The nurse is assessing a client with suspected Gastroesophageal Reflux Disease (GERD). Which word or statement is an accurate characteristic of GERD?

Choice A reason: Escherichia coli (E. coli) is the most common cause of urinary tract infections (UTIs), accounting for 70-90% of cases. This gram-negative bacillus, found in the gastrointestinal tract, ascends the urethra to the bladder, adhering to uroepithelial cells via fimbriae. Its prevalence in fecal flora and ability to colonize the urinary tract make it the primary pathogen.

Choice B reason: Staphylococcus aureus is a gram-positive coccus that can cause UTIs, particularly in catheterized or hospitalized patients, but it accounts for less than 5% of cases. It is more commonly associated with skin or bloodstream infections. Its lower prevalence in UTIs compared to E. coli makes it a less likely cause.

Choice C reason: Pseudomonas aeruginosa, a gram-negative bacillus, is an opportunistic pathogen causing UTIs primarily in immunocompromised or catheterized patients. It accounts for less than 10% of UTIs. Its resistance to antibiotics and preference for nosocomial settings make it less common than E. coli in community-acquired infections.

Choice D reason: Klebsiella pneumoniae, another gram-negative bacillus, causes about 5-10% of UTIs, often in hospitalized or immunocompromised patients. While it can adhere to urinary epithelium, its prevalence is significantly lower than E. coli, which dominates due to its ubiquitous presence in the gut and urogenital proximity.

Choice A reason: Ascites results from increased permeability of peritoneal capillaries, often due to inflammatory molecules like cytokines in conditions such as liver cirrhosis or portal hypertension. This allows plasma proteins and fluid to leak into the peritoneal cavity, causing fluid accumulation. This statement accurately describes the pathophysiology of ascites in liver-related disorders.

Choice B reason: Low aldosterone levels do not cause ascites; instead, high aldosterone in liver disease (e.g., cirrhosis) promotes sodium and water retention, exacerbating fluid accumulation. This statement is inaccurate, as secondary hyperaldosteronism due to reduced liver metabolism of aldosterone is a key factor in ascites development.

Choice C reason: The liver’s failure to produce clotting factors can lead to bleeding tendencies, like variceal hemorrhage, but this does not directly cause ascites. Ascites is driven by fluid leakage from capillaries, not bleeding. This statement is inaccurate, as clotting factor deficiency is unrelated to peritoneal fluid accumulation.

Choice D reason: While fluid imbalance contributes to ascites, the primary mechanism involves portal hypertension and capillary permeability, not just osmotic pressure changes. This statement is overly vague and less accurate than the specific role of inflammatory molecules increasing capillary leakage in the peritoneal cavity.