The nurse is planning care for a client with a direct (sliding) hiatal hernia. Nursing actions should be planned to meet which goal?

Prevent esophageal reflux.

Maintain intact oral mucosa.

Increase intestinal peristalsis.

Promote effective swallowing.

Answer and Explanation

The Correct Answer is A

Rationale for Choice A:

Direct (sliding) hiatal hernias: These are the most common type of hiatal hernia. They occur when the upper part of the stomach slides upward through the diaphragm into the chest cavity. This displacement disrupts the normal function of the lower esophageal sphincter (LES), which is a ring of muscle that acts as a valve between the esophagus and stomach. The LES is responsible for preventing stomach contents from refluxing back into the esophagus.

Esophageal reflux: When the LES is weakened or impaired, stomach acid, pepsin, and bile can flow back into the esophagus, causing a burning sensation known as heartburn, regurgitation of food or sour liquid, and irritation of the esophageal lining.

Prevention of esophageal reflux: Nursing actions aimed at preventing esophageal reflux are crucial in the management of hiatal hernias. These actions include:

Elevate the head of the bed: This helps to keep stomach contents below the level of the esophagus, reducing the risk of reflux. Avoid eating large meals: Large meals put more pressure on the stomach, which can increase the likelihood of reflux.

Avoid lying down after eating: Lying down can allow stomach contents to flow back into the esophagus more easily. Avoid foods that trigger reflux: Common triggers include fatty foods, spicy foods, acidic foods, caffeine, and alcohol.

Maintain a healthy weight: Excess weight can increase abdominal pressure and contribute to reflux.

Consider medications: If lifestyle changes are not enough to control reflux, medications such as antacids, H2 blockers, or proton pump inhibitors may be prescribed.

Rationale for Choice B:

Maintaining intact oral mucosa: This is not a primary goal in the care of a client with a hiatal hernia. While oral hygiene is important for overall health, it does not directly address the issue of esophageal reflux.

Rationale for Choice C:

Increasing intestinal peristalsis: This is not a relevant goal for a hiatal hernia. Hiatal hernias primarily affect the upper digestive tract, not the intestines.

Rationale for Choice D:

Promoting effective swallowing: This is not the most important goal in the care of a client with a hiatal hernia. While swallowing difficulties can occur in some cases, they are not the primary concern. The priority is to prevent esophageal reflux and its associated complications.

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Correct Answer is B

Explanation

Step 1: Identify the desired dose and the available concentration. Desired dose: 500 mg of vancomycin

Available concentration: 500 mg per 100 ml

Step 2: Determine the volume needed to deliver the desired dose.

Since the available concentration is 500 mg per 100 ml, no further calculation is required. The volume needed to deliver 500 mg of vancomycin is already 100 ml.

Step 3: Calculate the infusion rate in mL/hr.

The medication needs to be administered over 1 hour.

Therefore, the infusion pump should be set to deliver the 100 ml of solution over 1 hour. Infusion rate = 100 ml / 1 hour = 100 mL/hr.

A. "If I have sudden shortness of breath, I will use this inhaler." B. "When I cough up sputum, the secretions should be less thick." C. "I will use my other inhaler in between uses." D. "I should use this medication in its handihaler every day."

Correct Answer is D

Explanation

Choice D rationale:

Highlights daily use: Tiotropium is a long-acting bronchodilator, meaning it works to relax and open the airways over an extended period. It's crucial for managing COPD symptoms and preventing exacerbations. Daily use is essential to maintain its effectiveness.

Emphasizes the Handihaler: The Handihaler is the specific inhalation device designed for tiotropium delivery. It ensures proper medication administration and optimal lung deposition.

Demonstrates understanding of instructions: Choosing this option indicates the client has correctly grasped the intended frequency and method of use.

Choice A rationale:

Misunderstanding of purpose: Tiotropium is not a rescue inhaler for sudden shortness of breath. It's a maintenance medication that works gradually to improve lung function. For acute symptoms, a short-acting bronchodilator, like albuterol, is required.

Potential delay in appropriate treatment: Reliance on tiotropium for acute episodes could lead to delayed use of the correct rescue medication, potentially worsening symptoms and increasing risks.

Choice B rationale:

Potential side effect, not primary goal: While tiotropium may reduce sputum thickness in some individuals, it's not the primary aim of therapy. Focusing on this aspect could overlook its broader benefits in managing COPD.

Variable response: The extent of sputum thinning varies among individuals and shouldn't be the sole indicator of effectiveness.

Choice C rationale:

Potential for overmedication: Using multiple inhalers without clear guidance from a healthcare provider could increase the risk of excessive medication and adverse effects.

Importance of individualized regimens: Inhaler use depends on the specific medications prescribed and the severity of COPD. Healthcare professionals tailor regimens to individual needs.

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The nurse is planning care for a client with a direct (sliding) hiatal hernia. Nursing actions should be planned to meet which goal?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in "500 mg per 100 ml" of dextrose 5% in water. To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr?

Correct Answer is B

Explanation

A client diagnosed with chronic obstructive pulmonary disease (COPD) is given a new prescription for tiotropium via an inhalation device.Which statement indicates that the client understands the instructions for using this medication?

Correct Answer is D

Explanation

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