NU 160 Exam 4 Spring 2025

Correct Answer C: You should avoid or cut down on alcohol and caffeine, which can aggravate GERD.

Explanation:

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus, irritating the lining and causing symptoms like heartburn. Several lifestyle factors can contribute to or aggravate GERD. Here’s why the correct answer is C and why the others are not appropriate:

C. You should avoid or cut down on alcohol and caffeine, which can aggravate GERD.

Alcohol and caffeine are known to relax the lower esophageal sphincter (LES), which is the valve that prevents acid from flowing back into the esophagus. When the LES relaxes, acid reflux becomes more likely. Therefore, reducing or avoiding alcohol and caffeine is an important recommendation for managing GERD.

Why the Other Options Are Incorrect:

A. You should avoid possible mercury-containing foods such as some seafood because of their risk to GERD.

While it’s true that some seafood may contain mercury, there is no direct evidence linking mercury-containing foods to the development or exacerbation of GERD. The primary concern with seafood for people with GERD is not related to mercury, but rather the potential for foods that are high in fat or trigger acid reflux.

B. There is no causal link between lying down after eating and increased onset of GERD.

This statement is incorrect. Lying down after eating can actually increase the likelihood of GERD symptoms. When you lie down, it becomes easier for stomach acid to move back into the esophagus, especially if the lower esophageal sphincter is weakened or relaxed. This can worsen GERD symptoms like heartburn. It is recommended to wait at least 2-3 hours after eating before lying down.

D. It is okay to take aspirin with GERD.

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the stomach lining and exacerbate GERD symptoms by promoting the production of stomach acid. NSAIDs can also increase the risk of gastric ulcers and bleeding, which makes them less than ideal for individuals with GERD. Other pain relievers, such as acetaminophen, may be safer alternatives.

Correct Answer C: Both are inflammatory

Explanation:

C. Both are inflammatory

Ulcerative colitis and Crohn's disease are both classified as inflammatory bowel diseases (IBD). They involve chronic inflammation of the gastrointestinal (GI) tract, although they affect different areas and layers of the GI system. Despite their differences, the underlying process of immune-mediated inflammation is a hallmark of both diseases.

Why the Other Options Are Incorrect:

A. Both manifest fistula formation

Fistula formation is more commonly associated with Crohn’s disease due to the transmural (full-thickness) nature of the inflammation. Ulcerative colitis, on the other hand, involves only the mucosal layer and does not typically result in fistulas.

B. Both require frequent surgery

Surgery is more common in Crohn’s disease due to complications such as strictures, abscesses, and fistulas. While ulcerative colitis may sometimes require surgery (e.g., colectomy), it is not as frequent as in Crohn’s.

D. Both begin in the rectum

Ulcerative colitis characteristically begins in the rectum and may extend proximally through the colon. Crohn’s disease can affect any part of the GI tract from the mouth to the anus and does not necessarily begin in the rectum.

Correct Answer A: I get dizzy when I nod my head.

Explanation:

A. I get dizzy when I nod my head.

This statement suggests involvement of the inner ear, which is not only responsible for hearing but also for balance. Dizziness or vertigo can significantly impact a person's ability to perform ADLs such as bathing, dressing, and walking safely. Difficulty with balance due to inner ear issues can lead to falls or a need for assistance with basic daily functions, indicating that the hearing-related problem is affecting ADLs.

Why the Other Options Are Incorrect:

B. I can't eat as much as I used to.

This does not directly indicate an issue related to hearing or its impact on ADLs. It may suggest a separate issue such as appetite loss, gastrointestinal problems, or depression.

C. I walk my dog at least twice a day.

This statement suggests that the client is still active and capable of performing physical ADLs independently, not that their hearing loss is interfering.

D. I wash my hair every other day.

This shows that the client is maintaining personal hygiene, which is a component of ADLs. It does not suggest any impairment related to hearing loss.

Correct Answer B: It is important for you to practice good oral hygiene with this disorder.

Explanation:

B. It is important for you to practice good oral hygiene with this disorder.

Good oral hygiene is crucial for individuals with GERD because stomach acid that refluxes into the esophagus and into the mouth can erode tooth enamel and cause dental problems. GERD can lead to acid in the mouth, which increases the risk of tooth decay and oral health issues. Practicing good oral hygiene, such as brushing teeth regularly, using fluoride toothpaste, and rinsing with water after meals, can help mitigate these risks and maintain oral health. Additionally, regular dental checkups are important for those with GERD to monitor for damage caused by acid exposure.

Why the Other Options Are Incorrect:

A. You can lay down 30 minutes after eating if that will help you feel better.

This statement is incorrect because it is generally recommended that individuals with GERD avoid lying down immediately after eating. Lying down can increase the likelihood of acid reflux because it allows stomach acid to flow more easily back into the esophagus. It's best for patients to wait at least 2-3 hours after eating before lying down to prevent reflux symptoms.

C. Adding more citrus foods in your diet might help with easing the manifestations.

This statement is incorrect because citrus foods such as oranges, lemons, and grapefruits are acidic and can actually worsen GERD symptoms by increasing stomach acid production and irritating the esophagus. People with GERD are generally advised to avoid acidic foods that can trigger reflux.

D. A glass of wine per day might help with reducing your stress and improve your GERD.

This statement is incorrect because alcohol, including wine, can relax the lower esophageal sphincter (LES), which can worsen GERD symptoms by allowing stomach acid to flow back into the esophagus more easily. Alcohol is generally considered a trigger for GERD and is typically advised to be avoided or limited for individuals with this condition.

Correct Answer D: Prolonged exposure to loud noises

Explanation:

D. Prolonged exposure to loud noises

Prolonged or repeated exposure to loud noises is a well-established risk factor for noise-induced hearing loss (NIHL). This type of hearing damage occurs when the delicate hair cells in the cochlea are damaged due to sustained high-decibel environments, such as construction sites, loud music venues, military settings, or industrial workplaces. NIHL is often permanent and preventable with proper use of hearing protection like earplugs or earmuffs.

Why the Other Options Are Incorrect:

A. Alcohol use disorder

While chronic alcohol use can lead to various neurological issues, it is not a primary or direct cause of hearing loss. Some studies suggest a potential association with auditory processing issues, but it is not recognized as a leading cause of hearing damage.

B. Exposure to environmental toxins

Certain ototoxic chemicals, such as heavy metals (like lead or mercury) or industrial solvents, can contribute to hearing loss. However, this option is too vague ("environmental toxins") and less directly associated than the clear and commonly known cause of noise exposure.

C. Contact with excessive heat

Heat exposure does not contribute to hearing loss. While heat stroke or burns can have serious health consequences, they are unrelated to auditory function unless there is direct trauma to the ear.

Correct Answer A: Furosemide

Explanation:

A. Furosemide

Furosemide is a loop diuretic and is often prescribed to clients with Menière’s disease. The purpose is to reduce fluid volume within the body, which may help lower the fluid pressure in the inner ear. By doing so, it helps decrease the frequency and severity of vertigo episodes, one of the main symptoms of Menière’s disease.

Why the Other Options Are Incorrect:

B. Oxybutynin

Oxybutynin is an anticholinergic medication used to treat urinary incontinence and overactive bladder. It has no effect on the inner ear or vertigo and is not appropriate for Menière’s disease.

C. Warfarin

Warfarin is an anticoagulant used to prevent blood clots. It has no therapeutic benefit in treating Menière’s disease and is not part of the treatment protocol for this condition.

D. Pantoprazole

Pantoprazole is a proton pump inhibitor used to manage acid-related gastrointestinal disorders such as GERD. It is not used in the treatment of inner ear conditions like Menière’s disease.

Correct Answer C: Ask the client to open their mouth widely.

Explanation:

C. Ask the client to open their mouth widely

Tinnitus can be somatic, meaning it is influenced by musculoskeletal movement. Asking the client to open their mouth widely helps determine if temporomandibular joint (TMJ) dysfunction is contributing to the tinnitus. Movement of the jaw can exacerbate tinnitus if the cause is somatosensory in origin.

Why the Other Options Are Incorrect:

A. Ask the client to pull the pinna of their ears up and back

This technique is used to help straighten the ear canal for better visualization during ear examination, particularly with an otoscope. It does not assess whether movement worsens tinnitus.

B. Ask the client to move their eyes side to side while keeping their head still

This maneuver may be used during neurologic or vestibular assessments, such as in evaluation of nystagmus, but it does not directly assess tinnitus related to movement.

D. Ask the client to breathe in through pursed lips

This breathing technique is typically used in respiratory conditions like COPD to control shortness of breath. It has no known relevance to tinnitus assessment.

Correct Answer C: It is important to follow up with a GI specialist for recommended surveillance for Barrett's esophagus.

Explanation:

C. It is important to follow up with a GI specialist for recommended surveillance for Barrett's esophagus.

This statement is accurate and highly important for clients with long-term GERD symptoms. Barrett's esophagus is a condition where the lining of the esophagus changes due to repeated exposure to stomach acid from reflux. This condition increases the risk of developing esophageal cancer. Regular surveillance by a gastroenterologist (GI specialist) is necessary to monitor for changes in the esophagus, and early detection can help prevent the progression to esophageal cancer. The client with long-term GERD should have periodic endoscopies to check for Barrett's esophagus and other complications.

Why the Other Options Are Incorrect:

A. You will need to monitor for manifestations of liver issues.

While chronic GERD can lead to complications like esophageal scarring or Barrett’s esophagus, there is no direct link between GERD and liver disease. Liver issues are not a primary concern for GERD patients unless they have other conditions, such as cirrhosis or hepatitis, which is not typically associated with GERD. Therefore, monitoring for liver issues is not a routine part of GERD management.

B. Follow-up with an endocrinologist as your risks for diabetes increases.

There is no direct relationship between GERD and an increased risk of diabetes. GERD is related to gastrointestinal issues and the reflux of stomach acid into the esophagus. While certain medications for GERD (like steroids) could have an impact on blood sugar, diabetes is not a common concern that would require follow-up with an endocrinologist unless the client has other risk factors for diabetes.

D. It is important to watch for manifestations of pancreatic cancer.

Pancreatic cancer is not directly linked to GERD. The signs of pancreatic cancer (such as unexplained weight loss, jaundice, and abdominal pain) are not typical of GERD and are more likely to be associated with other conditions. Clients with GERD should focus on monitoring for complications related to acid reflux, such as esophageal damage or Barrett’s esophagus, rather than pancreatic cancer.

Correct Answer A: Check to see if the lines on the grid are blurry or distorted.

Explanation:

The Amsler grid is a tool used to monitor changes in vision, especially in conditions like macular degeneration, where damage to the macula can cause central vision loss. The purpose of the Amsler grid is to detect any changes in the visual field, such as blurring or distortion, that could indicate disease progression.

Why "A" is correct:

A. Check to see if the lines on the grid are blurry or distorted.

This is the correct statement. The Amsler grid consists of a series of straight horizontal and vertical lines, and the client should check if any of the lines appear blurry, wavy, or distorted. These changes can be signs of progression in macular degeneration, indicating that the macula is becoming affected by the disease. The grid helps the client identify any such changes in their vision.

Why the Other Options are Incorrect:

B. Note if you see any flashing bright lights on the grid.

Flashing lights are not a symptom of macular degeneration or a change that would typically be monitored with an Amsler grid. Flashing lights might be more indicative of retinal issues like retinal detachment or migraine with aura, not macular degeneration.

C. Monitor for the lines on the grid to change in color or brightness."

While changes in brightness or color can occur in certain eye conditions, they are not typical signs of macular degeneration. The key changes to monitor with macular degeneration using the Amsler grid are distortion, blurring, or missing areas, not changes in color or brightness.

D. Watch for floating dark spots on the grid.

Floaters (dark spots or strings) in the visual field are usually associated with conditions affecting the vitreous humor or retina, such as retinal detachment or diabetic retinopathy. These are not typically monitored with an Amsler grid, which is specifically designed to detect distortion or changes in the central vision.