Nokea
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client?
- A. Enteral tube feeding
- B. Esophageal dilation
- C. Nissen fundoplication
- D. Photodynamic therapy
Correct Answer: B
Rationale: Esophageal dilation provides immediate relief for strictures impairing swallowing. Enteral feeding may be used later if dilation fails, while Nissen fundoplication addresses reflux, and photodynamic therapy is for cancer treatment, not immediate swallowing relief.
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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.
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.)
- A. Chocolate
- B. Decaffeinated coffee
- C. Citrus fruits
- D. Peppermint
- E. Tomato sauce
Correct Answer: A,C,D,E
Rationale: Chocolate, citrus fruits, peppermint, and tomato-based products exacerbate GERD by promoting reflux. Decaffeinated coffee is less likely to trigger symptoms compared to caffeinated beverages.
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.
A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first?
- A. Notify the surgeon.
- B. Put on a pair of gloves.
- C. Reinsert the NG reinsert the NG tube.
- D. Take a set of vital signs.
Correct Answer: B
Rationale: Standard precautions require putting on gloves first to protect the nurse from exposure to blood and body fluids. This is the priority before assessing vital signs, notifying the surgeon, or attempting to reinsert the NG tube.
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.