Ch 41. Esophageal Disorders

The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching? "I should not bend over after eating." "I should sleep with the head of the bed elevated." "I should lie down for two to three hours after eating." "I should avoid eating within three hours of bedtime."

"I should lie down for two to three hours after eating." After eating, the patient should wait for three hours to lie down. This will help maintain gravity, which in turn prevents the development of acid reflux. The patient should not bend over after eating. The patient should not eat food within three hours of bedtime. The head of the bed should be elevated during sleep

Where does Zenker's diverticulum occur? At the wall of the esophagus Near the esophageal midpoint At the lower portion of the esophagus Above the upper esophageal sphincter

Above the upper esophageal sphincter Diverticula are the saclike outpouchings of one or more layers of the esophagus. Zenker's diverticulum occurs above the upper esophageal sphincter. Esophageal cancers occur at the wall of the esophagus. Traction diverticulum occurs near the esophageal midpoint. Esophageal varices occur at the lower portion of the esophagus.

A patient diagnosed with Eosinophilic esophagitis (EE) may require a referral to which kind of specialist because of the underlying pathology and etiology of the condition? Allergist Cardiologist Pulmonologist Rheumatologist

Allergist People with EE frequently have a personal or family history of other allergic diseases. The most common food triggers are milk, egg, wheat, rye, and beef. Environmental allergens, such as pollens, molds, cat, dog, and dust mite allergens, may be involved in the development of EE. Consults with a pulmonologist, cardiologist, and rheumatologist would not address the body system affected by this disorder, the immune system.

Which medication is beneficial to a patient reporting coughing, dyspnea, and radiating pain to the back, neck, and jaw? Nifedipine Prednisone Isosorbide dinitrate Aluminum hydroxide

Aluminum hydroxide Respiratory symptoms such as coughing and dyspnea accompanied with radiating pain to the back, neck, and jaw indicate gastroesophageal reflux disease (GERD). GERD-related chest pain is similar to angina. Antacids such as aluminum hydroxide are used in the treatment of GERD-related chest pain. Nifedipine and isosorbide dinitrate are used in the treatment of achalasia. Prednisone is used in the treatment of eosinophilic esophagitis.

Which factors increase intraabdominal pressure and lead to the development of a hiatal hernia? Select all that apply. Ascites Obesity Pregnancy Fatty foods Peppermint

Ascites Obesity Pregnancy Factors increasing intraabdominal pressure include ascites, obesity, and pregnancy. They may lead to the development of a hiatal hernia. Fatty foods and peppermint are factors that decrease lower esophageal sphincter pressure.

The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this is a disorder that can be aggravated by which of the following? Select all that apply. Caffeine Chocolate Dietary fiber Orange juice Cigarette smoking High-protein foods

Caffeine Chocolate Orange juice Cigarette smoking GERD results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux. Decreased LES pressure can be caused by certain foods (e.g., caffeine, chocolate, orange juice, and peppermint) and drugs (e.g., anticholinergics). Cigarette and cigar smoking also can contribute to GERD. GERD is not exacerbated by intake of dietary fiber or a high-protein diet.

Which medication has a side effect of milk-alkali syndrome? Misoprostol Metoclopramide Calcium carbonate Aluminum hydroxide

Calcium carbonate Calcium carbonate is an antacid used to treat gastroesophageal reflux disease (GERD). Ingestion of calcium carbonate may result in milk-alkali syndrome. Misoprostol causes abdominal pain, diarrhea, and gastrointestinal bleeding. Central nervous system side effects such as anxiety, hallucinations, and tremors are caused by metoclopramide. Aluminum hydroxide causes constipation.

Which otolaryngologic symptoms occur in gastroesophageal reflux disease (GERD)? Select all that apply. Choking Dyspnea Wheezing Hoarseness Sore throat

Choking Hoarseness Sore throat Otolaryngologic symptoms in GERD include choking, hoarseness, and sore throat. Wheezing and dyspnea are the respiratory symptoms that occur in GERD.

Which esophageal disorder does the nurse expect in a patient who has ingested a strong acid and is admitted to the emergency unit? Achalasia Esophageal varices Esophageal stricture Eosinophilic esophagitis (EE)

Esophageal stricture Esophageal stricture is the narrowing or tightening of the esophagus. It can occur due to ingestion of strong acids or alkalis, surgical anastomosis, and external beam radiation. Achalasia is a chronic disorder in which there is an absence of peristalsis of the lower two-thirds of the esophagus. Esophageal varices are dilated, tortuous veins in the lower part of the esophagus. EE is inflammation of the esophagus due to infiltration of eosinophils.

While caring for a patient with esophageal cancer, the nurse finds regurgitation of blood-flecked esophageal contents. What does the nurse expect to be the reason behind the patient's condition? Severe esophageal stenosis Tumor in the upper third of the esophagus Obstruction of the esophagus at the diaphragm Cancer eroding through the esophagus and into the aorta

Severe esophageal stenosis When there is severe narrowing of the esophagus, or stenosis, regurgitation of blood-flecked esophageal contents occurs. A tumor in the upper third of the esophagus causes sore throat, choking, and hoarseness. Achalasia occurs due to obstruction of the esophagus at the diaphragm. Cancer eroding through the esophagus and into the aorta leads to hemorrhage.

The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required? "So I don't have to follow a specific diet?" "Chewing gum may help relieve my symptoms." "I can have warm milk at bedtime, just not chocolate milk." "Instead of eating three large meals a day, I should eat small frequent meals throughout the day."

"I can have warm milk at bedtime, just not chocolate milk." Patients with GERD should be instructed to avoid milk, especially at bedtime, because it increases gastric acid secretion. There is not a specific diet for GERD, but rather the recommendation to avoid particular foods. Small frequent meals are recommended to prevent gastric distention. Chewing gum increases salivation and helps reduce a mild presentation of symptoms.

Which medication is responsible for causing flatulence in a patient on medication therapy for gastroesophageal reflux disease (GERD)? Sucralfate Famotidine Misoprostol Dexlansoprazole

Dexlansoprazole Proton pump inhibitors such as dexlansoprazole are used to treat GERD and are associated with flatulence as a side effect. Sucralfate is an antiulcer agent that is associated with constipation. Famotidine is a histamine (H 2) receptor blocker that causes headaches, constipation, abdominal pain, and diarrhea as side effects. Abdominal pain, diarrhea, uterine rupture in pregnancy, and gastrointestinal bleeding are side effects associated with misoprostol.

Which complication occurs when cancer erodes through the esophagus and into the aorta? Choking Hoarseness Hemorrhage Blood-flecked regurgitation

Hemorrhage Hemorrhage occurs when esophageal cancer erodes through the esophagus and into the aorta. Choking and hoarseness occur when the tumor is in the upper third of the esophagus. Blood-flecked regurgitation occurs with severe esophageal stenosis.

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply. The patient chews gum daily. The patient eats ginger daily. The patient eats oranges daily. The patient eats ice cream often. The patient drinks 2 L of water daily. The patient drinks a cup of milk at bedtime.

The patient eats oranges daily. The patient eats ice cream often. The patient drinks a cup of milk at bedtime. Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease ( GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities.

Which findings indicate that a patient with gastroesophageal reflux disease has aspirated gastric contents into the respiratory system? Select all that apply. Cough Asthma Pneumonia Bronchospasm Chronic bronchitis

Asthma Pneumonia Chronic bronchitis Asthma, pneumonia, and chronic bronchitis may develop as a result of aspiration into the respiratory system. Cough and bronchospasm cause irritation of the upper airway by gastric secretions.

Which diagnostic study is used to stage esophageal cancer? Radionuclide tests Manometric studies Esophagram (barium swallow) Endoscopic ultrasonography (EUS)

Endoscopic ultrasonography (EUS) EUS is used to stage esophageal cancer. Radionuclide tests help detect reflux of gastric contents. Manometric studies help measure pressure in the esophagus, lower esophageal sphincter, and esophageal motility function. Esophagram (barium swallow) shows the narrowing of the esophagus at the tumor site.

Which condition is indicated by endoscopic findings of saclike pouches on the esophagus? Esophageal varices Esophageal stricture Esophageal diverticula Eosinophilic esophagitis

Esophageal diverticula Esophageal diverticula are saclike outpouchings formed on one or more layers of the esophagus. Esophageal varices are dilated and tortuous veins observed in the lower portion of the esophagus due to portal hypertension. Narrowing of the esophagus is called esophageal stricture. Eosinophilic esophagitis is characterized by swelling of the esophagus.

Which treatment will the nurse expect will provide short-term relief to an elderly patient who has difficulty swallowing food and has chest pain immediately after meals? Heller myotomy Endoscopic pneumatic dilation Endoscopic stapling diverticulotomy Injection of botulinum toxin endoscopically

Injection of botulinum toxin endoscopically Achalasia is a chronic disorder in which peristalsis of the lower two-thirds of the esophagus is absent. The pressure on the lower esophageal sphincter (LES) is increased, which causes difficulty swallowing and chest pain after meals. Injection of botulinum toxin endoscopically into the LES is beneficial in elderly patients with achalasia. It causes relaxation of smooth muscles and provides short-term relief to the patient. A Heller myotomy is a surgical procedure and is inappropriate for elderly patients. In endoscopic pneumatic dilation, the LES muscle is disrupted from within using balloons of progressively larger diameter, which is contraindicated in elderly patients. Endoscopic stapling diverticulotomy is a treatment for esophageal diverticula, not achalasia.

Which medication used to treat nausea and vomiting may cause dyskinesia? Nizatidine Sucralfate Omeprazole Metoclopramide

Metoclopramide Metoclopramide is a prokinetic medication that causes extrapyramidal side effects such as tremor and dyskinesia. Nizatidine is a histamine (H 2) receptor blocker that causes abdominal pain, diarrhea, constipation, and headache as side effects. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes headache, nausea, vomiting, abdominal pain, and flatulence.

The nurse is preparing a care plan for a patient who underwent an open high abdominal incision. Which necessary interventions should the nurse include in the care plan? Select all that apply. Monitoring pulse rate Monitoring bowel sounds Monitoring blood glucose Monitoring respiratory rate Monitoring serum creatinine

Monitoring pulse rate Monitoring respiratory rate After an open high abdominal incision, respiratory complications can occur. Therefore the nurse should monitor pulse rate and respiratory rate. Bowel sounds and blood glucose level are not altered after an open high abdominal incision. Serum creatinine levels are altered in kidney and liver diseases but not after an open high abdominal incision.

A patient has had esophageal surgery, and a jejunostomy feeding tube is inserted to administer oral fluids. The nurse has been told to check for signs of intolerance and leakage of feeding into the mediastinum. Which signs should the nurse be observant for? Select all that apply. Pain Dyspnea Acid reflux Tachycardia Increased temperature

Pain Dyspnea Increased temperature With tube feedings, the patient should be observed for signs of intolerance of feeding or leakage of the feeding into the mediastinum. Symptoms that indicate leakage are pain, dyspnea, and increased temperature. Feeding is done through the tube in an upright position; therefore, the chance of acid reflux is unlikely. Tachycardia doesn't occur immediately as a sign of leakage into the mediastinum.

While providing fluids to a postgastrectomy patient, which symptoms support the nurse's suspicion that there is leakage from a jejunostomy feeding tube? Select all that apply. Pain Fever Cough Regurgitation Difficulty breathing

Pain Fever Difficulty breathing When there is a leakage from the feeding tube, the patient experiences pain, high temperature, and dyspnea (difficulty breathing). Therefore these symptoms support the nurse's suspicion. Cough and regurgitation are manifestations of esophageal cancer.

The primary health care provider orders endoscopic nutrition via a nasogastric tube for a postsurgical patient whose nutrition is disrupted. Which interventions should the nurse perform for this patient? Select all that apply. Irrigating the tube Providing oral care Providing nasal care Assessing the drainage Repositioning the tube

Providing oral care Providing nasal care Assessing the drainage While providing care for a postsurgical patient with a nasogastric tube, the nurse should provide oral and nasal care to the patient. The nursing responsibilities also include assessing the drainage from the nasogastric tube. Irrigating and repositioning the tube should be performed only after consulting the primary health care provider.

Which diagnostic test detects reflux of gastric contents? Biopsy Endoscopy Radionuclide test Manometric studies

Radionuclide test A radionuclide test detects reflux of gastric contents. A biopsy helps differentiate stomach or esophageal cancer from Barrett's esophagus. An endoscopy helps assess the lower esophageal competence, degree of inflammation, scarring, and potential strictures. Manometric studies help measure esophageal pressure and lower esophageal sphincter and esophageal motility function.

The nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching? Select all that apply. "You may drink soda." "You should avoid caffeine." "You should avoid chocolate." "You should suck peppermint." "You should drink orange juice."

"You should avoid caffeine." "You should avoid chocolate." Caffeine and chocolate are reflux-inducing foods that irritate the esophagus or weaken the lower esophageal sphincter, causing backward flow of stomach contents. Therefore caffeine and chocolate should be avoided in patients with a hiatal hernia. Soda is acidic and should be avoided in patients with a hiatal hernia. Peppermint is a reflux-inducing food and should be avoided. Acidic pH beverages such as orange juice should also be avoided by patients with a hiatal hernia.

Which statement made by the nurse to an achalasia patient about how to manage symptoms needs correction? "You should eat slowly." "You should only eat soft food." "You should drink fluids with meals." "You should sleep with your head elevated."

"You should only eat soft food." Achalasia is a condition in which peristalsis of the lower two-thirds of the esophagus is absent. Patients with achalasia can also eat semisoft foods. The patient should eat food slowly. The patient should drink fluids with meals and should keep the head elevated while sleeping.

Which medication increases lower esophageal sphincter pressure? Diazepam Bethanechol Theophylline Morphine sulfate

Bethanechol Bethanechol increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure.

Which complication does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has been taking dexlansoprazole for one year? Syncope Dyskinesia Renal calculi Bone fracture

Bone fracture Dexlansoprazole is a proton pump inhibitor (PPI). PPIs inhibit the proton pump responsible for the secretion of hydrochloric acid, which is an important mediator of calcium absorption. Long-term use of this medication will increase the risk of a bone fracture. Syncope is the temporary loss of consciousness leading to fainting. It occurs as a side effect of cholinergic drugs. Dyskinesia is a side effect of prokinetic medications. Renal calculi are a side effect of antacids.

A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter does the nurse monitor to provide effective care? Bowel sounds Motor movements Serum calcium levels Serum magnesium levels

Bowel sounds Cimetidine is a histamine receptor used in the treatment of peptic ulcer and GERD. Cimetidine decreases gastric motility and causes constipation. Therefore the nurse monitors the patient for any changes in bowel sounds. This may help with early detection of constipation. Cimetidine does not have extrapyramidal side effects and does not cause motor incoordination. Cimetidine does not alter serum calcium or magnesium levels.

Which intervention should the nurse perform when finding that a postgastrectomy patient has greenish yellow discharge eight hours after insertion of a nasogastric tube? Remove the nasogastric tube. Document it as a normal finding. Notify the primary health care provider. Place the patient in a semi-Fowler's position.

Document it as a normal finding. Discharge of bloody, greenish to yellow drainage from the nasogastric tube for 8 to 12 hours after insertion is a common observation. Therefore the nurse should document it as a normal finding. The nurse should not remove the nasogastric tube without consulting the primary health care provider. Notifying the primary health care provider is not necessary because discharge of bloody drainage is a normal finding. Placing the patient in a semi-Fowler's position will help prevent the risk of aspiration; however, it will not reduce the drainage from the nasogastric tube.

Which condition does the nurse suspect in a patient who reports pain and discomfort in the upper abdomen? Pyrosis Halitosis Dyspepsia Water brash

Dyspepsia Dyspepsia is discomfort or pain in the upper abdomen. Pyrosis or heartburn is a burning, tight sensation that is felt intermittently beneath the lower sternum and spreads toward the throat or jaw. Halitosis is foul-smelling breath in patient with achalasia. Water brash or hypersalivation is the regurgitation of an excessive accumulation of saliva from the lower part of the esophagus.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? Barium swallow Endoscopic biopsy Capsule endoscopy Endoscopic ultrasonography

Endoscopic biopsy Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. Capsule endoscopy can show alterations in the esophagus, but more often is used for small intestine problems. An endoscopic ultrasonography may be used to stage esophageal cancer. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

Which procedure involves the disruption of the lower esophageal sphincter using balloons? Heller myotomy Esophagectomy Esophagoenterostomy Endoscopic pneumatic dilation

Endoscopic pneumatic dilation Endoscopic pneumatic dilation is the procedure in which the lower esophageal sphincter is disrupted using balloons of increasing diameter. A Heller myotomy is a surgical procedure in which the lower esophageal sphincter is disrupted laparoscopically. Esophagectomy is the removal of part or the entire esophagus. Esophagoenterostomy is the resection of a portion of the esophagus and anastomosis of a segment of the colon to the remaining portion.

The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for which symptoms? Jaundice, ascites, and edema Heartburn, regurgitation, and dysphagia Abdominal cramps, diarrhea, and anorexia Pelvic pain, fever, and board-like abdominal rigidity

Heartburn, regurgitation, and dysphagia The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and board-like abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis.

Which treatment strategy does the nurse expect to be beneficial for an elderly patient with a hiatal hernia who has a cardiovascular complication? Antireflux surgery Laparoscopic surgery Calcium channel blocker therapy Nonsteroidal antiinflammatory drugs (NSAIDs)

Laparoscopic surgery Laparoscopic surgery is minimally invasive and when performed in elderly patients reduces the risk of complications and time for recovery and is beneficial. Antireflux surgery is a surgical intervention and is not recommended in elderly patients with cardiovascular and pulmonary complications. Calcium channel blocker therapy decreases lower esophageal pressure in elderly patients. Nonsteroidal antiinflammatory drugs (NSAIDs) may irritate the esophageal mucosa, which may aggravate the symptoms more.

Which respiratory complication occurs due to irritation of the upper airway by gastric secretions? Asthma Pneumonia Laryngospasm Chronic bronchitis

Laryngospasm Laryngospasm occurs due to irritation of the upper airway by gastric secretions. Asthma, pneumonia, and chronic bronchitis are respiratory complications that occur due to aspiration.

After reviewing the medical reports of a patient with portal hypertension, the nurse concludes that the patient has esophageal varices. Which other finding supports the nurse's conclusion? Kyphosis Liver cirrhosis Throat lacerations Squamous cell cancer

Liver cirrhosis Esophageal varices are the dilated, tortuous veins that occur in the lower portion of the esophagus. They occur as a result of portal hypertension. Esophageal varices are common complications of liver cirrhosis. Therefore liver cirrhosis is a finding that supports the nurse's conclusion. Kyphosis is associated with a hiatal hernia. Throat lacerations may cause esophageal strictures, and squamous cell carcinoma is associated with achalasia.

Which antacid does the nurse expect the primary health care provider to prescribe to a patient who reports mild, intermittent chest pain after meals? Sodium citrate Calcium carbonate Aluminum carbonate Magnesium trisilicate

Magnesium trisilicate Magnesium trisilicate helps relieve heartburn after meals by creating a foam barrier on the stomach acid. It is prescribed for mild and intermittent chest pain after meals. Sodium citrate, calcium carbonate, and aluminum carbonate are also antacids used in the treatment of gastroesophageal reflux disease causing heartburn; however, they are not used for mild and intermittent heartburn.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? Turn, deep breathe, cough, and use spirometer every four hours Maintain an upright position for at least two hours after eating Nasogastric (NG) tube will have bloody drainage and it should not be repositioned Keep in a supine position to prevent movement of the anastomosis

Nasogastric (NG) tube will have bloody drainage and it should not be repositioned The patient will have bloody drainage from the NG tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the health care provider. Turning and deep breathing will be done every two hours, and the spirometer will be used more often than every four hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine position, to prevent reflux and aspiration of secretions.

Which medication does the nurse expect to be beneficial to the patient who reports difficulty swallowing and is diagnosed with achalasia? Cisplatin Nifedipine Prednisone Porfimer sodium

Nifedipine Difficulty in swallowing is known as dysphagia. It is the most common symptom of achalasia. Calcium channel blockers such as nifedipine, when administered sublingually 30 to 45 minutes before meals, may help reduce dysphagia in patients with achalasia. Cisplatin is an antineoplastic agent used in the treatment of esophageal cancer. Prednisone is used in the treatment of eosinophilic esophagitis. Porfimer sodium is a photosensitizer that is injected intravenously during photodynamic therapy of esophageal cancer.

Which medications decrease lower esophageal sphincter pressure in elderly patients with a hiatal hernia and gastroesophageal reflux disease (GERD)? Select all that apply. Aspirin Nifedipine Potassium Imipramine Isosorbide dinitrate

Nifedipine Imipramine Isosorbide dinitrate Calcium channel blockers (nifedipine), antidepressants (imipramine), and nitrates (isosorbide dinitrate) are the medications commonly prescribed for elderly patients with a hiatal hernia and GERD. These medications result in decreased lower esophageal sphincter pressure. Nonsteroidal antiinflammatory drugs (aspirin) and potassium irritate the esophageal mucosa.

The nurse finds that a patient with weight loss reports nausea, vomiting, difficulty swallowing, and a burning sensation in the chest. The biopsy and endoscopy reports reveal infiltration of eosinophils. Which medication does the nurse expect to be beneficial to the patient? Sucralfate Prednisone Misoprostol Methotrexate

Prednisone A burning sensation in the chest, nausea, vomiting, weight loss, and difficulty swallowing indicate eosinophilic esophagitis (EE). Corticosteroids such as prednisone are used to treat EE. Sucralfate and misoprostol are used in the treatment of gastroesophageal reflux disease (GERD). Methotrexate is used in the treatment of esophageal cancer.

The nurse is assessing a patient who has suspected esophageal cancer. Which of these is the most common symptom of esophageal cancer? Weight loss Regurgitation Progressive dysphagia Epigastric pain during swallowing.

Progressive dysphagia Progressive dysphagia is the most common symptom of esophageal cancer and may be described as a substernal feeling, as if food were not passing. Initially, the dysphagia occurs only with meat, then with soft foods, and eventually with liquids. Weight loss, regurgitation, and epigastric pain during swallowing are also symptoms of esophageal cancer, but they occur later and are not the most common symptoms.

The nurse finds that a patient taking a prescribed medication for gastroesophageal reflux disease (GERD) had a miscarriage. Which medication does the nurse expect to be responsible for the miscarriage? Cholinergics Prostaglandins Antiulcer agents Histamine (H 2) receptor blockers

Prostaglandins Prostaglandins are a class of medications that cause uterine rupture in pregnancy. Uterine rupture in pregnancy leads to miscarriage. Therefore the nurse suspects prostaglandins to be the cause of miscarriage. Cholinergics cause syncope, diarrhea, stomach cramps, and dizziness. Antiulcer agents such as sucralfate cause constipation. Headache, abdominal pain, constipation, and diarrhea are the side effects of histamine (H 2) receptor blockers.

A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth." What does the nurse document in the patient's medical record? Dysphagia Regurgitation Hypersalivation Hyperchlorhydria

Regurgitation Regurgitation is described as a hot, bitter, or sour liquid coming into the throat or mouth. Dysphagia is difficulty swallowing food. Hypersalivation or water brash is the regurgitation of an excessive accumulation of saliva from the lower part of the esophagus. Hyperchlorhydria is the excessive secretion of acid in the stomach. p. 901

Why does a primary health care provider place stents endoscopically while preparing a patient with esophageal cancer for surgery? To prevent regurgitation To improve nutrition status To improve gastric emptying To prevent respiratory complications

To improve nutrition status Endoscopic stents are placed to improve nutrition and hydration. Placing the patient in an upright position will help prevent regurgitation and improve gastric emptying. Using an incentive spirometer will help prevent respiratory complications.