Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has dysphagia due to decreased esophageal motility.
Which of the following actions should the nurse take?
A. Encourage the client to drink thin liquids.
This is wrong because thin liquids are more difficult to swallow and control for clients who have dysphagia due to decreased esophageal motility.They can easily enter the airway and cause choking or pneumonia. Choice C is wrong
B. Instruct the client to tuck their chin when swallowing.
This action helps to prevent aspiration by closing off the airway and directing food and liquid into the esophagus.It also reduces the risk of food getting stuck in the throat or chest.
C. Offer the client foods that are hot or spicy.
This is wrong because hot or spicy foods can irritate the esophagus and worsen the symptoms of dysphagia.They can also trigger reflux, which can damage the esophageal lining and cause narrowing or inflammation.
D. Elevate the head of the bed to 30 degrees during meals.
This is wrong because elevating the head of the bed to 30 degrees during meals is not enough to prevent aspiration or regurgitation.The client should be sitting upright at 90 degrees or higher to facilitate swallowing and gravity.
This question is an excerpt from Nurse Dive's nursing test bank - Physiological Changes with Aging. Take the full exam now
Full Explanation
The correct answer is B.
Instruct the client to tuck their chin when swallowing.
This action helps to prevent aspiration by closing off the airway and directing food and liquid into the esophagus. It also reduces the risk of food getting stuck in the throat or chest .
Choice A is wrong because thin liquids are more difficult to swallow and control for clients who have dysphagia due to decreased esophageal motility. They can easily enter the airway and cause choking or pneumonia .
Choice C is wrong because hot or spicy foods can irritate the esophagus and worsen the symptoms of dysphagia. They can also trigger reflux, which can damage the esophageal lining and cause narrowing or inflammation .
Choice D is wrong because elevating the head of the bed to 30 degrees during meals is not enough to prevent aspiration or regurgitation. The client should be sitting upright at 90 degrees or higher to facilitate swallowing and gravity .
Normal ranges for esophageal motility are:.
• Lower esophageal sphincter pressure: 10 to 45 mm Hg.
• Peristaltic amplitude: 30 to 180 mm Hg.
• Peristaltic duration: 2.5 to 6 seconds.
• Peristaltic velocity: 2 to 4.5 cm/s .
Similar Questions
A nurse is reviewing the laboratory results of a client who is 80 years old.The nurse notes that the client has low levels of iron, calcium and vitamin B12. Which of the following statements by the client indicates an understanding of this finding?
A. “I need to eat more foods that are rich in these nutrients.”.
This statement indicates that the client understands that low levels of iron, calcium and vitamin B12 can be caused by inadequate dietary intake of these nutrients.Iron, calcium and vitamin B12 are mainly found in animal-based foods, such as meat, eggs, milk and cheese.A diet lacking in these foods can lead to vitamin deficiency anemia, which is a condition where the body produces fewer and larger red blood cells that cannot carry enough oxygen.
B. “I need to take supplements to correct these deficiencies.”.
This is wrong because supplements may not be necessary or sufficient to correct these deficiencies. Supplements can also interact with other medications or have side effects.The client should consult with their healthcare provider before taking any supplements.
C. “I need to increase my intake of gastric acid inhibitors.”.
This is wrong because gastric acid inhibitors can actually worsen vitamin B12 deficiency. Gastric acid inhibitors are medications that reduce the amount of stomach acid produced.However, stomach acid is needed to release vitamin B12 from food and to help it bind to a protein called intrinsic factor, which is essential for its absorption in the intestines. Therefore, taking gastric acid inhibitors can impair vitamin B12 absorption and lead to deficiency.
D. “I need to reduce my consumption of dairy products.”.
This is wrong because reducing dairy consumption can further lower calcium intake. Dairy products are a good source of calcium, which is a mineral that helps build and maintain strong bones and teeth.Calcium deficiency can lead to osteoporosis, which is a condition where the bones become weak and brittle.
Full Explanation
The correct answer is A.
“I need to eat more foods that are rich in these nutrients.” This statement indicates that the client understands that low levels of iron, calcium and vitamin B12 can be caused by inadequate dietary intake of these nutrients. Iron, calcium and vitamin B12 are mainly found in animal-based foods, such as meat, eggs, milk and cheese. A diet lacking in these foods can lead to vitamin deficiency anemia, which is a condition where the body produces fewer and larger red blood cells that cannot carry enough oxygen.
Choice B is wrong because supplements may not be necessary or sufficient to correct these deficiencies.
Supplements can also interact with other medications or have side effects. The client should consult with their healthcare provider before taking any supplements.
Choice C is wrong because gastric acid inhibitors can actually worsen vitamin B12 deficiency.
Gastric acid inhibitors are medications that reduce the amount of stomach acid produced. However, stomach acid is needed to release vitamin B12 from food and to help it bind to a protein called intrinsic factor, which is essential for its absorption in the intestines.
Therefore, taking gastric acid inhibitors can impair vitamin B12 absorption and lead to deficiency.
Choice D is wrong because reducing dairy consumption can further lower calcium intake.
Dairy products are a good source of calcium, which is a mineral that helps build and maintain strong bones and teeth. Calcium deficiency can lead to osteoporosis, which is a condition where the bones become weak and brittle.
Normal ranges for iron, calcium and vitamin B12 in the blood are:.
• Iron: 50 to 170 micrograms per deciliter (mcg/dL) for men; 40 to 150 mcg/dL for women.
• Calcium: 8.5 to 10.2 milligrams per deciliter (mg/dL).
• Vitamin B12: 200 to 900 picograms per milliliter (pg/mL).
A nurse is administering medications to a client who is 65 years old. The nurse knows that older adults are at increased risk for adverse drug reactions due to which of the following physiological changes?
A. Increased renal clearance
This is wrong because older adults have decreased renal clearance, not increased.This means that drugs that are eliminated by the kidneys may accumulate in the body and cause adverse effects.
B. Increased plasma protein levels.
This is wrong because older adults have decreased plasma protein levels, not increased.This means that drugs that are bound to plasma proteins may have higher free fractions and increased pharmacological effects.
C. Decreased liver function.
Older adults are at increased risk for adverse drug reactions due to various physiological changes that affect the absorption, distribution, metabolism and excretion of drugs.One of these changes is the reduction in liver blood flow, size, drug-metabolizing enzyme content and function.This can result in slower or decreased metabolism of drugs, leading to higher plasma concentrations and increased risk of toxicity.
D. Decreased blood-brain barrier.
This is wrong because older adults have increased permeability of the blood-brain barrier, not decreased.This means that drugs that cross the blood-brain barrier may have enhanced central nervous system effects in older adults.
Full Explanation
The correct answer is C.
Decreased liver function. Older adults are at increased risk for adverse drug reactions due to various physiological changes that affect the absorption, distribution, metabolism and excretion of drugs. One of these changes is the reduction in liver blood flow, size, drug-metabolizing enzyme content and function. This can result in slower or decreased metabolism of drugs, leading to higher plasma concentrations and increased risk of toxicity.
Choice A is wrong because older adults have decreased renal clearance, not increased. This means that drugs that are eliminated by the kidneys may accumulate in the body and cause adverse effects.
Choice B is wrong because older adults have decreased plasma protein levels, not increased. This means that drugs that are bound to plasma proteins may have higher free fractions and increased pharmacological effects.
Choice D is wrong because older adults have increased permeability of the blood-brain barrier, not decreased. This means that drugs that cross the blood-brain barrier may have enhanced central nervous system effects in older adults.
Normal ranges for liver function tests vary depending on the laboratory and the method used, but some common values are:.
• Alanine aminotransferase (ALT): 7-55 U/L.
• Aspartate aminotransferase (AST): 8-48 U/L.
• Alkaline phosphatase (ALP): 45-115 U/L.
• Total bilirubin: 0.1-1.2 mg/dL.
• Albumin: 3.5-5 g/dL.
A nurse is teaching a group of older adults about the effects of aging on the cardiovascular system. Which of the following statements should the nurse include? (Select all that apply.).
A. “You may experience dizziness when you stand up quickly.”.
This is true because aging causes the arteries and arterioles to become less elastic and less able to adjust the blood pressure quickly when the posture changes.This can lead to a drop in blood pressure when standing up, which can cause dizziness or fainting.
B. “Your blood pressure may drop when you are resting.”.
This is false because aging does not cause a decrease in blood pressure at rest. In fact, aging tends to increase the systolic blood pressure (the pressure when the heart contracts) due to the stiffening of the arteries.The diastolic blood pressure (the pressure when the heart relaxes) may remain normal or decrease slightly, resulting in a widened pulse pressure (the difference between systolic and diastolic pressures).
C. “Your heart may beat faster when you exercise.”.
This is false because aging does not cause a decrease in blood pressure at rest. In fact, aging tends to increase the systolic blood pressure (the pressure when the heart contracts) due to the stiffening of the arteries.The diastolic blood pressure (the pressure when the heart relaxes) may remain normal or decrease slightly, resulting in a widened pulse pressure (the difference between systolic and diastolic pressures).
D. “Your blood vessels may become stiffer and narrower.”.
This is true because aging causes the walls of the arteries and arterioles to become thicker and stiffer, which reduces their compliance and increases the resistance to blood flow.This can lead to high blood pressure, atherosclerosis, and other cardiovascular diseases.
E. “Your heart may skip some beats or have extra beats.”.
This is true because aging causes changes in the electrical system of the heart, which can result in arrhythmias such as atrial fibrillation, premature ventricular contractions, or sinus bradycardia.These can cause irregular heartbeats that may be felt as palpitations or skipped beats.
Full Explanation
The correct answer is A, D, and E.
Here is why:.
A. “You may experience dizziness when you stand up quickly.” This is true because aging causes the arteries and arterioles to become less elastic and less able to adjust the blood pressure quickly when the posture changes. This can lead to a drop in blood pressure when standing up, which can cause dizziness or fainting.
D. “Your blood vessels may become stiffer and narrower.” This is true because aging causes the walls of the arteries and arterioles to become thicker and stiffer, which reduces their compliance and increases the resistance to blood flow. This can lead to high blood pressure, atherosclerosis, and other cardiovascular diseases.
E. “Your heart may skip some beats or have extra beats.” This is true because aging causes changes in the electrical system of the heart, which can result in arrhythmias such as atrial fibrillation, premature ventricular contractions, or sinus bradycardia. These can cause irregular heartbeats that may be felt as palpitations or skipped beats.
B. “Your blood pressure may drop when you are resting.” This is false because aging does not cause a decrease in blood pressure at rest.
In fact, aging tends to increase the systolic blood pressure (the pressure when the heart contracts) due to the stiffening of the arteries. The diastolic blood pressure (the pressure when the heart relaxes) may remain normal or decrease slightly, resulting in a widened pulse pressure (the difference between systolic and diastolic pressures).
C. “Your heart may beat faster when you exercise.” This is false because aging does not cause an increase in heart rate during exercise.
In fact, aging tends to decrease the maximum heart rate that can be achieved during exercise due to the reduced responsiveness of the heart to adrenergic stimuli. The older heart also takes longer to recover after exercise.
Normal ranges for blood pressure are less than 120/80 mmHg for adults of any age. Normal ranges for heart rate are 60-100 beats per minute for adults of any age, but the maximum heart rate decreases with age according to the formula 220 minus age.