Nokea
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.
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The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
- A. Assisting with position changes and getting out of bed
- B. Keeping the head of the bed elevated to at least 30
- C. Turning the client
- D. Reminding the client to use the spirometer every 4 hours
- E. Taking and recording vital signs per hospital protocol
- F. Titrating oxygen based on the client oxygen saturations
Correct Answer: A,B,D
Rationale: UAPs can assist with mobility, maintain bed elevation, and remind about spirometer use (though it should be every 1-2 hours). Oxygen titration requires nursing judgment and cannot be delegated.
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 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.
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 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.