When admitting a patient with a stroke who is unconscious and unresponsive to stimuli. The nurse learns from the patient’s family that the patient has a history of GERD, the nurse will plan to do frequent assessment of the patient’s:

Breath sounds.

abdominal girth.

Bowel sounds.

Apical pulse.

Answer and Explanation

The Correct Answer is A

GERD can increase the risk of aspiration (inhalation of stomach contents into the lungs), which can cause respiratory issues, including abnormal breath sounds. In these cases, monitoring of breath sounds may be more appropriate than monitoring of bowel sounds.

Bowel sounds are not typically monitored for GERD patients as GERD is a condition that aﬀects the esophagus and the stomach, not the intestines. GERD is caused by the reﬂux of stomach contents into the esophagus, which can cause symptoms such as heartburn and regurgitation.

Abdominal girth is not routinely monitored for GERD patients as it is not typically related to the condition. GERD is a disorder that aﬀects the esophagus and stomach and does not typically cause significant changes in abdominal size or girth. In rare cases, GERD can be complicated by a condition known as a para oesophageal hernia, which can cause a visible bulge in the abdomen. In these cases, monitoring of abdominal size and shape may be necessary.

The apical pulse is not routinely monitored for GERD patients as it is not directly related to the condition. GERD is a disorder that aﬀects the digestive system, specifically the esophagus and stomach and does not typically have an impact on heart rate or rhythm.

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Correct Answer is A

Explanation

Broccoli and kale are good sources of calcium, and by adding them to their diet, the client can increase their calcium intake without consuming milk. It is important to note that some calcium supplements may irritate the stomach but stopping them altogether is not advisable without consulting a healthcare provider. Vitamin D is not a milk product, and it is essential for calcium absorption. Avoiding foods with vitamin D can worsen the low calcium levels. Cheese is a milk product and may not be suitable for someone with a milk allergy.

A. You really should not worry about how you look in the hospital, we see many worse things. B. Most of the physical and mental changes caused by the disease will gradually improve after surgery. C. "Let me show you how to dress so that the changes are not so noticeable." D. "I do not think you look bad; your appearance is just altered by your disease.

Correct Answer is B

Explanation

This response acknowledges the patient's concerns and provides reassurance that the changes are temporary and will improve after surgery. Response is dismissive of the patient's concerns and may make the patient feel unheard. Response c may be helpful, but it does not address the patient's emotional concerns. Response d is not accurate because the patient has expressed feeling awful about their appearance.

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When admitting a patient with a stroke who is unconscious and unresponsive to stimuli. The nurse learns from the patient’s family that the patient has a history of GERD, the nurse will plan to do frequent assessment of the patient’s:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching nutritional strategies to a client who has a low calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is A

Explanation

A patient with crushing syndrome is admited to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse "The worst thing about this disease is how terrible I look; I feel awful about it.' The best response by the nurse is:

Correct Answer is B

Explanation

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