A client with gastroesophageal reflux disorder (GERD), who has been self-medicating with famotidine for the past week, is admitted to the acute care center because the symptoms have worsened. The nurse should anticipate which treatment?

Insertion of a small bore tube for continuous enteral feedings.

Intravenous administration of a proton pump inhibitor.

Total parenteral nutrition administration via a central catheter.

Insertion of a nasogastric tube to low intermittent suction.

Answer and Explanation

The Correct Answer is B

Choice A reason: Inserting a small bore tube for enteral feedings is inappropriate for acute GERD exacerbation, as feeding increases gastric volume, worsening reflux by raising pressure and acid exposure. Proton pump inhibitors (PPIs) reduce acid production, alleviating mucosal irritation, addressing GERD’s pathophysiology more effectively than nutritional interventions.

Choice B reason: Intravenous PPIs (e.g., pantoprazole) are standard for severe GERD, inhibiting H+/K+-ATPase in parietal cells, reducing acid secretion. This promotes esophageal healing when oral famotidine fails. IV delivery ensures rapid onset, critical for controlling worsening symptoms, preventing complications like esophagitis or Barrett’s esophagus in acute settings.

Choice C reason: Total parenteral nutrition (TPN) bypasses the gut, used for conditions like bowel obstruction, not GERD, which involves acid reflux from sphincter dysfunction. TPN does not address acid production. PPIs target the pathophysiological cause, reducing esophageal acid exposure, making TPN irrelevant for GERD management.

Choice D reason: A nasogastric tube with suction removes gastric contents but does not treat GERD’s acid reflux, caused by lower esophageal sphincter dysfunction. It risks aspiration and is temporary. PPIs effectively reduce acid, preventing esophageal damage, making them the preferred treatment for severe GERD exacerbation.

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Correct Answer is C

Explanation

Choice A reason: Administering a PRN narcotic at 9 cm dilation is inappropriate, as labor is in transition, nearing delivery. Narcotics risk fetal respiratory depression, crossing the placenta, especially with a stable fetal heart rate (120 beats/minute). Preparing for imminent delivery is critical, prioritizing a safe birth environment over pain relief.

Choice B reason: Asking the husband to leave does not address the client’s advanced labor (9 cm, 100% effaced, frequent contractions). His presence may provide support, and removal could increase distress. Setting up the delivery table is urgent, as birth is imminent, ensuring a sterile, safe environment for delivery.

Choice C reason: At 9 cm dilation, 100% effacement, and contractions every 2 minutes, the client is in transition, with delivery imminent. Setting up the delivery table ensures readiness for vaginal birth, providing a sterile field and equipment, addressing the physiological progression of labor for safe delivery of the newborn.

Choice D reason: Notifying the rapid response team is unnecessary, as the fetal heart rate (120 beats/minute) is normal (110–160), and screaming reflects labor pain. Delivery is imminent, making table setup the priority to facilitate safe birth, avoiding escalation to emergency response for a normal labor progression.

A. Change the tracheostomy ties every 48 hours. B. Suction the tracheostomy every 2 hours routinely. C. Assess airway patency every shift. D. Clean the inner cannula with hydrogen peroxide daily.

Correct Answer is C

Explanation

Choice A reason: Changing tracheostomy ties every 48 hours maintains hygiene but is less critical than airway patency. Ties secure the tube, but obstruction from mucus or dislodgement risks respiratory failure. Regular patency checks ensure airflow, addressing the primary physiological need for oxygenation in tracheostomy care.

Choice B reason: Routine suctioning every 2 hours is unnecessary unless secretions obstruct the airway. Over-suctioning risks mucosal trauma or hypoxia. Assessing patency ensures the airway remains clear, guiding suctioning as needed, prioritizing respiratory function in tracheostomy clients over arbitrary suction schedules.

Choice C reason: Assessing airway patency every shift is critical, as tracheostomy tubes risk obstruction from mucus or dislodgement, causing respiratory distress. Regular checks confirm airflow, preventing hypoxia, addressing the physiological priority of oxygenation. This ensures timely intervention, maintaining airway integrity in clients with artificial airways.

Choice D reason: Cleaning the inner cannula daily prevents infection but is secondary to airway patency. Obstruction from secretions or tube displacement causes immediate respiratory failure. Patency assessment ensures airflow, guiding cleaning as needed, making it more urgent than routine cannula maintenance in tracheostomy care.

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A client with gastroesophageal reflux disorder (GERD), who has been self-medicating with famotidine for the past week, is admitted to the acute care center because the symptoms have worsened. The nurse should anticipate which treatment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A primigravida at 40 weeks gestation is contracting every 2 minutes, and her cervix is 9 cm dilated and 100% effaced. The fetal heart rate is 120 beats/minute. The client is screaming and her husband is alarmed. Which intervention should the nurse implement?

Correct Answer is C

Explanation

The nurse is caring for a client with a new tracheostomy. Which action is most important to include in the client’s plan of care?

Correct Answer is C

Explanation

The nurse observes an adult client perform a return demonstration of diaphragmatic breathing. The client inhales while holding the abdomen, then removes the hand to allow expansion of the abdomen during exhalation. Which action should the nurse take after observing the client’s demonstration?

The nurse measures the client’s blood pressure (BP) and notes that it is significantly higher than the previous reading. Which should the nurse do next? (Select all that apply)

Which instruction should the nurse provide a client who was recently diagnosed with Raynaud’s disease?

Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client?

Which serum laboratory test is most important for the nurse to monitor when administering enoxaparin to a client?

The nurse is changing a client’s abdominal surgical dressing. Which finding warrants notification to the healthcare provider?