GERD

A patient is diagnosed with gastroesophageal reflux disease (GERD). Which patient behavior should the nurse identify that would make the GERD symptoms worse? Use of mint to alleviate heartburn Use of proton-pump inhibitors Limited health insurance plan Elevating the head of the bed at night

Use of mint to alleviate heartburn

The nurse notes that a patient with gastroesophageal reflux disease (GERD) is prescribed famotidine, an H2-blocker. Which additional prescribed medication should the nurse identify as a contraindication to famotidine? Lisinopril Warfarin Heparin Paroxetine

Warfarin Rationale: Famotidine should not be taken with oral anticoagulants because of adverse drug reactions or toxicity. The other medications are not contraindicated for this medication.

A patient with gastroesophageal reflux disease (GERD) reports drinking 3 cups of coffee in the morning and 1-2 sodas later in the day. Which question should the nurse ask the patient based on this finding? "Do you experience heartburn throughout the day?" "Do you drink any water at all throughout the day?" "Have you been taking your proton pump inhibitors?" "In which position do you sleep at night?"

"Do you experience heartburn throughout the day?" Rationale: Due to the patient's high consumption of caffeinated beverages, the nurse should ask about subsequent symptoms that may be occurring. Proton pump inhibitors are used to treat GERD; however, the nurse needs to determine symptoms related to caffeine consumption. The nurse would inquire about all fluid intake to determine hydration. Which position the patient sleeps in will help in determining symptoms at night.

The nurse reviews the medical records of patients with a history of gastroesophageal reflux disease (GERD) scheduled to be seen during the GI clinic hours. Which patient should the nurse identify to benefit the most from ablation therapy? A patient with GERD unresponsive to medication A patient who has lost weight and has stopped smoking A patient with a new diagnosis of GERD A patient who has an increased risk of esophageal cancer

A patient who has an increased risk of esophageal cancer Rationale: Ablation therapy is used to treat the area in the esophagus that has been irritated and where cells have changed due constant reflux. This decreases the risk of esophageal cancer. A patient who has made positive lifestyle changes such as weight loss and smoking cessation would not benefit from this procedure. Fundoplication surgeries are performed in patients unresponsive to lifestyle changes and medications. A patient with a new diagnosis of GERD will try noninvasive treatment regimens such as lifestyle changes and medications first.

An older patient with gastroesophageal reflux disease (GERD) asks about long-term effects from taking pantoprazole, a proton pump inhibitor. Which statement should the nurse respond to this patient? "Most people only take this medication for 1 to 2 weeks until symptoms subside." "Long-term use can lead to hip fractures." "Let me ask your healthcare provider." "Dietary and lifestyle changes would be better than taking this medication."

"Long-term use can lead to hip fractures." Rationale: Long-term use of proton pump inhibitors (PPIs) can cause complications such as hip fractures, chronic kidney disease, and dementia. The nurse can explain medication adverse effects with the patient. It is important to make lifestyle and dietary changes, but this is not related to the use of PPIs. Patients are usually prescribed an 8-week course of treatment, not 1 or 2 weeks.

The nurse is teaching a patient the use of antacids to treat gastroesophageal reflux disease (GERD). Which instruction should the nurse include? "Avoid long-term use as it can cause gynecomastia." "Do not crush tablets prior to taking antacids." "Take antacids 1 to 2 hours before or after medications." "Notify the healthcare provider of extrapyramidal effects."

"Take antacids 1 to 2 hours before or after medications." Rationale: When teaching the patient on the use of antacids, the nurse should mention that medication should be taken 1 to 2 hours before or after other medications as this will interfere with absorption. Proton pump inhibitors should be swallowed whole and not crushed. Long-term use of H2-blockers can cause gynecomastia. Metoclopramide, which stimulates gastrointestinal motility, can cause extrapyramidal effects.

The nurse suspects that an infant is experiencing gastroesophageal reflux disease (GERD). Which symptom did the infant's mother most likely share with the nurse? Watery stools Arching back Swollen extremities Frequent drooling

Arching back Rationale: The clinical manifestations of GERD for the pediatric population are different from clinical manifestations of GERD in the adult population. An infant or child may exhibit poor eating, arching of the back, recurrent vomiting, irritability, and respiratory symptoms. Watery stools, edema in the extremities, and frequent drooling do not support the diagnosis of GERD.

The nurse is assessing a patient with a history of gastroesophageal reflux disease (GERD). Which assessment finding should the nurse identify that requires immediate intervention? Use of over-the-counter antacids Epigastric tenderness Atypical chest pain Dyspepsia

Atypical chest pain Rationale: Atypical chest pain requires immediate intervention as it can be cardiac-related. Dyspepsia and epigastric pain are normal findings related to gastroesophageal reflux disease (GERD). This does not require immediate intervention. Use of over-the-counter antacids indicates excessive gastric acid production but does not require immediate intervention.

10. A patient with gastroesophageal reflux disease (GERD) asks when the procedure that involves instilling saline and an acid into the esophagus to observe for symptoms will be done. Which diagnostic procedure should the nurse schedule for this patient? Bernstein test Upper endoscopy Barium swallow 24-hour ambulatory pH monitoring

Bernstein test Rationale: Based upon the description, this patient is having a Bernstein test. This diagnostic test establishes the diagnosis of GERD by instilling saline and then acid into the esophagus. The patient with GERD will have symptoms of heartburn and reflux when the acid is instilled; the patient without GERD will have no reaction. The description of the procedure does not indicate a barium swallow, upper endoscopy, or 24-hour ambulatory pH monitoring.

A patient with gastroesophageal reflux disease (GERD) reports heartburn and reflux after eating. Which instruction should the nurse provide? Adding coffee with each meal Encouraging to select foods that are high in fat Administering antacids prior to eating meals Consuming smaller meals with in between meal snacks

Consuming smaller meals with in between meal snacks Rationale: The nurse should instruct the patient with GERD who reports heartburn and reflux after meals is to consume smaller meals with in between meal snacks. This decreases gastric distention and reflux. Antacids decrease acid production after the problem of reflux is occurring. It does not prevent the problem. The nurse would encourage meals that restrict fat intake. Coffee should be avoided for patients with GERD.

A patient taking prescribed medication and following dietary changes for gastroesophageal reflux disease (GERD) continues to experience severe symptoms. Which plan of treatment should the nurse expect the healthcare provider to consider next? Stress management techniques Gastric bypass surgery Fundoplication Proton pump inhibitors

Fundoplication Rationale: Surgery may be necessary for patients who do not respond to pharmacologic and lifestyle interventions. Laparoscopic fundoplication is the treatment of choice for GERD. Proton pump inhibitors would not be prescribed since medication has not been effective. Gastric bypass surgery is for weight loss, not GERD. The patient has already used lifestyle modifications for treatment without success. Therefore, stress management techniques would not be the best treatment option.

The nurse reviews medications prescribed for a patient with gastroesophageal reflux disease (GERD) and a history of osteoporosis. Which prescribed medication should the nurse question? Metoclopramide Ranitidine Aluminum hydroxide Lansoprazole

Lansoprazole

The nurse suspects that a patient with gastroesophageal reflux disease (GERD) is experiencing severe regurgitation. Which finding caused the nurse to make this clinical determination? Extrapyramidal effects Gynecomastia Mouth sores Black, tarry stools

Mouth sores

The nurse is reviewing information received during hand-off communication. Which risk factor should the nurse identify in assigned patients that increases the risk of experiencing gastroesophageal reflux disease (GERD)? Pregnancy Pancreatitis Heart disease Asthma

Pregnancy Rationale: Pregnancy is a known risk factor for developing GERD. Heart disease, asthma, and pancreatitis are not risk factors for developing GERD.

Nissen fundoplication.

The fundus of the stomach is wrapped around the lower esophagus and the edges are sutured together.

The nurse is caring for a patient with a new diagnosis of gastroesophageal reflux disease (GERD). Which pathophysiological change should the nurse identify as the cause of this disease? Weakened lower esophageal sphincter pressure Thickening of the muscle between the stomach and intestines Decreased gastric acid secretion Herniation of the stomach through the diaphragm

Weakened lower esophageal sphincter pressure

An older patient seeks medical attention for a new onset of symptoms. For which atypical symptom should the nurse suspect that this patient is experiencing gastroesophageal reflux disease (GERD)? Regurgitation Barrett esophagus Heartburn Wheezing

Wheezing Rationale: Atypical symptoms of gastroesophageal reflux disease (GERD) happen in the older adult due to decreased gastric acid production. This can lead to atypical respiratory symptoms such as wheezing. Normal symptoms of GERD include heartburn and regurgitation. Barrett esophagus develops from constant reflux changing cells in the esophagus.

Common GERD diagnostic tests include:

• Bernstein test • Upper endoscopy • Barium swallow • Esophageal manometry • 24-hour ambulatory pH monitoring.

Surgical treatments of GERD are used when medications and lifestyle changes are unsuccessful and include:

• Laparoscopic or Nissen fundoplication • Surgery to tighten the tighten the lower esophageal sphincter • Ablation therapy.

Health history questions related to gastroesophageal reflux disease (GERD) include:

• When does the pain occur? • What is the pain like? • What makes the pain worse? • What makes the pain better? • Are you experiencing any regurgitation? • Are you experiencing any difficulty swallowing? • Are you experiencing any atypical chest pain?

Interventions to control gastroesophageal reflux disease (GERD) in the older adult include:

• cautious use of proton pump inhibitors and H2-receptor blockers • dietary modifications • low fat • no caffeine • no chocolate • avoiding highly spiced foods • lifestyle changes • sleeping with the head of the bed elevated • not eating before lying down.

Complications of long-term use of PPIs include:

• hip fractures • osteoporosis • chronic kidney disease • dementia.

Antacid patient education includes:

• learning that overuse can cause electrolyte imbalances • taking antacids 1 to 2 hours before or after other medications • avoiding calcium and magnesium-based medications with pre-existing renal disease.

Risk factors for the development of GERD include:

• obesity • smoking • excessive alcohol consumption • pregnancy • hiatal hernia

Patient education for H2-receptor blockers includes:

• once a day dosage to be taken at bedtime • refraining from taking antacids 1 hour before and after administration • avoiding cigarette smoking, alcohol, aspirin, and NSAIDs • learning that long-term use can lead to gynecomastia • reporting diarrhea, confusion, rash, fatigue, malaise, or bruising.