A nurse is teaching a client who has a hiatal hernia about dietary recommendations. Which of the following client s understanding of the teaching? (Select all that apply)

“I consume less caffeine and fewer spicy foods"

“ I will try not to gain weight"

“ I will lie down for one half hour after meals

“ I will drink less fluid

Answer and Explanation

Correct Answer : A,B,D

Choice A reason:

This statement demonstrates the client's understanding of the need to reduce intake of caffeine and spicy foods, which can exacerbate symptoms of hiatal hernia.

Choice B reason:

This statement shows the client's awareness of the importance of maintaining a healthy weight, which can help manage hiatal hernia symptoms.

Choice C reason:

This statement is not related to the dietary recommendations for hiatal hernia.

Choice D reason:

Limiting fluid intake can help prevent excessive stomach distension, which may aggravate hiatal hernia symptoms.

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Correct Answer is A

Explanation

Choice A reason:

This presentation of hepatic encephalopathy includes severe manifestations, such as profound confusion, difficulty in arousal, and the presence of rigidity, indicating advanced neurological impairment. This places the patient in Stage 4, which is the most severe stage of hepatic encephalopathy.

Choice B reason:

Stage 3 is characterized by severe symptoms, such as drowsiness, anxiety, seizures, severe personality changes, confused speech, and shaky hands.

Choice C reason:

Stage 1 is characterized by mild symptoms, such as difficulty thinking, personality changes, poor concentration, and problems with handwriting.

Choice D reason

Stage 2 is characterized moderate symptoms, such as confusion, forgetfulness, poor judgment, and a musty or sweet breath odor.

A. Sudden thirst, unrelieved by oral fluid administration B. Tachycardia, hypotension, and tachypnea C. Diaphoresis and sudden onset of abdominal pain D. Tarry, foul-smelling stools

Correct Answer is B

Explanation

Choice A reason:

Sudden thirst, unrelieved by oral fluid administration, may indicate dehydration, but it is not specific to a recurrence of upper GI bleeding.

Choice B reason:

This is the correct answer. Tachycardia (rapid heart rate), hypotension (low blood pressure), and tachypnea (rapid breathing) are signs of potential recurrence of upper GI bleeding and should be closely monitored.

Choice C reason:

Diaphoresis (excessive sweating) and sudden onset of abdominal pain could be indicative of various conditions, but they are not specific to a recurrence of upper GI bleeding.

Choice D reason:

Tarry, foul-smelling stools (melena) are indicative of upper GI bleeding. However, in this scenario, the bleeding has been controlled, so this is not an expected sign of recurrence.

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A nurse is teaching a client who has a hiatal hernia about dietary recommendations. Which of the following client s understanding of the teaching? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?

Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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