Nokea
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.)
- A. I just joined a gym, so I hope that helps me lose weight.
- B. I sure hate to give up my coffee, but I guess I have to.
- C. I will eat three small meals and three small snacks a day.
- D. Sitting upright and not lying down after meals will help
- E. Smoking a pipe is not a problem and I don't have to stop
Correct Answer: A,B,C,D
Rationale: Weight loss, avoiding caffeine (e.g., coffee), eating smaller frequent meals, and staying upright post-meals help manage GERD. All tobacco use, including pipe smoking, is a risk factor and should be avoided.
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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.
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 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.
A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the clients neck. What action by the nurse takes priority?
- A. Assess the client's oxygenation.
- B. Facilitate a STAT chest x-ray.
- C. Prepare for immediate surgery.
- D. Start two large-bore IVs.
Correct Answer: A
Rationale: Subcutaneous emphysema suggests possible airway or esophageal injury. The priority is ensuring airway and breathing (assessing oxygenation) before diagnostic or therapeutic interventions, following the ABC (airway, breathing, circulation) priority framework.
A client is 1 day postoperative after having Zanders diverticula removed. The client has a nasogastric (NG) tube in place. The NG tube is not being used for suctioning drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate?
- A. Document the findings as normal.
- B. Irrigate the NG tube with sterile saline.
- C. Notify the surgeon about this finding.
- D. Remove and reinsert the NG tube.
Correct Answer: C
Rationale: NG tubes placed during surgery should not be manipulated without surgeon orders. Lack of suction or drainage is not normal and requires notifying the surgeon for further evaluation, as irrigation or reinsertion could be harmful.