Chapter 54: Care of Patients with Esophageal Problems
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1.A client has been
... [Show More] taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective?
a. “I can only take this medicine at night.”
b. “I should take this on a full stomach.”
c. “This drug decreases stomach acid.”
d. “This should be taken 1 hour before meals.”
ANS: B
Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid.
DIF:Evaluating/SynthesisREF:1113
KEY:Gastrointestinal disorders| antacids| patient education
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
2.A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling uri- nary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first?
a. Document the findings in the chart.
b. Notify the surgeon immediately.
c. Reassess the drainage in 1 hour.
d. Take a full set of vital signs.
ANS: D
The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indi- cates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Docu- mentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess.
DIF:Applying/ApplicationREF:1116
KEY: Gastrointestinal disorders| postoperative nursing| nursing assessment
MSC:Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
3.A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preop- erative teaching?
a. “After the operation I can eat anything I want.”
b. “I will have to eat smaller, more frequent meals.”
c. “I will take stool softeners for several weeks.”
d. “This surgery may not totally control my symptoms.”
ANS: A
Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure.
The other statements show good understanding.
DIF:Evaluating/SynthesisREF:1117
KEY:Gastrointestinal disorders| patient education
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
4.A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met?
a. Choosing foods that are easy to swallow
b. Lungs clear after meals and snacks
c. Properly performing swallowing exercises
d. Weight unchanged after 2 weeks
ANS: B
All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallow- ing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met.
DIF:Evaluating/SynthesisREF:118
KEY:Gastrointestinal disorders| respiratory assessment| patient safety
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
5.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
ANS: B
Esophageal dilation can provide immediate relief of esophageal strictures that impair swallowing. Enteral tube feeding is a method of providing nutrition when dysphagia is severe, but esophageal dilation would be at- tempted before this measure is taken. Nissen fundoplication is performed for severe gastroesophageal reflux disease. Photodynamic therapy is performed for esophageal cancer.
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