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The nurse is providing dietary education to a client with gastroesophageal reflux disease (GERD). The nurse indicates that the client understands the teaching if the client states a plan to avoid which foods to prevent symptom exacerbation? (Select all that apply)

Tea.

Beer.

Cheese.

Oatmeal.

Chocolate.

Sweet potatoes.

Alcohol.

French fries.

Answer and Explanation

Correct Answer : A,B,E,G,H

Choice A reason: Tea, especially caffeinated, relaxes the lower esophageal sphincter, worsening GERD symptoms. Avoiding it shows understanding, making this a correct food the nurse would expect the client to avoid based on dietary education to prevent GERD exacerbation.

Choice B reason: Beer, an alcoholic beverage, irritates the esophagus and relaxes the sphincter, triggering GERD symptoms. Avoiding it reflects correct understanding, making this a correct food the nurse would include in teaching for the client to prevent GERD flare-ups.

Choice C reason: Cheese, while high-fat, is less likely to trigger GERD than alcohol or chocolate. Oatmeal is GERD-friendly, making this incorrect, as it’s not a primary trigger compared to the nurse’s teaching on foods to avoid for GERD symptom management.

Choice D reason: Oatmeal is a bland, high-fiber food that soothes GERD symptoms, not exacerbating them. Avoiding chocolate is correct, making this incorrect, as it’s a beneficial food, unlike the triggers the nurse teaches the client to avoid in GERD management.

Choice E reason: Chocolate contains caffeine and fat, relaxing the esophageal sphincter and worsening GERD. Avoiding it shows understanding, making this a correct food the nurse would expect the client to avoid to prevent symptom exacerbation based on GERD dietary teaching.

Choice F reason: Sweet potatoes are low-fat and non-irritating, not triggering GERD symptoms. Avoiding alcohol is correct, making this incorrect, as it’s a safe food, unlike the nurse’s teaching on foods the client should avoid to manage GERD effectively.

Choice G reason: Alcohol, including beer, relaxes the esophageal sphincter and irritates the mucosa, exacerbating GERD. Avoiding it reflects understanding, making this a correct food the nurse would include in teaching for the client to prevent GERD symptom flare-ups.

Choice H reason: French fries, high in fat, delay gastric emptying and worsen GERD symptoms. Avoiding them shows understanding, making this a correct food the nurse would expect the client to avoid based on dietary education to manage GERD effectively.

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Correct Answer is B

Explanation

Choice A reason: A respiratory rate of 10 breaths/min with deep breathing is low but less concerning than 8 breaths/min with snoring, indicating potential airway obstruction. Respiratory depression is the primary opioid risk, making this incorrect compared to the more severe respiratory compromise.

Choice B reason: A respiratory rate of 8 breaths/min with snoring suggests severe opioid-induced respiratory depression, a life-threatening side effect requiring immediate intervention. This aligns with opioid safety monitoring, making it the correct patient most likely experiencing a critical opioid adverse effect.

Choice C reason: Elevated blood pressure and heart rate suggest pain or stress, not respiratory depression, the primary opioid danger. A low respiratory rate with snoring is more critical, making this incorrect, as it doesn’t indicate a life-threatening opioid side effect.

Choice D reason: A temperature of 100.5°F and being easily roused suggest mild fever, not respiratory depression. Snoring with a rate of 8 breaths/min is more dangerous, making this incorrect, as it doesn’t reflect a life-threatening opioid effect in the patient.

A. This is a normal, expected event. B. The client is experiencing early signs of ischemic bowel. C. The client should not have the nasogastric tube removed. D. This indicates inadequate preoperative bowel preparation.

Correct Answer is A

Explanation

Choice A reason: Malodorous flatus 2 days post-colostomy is normal, indicating bowel function resumption. This aligns with postoperative colostomy expectations, making it the correct interpretation by the nurse, as flatus is an expected milestone in the client’s recovery process.

Choice B reason: Ischemic bowel causes pain, fever, or absent output, not just malodorous flatus, which is normal post-colostomy. This is incorrect, as it misinterprets a typical finding as a serious complication in the nurse’s assessment of the client’s stoma.

Choice C reason: Flatus doesn’t indicate the need for a nasogastric tube, which is used for obstruction or ileus. Normal flatus is expected, making this incorrect, as it wrongly suggests intervention for a typical post-colostomy finding in the nurse’s evaluation.

Choice D reason: Malodorous flatus is unrelated to preoperative bowel preparation; it’s a normal post-colostomy event. This is incorrect, as it misattributes a standard recovery sign to surgical preparation, unlike the nurse’s correct interpretation of expected bowel function.

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The nurse is providing dietary education to a client with gastroesophageal reflux disease (GERD). The nurse indicates that the client understands the teaching if the client states a plan to avoid which foods to prevent symptom exacerbation? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

You are taking care of 4 clients who are receiving opioid analgesics for pain management. Which patient is MOST likely to be experiencing a life-threatening opioid side effect?

Correct Answer is B

Explanation

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

Correct Answer is A

Explanation

A client is brought to the emergency department with partial-thickness burns to the face, neck, arms, and chest after trying to put out a car fire. The nurse needs to implement which nursing actions for this client? (Select all that apply)

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? (Select all that apply)

A nurse has just received report on 4 clients who all have chest tubes in place. Which client is the priority to see first?

In collaboration with the registered dietitian nutritionist (RDN), which foods will the nurse teach a client who is taking a potassium-sparing diuretic to avoid or use cautiously? (Select all that apply)

The laboratory notifies the night nurse that the patient has a critical magnesium level of 1.1 mEq/L. The patient has a do-not-resuscitate order. The nurse does not inform the practitioner because of the patient’s code status. In doing so, the nurse is negligent for which action?

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse would anticipate a prescription from the primary health care provider for which type of diet for this client?

A client is admitted to the ED with a burn injury. The client’s vital signs are the following: blood pressure: 72/48, heart rate: 152 beats/min, respiratory rate: 26/min. He is pale in color and the nurse is unable to feel his pedal pulses. Which action will the nurse take first?