces the risk of prolonged pressure on bony prominences. The short duration post-procedure and ability to ambulate make this client less susceptible to pressure ulcer development.

Choice B rationale

Postoperative delirium can lead to decreased mobility, increased agitation and friction against surfaces, and impaired ability to communicate discomfort or reposition themselves. These factors significantly increase the risk of prolonged pressure and subsequent pressure ulcer formation.

Choice C rationale

Protein-calorie malnutrition results in decreased subcutaneous tissue and muscle mass, which normally provide cushioning over bony prominences. Poor nutritional status also impairs tissue repair and increases skin fragility, making the client highly susceptible to pressure ulcer development.

Choice D rationale

Right-sided heart failure can cause fluid overload and peripheral edema, particularly in the lower extremities. This edema increases tissue fragility and reduces blood flow to the skin, making it more susceptible to breakdown and pressure ulcer formation, especially in areas with bony prominences like heels and ankles.

Choice E rationale

While hyperglycemia in type 1 diabetes mellitus can impair wound healing and increase the risk of infection if a pressure ulcer develops, it is not a direct primary risk factor for the initial development of pressure ulcers. Immobility, malnutrition, and edema are more direct contributors to skin breakdown due to pressure.