GERD Practice Questions (Test #2, Fall 2020)

The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

1 1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one's behavior. 2. The client should be encouraged to quit smoking altogether. Referral to support groups for smoking cessation should be made. 3. The nurse should be careful when recommending OTC medications. This is not the most appropriate intervention for a client with GERD. 4. The client should be instructed to discontinue using alcohol, but the stem does not indicate the client is an alcoholic. TEST-TAKING HINT: Clients are encouraged to quit, not decrease, smoking. Current research indicates smoking is damaging to many body systems, including the gastrointestinal system. The test taker should not assume anything not in the stem of a question.

The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1."I'll avoid lying down after a meal." 2."I can still enjoy my potato chips and cola at bedtime." 3."I wish I didn't have to give up swimming." 4."If I wear a girdle, I'll have more support for my stomach.

1 A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided. Excessive vigorous exercise also should be avoided, especially after meals, but there is no reason why the client must give up swimming. Wearing tight, constrictive clothing such as a girdle can increase intra-abdominal pressure and thus lead to reflux of gastric juices.

Which of the following dietary measures would be useful in preventing esophageal reflux? 1.Eating small, frequent meals. 2.Increasing fluid intake. 3.Avoiding air swallowing with meals. 4.Adding a bedtime snack to the dietary plan.

1 Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client decreases the intake of which of the following foods? 1.Fats. 2.High-sodium foods. 3.Carbohydrates. 4.High-calcium foods.

1 Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1.Heartburn. 2.Jaundice. 3.Anorexia. 4.Stomatitis.

1 Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, which results from a high concentration of bilirubin in the blood, is not associated with hiatal hernia. Anorexia is not a typical symptom of hiatal hernia. Stomatitis is inflammation of the mouth.

The physician prescribes metoclopramide hydrochloride for the client with hiatal hernia. This drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1.Increase tone of the esophageal sphincter. 2.Neutralize gastric secretions. 3.Delay gastric emptying. 4.Reduce secretion of digestive juices.

1 Metoclopramide hydrochloride increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux and esophagitis and to decrease or neutralize gastric secretions. Reglan is not effective in decreasing or neutralizing gastric secretions

The nurse is discharging a client 2 days postoperative hiatal hernia repair. Which discharge instructions should the nurse include? Select all that apply. 1. "Take all of the prescribed antibiotic." 2. "Eat six small meals per day." 3. "Use the legs to bend down, not the back." 4. "Take esomeprazole twice a day." 5. "Use the pain medication when the pain is at 8-10."

1,2,3 1. Prophylactic antibiotics are frequently prescribed both presurgery and postsurgery. The client should be instructed to take all the medication as directed. 2. Hiatal hernia repair may not last and the client should continue the recommended lifestyle modifi cations, such as eating small meals. 3. Part of the lifestyle modifi cations for hiatal hernia is to limit pressure on the abdominal cavity, especially after a meal. Using the leg muscles to bend down, rather than bending over, should be taught to the client. 4. Esomeprazole (Nexium) is administered daily, not twice a day. 5. For best relief, pain medication should be taken at the onset of the pain. The client should not wait until the pain is an 8

The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1.Take a laxative. 2.Follow a clear liquid diet. 3.Administer an enema. 4.Take an antiemetic

1. The client should take a laxative after an upper gastrointestinal series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction. A clear liquid diet would have no effect on stimulating removal of the barium. The client should not have nausea and an antiemetic would not be necessary; additionally, the antiemetic will decrease peristalsis and increase the likelihood of eliminating the barium. An enema would be ineffective because the barium is too high in the gastrointestinal tract.

Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer

1. A hiatal hernia places the client at risk for GERD; GERD does not predispose the client for developing a hiatal hernia. 2. Gastroenteritis is an inflammation of the stomach and intestine, usually caused by a virus. 3. Barrett's esophagus results from longterm erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer. 4. The problems associated with GERD result from the reflux of acidic stomach contents into the esophagus, which is not a precursor to gastric cancer. TEST-TAKING HINT: The test taker may associate hiatal hernia with GERD. One can be a result of the other, and this can confuse the test taker. If the test taker did not have any idea of the correct answer, option "3" has the word "esophageal" in it, as does the stem of the question, and, therefore, the test taker should select this as the correct answer

Which statement is the scientific rationale for administering a proton-pump inhibitor (PPI) to a client diagnosed with GERD? 1. PPI medications neutralize the gastric secretions. 2. PPI medications block H2 receptors on the parietal cells. 3. PPI medications inhibit the enzyme that generates gastric acid. 4. PPI medications form a protective barrier against acid and pepsin.

1. Antacids, not PPIs, neutralize gastric secretions. 2. H2 blockers block receptors on the parietal cells. 3. PPIs inhibit the enzyme that generates gastric acid. 4. Mucosal barrier agents form a p

Which side effects should the nurse explain to the male client who is prescribed cimetidine? 1. The medication can cause indigestion and heartburn. 2. The medication can cause impotence and gynecomastia. 3. The medication can cause insomnia and hypervigilance. 4. The medication can cause Zollinger-Ellison syndrome

1. Cimetidine (Tagamet), an H2 blocker, is used to treat indigestion and heartburn (pyrosis). 2. Cimetidine (Tagamet) is an H2 blocker. Over time, Tagamet can cause males to become impotent, have decreased libido, and have breast development (gynecomastia). 3. Tagamet can cause lethargy and somnolence, not insomnia and hypervigilance. 4. Tagamet is used to treat Zollinger-Ellison syndrome, a syndrome characterized by hypersecretion of gastric acid and the formation of peptic ulcers

The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"

1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss but not weight gain. 2. Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance but are not important for "heartburn." 4. Heartburn is not a symptom of a viral illness. TEST-TAKING HINT: Clients will use common terms such as "heartburn" to describe symptoms. The nurse must be able to interpret or clarify the meaning of terms used with the client. Part of the assessment of a symptom requires determining what aggravates and alleviates the symptom.

Which statement is an advantage to administering a histamine2 (H2) blocker rather than an antacid to a client diagnosed with GERD? 1. Antacids are more potent than H2 blockers in relieving the symptoms of GERD. 2. H2 blockers have more side effects than antacids. 3. H2 blockers are less expensive than antacids. 4. H2 blockers require less frequent dosing than antacids

1. H2 blockers actually block the production of gastric acid and have a longer effect than an antacid 2. An increase in side effects would not be an advantage. 3. Antacids are usually less expensive than H2 blockers. 4. H2 blockers require less frequent administration than do antacids, which require frequent administration, seven or more times a day, for therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen

The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000/mm3 . 4. The client's hemoglobin is 13.8 g/dL.

1. In a Bernstein test, acid is instilled into the distal esophagus, causing immediate heartburn for a client diagnosed with GERD. This would not warrant notifying the HCP. 2. Hiatal hernias are frequently the cause of GERD; therefore, this finding would not warrant notifying the HCP. 3. The client's WBC count is elevated, indicating a possible infection, which warrants notifying the HCP. 4. This is a normal hemoglobin result and would not warrant notifying the HCP. TEST-TAKING HINT: When the test taker is deciding when to notify a health-care provider, the answer should be data not normal for the disease process or signaling a potential or life-threatening complication

The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying

1. Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD). 2. Pancreatitis is not related to GERD. 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. 4. GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter. TEST-TAKING HINT: Some questions are knowledge based. There are no test-taking strategies for knowledge-based questions.

The adult client recently has been diagnosed with asthma. Which medication is recommended to treat this problem? 1. Omeprazole daily. 2. Amoxicillin twice daily. 3. Loratadine daily. 4. Prednisone daily

1. Omeprazole (Prilosec) is a PPI. Up to 90% of adult-onset asthma is the result of GERD. Treating the gastric refl ux will treat the asthma. 2. Amoxicillin (Amoxil) is a penicillinderived antibiotic. The client is diagnosed with asthma, not an infection. There is no reason to administer an antibiotic. 3. Loratadine (Claritin) is an antihistamine. Antihistamines such as Claritin are used to treat allergic reactions to pollens, dust, or other irritating substances. They are not effective against asthma 4. Prednisone is a glucocorticoid. Glucocorticoids are prescribed daily for clients with chronic lung diseases, such as emphysema or chronic bronchitis. A client with asthma would not be prescribed a daily steroid.

Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. "My spouse tells me I snore very loudly at night." 4. "I drink six (6) to seven (7) soft drinks every day."

1. Pain in the chest when walking up stairs indicates angina. 2. Frequent use of antacids indicates an acid reflux problem 3. Snoring loudly could indicate sleep apnea but not GERD. 4. Carbonated beverages increase stomach pressure. Six (6) to seven (7) soft drinks a day would not be tolerated by a client with GERD. TEST-TAKING HINT: The stem of the question indicates an acid problem. The drug classification of antacid, or "against acid," provides the test taker a hint as to the correct answer.

The nurse on a medical unit has received the morning report. Which medication should the nurse administer first? 1. Pantoprazole to a client on call to surgery. 2. Calcium carbonate to a client reporting indigestion. 3. Bismuth to a client diagnosed with an ulcer. 4. Famotidine to a client diagnosed with gastroesophageal reflux disease (GERD).

1. Pantoprazole (Protonix) is a PPI. A medication for a client on call to surgery is a priority; the client's surgery could be delayed if the medication has not been administered when the call to surgery comes. 2. Calcium carbonate (Tums) is an antacid. This would be the second medication to administer, as this client has a report of discomfort. 3. Bismuth (Pepto Bismol) is an antimicrobial. This medication is a routine medication and could be administered at any time. 4. Famotidine (Pepcid) is an H2 blocker. This medication is a routine medication and could be administered at any time.

The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.

1. Proton pump inhibitors can be administered at routine dosing times, usually 0900 or after breakfast. 2. Pain medication is important, but a nonnarcotic medication, such as Tylenol, can be administered after a medication, which must be timed. 3. A histamine receptor antagonist can be administered at routine dosing times. 4. A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach. TEST-TAKING HINT: Basic knowledge of how medications work is required to administer medications for peak effectiveness. There are very few medications requiring a specific time.

The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.

1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD. 2. Gastroesophageal reflux disease does not cause weight loss. 3. There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. 4. Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease. TEST-TAKING HINT: Frequently, incorrect answer options will contain the symptoms of a disease of the same organ system.

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. "I should not eat for at least one (1) day following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid orange juice and eating tomatoes until my esophagus heals."

1. The client is allowed to eat as soon as the gag reflex has returned. 2. An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for two (2) to three (3) hours after eating. 3. Stomach contents are acidic and will erode the esophageal lining. 4. Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal. TEST- TAKING HINT: This question assumes the test taker has knowledge of diagnostic procedures for specific disease processes.

The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day

1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach. 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux. TEST-TAKING HINT: The word "any" in option "1" should give the test taker a clue that, unless there are absolutely no dietary restrictions, this is an incorrect answer. Option "2" requires knowledge of medical terminology.

The client reporting "acid" when lying down at night asks the nurse if there is any medication that might help. Which statement is the nurse's best response? 1. "There are no medications to treat this problem, but losing weight will sometimes help the symptoms." 2. "There are several over-the-counter and prescription medications available to treat this. You should discuss this with your health-care provider." 3. "Have you had any x-rays or other tests to determine if you have cancer or some other serious illness?" 4. "Acid reflux at night can lead to serious complications. You need to have tests done to determine the cause."

1. There are several classifi cations of medications used to treat acid refl ux problems. Sometimes losing weight will help relieve symptoms, but the client did not ask about lifestyle modifi cations. 2. PPIs, H2 blockers, and antacids all treat the symptoms of acid reflux. The nurse should encourage the client to discuss which medication is best with the HCP. 3. The symptoms do not indicate cancer. The nurse should not scare the client. 4. Acid refl ux can lead to complications, including adult-onset asthma, that should be treated, but most HCPs will empirically treat the symptoms of acid refl ux before ordering tests to determine the cause or possible complications.

The nurse is discharging a client diagnosed with GERD. Which information should the nurse include in the teaching? 1. "There are no complications of GERD as long as you take the medications." 2. "Notify the HCP if the medication does not resolve the symptoms." 3. "Immediately after a meal, lie down for at least 45 minutes." 4. "If any discomfort is noted, take an NSAID for the pain."

1. There may be several complications of GERD. Adult-onset asthma and Barrett's esophagus leading to cancer of the esophagus are two complications of GERD. The chance of developing these problems is less if the GERD is adequately treated, but there are no guarantees. 2. The client should always be informed of what symptoms to report to the HCP. 3. The client should be instructed to sit upright for at least 60 minutes following a meal to prevent reflux from occurring. 4. NSAIDs can increase gastric distress. Ulcers caused by NSAID use may be asymptomatic, or the symptoms may be attributed to the GERD. The client should use the prescribed H2 receptor blocker, PPI, or an antacid to relieve the discomfort associated with GERD.

The home health-care nurse is caring for a male client diagnosed with a hiatal hernia and reflux. Which data indicates the medication therapy is effective? 1. The client takes the antacid 1 hour before and 3 hours after a meal. 2. The client reports indigestion after eating a large meal. 3. The client states that he did not wake up with heartburn during the night. 4. The client has lost 3 pounds in the past 2 weeks

1. This indicates client compliance with the dosing regimen for antacids, not that the medication is effective. 2. The return of symptoms indicates the medication is not effective. 3. This indicates an improvement in symptoms and that the medication is effective. 4. Losing weight would not indicate that a medication for hiatal hernia is effective

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1.Having a sedentary desk job. 2.Being 5 feet, 3 inches tall (160 cm) and weighing 190 lb (86.2 kg). 3.Using laxatives frequently. 4.Being 40 years old

2 Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1.Number and length of breaks. 2.Body mechanics used in lifting. 3.Temperature in the work area. 4.Cleaning solvents used.

2 Bending, especially after eating, can cause gastroesophageal reflux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications. Number and length of breaks, temperature in the work area, and cleaning solvents used are not directly related to treatment of hiatal hernia.

Bethanechol has been prescribed for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? 1.Constipation. 2.Urinary urgency. 3.Hypertension. 4.Dry oral mucosa.

2 Bethanechol, a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation. To avoid these adverse effects, the client should be closely monitored to establish the minimum effective dose

The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be most accurate? 1."Surgery is usually required, although medical treatment is attempted first." 2."Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3."Surgery is not performed for this type of hernia." 4."A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned.

2 Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery to correct a hiatal hernia, which commonly produces complications, is performed only when medical therapy fails to control the symptoms.

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1.Daily aerobic exercise. 2.Eliminating smoking and alcohol use. 3.Balancing activity and rest. 4.Avoiding high-stress situations.

2 Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia. Daily aerobic exercise, balancing activity and rest, and avoiding high-stress situations may increase the client's general health and well-being, but they are not directly associated with hiatal hernia.

The nurse is preparing to administer esomeprazole. Which intervention should the nurse implement? Select all that apply. 1. Order an infusion pump for the client. 2. Elevate the client's head of the bed. 3. Check the client's ID with the medication administration record (MAR). 4. Check for allergies to cephalosporin. 5. Ask the client his or her date of birth.

2,3,5 1. Esomeprazole (Nexium), a PPI, is an oral medication. An IV pump is not needed. 2. The head of the bed is elevated for the client to be able to swallow the medication. 3. The nurse must check the MAR with the client's ID band to ensure the correct client is receiving the medication. 4. Esomeprazole (Nexium) is a PPI, not a cephalosporin. The cephalosporins are a class of antibiotics. 5. The Joint Commission requires that two patient identifiers be used to determine the "right patient." Most health-care

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1.Limit caffeine intake to two cups of coffee per day. 2.Do not lie down for 2 hours after eating. 3.Follow a low-protein diet. 4.Take medications with milk to decrease irritation.

2. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux. Caffeinated beverages decrease pressure in the lower esophageal sphincter and milk increases gastric acid secretion, so these beverages should be avoided. The client is encouraged to follow a high-protein, low-fat diet, and avoid foods that are irritating.

The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today

3 1. Pyrosis is heartburn and is expected in a client diagnosed with GERD. The new graduate can care for this client. 2. Barrett's esophagus is a complication of GERD; new graduates can prepare a client for a diagnostic procedure. 3. This client is exhibiting symptoms of asthma, a complication of GERD. This client should be assigned to the most experienced nurse. 4. This client can be cared for by the new graduate, and ambulating can be delegated to the unlicensed assistive personnel (UAP). TEST-TAKING HINT: The most experienced nurse should be assigned to the client whose assessment and care require more experience and knowledge about the disease process, potential complications, and medications. The term "most experienced" in the stem is the key to answering this question.

A client is taking cimetidine (Tagamet) to treat a hiatal hernia. The nurse should evaluate the client to determine that the drug has been effective in preventing which of the following? 1.Esophageal reflux. 2.Dysphagia. 3.Esophagitis. 4.Ulcer formation.

3 Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux. Cimetidine is not used to prevent reflux, dysphagia, or ulcer development.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1.Introduce the client to other people who are successfully managing their care. 2.Include the client's daughter in the teaching so that she can help implement the plan. 3.Ask the client to identify other situations in which the client changed health care habits. 4.Provide reassurance that the client will be able to implement all aspects of the plan successfully

3 Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits. Meeting other people who are managing their care and involving family members can be helpful, but individual motivation is more important. Reassurance can be helpful but is less important than individualization of care

The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1.Anorexia. 2.Weight gain. 3.Diarrhea. 4.Constipation

3 The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain

A client who has been diagnosed with gastroesophageal reflux disease (GERD) has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1.Lean beef. 2.Air-popped popcorn. 3.Hot chocolate. 4.Raw vegetables.

3. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.

The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client.

4 1. The client is encouraged to lie with the head of the bed elevated, but this is difficult to achieve when on the stomach. NSAIDs inhibit prostaglandin synthesis in the stomach, which places the client at risk for developing gastric ulcers. The client is already experiencing gastric acid difficulty. 2. The client will need to lie down at some time, and walking will not help with GERD. 3. If lying on the side, the left side-lying position, not the right side, will allow less chance of reflux into the esophagus. Antacids are taken one (1) and three (3) hours after a meal. 4. The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux. TEST-TAKING HINT: Option "2" has an "all," which should alert the test taker to eliminate this option. If the test taker has no idea of the answer, lifestyle modifications are an educated guess for most chronic problems.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride? 1.Antacids. 2.Antihypertensives. 3.Anticoagulants. 4.Alcohol.

4 Metoclopramide hydrochloride can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.

The client with gastroesophageal reflux disease (GERD) has a chronic cough. This symptom may be indicative of which of the following ? 1.Development of laryngeal cancer. 2.Irritation of the esophagus. 3.Esophageal scar tissue formation. 4.Aspiration of gastric contents.

4. Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.