Nokea
A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client at the rehabilitation center indicate a good understanding of dietary instructions? (Select all that apply.)
- A. Boost supplement
- B. Greek yogurt
- C. Scrambled eggs
- D. Whole milk shake
- E. Whole wheat toast
Correct Answer: A,B,C,D
Rationale: High-protein, high-calorie, easy-to-swallow foods like Boost, Greek yogurt, scrambled eggs, and whole milk shakes are appropriate post-esophagogastrectomy. Whole wheat toast is dry and harder to swallow, making it a poor choice.
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A client is 1 day postoperative after having Zanders diverticula removed. The client has a nasogastric (NG) tube in place. The NG tube is not being used for suctioning drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate?
- A. Document the findings as normal.
- B. Irrigate the NG tube with sterile saline.
- C. Notify the surgeon about this finding.
- D. Remove and reinsert the NG tube.
Correct Answer: C
Rationale: NG tubes placed during surgery should not be manipulated without surgeon orders. Lack of suction or drainage is not normal and requires notifying the surgeon for further evaluation, as irrigation or reinsertion could be harmful.
The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
- A. Assisting with position changes and getting out of bed
- B. Keeping the head of the bed elevated to at least 30
- C. Turning the client
- D. Reminding the client to use the spirometer every 4 hours
- E. Taking and recording vital signs per hospital protocol
- F. Titrating oxygen based on the client oxygen saturations
Correct Answer: A,B,D
Rationale: UAPs can assist with mobility, maintain bed elevation, and remind about spirometer use (though it should be every 1-2 hours). Oxygen titration requires nursing judgment and cannot be delegated.
After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best?
- A. Bacteria can often cause ulcers.
- B. This operation often causes ulcers.
- C. The medication keeps your blood pH.
- D. It prevents stress-related ulcers.
Correct Answer: D
Rationale: Pantoprazole is given post-surgery to prevent stress-related ulcers, which can occur due to surgical stress, not because of bacteria, the operation itself, or blood pH regulation.
A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best?
- A. Arrange an intensive care unit tour.
- B. Assess the client's psychosocial status.
- C. Document the teaching and response.
- D. Have the client begin nutritional supplements.
Correct Answer: B
Rationale: Clients facing esophagogastrostomy are often anxious due to the procedure's complexity. Assessing psychosocial status is critical to address anxiety and provide tailored support, making it the best action compared to the more limited scope of the other options.
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.)
- A. Delayed gastric emptying
- B. Eating large meals
- C. Hiatal hernia
- D. Obesity
- E. Viral infections
Correct Answer: A,B,C,D
Rationale: Delayed gastric emptying, large meals, hiatal hernia, and obesity are known risk factors for GERD. Viral infections are not associated with GERD, though Helicobacter pylori infection is.