A client with rheumatoid arthritis and psoriasis has been prescribed adalimumab, a biologic agent that blocks tumor necrosis factor alpha (TNF-alpha). Which of the following statements by the client indicates a need for further teaching?

Choice A reason: Gastritis is not the most likely condition that these clinical manifestations indicate. Gastritis is an inflammation of the stomach lining, which can cause abdominal pain, nausea, vomiting, and loss of appetite. Gastritis may cause heartburn or dyspepsia, but it does not usually cause dysphagia, which is difficulty swallowing.

Choice B reason: GERD is the most likely condition that these clinical manifestations indicate. GERD stands for gastroesophageal reflux disease, which is a chronic condition where the stomach acid flows back into the esophagus, causing irritation and inflammation. GERD can cause heartburn, which is a burning sensation in the chest or throat, dysphagia, which is difficulty swallowing or a feeling of a lump in the throat, and dyspepsia, which is indigestion or discomfort in the upper abdomen.

Choice C reason: Peptic ulcer disease is not the most likely condition that these clinical manifestations indicate. Peptic ulcer disease is a condition where there are open sores or ulcers in the lining of the stomach or duodenum, which can cause bleeding, perforation, or obstruction. Peptic ulcer disease can cause dyspepsia, which is indigestion or discomfort in the upper abdomen, but it does not usually cause heartburn or dysphagia, which are more characteristic of GERD.

Choice D reason: Pancreatitis is not the most likely condition that these clinical manifestations indicate. Pancreatitis is an inflammation of the pancreas, which can cause severe abdominal pain, nausea, vomiting, fever, and jaundice. Pancreatitis does not cause heartburn, dysphagia, or dyspepsia, which are more characteristic of GERD.

Choice A reason: Monitoring respiratory status for signs and symptoms of pulmonary complications is a priority nursing intervention for a client with hypervolemia. Hypervolemia is a condition where there is excess fluid in the blood vessels, which can cause fluid to leak into the lungs and impair gas exchange. The nurse should assess the client for signs of pulmonary edema, such as dyspnea, crackles, cough, and pink-tinged sputum.

Choice B reason: Encouraging the client to consume sodium-free fluids is not a priority nursing intervention for a client with hypervolemia. Sodium-free fluids may still contribute to fluid overload, especially if the client has impaired renal function or heart failure. The nurse should limit the client's fluid intake and administer diuretics as prescribed to reduce the fluid volume.

Choice C reason: Weighing dressings with a large-bore catheter is not a priority nursing intervention for a client with hypervolemia. This may be a relevant intervention for a client with hemorrhage, who may lose blood through a large-bore catheter or dressing. The nurse should monitor the client's blood pressure, pulse, and hemoglobin levels for signs of blood loss.

Choice D reason: Drawing a blood sample for typing and cross-matching is not a priority nursing intervention for a client with hypervolemia. This may be a relevant intervention for a client who needs a blood transfusion, which may be indicated for a client with anemia, trauma, or surgery. The nurse should check the client's blood type and compatibility before administering any blood products.