The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). Which instruction should the nurse give for management of this disease process?

Drink a carbonated beverage before bed

Increase fatty foods one at a time

Elevate the head of the bed when sleeping

Eat dinner late in the evening

Answer and Explanation

The Correct Answer is C

Choice A reason: This is not a correct instruction because drinking a carbonated beverage before bed can worsen the reflux symptoms by increasing the gastric pressure and the production of gas.

Choice B reason: This is not a correct instruction because increasing fatty foods can worsen the reflux symptoms by delaying the gastric emptying and relaxing the lower esophageal sphincter (LES), which allows the stomach acid to flow back into the esophagus.

Choice C reason: This is a correct instruction because elevating the head of the bed when sleeping can help prevent the reflux symptoms by using gravity to keep the stomach contents from flowing back into the esophagus.

Choice D reason: This is not a correct instruction because eating dinner late in the evening can worsen the reflux symptoms by increasing the amount and acidity of the stomach contents, which can easily flow back into the esophagus when lying down. The client should avoid eating within 3 hours of bedtime.

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Correct Answer is B

Explanation

Choice A reason: This is not a correct manifestation of appendiceal perforation. Blanched abdomen means that the skin of the abdomen is pale or white, which can indicate shock or blood loss. However, it is not a specific sign of appendiceal perforation, as it can occur in other conditions as well.

Choice B reason: This is a correct manifestation of appendiceal perforation. Sudden decrease in abdominal pain means that the pain that was previously felt in the right lower quadrant of the abdomen has subsided or disappeared. This can indicate that the appendix has ruptured and released the pus and bacteria into the peritoneal cavity, causing peritonitis. This is a serious complication that requires immediate surgical intervention.

Choice C reason: This is not a correct manifestation of appendiceal perforation. Absent Rovsing's sign means that there is no pain in the right lower quadrant of the abdomen when the left lower quadrant is palpated. This is a sign of appendicitis, not appendiceal perforation, as it indicates that the appendix is inflamed and irritated by the pressure.

Choice D reason: This is not a correct manifestation of appendiceal perforation. Fever means that the body temperature is above the normal range, which can indicate infection or inflammation. However, it is not a specific sign of appendiceal perforation, as it can occur in other conditions as well.

A. Client who weighs 28% above ideal body weight B. Client who has a waist circumference of 81.3 cm (32 in) C. Client who has a BMI of 28 D. Client who has a body fat of 22%

Correct Answer is A

Explanation

Choice A reason: This is the correct answer because weighing 28% above ideal body weight is a sign of obesity. Ideal body weight is an estimate of the weight that corresponds to the lowest mortality for a given height and gender. Obesity is defined as having a body weight that is 20% or more above ideal body weight.

Choice B reason: This is not the correct answer because having a waist circumference of 81.3 cm (32 in) is not a manifestation of obesity. Waist circumference is a measure of abdominal fat, which is associated with increased health risks. However, the cut-off point for waist circumference varies by gender and ethnicity. For women, a waist circumference of more than 88 cm (35 in) is considered high.

Choice C reason: This is not the correct answer because having a BMI of 28 is not a manifestation of obesity. BMI is a measure of body mass index, which is calculated by dividing weight in kilograms by height in meters squared. BMI is used to classify weight status and health risks. For adults, a BMI of 18.5 to 24.9 is considered normal, 25 to 29.9 is considered overweight, and 30 or more is considered obese.

Choice D reason: This is not the correct answer because having a body fat of 22% is not a manifestation of obesity. Body fat is a measure of the percentage of fat in the body, which is determined by various methods such as skinfold thickness, bioelectrical impedance, or underwater weighing. Body fat is influenced by age, gender, and physical activity. For women, a body fat of 21 to 33% is considered normal, 33 to 39% is considered high, and more than 39% is considered very high.

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The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). Which instruction should the nurse give for management of this disease process?

Nursing Test Bank

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