A nurse is teaching a newly licensed nurse about advance directives.
Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

Choice A rationale

Carbonated beverages contain gas that expands the stomach, increasing pressure on the lower esophageal sphincter (LES). This increased pressure can cause the LES to relax and allow gastric contents to reflux into the esophagus, exacerbating heartburn. Additionally, the acidic nature of many carbonated drinks can irritate the already inflamed esophageal lining.

Choice B rationale

Hot herbal tea can relax the esophageal muscles and soothe irritation. However, some herbal teas, like peppermint, can relax the lower esophageal sphincter, potentially worsening reflux. In contrast, chamomile or ginger tea may have a calming effect on the stomach and reduce inflammation, which can alleviate the symptoms of heartburn.

Choice C rationale

High-fat snacks, especially those consumed at bedtime, delay gastric emptying. The presence of food in the stomach for a prolonged period increases the risk of gastric reflux. Delayed emptying leads to a larger volume of stomach contents exerting pressure on the lower esophageal sphincter, making it more likely to open and allow acid to escape.

Choice D rationale

Lying down after meals increases the pressure on the lower esophageal sphincter and places the stomach contents in a position where gravity no longer helps keep them down. This postural change makes it easier for stomach acid to flow back into the esophagus, which is a primary cause of heartburn. Remaining upright for at least 30 minutes after eating is recommended. *.

Choice A rationale

Documenting a summary of data at the change of shift is a critical component of interprofessional communication, ensuring continuity of care. However, initial charting should be done promptly after data collection to maintain accuracy and prevent errors. Delaying documentation can lead to misinterpretation or omission of crucial information regarding the client's condition and needs. This practice ensures all members of the healthcare team are informed.

Choice B rationale

Noting whether a client has a living will is a fundamental ethical and legal obligation. This advance directive provides a written expression of a client’s wishes regarding medical treatment, which must be respected and documented in the medical record. It guides the healthcare team's decisions and ensures that the client's autonomy and right to self-determination are upheld.

Choice C rationale

Evaluation is the final step of the nursing process, following assessment, diagnosis, planning, and implementation. The nurse must first collect objective and subjective data, then analyze it before determining an appropriate plan of care. Beginning with an evaluation would bypass the essential steps of data collection and analysis, leading to an inaccurate or unsafe plan of care.

Choice D rationale

While assistive personnel can collect vital signs, the nurse is professionally and legally responsible for the data's accuracy and interpretation. The nurse must verify the data, analyze trends, and ensure it is documented accurately and promptly. The nurse is ultimately accountable for any actions taken based on this data, making proper documentation and validation essential.