Nokea
A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching?
- A. After the operation I can eat anything I want.
- B. I will have to eat smaller, more frequent meals.
- C. I will take stool softeners for several weeks.
- D. This surgery may not totally control my symptoms.
Correct Answer: A
Rationale: Nutritional and lifestyle changes must continue after fundoplication, as it does not offer a lifetime cure. The other statements reflect accurate understanding of postoperative expectations.
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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.
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.
A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first?
- A. Document the findings in the chart.
- B. Notify the surgeon immediately.
- C. Reassess the drainage in 1 hour.
- D. Take a full set of vital signs.
Correct Answer: D
Rationale: Bright red blood in the NG tube indicates possible bleeding, which requires immediate assessment. Taking vital signs first helps evaluate for shock, which is a priority before notifying the surgeon. Documentation and reassessment are secondary actions.
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first?
- A. Client who underwent diverticula removal with a pulse of 106/min
- B. Client who had esophageal dilation and is attempting first postprocedure oral intake.
- C. Client who had an esophagectomy with a respiratory rate of 32/min
- D. Client who underwent hernia repair, reporting incisional pain of 7/10
Correct Answer: C
Rationale: A respiratory rate of 32/min post-esophagectomy suggests possible sepsis, a life-threatening condition requiring immediate assessment. The other clients' conditions (elevated pulse, oral intake, pain) are less urgent.