GERD HESI EAQ

Which dietary modifications will be important for a patient newly diagnosed with gastroesophageal reflux disease (GERD)? SATA a. Avoidance of chocolate b. Incorporation of citrus fruits in the diet c. Increased intake of protein-rich foods d. Avoidance of tomatoes and tomato-based foods e. Switching to a soft diet of pureed vegetables f. Avoidance of coffee and other caffeinated beverages

a. Avoidance of chocolate d. Avoidance of tomatoes and tomato-based foods f. Avoidance of coffee and other caffeinated beverages These foods contribute to decreased lower esophageal sphincter pressure, which occurs in GERD. The patient should avoid citrus fruits because of the amount of citric acid contained in them. Protein-rich foods should be maintained for a balanced diet but do not need to be increased. A soft diet is not a necessary dietary modification for GERD.

regurgitation

backward flowing, as in the return of solids or fluids to the mouth from the stomach

dysphagia

difficulty swallowing not associated with pain

globus

sensation of a lump in the throat

Which factor predisposes a patient to gastroesophageal reflux disease (GERD)? Belching Flatulence Water brash Large meals

Large Meals Eating large meals causes gastric distention, which can lead to GERD. Belching, flatulence, and water brash do not lead to gastric distention.

Odynophagia

pain with swallowing

Which condition is often associated with gastroesophageal reflux disease (GERD)? Weight loss Depression Hypothyroidism Obstructive sleep apnea (OSA)

Obstructive Sleep Apnea Many patients with OSA report frequent episodes of GERD. Obesity is a risk factor for GERD; weight loss is not associated with GERD. Depression is associated with gastric ulcers but not dyspepsia or heartburn. Hypothyroidism may cause headache and weight gain.

water brash

Regurgitation of watery acid or excessive saliva from the stomach; a symptom of GERD.

Which action is useful in preventing esophageal reflux? Taking medications with milk Eating a snack before bedtime Eating four to six small meals every day Increasing intake of fluids with each meal

Eating four to six small meals every day Eating four to six small meals per day as opposed to three large meals per day can help prevent esophageal reflux. Large meals increase the volume and pressure in the stomach, which can result in delayed gastric emptying and increased reflux. Fluid intake should be restricted during meals to reduce abdominal distension. Food intake in the evening such as a bedtime snack should be restricted to decrease nighttime reflux episodes. Milk increases gastric acid secretion, so it should be avoided to prevent reflux.

Which information would the nurse include in discharge instructions for a patient with a new diagnosis of gastroesophageal reflux disease (GERD) about ways to decrease acid production? Select all that apply. One, some, or all responses may be correct. Low-fat diet Smoking cessation Alcohol abstinence Flat sleeping position Three larger meals daily

Low-fat diet Smoking cessation Alcohol abstinence The nurse should instruct the patient to consume a low-fat diet, refrain from alcohol consumption, and stop smoking as these can make the symptoms of GERD worse. The patient would sleep with the head of the bed elevated, not flat, to prevent reflux. The patient would need to eat smaller, more frequent meals to decrease pressure and improve gastric emptying.

Which common complication is associated with gastroesophageal reflux disease (GERD) in the older adult? Select all that apply. One, some, or all responses may be correct. Sleep apnea Barrett esophagus Esophageal strictures Aspiration pneumonia Esophageal diverticula Esophageal perforation

Sleep apnea Barrett esophagus Esophageal strictures Aspiration pneumonia In older adults with GERD the incidence of heartburn decreases, and instead they develop more severe complications such as sleep apnea, Barrett esophagus, esophageal strictures, and aspiration pneumonia. Esophageal diverticula can occur because of herniation of the esophageal mucosa and submucosa into the surrounding tissue. Esophageal perforation may occur when excessive force is exerted on the esophageal mucosa.

What risk factors are associated with the development of gastroesophageal reflux disease (GERD)? SATA a. Ascites b. Obesity c. seizures d. Pregnancy e. Wearing tight girdles f. continuous severe vomiting

a. Ascites b. Obesity d. Pregnancy e. Wearing tight girdles These factors increase intra-abdominal and intragastric pressure, overcoming the gastroesophageal pressure gradient maintained by the lower esophageal sphincter. This allows the reflux to occur resulting in GERD. Seizures and continuous severe vomiting may result in esophageal perforation by exerting excessive force on the esophageal mucosa.

A patient presents with signs and symptoms of gastroesophageal reflux disease (GERD). Which common misdiagnosis would the nurse look for in the patient's recent health history? Asthma Crohn disease Sick sinus syndrome Uncontrolled hypertension

asthma Patients with GERD are often misdiagnosed with asthma because typical signs and symptoms of GERD are similar to those of asthma; therefore it is important to ask patients who have been newly diagnosed with GERD about any previous diagnosis. Crohn disease does not have symptoms similar to GERD and is not likely to be misdiagnosed. Sick sinus syndrome and uncontrolled hypertension do not have similar characteristics to GERD.

What symptoms are suggestive of a sliding hiatal hernia? SATA a.Belching b. Heartburn c. Difficulty in swallowing d. feeling of fullness after eating e. Backward flow of food into the throat f. worsening of symptoms when lying down

a.Belching b. Heartburn c. Difficulty in swallowing e. Backward flow of food into the throat a feeling of fullness after eating and worsening symptoms when lying down are observed with a paraesophageal hiatal hernia.

Which instruction would the nurse provide to a patient diagnosed with gastroesophageal reflux disease (GERD)? a. "Sleep only on your back." b. "Avoid eating 1 hour before going to sleep." c. "Elevate the head of your bed 6 to 12 inches." d. "Avoid using continuous positive airway pressure (CPAP)."

b. "Avoid eating 1 hour before going to sleep" It is important to elevate the head of the patient's bed 6 to 12 inches to prevent nighttime reflux. Patients should not sleep on their backs; it is better that they sleep on their sides to help with swallowing and oxygenation. Patients should not eat for 3 hours before sleep, not only 1 hour. CPAP treatments are indicated and encouraged for patients with sleep apnea and should not be avoided in patients with GERD.

The nurse is caring for a patient with gastroesophageal reflux disease (GERD) who presents with retrosternal burning. What term does the nurse use to document this symptom? a. Globus b. Pyrosis c. Halitosis d. Water brash

b. Pyrosis Retrosternal pain, one of the symptoms of GERD, is also referred to as pyrosis. Globus is a feeling of something getting stuck in the back of throat. Halitosis refers to foul breath, and water brash refers to hypersalivation. Globus and water brash are usually observed in GERD, whereas halitosis is seen with hiatal hernia.

halitosis

bad breath

eructation

belching

Which action made by a patient with GERD indicates an understanding of behaviors that need to be modified? a. consumes a snack before bed b. decreases alcohol consumption c. elevates the head of bed at night d. uses peppermint candy for reflux

c. Elevates the head of the bed at night Patients with GERD should sleep with the HOB elevated at night to decrease the amount of gastric acid that can reflux into the esophagus. This behavior indicates an understanding of changing behaviors. The patient should avoid snacking before bed as this can worsen reflux. The patient should avoid consuming alcohol, not just decrease intake. Peppermint actually makes the reflux worse and should be avoided.

A patient diagnosed with GERD reports a sensation of fluid in the throat that does not have the bitter taste previously experienced with reflux. What symptom is this patient experiencing? a. pyrosis b. dyspepsia c. water brash d. odynophagia

c. water brash Water brash is the sensation of fluid in the throat with no bitter or sour taste. Pyrosis is heartburn. Dyspepsia is indigestion. Odynophagia is painful swallowing.

Which information would the nurse teach a patient about home care after an open fundoplication? a. The need to belch frequently to eliminate air from the stomach b. How to correctly insert a nasogastric tube to minimize bloating c. The need to contact the health care provider at the first sign of a respiratory infection d. The importance of eating three well-balanced meals daily to facilitate healing

The need to contact the health care provider at the first sign of a respiratory infection Patients recovering from fundoplication must be taught ways to minimize strain on the surgical incision. Coughing can cause the incision to dehisce, so patients should report respiratory infection to the health care provider. Nasogastric tubes are used during hospitalization to decompress the stomach; reinsertion can perforate the fundoplication and should not be done unless necessary, and it should be performed by someone with expertise in the procedure. Patients should be taught to consume smaller, more frequent meals. Belching can strain the incision.

Which finding is likely in a patient who has gastroesophageal reflux disease (GERD)? Select all that apply. One, some, or all responses may be correct. a. Nausea b. Vomiting c. Eructation d. Flatulence e. Weight loss

a nausea c eructation d flatulence Eructation, flatulence, and nausea are common findings in patients with GERD. Vomiting rarely occurs in patients with GERD. Weight loss is not common in patients with GERD.

A patient being treated for gastroesophageal reflux disease (GERD) with pantoprazole reports continued symptoms. While reviewing the patient's 24-hour dietary recall, the nurse understands that which dietary choice would likely be a contributing factor? Milk Coffee Apples Red meat

Coffee Caffeinated products such as coffee can increase the risk for GERD symptoms. Milk, apples, and red meat do not exacerbate symptoms.

During the nursing assessment of a patient with a history of gastroesophageal reflux disease (GERD), which cue indicates the disease is not well controlled? Select all that apply. One, some, or all responses may be correct. Globus Pyrosis Belching Dysphagia Epigastric pain

Globus Pyrosis Belching Dysphagia Epigastric pain Globus is the term for feeling something is stuck in the back of the throat and is a clinical manifestation of GERD. The presence of globus, pyrosis, belching, dysphagia, and epigastric pain all reflect poorly controlled GERD.

Which assessment finding would the nurse anticipate for a patient suspected of having gastroesophageal reflux disease (GERD)? Diarrhea Vomiting Eructation Weight loss

Eructation Eructation is a common finding in patients with GERD. Vomiting and diarrhea rarely occur. Weight loss is not common finding.

Which drug classification may cause heartburn in a patient diagnosed with GERD? SATA a. nitrates b. prokinetic drugs c. oral contraceptives d. anticholinergic drugs e. proton pump inhibitors f. calcium channel blockers

a. nitrates c. oral contraceptives d. anticholinergic drugs f. calcium channel blockers Several drug decrease lower esophageal sphincter pressure causing reflux of gastric content and heartburn in GERD. Prokinetic drugs and PPIs do not cause heartburn; they are used in the treatment of GERD

The nurse is preparing teaching plans for a patient with gastroesophageal reflux disease (GERD). Which recommendation would the nurse include? "Avoid sleeping flat in the bed." "Eat three small meals a day." "Consume small snacks in the evening." "Chew chewable antacids thoroughly without water."

"avoid sleeping flat in the bed" A patient with GERD should not sleep flat in bed to avoid complications from reflux. The patient should eat four to six small meals in a day, not three. The patient should avoid snacks in the evening. The patient should chew chewable antacids thoroughly with a glass of water.

A portion of a patient's fundus and the esophagogastric junction has moved upward through the esophageal hiatus. Which condition does this describe? Sliding hernia Esophageal reflux Esophageal diverticula Paraesophageal hernia

Sliding hernia In a sliding hiatal hernia, the esophagogastric junction of the esophagus and part of the fundus of the stomach move upward into the chest through the esophageal hiatus. Esophageal reflux is the reflux of GI contents into the esophagus, which is observed in gastroesophageal reflux disease (GERD) and sliding hiatal hernias. In a paraesophageal hernia, the esophagogastric junction remains in the normal intra-abdominal location, but the fundus and a portion of the greater curvature of the stomach moves into the chest through the esophageal hiatus. Esophageal diverticula are sacs that occur because of the herniation of esophageal mucosa and submucosa into surrounding tissue.

A patient with gastroesophageal reflux disease (GERD) has been taking esomeprazole for more than a year. For which potential adverse effect would the nurse plan to monitor in this patient? a. Constipation b. Hallucinations c. Abdominal cramps d. GI infection

d. GI infection Long-term use of proton pump inhibitors such as esomeprazole may cause community-acquired pneumonia and GI infections. Constipation is often a side effect of aluminum-based antacids. Abdominal cramps can occur with omeprazole, a proton pump inhibitor. Hallucinations can be observed when taking metoclopramide, a prokinetic agent.

Which symptom would alert the nurse that a patient may have a paraesophageal hiatal hernia? a. dysphagia b. eructation c. regurgitation d. breathlessness

d. breathlessness Because a paraesophageal hiatal hernia involves protrusion of the fundus and other parts of the stomach into the thorax, patients often report breathlessness after a meal. The lower esophageal sphincter remains in place, so regurgitation is often not present. Dysphagia and eructation are associated with sliding hiatal hernia.

Which cue would the nurse expect to assess in a patient with GERD if the medication used for treatment is effective? SATA a. Afebrile b. Flatulence c. Odynophagia d. Increased salivation e. Decreased indigestion

e. Decreased indigestion Clinical manifestations of GERD include indigestion. Therefore if medication is effective, the nurse should notice decreased indigestion. The patient would not have a fever with GERD. The presence of flatulence, odynophagia, and increased salivation are signs of GERD If theses are present, this indicates the medication is not effective.

Which nutritional information would the nurse include in the teaching plan for a patient diagnosed with gastroesophageal reflux disease (GERD)? Select all that apply. One, some, or all responses may be correct. Limit caffeine. Eat a peppermint. Decrease chocolate intake. Eat three small meals a day. Avoid drinking fluids at meals.

limit caffeine decrease chocolate intake Caffeine and chocolate should be limited in patients with GERD. Peppermint may contribute to reflux and should be limited or avoided. The patient should eat six small meals a day, not three. Drinking fluids with meals is not restricted for patients with GERD.

Which information would the nurse include when teaching a patient about risk factors for the development of gastroesophageal reflux disease (GERD)? Select all that apply. One, some, or all responses may be correct. Smoking Legumes Peppermint Coffee Artificially sweetened beverages

smoking peppermint coffee Smoking, peppermint, and coffee are all risk factors for GERD by contributing to decreased lower esophageal sphincter pressure. Legumes and artificially sweetened beverages do not affect the lower esophageal sphincter.