Which client would the nurse identify as high risk for developing aspiration pneumonia?

A patient with migraines

A patient with leukemia

A patient with asthma

A patient who had a stroke

Answer and Explanation

The Correct Answer is D

D. Patients who have had a stroke are at high risk for aspiration pneumonia due to potential impairment of their swallowing mechanisms and decreased gag reflex, which can occur if the stroke affects the parts of the brain that control these functions. Dysphagia is a common complication of strokes and significantly increases the risk of aspiration.

A. Migraines can cause significant discomfort and sometimes nausea and vomiting, they do not typically impair swallowing or protective airway reflexes. Thus, this patient is not at high risk for aspiration pneumonia.
B. Leukemia itself does not directly increase the risk of aspiration pneumonia. However, if the patient has complications such as severe weakness, altered mental status, or treatment side effects (like mucositis or infections), their risk could be increased, but it is not the primary concern in most leukemia cases.
C. Asthma affects the airways and causes difficulty breathing but does not typically impair swallowing or increase the risk of aspiration. While severe asthma attacks can cause coughing and choking, the primary issue is airway inflammation, not the risk of inhaling food or liquid.

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Correct Answer is D

Explanation

D. Obesity and weight loss are more directly linked to type 2 diabetes but they are not primary factors in the management of type 1 diabetes. Type 1 diabetes is characterized by the autoimmune destruction of beta cells, leading to an absolute deficiency of insulin. Weight loss can improve insulin sensitivity, which might be relevant for type 2 diabetes or insulin resistance, but type 1 diabetes patients will always require exogenous insulin regardless of weight changes.
A. Patients with type 1 diabetes are at risk for diabetic ketoacidosis (DKA), a serious condition caused by high blood glucose levels and ketone buildup due to insufficient insulin. Monitoring blood glucose levels is crucial in preventing DKA.
B. Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin- producing beta cells in the pancreas. A viral infection can sometimes trigger this autoimmune response in genetically susceptible individuals.
C. There is a genetic component to type 1 diabetes, and having a family history of the disease can increase the risk, although environmental factors also play a role.

A. "I can have 6 ounces of alcohol before bed, to help me sleep." B. "I will sleep on my stomach with my head flat." C. "I should elevate the head of the bed." D. "I will have a snack 1 hour before going to bed."

Correct Answer is C

Explanation

C. Elevating the head of the bed can help reduce nighttime GERD symptoms. By elevating the head of the bed by about 6 to 8 inches (15 to 20 centimeters), gravity helps prevent stomach acid from refluxing into the esophagus while the individual is lying down. This position can alleviate symptoms such as heartburn, regurgitation, and coughing during sleep.
A. Alcohol consumption, especially before bedtime, can exacerbate GERD symptoms. Alcohol relaxes the lower esophageal sphincter (LES), allowing stomach acid to reflux into the esophagus more easily.
B. Sleeping on the stomach with the head flat can worsen GERD symptoms. This position can increase pressure on the stomach and promote reflux of stomach acid into the esophagus. Sleeping on the stomach is generally not recommended for individuals with GERD.
D. Eating a large meal or having a snack shortly before bedtime can increase the likelihood of GERD symptoms during sleep. It's generally recommended to avoid eating large meals or heavy snacks close to bedtime. Instead, individuals with GERD should aim to finish eating at least 2 to 3 hours before lying down to sleep.

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Which client would the nurse identify as high risk for developing aspiration pneumonia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is evaluating the knowledge of a patient recently diagnosed with type 1 DM. Which statement by the patient indicates a need for additional information?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of reflux during sleep. Which of the following client statements indicates an understanding of the teaching?

Correct Answer is C

Explanation

Which client would the nurse identify as high risk for developing aspiration pneumonia?

A nurse is reinforcing teaching for a client who has a duodenal ulcer and a new prescription for sucralfate. The client asks the nurse how sucralfate works. Which of the following statements should the nurse make?

The nurse is assisting with nutrition teaching for a patient who voices concern over adjusting to a diabetic diet. Which response by the nurse about medical nutrition therapy is correct?

A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse identify as a risk factor for this condition?

43. A nurse is reinforcing teaching about use of a metered-dose inhaler (MDI) with a client who has a new diagnosis of asthma. Identify the sequence the client should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all steps.)

What is the desired peripheral capillary oxygen saturation (Spo2) level in the patient with chronic obstructive pulmonary disease?