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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.
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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.
The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which assessment. (Select all that apply.)
- A. Aphasia
- B. Dysphagia
- C. Eructation
- D. Halitosis
- E. Weight gain
Correct Answer: B,C,D
Rationale: Esophageal disorders commonly cause dysphagia (difficulty swallowing), eructation (belching), halitosis (bad breath), and weight loss. Aphasia is unrelated, as it involves speech difficulties typically from neurological issues.
A client has a nasogastric (NG) tube. What action by the nursing student requires the registered nurse to intervene?
- A. Checking tube placement every 4 or 8 hours
- B. Monitoring and client listening drainage from the NG tube
- C. Pinning the tube to the gown so the client cannot turn the head
- D. Providing oral care every 4 to 8 hours
Correct Answer: C
Rationale: Pinning the NG tube to restrict head movement is incorrect, as it can cause discomfort or dislodge the tube. The client should have freedom to move their head. The other actions are appropriate for NG tube care.
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client?
- A. Famotidine (Pepcid)
- B. Magnesium hydroxide
- C. Omeprazole (Prilosec)
- D. Ranitidine (Zantac)
Correct Answer: C
Rationale: Omeprazole is a proton pump inhibitor used for GERD. Famotidine and ranitidine are histamine blockers, and magnesium hydroxide is an antacid, none of which are proton pump inhibitors.
The following data relate to an older client who is 2 hours postoperative after an esophagogastrostomy: Physical Assessment: Skin dry, Urine output 20/ml/hr, NG tube patent with 100/ml, brown drainage/hr, Restless; Vital Signs: Pulse: 128 beats/min, Blood pressure: 85/50 mm Hg, Respiratory rate: 20 on ventilator, Cardiac output: 2.1 l/min; Physician Orders: Normal saline at 75/ml/hr, Morphine sulfate 2 mg IV push every 1 hr, Vancomycin (Vancocin) 1 g IV every 8 hr. What action by the nurse is best?
- A. Administer the prescribed pain medication.
- B. Consult the surgeon about a different antibiotic.
- C. Consult the surgeon about increased IV fluids.
- D. Have respiratory therapy reduce the respiratory rate.
Correct Answer: C
Rationale: The client's vital signs, low urine output, dry skin, and low cardiac output indicate hypovolemia. Consulting the surgeon to increase IV fluids is the priority to address hypotension, rather than pain, antibiotics, or respiratory rate adjustments.