Chapter 54: Care of Patients with Esophageal Problems

22. What is the primary focus of care after conventional surgery for hiatal hernia? a. Prevention of respiratory complications b. Pain management c. Management of fluid balance d. Teaching the patient self-care activities

a. Prevention of respiratory complications

30. The patient describes experiencing a dull and steady substernal pain, especially after drinking cold liquids. Which manifestation of esophageal cancer does the nurse recognize? a. Angina b. Aspiration c. Dysphagia d. Odynophagia

d. Odynophagia

33. For which patient is radiation therapy contraindicated? a. Patient with lung cancer b. Patient with esophageal tumor c. Patient with sliding hernia d. Patient with tracheoesophageal

d. Patient with tracheoesophageal

18. Which statements will the nurse include when providing health teaching for a patient with hiatal hernia? (Select all that apply) a. "Elevate the head of your bed at least 6 inches for sleeping at night." b. "Remain in the upright position for several hours after eating." c. "Avoid straining or excessive vigorous exercise." d. "After surgery, you will have no dietary restriction." e. "Avoid wearing clothing that is tight around the abdomen." f. "Avoid eating in the late evening."

a. "Elevate the head of your bed at least 6 inches for sleeping at night." b. "Remain in the upright position for several hours after eating." c. "Avoid straining or excessive vigorous exercise." e. "Avoid wearing clothing that is tight around the abdomen." f. "Avoid eating in the late evening."

10. A patient who has been prescribed famotidine (Pepcid) is being discharged home. Which statement by the patient indicates a need for further discharge teaching by the nurse? a. "I will double up on the dose if I begin to feel increased heartburn." b. "I will avoid all alcohol." c. "I will call the healthcare provider if I continue to have heartburn." d. "This drug is available over the counter."

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

36. The nurse is collaborating with the speech-language pathologist to assist the patient with oral exercises to improve swallowing (swallowing therapy) and with occupational therapist for feeding therapy. Which key points must be included when teaching this patient? Select all that apply a. Ask the patient to suck on a lollipop to enhance tongue strength b. Teach the patient to reach for food particles on the lips or chin using the tongue c. Instruct the patient to place food at the front of the mouth d. In preparation for swallowing, remind the patient to position the head in forward flexion(chin tuck) e. Monitor the patient for sealing of the lips and for tongue movements while eating f. Check for pocketing of food under the tongue after swallowing

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

17. Which lifestyle adjustment made a patient have to make two best control GERD? a. Sleep in the Trendelenburg position. b. Attain and maintain ideal body weight. c. Wear snug-fitting belts and waistbands. d. Engage in strenuous exercise such as weightlifting.

b. Attain and maintain ideal body weight.

38. The nurse is caring for a patient with esophageal cancer who is scheduled to undergo an esophagogastrostomy with a section of the jejunum to replace the esophagus. Which procedure does the nurse expect to perform preoperatively? a. Complete bowel preparation b. Chest tube placement c. Urinary catheter placement d. Nasogastric tube placement for feeding

a. Complete bowel preparation

24. The nurse is assessing a patient's nasogastric drainage following a conventional fundoplication procedure. How does the nurse expect the drainage to appear the first 8 hours after surgery? a. Dark brown b. Bright red mixed with brown c. Yellowish to Green d. Green to clear

a. Dark brown

23. Uncontrolled GERD can be a cause of which adult-onset disorders? Select all that apply a. Dental decay b. Aspiration pneumonia c. Laryngitis d. Diverticulitis e. Asthma f. Cardiac disease

a. Dental decay b. Aspiration pneumonia c. Laryngitis e. Asthma f. Cardiac disease

6. A patient With severe gastroesphophageal reflux disease(GERD) tells a nurse that she has pain after each meal that lasts for 45 minutes and is worse when she lies down. What interventions should the nurse teach this patient? Select all that apply a. Drink fluid b. When you lie down, try lying on your side c. Take an antacid as prescribed by your health care provider d. Eat something bland such as a slice of white bread e. Maintain an upright position for at least 1 hour after you eat f. Try pressing over your abdomen to mobilize the food in your stomach

a. Drink fluid c. Take an antacid as prescribed by your health care provider e. Maintain an upright position for at least 1 hour after you eat

25. The nurse is giving discharge instructions to a patient after a fundoplication procedure. The patient is instructed to avoid which activities? Select all that apply a. Drinking carbonated beverages b. Beginning clear liquids when peristalsis c. Drinking with a straw d. Eating gas-producing foods e. Eating soft foods that are easy to swallow f. Chewing gum

a. Drinking carbonated beverages c. Drinking with a straw d. Eating gas-producing foods f. Chewing gum

4. Which are the two most common manifestations of GERD? (Select all that apply) a. Dyspepsia b. Eructation c. Water brash d. Regurgitation e. Odynophagia f. Flatulence

a. Dyspepsia d. Regurgitation

44. What manifestations are expected when a patient has esophageal diverticula? Select all that apply a. Halitosis b. Dysphasia c. Swelling with difficulty breathing d. Nocturnal cough e. Regurgitation f. Pain radiating to the right arm

a. Halitosis b. Dysphasia d. Nocturnal cough e. Regurgitation

12. Which group of drugs is the main treatment for GERD? a. Antacid b. Histamine receptor agonists c. Proton pump inhibitors d. Gaviscon preparation

c. Proton pump inhibitors

14. By which actions do drugs used to treat GERD help to decrease the pain and discomfort the patient experiences? Select all that apply a. Inhibition of gastric acid production b. Blocking of pain sensation in the CNS c. Accelerating gastric emptying d. Decreasing lower esophageal sphincter pressure e. Protecting the gastric mucosa f. Destroying H.pylori bacteria

a. Inhibition of gastric acid production c. Accelerating gastric emptying e. Protecting the gastric mucosa

20. Which statements about Barrett's esophagus are accurate? (Select all that apply) a. It is considered to be a premalignant condition. b. It is associated with excessive intake of fresh fruits and vegetables. c. It results from exposure to acid and pepsin. d. It is associated with pickled and fermented foods. e. Normal cells undergo dysplasia to become cancerous.

a. It is considered to be a premalignant condition. c. It results from exposure to acid and pepsin. d. It is associated with pickled and fermented foods. e. Normal cells undergo dysplasia to become cancerous.

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

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

3. Which statements about GERD are correct? (Select all that apply) a. Overweight and obese patients are at an increased risk. b. Thin and underweight patients are at an increased risk. c. It is a common disorder in the Asian and his Hispanic populations. d. There is a high incidence in patients who eat mostly hot and spicy foods.e. It is a common upper gastrointestinal disorder in the United States. e. It is a common upper gastrointestinal disorder in the United States.

a. Overweight and obese patients are at an increased risk. e. It is a common upper gastrointestinal disorder in the United States.

32. Nonsurgical treatment options for cancer of the esophagus can include which therapies? Select all that apply a. Swallowing therapy b. Chemoradiation c. Targeted therapies d. Smoking cessation programs e. Photodynamic therapy f. Endoscopic therapies

a. Swallowing therapy b. Chemoradiation c. Targeted therapies e. Photodynamic therapy f. Endoscopic therapies

35. A patient with esophageal cancer has excess of HER2 protein on the cell surface. What therapy does the nurse expect will be ordered for this patient? a. Targeted therapy with IV trastuzumab b. Chemoradiation with chemotherapy during the first and fifth week c. Radiation therapy alone shrinks the tumor d. Nutrition and swallowing therapy to prevent malnutrition

a. Targeted therapy with IV trastuzumab

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

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

39. After in esophagectomy, what is the nurse's priority for patient care? a. Wound care b. Nutrition care c. Respiratory care d. Hydration care

c. Respiratory care

2. Which statement is true about Barrett's epithelium in the patient with GERD? a. While the body heals, a different type of cell forms on the lower part of the esophagus. b. This new tissue is less resistant to acid so it must be taken care of. c. Barrett's epithelium is resistant to the development of cancer. d. Esophageal stricture's are less likely to occur with this type of epithelium.

a. While the body heals, a different type of cell forms on the lower part of the esophagus.

21. The nurse has provided postoperative teaching for a patient who underwent a laparoscopic Nissen fundoplication (LNF). Which statement by the patient indicates a need for additional teaching? a. "I will walk every day." b. "I will no longer need the anti-reflux drugs after the surgery." c. "I will report a fever above 101°F." d. "I'll remove the gauze dressing 2 days after surgery and shower."

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

7. A patient is scheduled to have several diagnostic tests to verify the medical diagnosis of GERD. Which diagnostic test is the most accurate method of diagnosing this disorder? a. Esophagogastroduodenoscopy (EGD) b. 24-hour ambulatory pH monitoring c. Esophageal manometry d. Motility testing

b. 24-hour ambulatory pH monitoring

41. The nurse is caring for a postoperative patient after esophageal surgery. On assessment, the nurse discovers that the patient's temperature is 10 1°F, heart rate is 120/minute, and respiratory rate is 32/minute. Lung sounds include bilateral crackles. What is the nurses priority first action? a. Raise the head of the patient's bed. b. Call the Rapid Response Team. c. Apply oxygen at 2L per nasal cannula. d. Administer IV normal saline at 75 mL/hour.

b. Call the Rapid Response Team.

34. Which procedure would the health care provider recommend for immediate relief of dysphasia? a. Photodynamic therapy b. Esophageal dilation c. Targeted therapy d. Chemoradiation therapy

b. Esophageal dilation

1. Which physiological factor contributes to gastroesophageal reflux disease (GERD)? a. Accelerated gastric emptying b. Irritation from reflux of stomach contents c. Competent lower esophageal sphincter d. Increased esophageal clearance

b. Irritation from reflux of stomach contents

13. The nurse is teaching a patient with GERD about lifestyle changes. Which key points would the nurse include? Select all that apply a. Consume 4-6 large meals per day b. Limit or eliminate alcohol and tobacco c. Eat slowly and chew food thoroughly d. Elevate the head of the bed 3-5 inches using wooden blocks e. Do not wear restrictive clothing f. Reduce or eliminate spicy foods that cause increased gastric acid

b. Limit or eliminate alcohol and tobacco c. Eat slowly and chew food thoroughly e. Do not wear restrictive clothing f. Reduce or eliminate spicy foods that cause increased gastric acid

9. A patient with GERD is on a medication that raises the pH of gastric contents. Which drug does the nurse expect to administer? a. Ranitidine b. Mylanta c. Gaviscon d. Omeprazole

b. Mylanta

37. Which therapy may be used as a cure for patients who have small localized tumors? a. Chemotherapy b. Photodynamic therapy c. Nutrition therapy d. Radiation therapy

b. Photodynamic therapy

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

b. Position the patient in high fowler's position before feeding

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

b. Student prepares to irrigate NG tube.

28. A patient is undergoing a work up for carcinoma of the esophagus. What are the two primary risk factors associated with the development of this carcinoma? a. High-fat, low-fiber diet and tobacco use b. Tobacco use and obesity c. Sedentary lifestyle and family history of squamous cell carcinoma d. Heavy alcohol intake and high-fat, low-fiber diet

b. Tobacco use and obesity

29. What is the most common symptom of esophageal cancer reported by patients? a. Productive cough b. Reflux especially at night c. Difficulty with swallowing d. Shortness of breath

c. Difficulty with swallowing

31. The definitive diagnosis for esophageal cancer is made with which procedure? a. Barium swallow b. Esophageal manometry c. Esophageal ultrasound with fine needle aspiration d. Esophagogastroduodenoscopy (EGD)

c. Esophageal ultrasound with fine needle aspiration

5. The patient with GERD describes painful swallowing. Which symptom does the nurse recognize? a. Dyspepsia b. Regurgitation c. Odynophagia d. Dysphasia

c. Odynophagia

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

c. Strong alkalis can cause full perforation of esophagus within 1 minute

8. The nurse has provided teaching to a patient with GERD. Which statement by the patient indicates the teaching has been effective? a. "I will eat three meals a day." b. "I won't snack for one hour before I go to bed." c. "I will stay up for at least 15-30 minutes after eating dinner before going to bed." d. "I won't lift heavy objects."

d. "I won't lift heavy objects."

16. A patient has returned to the unit after a Stretta procedure for GERD. Which action by the student nurse requires the supervising nurse to intervene? a. The patient is offered clear liquids in the early post-procedure period. b. The patients routine 81 mg of aspirin is held. c. A proton pump inhibitor is administered. d. A nasogastric tube is prepared for insertion.

d. A nasogastric tube is prepared for insertion.

19. What diagnostic test best identifies a hiatal hernia? a. EGD b. 24-hour ambulatory pH monitoring c. Esophageal manometry d. Barium swallow study with fluoroscopy

d. Barium swallow study with fluoroscopy

11. Which statement is true about the drug rabeprazole (Aciphex) for treatment of GERD. a. It is rapidly released into the body after administration. b. The tablets are large and may be crushed if the patient has difficulty swallowing them. c. It is a histamine receptor antagonist. d. If once-a-day dosing does not control symptoms, it may be taken twice a day

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

26. A patient is prescribed pantoprazole (Protonix). What does the nurse tell the patient is the major action of this medication? a. It produces a coating on the stomach lining. b. It neutralizes gastric acid. c. It heals esophageal irritation. d. It inhibits gastric acid secretion.

d. It inhibits gastric acid secretion.

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

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