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A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?
- A. Pyloric sphincter
- B. Lower esophageal sphincter
- C. Hypopharyngeal sphincter
- D. Upper esophageal sphincter
Correct Answer: B
Rationale: The lower esophageal sphincter, also called the gastroesophageal sphincter or cardiac sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric contents. The upper esophageal sphincter and the hypopharyngeal sphincter are synonymous and are not responsible for the manifestations of GERD. The pyloric sphincter exists between the stomach and the duodenum.
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A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patients care?
- A. Risk for Aspiration Related to Inhalation of Gastric Contents
- B. Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired Absorption
- C. Risk for Decreased Cardiac Output Related to Vasovagal Response
- D. Risk for Impaired Verbal Communication Related to Oral Trauma
Correct Answer: A
Rationale: Achalasia can result in the aspiration of gastric contents. It is not normally an acute risk to the patients nutritional status and does not affect cardiac output or communication.
A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer?
- A. A 65-year-old man with alcoholism who smokes
- B. A 45-year-old woman who has type 1 diabetes and who wears dentures
- C. A 32-year-old man who is obese and uses smokeless tobacco
- D. A 57-year-old man with GERD and dental caries
Correct Answer: A
Rationale: Oral cancers are often associated with the use of alcohol and tobacco, which when used together have a synergistic carcinogenic effect. Most cases of oral cancers occur in people over the age of 60 and a disproportionate number of cases occur in men. Diabetes, dentures, dental caries, and GERD are not risk factors for oral cancer.
Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patients knowledge of this new diagnosis. Which of the following should the nurse encourage?
- A. Eating several small meals daily rather than 3 larger meals
- B. Keeping the head of the bed slightly elevated
- C. Drinking carbonated mineral water rather than soft drinks
- D. Avoiding food or fluid intake after 6:00 p.m.
Correct Answer: B
Rationale: The patient with GERD is encouraged to elevate the head of the bed on 6- to 8-inch (15- to 20-cm) blocks. Frequent meals are not specifically encouraged and the patient should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided.
A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease?
- A. Perforation into the mediastinum
- B. Development of an esophageal lesion
- C. Erosion into the great vessels
- D. Painful swallowing
- E. Obstruction of the esophagus
Correct Answer: A,C,E
Rationale: In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.
A nurse is caring for a patient who has had surgery for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status?
- A. Ensure that none of the patients visitors has an infection.
- B. Arrange for a diet that is high in protein and low in fat.
- C. Administer colony stimulating factors (CSFs) as ordered.
- D. Prepare to administer chemotherapeutics as ordered.
Correct Answer: A
Rationale: Leukopenia reduces defense mechanisms, increasing the risk of infections. Visitors who might transmit microorganisms are prohibited if the patients immunologic system is depressed. Changes in diet, CSFs, and the use of chemotherapy do not resolve leukopenia.