To prevent gastroesophageal reflux in a male client with a hiatal hernia, the nurse should provide which of the following discharge instructions?

Correct Answer: B

Rationale: The correct answer is B: "Avoid coffee and alcoholic beverages." This is because both coffee and alcohol can relax the lower esophageal sphincter, leading to increased likelihood of gastroesophageal reflux. A: "Lie down after meals" can worsen reflux symptoms as gravity helps keep stomach contents down. C: "Take antacids with meals" may provide temporary relief but does not address the underlying cause of reflux. D: "Limit fluid intake with meals" can help reduce bloating but has no direct impact on preventing reflux.

Correct Answer: C

Rationale: The correct answer is C: uvula. The uvula is a teardrop-shaped projection from the posterior edge of the soft palate that elevates during swallowing to help close off the nasopharynx, preventing food or liquids from entering the nasal cavity. The uvula's contraction is essential for proper swallowing function. A: Buccal fat pad - located in the cheek area, not involved in swallowing or closing off the nasopharynx. B: Epiglottis - a flap of tissue that covers the trachea during swallowing to prevent food from entering the airway, not related to closing off the nasopharynx. D: Palatine tonsil - located on the sides of the throat, important for immune function but not directly involved in swallowing or closing off the nasopharynx.

Correct Answer: C

Rationale: The pharyngeal phase of swallowing is an involuntary process, meaning it occurs automatically without conscious control. This phase involves the contraction of skeletal muscles in the pharynx to propel the food bolus towards the esophagus. Skeletal muscles are under voluntary control, but in the context of swallowing, the pharyngeal phase is involuntary. Thus, the correct answer is C: involuntary; skeletal. Choice A (involuntary; smooth) is incorrect because smooth muscles are not typically involved in the pharyngeal phase of swallowing. Choice B (voluntary; smooth) is incorrect because the pharyngeal phase is not under voluntary control, and smooth muscles are not the primary muscles involved. Choice D (voluntary; skeletal) is incorrect because the pharyngeal phase is involuntary and skeletal muscles, not smooth muscles, are responsible for the muscle contractions during this phase.

Correct Answer: D

Rationale: The correct answer is D because the described sequence of events matches the process of swallowing. Raising the larynx and hyoid bone helps to protect the airway, closing the epiglottis prevents food from entering the trachea, closing the soft palate blocks the nasopharynx to prevent food from entering the nasal cavity, and the contraction of the diaphragm and abdominal muscles along with relaxation of the lower esophageal sphincter facilitate the movement of food into the esophagus. This series of actions is characteristic of the swallowing reflex. Choices A, B, and C are incorrect. Low blood glucose levels do not directly trigger the swallowing reflex. Irritation in the GI tract would not lead to the described sequence of events. Bolus entering the larynx or nasopharynx would not be part of the normal swallowing process and would typically trigger the gagging reflex instead.

Correct Answer: B

Rationale: The gallbladder contracts in response to cholecystokinin and vagal stimulation. Cholecystokinin is released in response to the presence of fatty acids and amino acids in the duodenum, signaling the gallbladder to contract and release bile. Vagal stimulation also plays a role in gallbladder contraction by transmitting signals from the brain to the gallbladder. Secretin is primarily involved in stimulating pancreatic secretion, not gallbladder contraction. A low pH of chyme does not directly stimulate gallbladder contraction.