The nurse should first address the client’s

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followed by the client’s

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.

Choice A rationale

A sliding hiatal hernia occurs when the gastroesophageal junction and a portion of the stomach slide up into the chest through the diaphragm's esophageal hiatus. This displacement disrupts the lower esophageal sphincter's function, causing gastric acid to reflux into the esophagus and resulting in heartburn.

Choice B rationale

Abdominal cramping is typically associated with conditions affecting the intestines, such as irritable bowel syndrome, inflammatory bowel disease, or bowel obstruction. It is not a direct symptom of a sliding hiatal hernia, which primarily affects the stomach and esophagus.

Choice C rationale

Breathlessness or dyspnea can be a symptom of a very large hiatal hernia that compresses the lungs. However, for a standard sliding hiatal hernia, it is not a primary or expected finding. The most common manifestation is related to acid reflux.

Choice D rationale

Constipation is a condition of the large intestine and is characterized by infrequent bowel movements. It is not directly caused by a sliding hiatal hernia, as the hernia’s primary impact is on the stomach and esophagus, causing upper gastrointestinal symptoms. *.

Choice A rationale

Looping the tubing so it is lower than the collection bag creates a dependent loop, which can cause urine to pool and create a backflow into the bladder. This stasis of urine provides a fertile environment for bacteria to multiply and ascend the urinary tract, significantly increasing the client's risk for a urinary tract infection. The bag should always be below the bladder.

Choice B rationale

Keeping the urinary bag at bladder level or higher when ambulating is a significant risk factor for urinary tract infections. This positioning allows for the backflow of urine from the collection bag into the bladder. The retrograde flow of urine can transport bacteria into the sterile bladder, leading to bacterial colonization and a subsequent infection.

Choice C rationale

Securing the catheter to the client's thigh is a crucial intervention for minimizing the risk of a UTI. It prevents movement and traction on the catheter at the urethral meatus. This minimizes urethral tissue irritation and micro-trauma, which can serve as entry points for bacteria. It also reduces tension on the catheter, preventing accidental dislodgement.

Choice D rationale

Disconnecting the tubing connections to obtain a urinary sample is a high-risk action for introducing microorganisms. Each disconnection breaks the closed, sterile system, allowing airborne bacteria or contaminants from the external environment to enter the catheter and tubing. This breach of sterility can lead to bacterial ascension into the bladder, causing a urinary tract infection. *.