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A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met?
- A. Choosing foods that are easy to swallow
- B. A length of the swallowing is being
- C. Properly performing swallowing
- D. Weight unchanged after 2 weeks
Correct Answer: B
Rationale: The priority goal for a client with an esophageal tumor and difficulty swallowing is preventing aspiration. Clear lungs after eating (implied by 'A length of the swallowing is being' in the context) indicate no aspiration, which is the priority over other findings.
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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.
A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective?
- A. I can only take this medicine at night.
- B. I should take this on a full stomach.
- C. This drug decreases stomach acid.
- D. This should be taken 1 hour before meals.
Correct Answer: B
Rationale: Gaviscon should be taken with food in the stomach to form a protective barrier. It can be taken with meals at any time, and its mechanism of action is not to decrease stomach acid but to create a foam barrier to prevent reflux.
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 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.
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.