Esophageal Problems

Which statements will the nurse include when providing health teaching for a patient with hiatal hernia? SELECT ALL THAT APPLY. A.) "Elevate the head of your bed at least 6 inches for sleeping at night." B.) "Remain in the upright position for several hours after eating." C.) "Avoid stringing or excessive vigorous exercise." D.) "After surgery, you will have no dietary restriction." E.) "Avoid wearing clothing that is tight around the abdomen." F.) "Avoid eating in the late evening."

A.) "Elevate the head of your bed at least 6 inches for sleeping at night." B.) "Remain in the upright position for several hours after eating." C.) "Avoid stringing or excessive vigorous exercise." E.) "Avoid wearing clothing that is tight around the abdomen." F.) "Avoid eating in the late evening."

A patient who has been prescribed famotidine is being discharged home. Which statement by the patient indicated a need for further discharge teaching by the nurse? A.) "I will double up on the dose if I begin to feel increased heartburn." B.) "I will avoid all alcohol." C.) "I will call the health care provider if I continue to have heartburn." D.) "This drug is available over the counter."

A.) "I will double up on the dose if I begin to feel increased heartburn."

Then nurse is collaborating with the speech lunges pathologist to assist the patient with oral exercises to improve swallowing (swallowing therapy) and with the occupational therapist for feeding therapy. Which key points must be included when teaching this patient? SELECT ALL THAT APPLY. A.) Ask the patient to suck on a lollipop to enhance tongue strength. B.) Teach the patient to reach for food particles on the lips or chin using the tongue. C.) Instruct the patient to place food at this front of the mouth. D.) In preparation for stalling, remind the patient to position the head in forward flexion (chin tuck). E.) Monitor the patient for sealing of the lips and for tongue movements while eating. F.) Check for pocketing of food under the tongue after swallowing.

A.) Ask the patient to suck on a lollipop to enhance tongue strength. B.) Teach the patient to reach for food particles on the lips or chin using the tongue. D.) In preparation for stalling, remind the patient to position the head in forward flexion (chin tuck). E.) Monitor the patient for sealing of the lips and for tongue movements while eating.

The nurse is caring for ap taint with esophageal cancer who is scheduled to undergo an esophagogastrostomy with a section of the jejunum to replace the esophagus. Which procedure does the nurse expect to perform preoperatively? A.) Complete bowel preparation B.) Abdominal shave C.) Urinary catheter placement D.) Nasogastric tube placement for feeding

A.) Complete bowel preparation

The nurse is assessing a patient's nasogastric drainage following a conventional fundoplication procedure. how does the nurse expect the drainage to appear in the first 8 hours after surgery? A.) Dark brown B.) Bright red mixed with brown C.) Yellowish to green D.) Green to clear

A.) Dark brown

Uncontrolled gastroesophageal reflux disease (GERD) can be a cause of which adult-onset disorders? SELECT ALL THAT APPLY A.) Dental decay B.) Aspiration pneumonia C.) Laryngitis D.) Diverticulitis E.) Asthma F.) Cardiac disease

A.) Dental decay B.) Aspiration pneumonia C.) Laryngitis E.) Asthma F.) Cardiac disease

A patient with sever gastroesophageal reflux disease (GERD) tells he nurse that she has pain after each meal that last for 45 minutes and is worse when she lies down. What interventions should the nurse teach this patient? SELECT ALL THAT APPLY. A.) Drink fluids. B.) When you lie down, try lying on your side. C.) Take an antacid as prescribed by your health care provider. D.) Eat something bland such as a slice of white bread. E.) Maintain an upright position for at least 1 hour after you eat. F.) Try pressing over your abdomen to mobilize the food in your stomach.

A.) Drink fluids. C.) Take an antacid as prescribed by your health care provider. E.) Maintain an upright position for at least 1 hour after you eat.

The nurse is giving discharge instruction to a patient after a fundoplication procedure. The patient is instructed to AVOID which activities? SELECT ALL THAT APPLY. A.) Drinking carbonated beverages B.) Beginning clear liquids when peristalsis has returned C.) Drinking with a straw D.) Eating gas-producing foods E.) Eating soft foods that are easy to swallow F.) Chewing gum

A.) Drinking carbonated beverages C.) Drinking with a straw D.) Eating gas-producing foods F.) Chewing gum

Which are TWO MOST common manifestations of gastroesophageal reflux disease (GERD)? SELECT ALL THAT APPLY. A.) Dyspepsia B.) Eructation C.) Water brash D.) Regurgitation E.) Odynophagia F.) Flatulence

A.) Dyspepsia D.) Regurgitation

What manifestations are expected when a patient has esophageal diverticula? SELECT ALL THAT APPLY. A.) Halitosis B.) Dysphagia C.) Swelling with difficulty breathing D.) Nocturnal cough E.) Regurgitation F.) Pain radiation to the right arm

A.) Halitosis B.) Dysphagia D.) Nocturnal cough E.) Regurgitation

By which action do drugs used to treat gastroesophageal reflux disease (GERD) help to decrease the pain and discomfort the patient experiences? SELECT ALL THAT APPLY. A.) Inhibition of gastric acid production B.) Blocking of pain sensation in the CNS C.) Accelerating gastric emptying D.) Decreasing lower esophageal sphincter pressure E.) Protecting the gastric mucosa F.) Destroying H.pylori bacteria

A.) Inhibition of gastric acid production C.) Accelerating gastric emptying E.) Protecting the gastric mucosa

Which statement is true about Barrett's epithelium in the patient with gastroesophageal reflux disease (GERD)? A.) It is considered premalignant and is associated with higher risk for cancer. B.) This new tissue is less resistant to acid so it must be removed. C.) Barrett's epithelium is resistant to the development of cancer. D.) Esophageal strictures are less likely to occur with this type of epithelium.

A.) It is considered premalignant and is associated with higher risk for cancer.

Which statements about Barrett's esophagus are accurate? SELECT ALL THAT APPLY. A.) It is considered to be a premalignant condition. B.) It is associated with excessive intake of fresh fruits and vegetables. C.) It results from exposure to acid and pepsin. D.) It is associated with pickled and fermented foods. E.) Normal cells undergo dysplasia to become cancerous. F.) It is more common in younger adults.

A.) It is considered to be a premalignant condition. C.) It results from exposure to acid and pepsin. D.) It is associated with pickled and fermented foods. E.) Normal cells undergo dysplasia to become cancerous.

An older adult with gastroesophageal reflux disease (GERD) is prescribed omeprazole. What PRIORITY teaching point must the nurse instruct the patient about while taking this drug? A.) Older adults taking this drug may be at increased risk for hip fracture because it interferes with calcium absorption. B.) Because of this drug's effect of decreasing potassium, the patient may be prescribed a potassium supplement. C.) This drug causes sodium retention so the patient may be prescribed a sodium restriction. D.) A heart monitor may be needed because of changes in magnesium that can lead to life-threatening dysrhythmias.

A.) Older adults taking this drug may be at increased risk for hip fracture because it interferes with calcium absorption.

Which statements about gastroesophageal reflux disease (GERD) are correct? SELECT ALL THAT APPLY. A.) Overweight and obese patient are at an increased risk. B.) This and underweight patients are at an increased risk. C.) It is a common disorder in the Asian and Hispanic populations. D.) There is a high incidence in patient who eat mostly hot and spicy foods. E.) It is a common upper gastrointestinal disorder in the United States. F.) Eating large meals predisposes a patient to reflux.

A.) Overweight and obese patient are at an increased risk. E.) It is a common upper gastrointestinal disorder in the United States. F.) Eating large meals predisposes a patient to reflux.

What is the PRIMARY focus of care after conventional surgery for hiatal hernia? A.) Prevention of respiratory complications B.) Pain management C.) Management of fluid balance D.) Teaching the patient self-care activities

A.) Prevention of respiratory complications

Nonsurgical treatment options for cancer of the esophagus can include which therapies? SELECT ALL THAT APPLY. A.) Swallowing therapy B.) Chemoradiation C.) Targeted therapies D.) Smoking cessation programs E.) Photodynamic therapy F.) Endoscopic therapies

A.) Swallowing therapy B.) Chemoradiation C.) Targeted therapies E.) Photodynamic therapy F.) Endoscopic therapies

The patient esophageal cancer has na excess of HER2 protein on the cell surface. What therapy does the nurse expect will be ordered fro this patient? A.) Targeted therapy with IV trastuzumab B.) Chemoradiation with chemotherapy during the first and fifth weeks C.) Radiation therapy alone to shrink the tumor D.) Nutrition and swallowing therapy to prevent malnutrition

A.) Targeted therapy with IV trastuzumab

In the postoperative period, following an open fundoplication repair for a paraesophageal (rolling) hernia, the nurse notes that with oral feedings, he patient has continuous dysphagia. What is the nurse's BEST interpretation of this finding? A.) The fundoplication is too tight, and dilation may be required. B.) The patient is not ready for any nutrition other than clear liquids. C.) The health care provider will need to prescribe a stool softener. D.) The patient needs a nasogastric tube placed to decompress the stomach.

A.) The fundoplication is too tight, and dilation may be required.

The nurse has provided postoperative teaching for a patient who underwent a laparoscopic Nissen fundoplication. Which statement by the patient indicates a need for additional teaching? A.) "I will walk everyday." B.) "I will no longer need the anti-reflux drugs after the surgery." C.) "I will report a fever above 101 F degrees." D.) "I'll remove the gauze dressing 2 days after surgery and shower."

B.) "I will no longer need the anti-reflux drugs after the surgery."

A patient is scheduled to have several diagnostic tests to verify the medical diagnosis of gastroesophageal reflux disease (GERD). Which diagnostic test is the MOST accurate method of diagnosing this disorder? A.) Esophagogastroduodenoscopy (EGD) B.) Ambulatory pH monitoring examination C.) Esophageal manometry D.) Motility testing

B.) Ambulatory pH monitoring examination

Which lifestyle adjustment may a patient have to make to BEST control gastroesophageal reflux disease (GERD)? A.) Sleep in the Trendelenburg position. B.) Attain and maintain ideal body weight. C.) Wear snug-fitting belts and waistbands. D.) Engage in strenuous exercise such as weightlifting.

B.) Attain and maintain ideal body weight.

The nurse is caring for a postoperative patient after esophageal surgery. On assessment, the nurse discovers that the patient's temperature is 101 F degrees (38.3 C degrees), heart rate is 120/minute, and respiratory rate is 32/minute. Lung sounds include bilateral crackles. What is the nurse's PRIORITY FIRST action? A.) Raise the head of the patient's bed. B.) Call the Rapid Response Team. C.) Apply oxygen at 2 L per nasal cannula. D.) Administer IV normal saline at 75 mL/hour.

B.) Call the Rapid Response Team.

Which procedure would the health care provider recommend for immediate relief of dysphagia? A.) Photodynamic therapy B.) Esophageal dilation C.) Targeted therapy D.) Chemoradiation therapy

B.) Esophageal dilation

Which physiologic factor contributes to gastroesophageal reflux disease (GERD)? A.) Accelerated gastric emptying B.) Irritation from reflux of stomach contents C.) Competent lower esophageal sphincter D.) Increased esophageal clearance

B.) Irritation from reflux of stomach contents

The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about lifestyle changes. Which key points would the nurse include? SELECT ALL THAT APPLY. A.) Consume 4-6 large meals per day. B.) Limit or eliminate alcohol and tobacco. C.) Eat slowly and chew food thoroughly. D.) Elevate the head of your bed 3-5 inches using wooden blocks. E.) Do not wear restrictive clothing. F.) Reduce or eliminate spicy foods that cause increased gastric acid.

B.) Limit or eliminate alcohol and tobacco. C.) Eat slowly and chew food thoroughly. E.) Do not wear restrictive clothing. F.) Reduce or eliminate spicy foods that cause increased gastric acid.

A patient with gastroesophageal reflux disease (GERD) is on a medication that raises the pH of gastric contents. Which drug does the nurse expect to administer? A.) Ranitidine B.) Mylanta C.) Gaviscon D.) Omeprazole

B.) Mylanta

Which therapy may be used as a cure for patient who have SMALL LOCALIZED tumors? A.) Chemotherapy B.) Photodynamic therapy C.) Nutrition therapy D.) Radiation therapy

B.) Photodynamic therapy

Which instruction would the nurse be sure to give to the unlicensed assistive personnel (UAP) who will be assisting a patient with an esophageal tumor to eat? A.) Feed the patient as fast as you can because there are three more patient who will need help. B.) Position the patient in a high Fowler's position before feedings. C.) Always suction the patient between bites to avoid aspiration. D.) Remind the patient to cough and deep breathe between bites of food.

B.) Position the patient in a high Fowler's position before feedings.

The nurse is supervising a senior nursing student in the car of a patient after esophageal surgery. For which action by the student must the nurse intervene? A.) Student secures the NG tube to prevent dislodgment. B.) Student prepares to irrigate NG tube. C.) Student provides mouth care every 2-4 hours. D.) Student elevates the head of the patient's bed.

B.) Student prepares to irrigate NG tube.

A patient is undergoing a workup for carcinoma of the esophagus. What are the two PRIMARY risk factors associated with the development of this carcinoma? A.) High-fat, low-fiber diet and tobacco use B.) Tobacco use and obesity C.) Sedentary lifestyle and family history of squamous cell carcinoma D.) Heavy alcohol intake and high-fat, low-fiber diet

B.) Tobacco use and obesity

What is the MOST common symptom of esophageal cancer reported by patient's? A.) Productive cough B.) Reflux especially at night C.) Difficulty with swallowing D.) Shortness of breath

C.) Difficulty with swallowing

The DEFINITIVE diagnosis for esophageal cancer is made with which procedure? A.) Barium swallow B.) Esophageal manometry C.) Esophageal ultrasound with fine needle aspiration D.) Esophagogastroduodenscopy (EGD)

C.) Esophageal ultrasound with fine needle aspiration

The patient with gastroesophageal reflux disease painful swallowing. Which symptom does the nurse identify? A.) Dyspepsia B.) Regurgitation C.) Odynophagia D.) Dysphagia

C.) Odynophagia

Which group of drugs is the main treatment for sever gastroesophageal reflux disease (GERD)? A.) Antacids B.) Histamine receptor agonists C.) Proton pump inhibitors D.) Gaviscon preparations

C.) Proton pump inhibitors

After an esophagectomy, what is the nurse's PRIORITY for patent care? A.) Wound care B.) Nutrition care C.) Respiratory care D.) Hydration care

C.) Respiratory care

Which statement about esophageal trauma caused by chemical injury is accurate? A.) Alkaline substances tend to affect the superficial mucosal lining. B.) Acid burns cause deep penetrating injuries. C.) Strong alkalis can cause full perforation of the esophagus within 1 minute. D.) Chemical injuries damages the mouth and esophagus over a period of several hours.

C.) Strong alkalis can cause full perforation of the esophagus within 1 minute.

The nurse has provided teaching to a patient with gastroesophageal reflux disease (GERD). which statement by the patient indicated the teach has been effective? A.) "I will eat three meals a day." B.) "I will not snack 1 hour before I go to bed." C.) "I will stay up for at least 15-30 minutes after eating dinner before going to bed." D.) "I won't lift heavy objects."

D.) "I won't lift heavy objects."

A patient has returned to the unit after a Stretta procedure for gastroesophageal reflux disease (GERD). Which action by the student nurse requires the supervising nurse to intervene? A.) The patient is offered clear liquids in the early post procedure period. B.) The patient's routine 81 mg of aspirin is held. C.) A proton pump inhibitor is administered. D.) A nasogastric tube is prepared for insertion.

D.) A nasogastric tube is prepared for insertion.

What diagnostic test BEST identifies a hiatal hernia? A.) Esophagogastroduodenoscopy (EGD) B.) 24-hour ambulatory pH monitoring C.) Esophageal manometry D.) Barium swallow study with fluoroscopy

D.) Barium swallow study with fluoroscopy

Which statement is true about the drug rabeprazole for treatment of gastroesophageal reflux disease (GERD)? A.) It is rapidly released into the body after it is administered. B.) The tablets are large and may be crushed if the patient has difficulty swallowing them. C.) It is a histamine receptor antagonist. D.) If once-a-day dosing does not control symptoms, it may be taken twice a day.

D.) If once-a-day dosing does not control symptoms, it may be taken twice a day.

A patient is prescribed pantoprazole. What does the nurse tell the patient is the MAJOR action of this medication? A.) It produces a coating on the stomach lining. B.) It neutralizes gastric acid. C.) It heals esophageal irritation. D.) It inhibits gastric acid recreation.

D.) It inhibits gastric acid recreation.

The patient describes experiencing a dull and steady substernal pain, especially after drinking cold liquids. Which manifestation of esophageal cancer does the nurse recognize? A.) Angina B.) Aspiration C.) Dysphagia D.) Odynphagia

D.) Odynphagia

For which patient is radiation therapy CONTRAINDICATED? A.) Patient with lung cancer B.) Patient with esophageal tumor C.) Patient with sliding hernia D.) Patient with tracheosophageal fistula

D.) Patient with tracheosophageal fistula

The postoperative patient who had esophageal surgery has an NG tube in place. What intervention should the nurse delegate to the unlicensed assistive personnel (UAP)? A.) Check the NG tube for proper placement. B.) Teach the patient about the purpose of the NG tube. C.) Assess the patient's lungs for the presence of abnormal breath sounds. D.) Provide the patient with thorough mouth and nasal care every 2-4 hours.

D.) Provide the patient with thorough mouth and nasal care every 2-4 hours.