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The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply.
- A. Encourage the client to eat frequent, small, well-balanced meals.
- B. Inform the client to remain upright for at least 2 hours after meals.
- C. Encourage the client to eat later in the day before bedtime rather than early in the morning.
- D. Instruct the client to avoid alcohol or tobacco products.
- E. Instruct the client to eat slowly and chew the food thoroughly.
Correct Answer: A,B,D,E
Rationale: The nurse should encourage the client to eat frequent, small, well-balanced meals, inform the client to remain upright for at least 2 hours after meals, instruct the client to avoid alcohol or tobacco products, and instruct the client to eat slowly and chew the food thoroughly when teaching the client how to reduce reflux. The nurse should discourage the client from eating before bedtime.
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The nurse is managing the care of a client needing gastrointestinal suction and decompression with a Levin tube. Place the steps of initiating suction and decompression in the order the nurse should perform them.
- A. Insert the gastric decompression tube.
- B. Locate the suction source.
- C. Connect the decompression tube to the suction.
- D. Select suction according to health care provider prescription.
Correct Answer: B,D,A,C
Rationale: The nurse should locate the suction source, usually a wall outlet or portable machine. The nurse should then adjust the suction level on the wall outlet or portable machine to provide the amount and frequency of suction specified by the primary provider. The nurse should select intermittent high, low, or continuous suction when using a Salem sump tube; the nurse should select low intermittent suction when using a Levin tube because the single lumen may adhere to the lining of the stomach during continuous suction (if the tube is used only to obtain specimens for diagnostic purposes, manual suction may be achieved by attaching a syringe to the end of the tube and drawing back on the plunger). Finally, the nurse should insert the gastric decompression tube in accordance with accepted standards and connect it to the suction.
The nurse is holding a teaching workshop on managing the symptoms of hiatal hernia in older adults. Which lifestyle modification should be included in the presentation?
- A. Eliminating tobacco use
- B. Aerobic exercising
- C. Avoiding excess stress
- D. Providing adequate rest
Correct Answer: A
Rationale: Approximately 60% of people older than 70 years of age will develop hiatal hernias. Because tobacco use reduces esophageal sphincter tone, which can result in reflux, tobacco should be avoided. Aerobic exercising, managing stress, and providing adequate rest are good for general health not specific to the management of hiatal hernias.
An older adult client seeks medical attention for a report of general difficulty swallowing. Which assessment finding is most significant as related to this symptom?
- A. Hiatal hernia
- B. Gastroesophageal reflux disease
- C. Gastritis
- D. Esophageal tumor
Correct Answer: D
Rationale: The finding of an esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but are less likely to be as significant as esophageal tumor/cancer.
The nurse has placed a feeding tube for a client with a gastroesophageal disorder. What recommendation(s) should the nurse follow to confirm proper placement of the tube? Select all that apply.
- A. Observe for respiratory distress.
- B. Measure pH of feeding tube aspirates.
- C. Auscultate.
- D. Monitor aspirate for sudden change in amount.
- E. Mark the tube at the exit site.
- F. Obtain radiographic confirmation.
Correct Answer: A,B,D,E,F
Rationale: The nurse should observe for respiratory distress, measure the pH of feeding tube aspirates, monitor the aspirate for a sudden change in the amount, and mark the tube at the exit site after radiographic confirmation and then use the marker to ensure that the correct location is maintained during use. Auscultation should not be used to determine location, because this is not a valid way to confirm tube placement.
A client who has occasional gastric symptoms is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching?
- A. I will eat two large meals a day, instead of three.
- B. I will eliminate bothersome foods from my diet.
- C. I will plan to sleep flat without pillows.
- D. I will start taking a nap after meals, when possible.
Correct Answer: B
Rationale: Irritating foods such as spices, caffeine, and alcohol should be avoided because doing so will assist in decreasing gastric acidity. Eating smaller meals is recommended to avoid lower pressure in the lower esophageal sphincter. Gastric reflux of acid is more likely to occur with positioning flat and lying down after a meal, so this should be avoided.