The nurse is assessing a client who reports having a history of gastroesophageal reflux disease (GERD). Which assessment finding does the nurse report to the primary health care provider?

“When I buy meat, I ask for the leanest cut that is available."

“I quit smoking 6 months ago."

"Sometimes I wake up gasping for air in the middle of the night.”

“My family likes to eat small meals every 3 to 4 hours throughout the day.”

Answer and Explanation

The Correct Answer is C

GERD can lead to severe extra-esophageal complications if gastric refluxate reaches the upper airway. During sleep, the protective laryngeal reflexes are diminished, allowing for the microaspiration of acid into the trachea and lungs. This can cause laryngospasm, chronic cough, and nocturnal asthma-like symptoms. Identifying these occurrences is critical to prevent permanent pulmonary damage and to screen for Barrett's esophagus.

Rationale:

A. Reporting the use of lean cuts of meat is a positive finding that indicates the patient is following dietary recommendations to manage their GERD. Lean meats reduce the fat load in the stomach, which helps prevent delayed gastric emptying and minimizes the risk of reflux. This is a sign of effective self-management rather than an alarming finding for the provider.

B. Quitting smoking is a significant health achievement that improves GERD symptoms because nicotine is a known relaxant of the lower esophageal sphincter. This information should be documented as a positive behavioral change in the patient's history. It does not represent a new or worsening complication that requires an urgent medical report or intervention.

C. The nurse must report "waking up gasping for air" because it suggests nocturnal aspiration of gastric contents. This is a serious complication of GERD where acid enters the airway, potentially causing aspiration pneumonia or bronchospasm. This finding indicates that the patient's GERD is not well-controlled and poses a significant risk to their respiratory health and airway patency.

D. Eating small, frequent meals is a recommended lifestyle modification for GERD. This practice prevents excessive gastric distention, which reduces the pressure against the lower esophageal sphincter and decreases the volume of acid available for reflux. This finding shows the patient is adhering to appropriate non-pharmacological management strategies and is not a cause for medical concern.

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Correct Answer is B

Explanation

Gastroesophageal reflux disease(GERD), commonly experienced as heartburn, occurs when the lower esophageal sphincter(LES) fails to remain closed, allowing acidic gastric contents to reflux into the esophagus. Certain dietary components contain methylxanthines or specific fats that exert a pharmacological effect on the smooth muscle of the LES, causing it to relax. Reducing these triggers is a primary strategy to prevent mucosal injury and esophagitis.

Rationale:

A.Steak is a high-protein food that generally does not cause the immediate relaxation of the lower esophageal sphincter. While very fatty cuts of meat can delay gastric emptying and contribute to reflux, steak itself is not a classic, direct chemical trigger for heartburn. The patient should focus on eliminating known chemical relaxants of the esophageal muscle first.

B.Chocolateshould be eliminated because it contains methylxanthines(like theobromine) which relax the lower esophageal sphincter(LES). This relaxation allows stomach acid to backflow into the esophagus, causing the burning sensation known as pyrosis. Chocolate is also often high in fat, which further slows gastric emptying and increases the likelihood of reflux episodes.

C.Carrots are a non-acidic, low-fat vegetable that is generally well-tolerated by patients with GERD. They do not contain chemicals that affect sphincter tone or increase gastric acid production. Carrots are actually a recommended part of a "reflux-friendly" diet because they provide fiber and nutrients without triggering the symptoms of heartburn or esophageal irritation.

D.Popcorn is a whole-grain snack that is generally safe for GERD patients, provided it is not prepared with excessive butter or spicy seasonings. Plain or lightly salted popcorn does not possess the chemical properties needed to relax the esophageal sphincter. It is considered a low-risk food compared to the strong chemical triggers found in cocoa or caffeinated products.

A. The client's urine specific gravity is 1.048. B. The client’s blood pressure is 152/88 mm Hg. C. The client lost 11 lb (5 kg) in the past 10 days. D. No blood is observed in the client’s urine

Correct Answer is C

Explanation

Acute glomerulonephritisis an inflammatory condition of the glomerular capillaries, often following a streptococcal infection. The inflammation reduces the glomerular filtration rate(GFR), leading to the retention of sodium and water, which causes systemic edema and hypertension. A positive response to treatment is indicated by the resolution of this fluid volume excess as the glomerular basement membranebegins to heal and resume normal filtration.

Rationale:

A.A urine specific gravity of 1.048 is abnormally high (normal is 1.005 to 1.030) and indicates extremely concentrated urine. This usually signifies dehydration or the presence of excess solutes like protein and glucose. In the context of GN, it does not indicate healing; rather, it suggests that the kidney is still struggling to produce an appropriate volume of filtrate.

B.A blood pressure of 152/88 mm Hg is hypertensive and indicates that the disease process is still causing significant fluid retention and vascular resistance. Hypertension is a key symptom of GN due to the activation of the renin-angiotensin systemand fluid overload. A positive response to treatment would be a return of blood pressure toward the normal range of <120/80 mm Hg.

C.Losing 11 lb (5 kg)over 10 days is a positive response because it indicates the mobilization and excretion of excess fluid. In GN, weight gain is caused by edema and fluid retention. As the glomerular inflammation subsides and diuresis occurs, the patient will lose this excess water weight. This is the most objective evidence that the kidneys are regaining their filtration capacity.

D.While the absence of gross hematuria is good, microscopic hematuria can persist for many months after an episode of acute GN and does not necessarily mean the acute phase is over. Weight loss and blood pressure stabilization are more immediate and reliable indicators of the resolution of fluid volume excess, which is the most dangerous acute complication of the condition.

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The nurse is assessing a client who reports having a history of gastroesophageal reflux disease (GERD). Which assessment finding does the nurse report to the primary health care provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client reports ongoing episodes of "heartburn.” Which food will the nurse recommend that the client eliminate from the diet?

Correct Answer is B

Explanation

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment?

Correct Answer is C

Explanation

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