Deck 57: Care of Patients With Esophageal Problems

Question 1

Which statement indicates that the client understands the management of his or her sliding hiatal hernia?

A) "I will lie flat for 30 minutes after each meal."
B) "I will remain upright for several hours after each meal."
C) "I will have my blood count done in 2 weeks to check for anemia."
D) "I will sleep at night while lying on my left side to prevent reflux."

Answer 1

"I will remain upright for several hours after each meal."

Question 2

A client is admitted to the cardiac monitoring unit for a suspected myocardial infarction.The client reports long-standing nighttime reflux,and the health care provider orders nizatidine (Axid)150 mg twice a day.Which action by the nurse is most appropriate?

A) Consult with the health care provider because the dose is too high.
B) Check the client's kidney function tests before administering the drug.
C) Ask the pharmacist to recommend another histamine receptor agonist.
D) Give the medication as ordered and monitor for effectiveness.

Answer 2

Ask the pharmacist to recommend another histamine receptor agonist.

Question 3

The health care provider is prescribing medication to treat a client's severe gastroesophageal reflux disease (GERD).Which medication does the nurse anticipate teaching the client about?

A) Magnesium hydroxide (Gaviscon)
B) Ranitidine (Zantac)
C) Nizatidine (Axid)
D) Omeprazole (Prilosec)

Answer 3

Omeprazole (Prilosec)

Question 4

A client is admitted with progressive dysphagia.What intervention by the nurse takes priority?

A) Weigh the client daily.
B) Instruct the client on a high-protein diet.
C) Assess and treat the client's pain.
D) Administer antitussive medications.

Question 5

A client is undergoing diagnostic testing for gastroesophageal reflux disease (GERD).Which test does the nurse tell the client is best for diagnosing this condition?

A) Endoscopy
B) Schilling test
C) 24-Hour ambulatory pH monitoring
D) Stool testing for occult blood

Question 6

A client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care unit with a nasogastric tube draining dark brown fluid.Which is the nurse's priority action?

A) Assess the placement of the tube.
B) Document the finding and continue to monitor.
C) Clamp the nasogastric tube for 30 minutes.
D) Irrigate the nasogastric tube with normal saline.

Question 7

A client just experienced an episode of reflux with regurgitation.What assessment by the nurse is the priority?

A) Auscultate the lungs for crackles.
B) Inspect the oral cavity.
C) Check the oxygen saturation.
D) Teach the client to sleep sitting up.

Question 8

A client has Barrett's esophagus.Which client assessment by the nurse requires consultation with the health care provider?

A) Sleeping with the head of the bed elevated
B) Coughing when eating or drinking
C) Wanting to eat several small meals during the day
D) Chewing antacid tablets frequently during the day

Question 9

The nurse is teaching a client about self-management of gastroesophageal reflux.Which statement by the nurse is most appropriate?

A) "Eat four to six small meals each day."
B) "Eat a small evening snack 1 to 2 hours before bed."
C) "No specific foods or spices need to be cut from your diet."
D) "You may include orange or tomato juice with your breakfast."

Question 10

The nurse is in the room of a client who is sleeping in bed.The client experiences an episode of reflux with regurgitation.Which action does the nurse take first?

A) Have the client roll to the side.
B) Raise the head of the client's bed.
C) Auscultate the client's lung sounds.
D) Call the Rapid Response Team.

Question 11

A client who has undergone an open fundoplication hernia repair is preparing for discharge.Which information is most important for the nurse to include in discharge instructions?

A) "You can take laxatives for constipation."
B) "Eat three normal-sized meals daily."
C) "Notify your health care provider if you get a cough."
D) "You can go back to work in about a week."

Question 12

A client had an open fundoplication 2 days ago.Which assessment by the nurse indicates that an important National Patient Safety Goal is being met for this client?

A) The client uses the spirometer during the shift.
B) The client's pain is monitored and treated.
C) The client has vital signs taken routinely.
D) The client verbalizes understanding of the discharge teaching.

Question 13

An obese client has reflux and asks how being overweight could cause this condition.Which response by the nurse is best?

A) "You eat more food, more often, than nonobese people do."
B) "The weight adds extra pressure, which helps push stomach contents up."
C) "Obese people tend to eat more high-fat food, which presents a risk."
D) "Obesity is not related to reflux, but losing weight would be healthy."

Question 14

Which symptom indicates a need for immediate intervention in a client with a rolling hernia?

A) Reflux
B) Crackles in the lungs
C) Distended and firm abdomen
D) Two episodes of diarrhea

Question 15

Which client does the nurse assess most carefully for the development of gastroesophageal reflux disease?

A) Client with atrial fibrillation who drinks decaffeinated coffee
B) Client who has lost 20 pounds through diet and exercise
C) Diabetic client taking oral hypoglycemic agents
D) Postoperative client who has a nasogastric (NG) tube

Question 16

What is the pH range of the distal esophagus?

A) 1.5 to 2.0
B) 3.0 to 4.5
C) 4.5 to 6.0
D) 6.0 to 7.0

Question 17

A client with severe gastroesophageal reflux disease (GERD)is still having symptoms of reflux despite taking omeprazole,(Prilosec)20 mg daily.What does the nurse do next?

A) Document the finding in the client's chart.
B) Obtain an order for omeprazole twice daily.
C) Instruct the client to double the daily dose.
D) Tell the client to take antacids with omeprazole.

Question 18

A client has returned to the nursing unit after a sliding hernia repair.Which action by the nurse is most important in preventing complications?

A) Range of motion to the lower extremities
B) Elevating the head of the bed to 30 degrees
C) Monitoring input and output
D) Assessing for bowel sounds

Question 19

A client with esophageal reflux who experiences regurgitation while lying flat is at risk for which complication?

A) Erosion
B) Bleeding
C) Aspiration
D) Odynophagia

Question 20

A client who has undergone Nissen fundoplication for gastroesophageal reflux disease (GERD)is ready for discharge home.Which statement made by the client indicates understanding of the disease?

A) "I will no longer need any medication for my GERD."
B) "I will avoid spicy foods because they can irritate the suture line."
C) "I should take anti-reflux medications when I eat a large meal."
D) "I will need to continue to watch my diet and may still need medication."

Question 21

A client with esophageal cancer is receiving radiation therapy.Which finding alerts the nurse to a possible complication in this client?

A) Redness of the skin at the site of radiation
B) Worsening of dysphagia or odynophagia
C) Development of nausea or vomiting
D) A profound feeling of tiredness

Question 22

A client has esophageal cancer.Which intervention by the nurse takes priority?

A) Maintaining nutritional intake
B) Allowing grieving
C) Preventing aspiration
D) Managing pain relief

Question 23

A client has been diagnosed with early esophageal cancer.The nurse plans care by implementing measures designed to address which priority concern?

A) Nutritional support
B) Pulmonary toileting
C) Fluid and electrolyte balance
D) Educational needs

Question 24

The nurse is obtaining the history of a client with a sliding hernia.Which symptoms does the nurse expect to see in this client?

A) Reflux
B) Bleeding
C) Dysphagia
D) Belching
E) Breathlessness
F) Vomiting

Question 25

Which referrals does the nurse make for an older adult client who is being discharged with esophageal cancer?

A) IV infusionist
B) Home health aide
C) Medicare or Medicaid
D) Meals on Wheels
E) Housecleaning service
F) Transportation to and from treatment

Question 26

A client 2 hours post-esophageal dilation develops increasing pain in the throat.Which is the best action of the nurse?

A) Administer an analgesic.
B) Document the finding.
C) Reposition the client.
D) Assess the client for perforation.

Question 27

A client with esophageal cancer and dysphagia states that it has become more difficult to swallow,and the client has experienced several choking episodes during meals.Which strategy would the nurse recommend to assist this client in obtaining adequate nutrition?

A) Monitor caloric intake and weigh the client daily.
B) Instruct the client to drink only clear liquids.
C) Tell the client that artificial feeding will now be required.
D) Encourage the client to eat semisoft foods and thickened liquids.

Question 28

A client has undergone an esophagogastrostomy for cancer of the esophagus.How will the nurse best support the client's respiratory status?

A) Assessing the client's breath sounds every 4 hours
B) Performing chest physiotherapy every 6 hours
C) Maintaining the client in a supine position
D) Administering analgesia regularly

Question 29

An older client is 1 day post-esophagectomy.The nurse finds the client short of breath with a heart rate of 120 beats/min.Which action by the nurse takes priority?

A) Assess the client's lungs and oxygen saturation.
B) Ask the client to rate pain, and treat if needed.
C) Help the client change to a side-lying position.
D) Increase the client's supplemental oxygen.

Question 30

The nurse notes frank red blood in the drainage container from the nasogastric (NG)tube of a client who is 2 days post-esophagogastrostomy.Which is the nurse's priority intervention?

A) Irrigate the NG tube with cold saline.
B) Document the drainage in the chart.
C) Reposition the tube in the opposite nostril.
D) Assess the client's vital signs and abdomen.

Question 31

The nurse is performing an assessment of a client with suspected esophageal cancer.Which statement made by the client does the nurse correlate with advanced disease?

A) "I have difficulty swallowing solids."
B) "I usually have a sticking feeling in my throat."
C) "I have difficulty swallowing soft foods."
D) "I have difficulty swallowing liquids."

Question 32

What does the nurse teach the client with esophageal diverticula about dietary needs?

A) "Eat soft foods and smaller meals."
B) "Only eat puréed foods."
C) "Avoid drinking liquids with meals."
D) "Avoid dairy products."

Question 33

A client is admitted with a chemical injury to the esophagus after ingestion of an alkaline substance.The client states,"I am having trouble breathing because of these air bubbles in my neck." Which action by the nurse is most appropriate?

A) Continue assessing the client while another nurse calls the health care provider.
B) Ask the client to rate the pain and prepare to administer pain medication.
C) Have the client cough and deep breathe, then assess his or her lung sounds.
D) Give the client small sips of water to see whether he or she has dysphagia.

Question 34

Which factor places a client at risk for esophageal cancer?

A) High-stress occupation
B) Preference for high-fat foods
C) 20-pack-year smoking history
D) History of myocardial infarction

Question 35

Which interventions can the nurse delegate to unlicensed personnel when caring for a client with esophageal cancer?

A) Maintaining intake and output
B) Maintaining calorie count
C) Administering tube feeding
D) Obtaining vital signs
E) Teaching changes in daily activities
F) Changing the incision dressing