Med Surg Prep U Ch.46

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

"Avoid coffee and alcoholic beverages." *To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

An adolescent client with multiple dental caries is discussing his diet with the nurse. The nurse explores the client's behaviors and identifies a risk factor for dental caries when the client states:

"I drink a can of carbonated soda at lunch every day." *Measures to prevent dental caries include brushing teeth after meals, flossing daily, and having regular dental visits. Other factors increase risk, such as drinking the refined sugars found in carbonated soda

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. The first activity of the nurse is to:

Assess lung sounds bilaterally *All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment.

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to

Assess the graft for color and temperature. *The nurse may do all these activities related to the neck wound and dressing. Airway, breathing, circulation (ABCs) take priority. Assessing the graft for color and temperature addresses circulation

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. The client has understood the recommended dietary changes by:

Avoiding chocolate and coffee. *Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

A nurse caring for a patient who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. An expected normal amount of drainage is:

Between 80 to 120 mL may drain over the first 24 hours. Drainage of greater than 120 mL may be indicative of a chyle fistula or hemorrhage.

Which of the following is an accurate statement regarding cancer of the esophagus?

Chronic irritation of the esophagus is a known risk factor. *In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life.

Which of the following is the primary symptom of achalasia?

Difficulty swallowing *The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

Cancer of the esophagus is most often diagnosed by which of the following?

Esophagogastroduodenoscopy (EGD) with biopsy and brushings *Currently, diagnosis is confirmed most often by EGD with biopsy and brushings. The biopsy can be used to determine the presence of disease and cell differentiation. X-ray, barium swallow, and fluoroscopy are used in the diagnosis of hiatal hernia

An elderly client states, "I don't understand why I have so many caries in my teeth." The nurse assesses the following as placing the client at risk:

Exhibiting hemoglobin A1C 8.2 *Measures used to prevent and control dental caries include controlling diabetes. A hemoglobin A1C of 8.2 is not controlled. It is recommended for hemoglobin A1C to be less than 7 for people with diabetes. Other measures to prevent and control dental caries include drinking fluoridated water; eating foods that are less cariogenic, which include fruits, vegetables, nuts, cheese, or plain yogurt; and brushing teeth evenly with a soft-bristled toothbrush

Postoperatively, a patient with a radical neck dissection should be placed in which position?

Fowler's *The patient should be placed in the Fowler's position to facilitate expansion of the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs. The other positions are not the position of choice postoperatively.

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication can be safely administered for which conditon?

Gastroesophageal reflux disease *Metoclorpramide is a prokinetic agent that accelerates gastric emptying. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

During a psychotic episode, a client with schizophrenia swallows a small wooden spoon. Which of the following medications would the nurse in the emergency department be most likely to administer to facilitate removal of the foreign body?

Glucagon *Glucagon is administered before removing a foreign body because it relaxes the smooth muscle of the esophagus, thereby facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Insulin and epinephrine would not assist with foreign body removal.

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are?

Hairy leukoplakia *Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough hairlike projections occur, typically found on lateral border of the tongue

Which of the following is one of the first clinical manifestations of esophageal cancer?

Increasing difficulty is swallowing *The patient first becomes aware of intermittent and increasing difficulty in swallowing. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include sensation of a mass in the throat, foul breath, and hiccups

Which of the following mouth conditions are associated with HIV infection?

Kaposi's sarcoma *Kaposi's sarcoma appears first on the oral mucosa as a red, purple, or blue lesion. It is associated with HIV infection. Stomatitis is associated with chemotherapy and radiation therapy. Krythoplakia is caused by a nonspecific inflammation. Candidiasis is caused by fungus

Tyrone Freeman is a 49-year-old male being treated for GERD at the gastroenterology office where you work. During his visit, he states that his reflux is much improved, but now, he is having diarrhea. In addition to his prescribed treatment for GERD, he has been taking an antacid. Which of the following components of an antacid might be causing his diarrhea?

Magnesium *The magnesium component may tend to cause diarrhea in some clients. Magnesium can cause diarrhea in some clients

A client with cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is:

Make a notation on the call light system that the client cannot speak. *The client who has a laryngectomy cannot speak. Other personnel need to know this when answering the call light system. Exercises for the neck and shoulder are usually started after the drains have been removed and the neck incision is sufficiently healed. Humidified oxygen is provided through the tracheostomy to keep secretions thin. To prevent pneumonia, the client should be placed in a sitting position

A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland?

Parotid *The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:

Proton pump inhibitors. *Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an)

Protrusion of the upper stomach into the lower portion of the thorax. *It is important for the patient and his family to understand the altered association between the esophagus and the stomach. The diaphragm opening, through which the esophagus passes, becomes enlarged and part of the upper stomach moves up into the lower portion of the thorax. The abnormality is not an involuntary, protruding, or twisted segment.

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client?

Provide the client with an irrigating solution of baking soda and warm water *If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended

The nurse is standing next to the bed of a client who is experiencing a hemorrhage from the neck area following a neck dissection. The first intervention of the nurse is to:

Put on gloves. *If the carotid artery hemorrhages following a neck dissection, the nurse will probably do all these interventions. The nurse is to follow recommendations from the Centers for Disease Control in regards to protecting self, and this is to follow universal precautions

Which of the following terms refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus?

Pyrosis *Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain on swallowing is termed odynophagia

Josephine Hites, an 80-year-old retired dress shop clerk, is reporting for her semiannual physical exam at the primary care group where you practice nursing. She demonstrates an unintentional weight loss of 10 lb in the last 6 months. When asked, she reports, "Food just doesn't taste good anymore!" What could be the cause of her reaction to food?

Reduced number of taste buds *With age, the salivary glands become less active and the numbers of taste buds are reduced, contributing to anorexia in the older adult. A contributing factor of anorexia in the older adult is the decrease in the number of taste buds and the salivary glands become less active, both a normal consequence of aging.

The nurse is caring for patient scheduled to undergo radical neck dissection. During preoperative teaching, the nurse includes that which of the following as associated complications?

Shoulder Drop *The nurse should include shoulder drop as an associated complication of radical neck dissection. Another associated complication includes poor cosmesis, which is a visible depression in the neck. Clavicle fracture, venous engorgement, and neck distension are not complications associated with radical neck dissection.

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis?

Staphylococcus aureus *People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for parotitis. The infecting organisms travel from the mouth through the salivary duct. The organism is usually Staphylococcus aureus (except in mumps).

Select the assessment finding that the nurse should immediately report, post radical neck dissection.

Stridor *Stridor is the presence of coarse, high-pitched sounds on inspiration. The nurse would auscultate frequently over the trachea. This finding must be immediately reported because it indicates airway obstruction.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

The client lying in a lateral position, with the head of bed flat *A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern

A client has a new order for metoclorpramide (Reglan). The nurse knows that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following?

Uncontrolled rhythmic movements of the face or limbs *Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?

Vagus *Cardiac complications include atrial fibrillation, which occurs due to irritation of the vagus nerve at the time of surgery. The hypoglossal nerve controls muscles of the tongue. The vestibulocochlear nerve functions in hearing and balance. The trigeminal nerve functions in chewing of food

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?

Weakness, diaphoresis, diarrhea 90 minutes after eating *Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a

chancre. *A chancre is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis. Lichen planus are white papules at the intersection of a network of interlacing lesions. Actinic cheilitis is an irritation of the lips associated with a scaling, crusting fissure. Leukoplakias are white patches usually in the buccal mucosa

The most common symptom of esophageal disease is

dysphagia. *This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain on swallowing.

When caring for a client with the nursing diagnosis Impaired swallowing related to neuromuscular impairment, the nurse should:

elevate the head of the bed 90 degrees during meals *The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent position — not a supine position — when lying down to reduce the risk of aspiration. The nurse should encourage the client to wear properly fitted dentures to enhance his chewing ability. Thick liquids — not thin — decrease the risk of aspiration

The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department for chest pain. The client was diagnosed as having gastroesophageal reflux disease. The nurse notes in the client's record that the client is taking carbidopa/levodopa (Sinemet). The nurse questions the physician's order for

metoclopramide *The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa, which is used for Parkinson's disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson's disease.

A nurse is reviewing dietary guidelines with a client who recently had Roux-en-Y gastric bypass (RYGB) surgery. Which of the following would be included? Select all that apply.

• Gradually progress to five or six small meals daily, with each feeding providing protein, fat, and complex carbohydrate. Restrict total amount to less than one cup. • Avoid all sweets *Initially, the stomach will be about the size of an egg, stretching slowly over time to about the size of a cup. Sweets will trigger the symptoms associated with dumping syndrome. Take fluids between meals to prevent dumping syndrome and delay gastric emptying. Avoid commonly problematic foods, such as doughy breads, pasta, rice, skins and seeds of fruits and vegetables, nuts, and popcorn.

The nurse working in the recovery room is caring for a patient who had a radical neck dissection. The nurse notices that the patient has a coarse, high-pitched sound on inspiration. Which of the following is the appropriate intervention by the nurse?

Notifying the physician *The presence of stridor, a coarse, high-pitched sound on inspiration, in the immediate postoperative period following radical neck dissection indicates obstruction of the airway and requires that the nurse report it immediately to the physician

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an):

Protrusion of the upper stomach into the lower portion of the thorax. *It is important for the patient and his family to understand the altered association between the esophagus and the stomach. The diaphragm opening, through which the esophagus passes, becomes enlarged and part of the upper stomach moves up into the lower portion of the thorax. The abnormality is not an involuntary, protruding, or twisted segmen

Which term describes an inflammation of the salivary glands?

Sialadenitis *Sialadenitis is the inflammation of the salivary glands. Parotitis is inflammation of the parotid glands. Stomatitis is inflammation of the oral mucosa. Pyosis is pus.

Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland?

Sialolithiasis *Salivary stones are formed mainly from calcium phosphate. Parotitis refers to inflammation of the parotid gland. Sialadenitis refers to inflammation of the salivary glands. Stomatitis refers to inflammation of the oral mucosa.

Regarding oral cancer, the nurse provides health teaching to inform the patient that

many oral cancers produce no symptoms in the early stages *The most frequent symptom of oral cancer is a painless sore that does not heal. The patient may complain of tenderness, and difficulty with chewing, swallowing, or speaking as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless hardened ulcer with raised edges

You are caring for a client with oral cancer. The client's healthcare provider has ordered the placement of a GI tube to provide nutrition and to deliver medications. Which of the following would be the preferred route?

Nasogastric intubation *The nasal route is the preferred route for passing a tube when the client's nose is intact and free from injury.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?

Take long, slow breaths *During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

The client is free from esophagitis and achalasia. *Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures

Which of the following is the most common type of diverticulum?

Zenker's diverticulum *The most common type of diverticulum, which is found three times more frequently in men than women, is Zenker's diverticulum (also known as pharyngoesophageal pulsion diverticulum or a pharyngeal pouch)

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as

a canker sore of the oral soft tissues. *Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, the nurse plans postoperative care to include the following: (Select all that apply.)

• Assess lung sounds every 4 hours and prn. • Monitor drainage in the closed chest drainage system. • Verify rhythm on the cardiac monitoring system. *Following recovery from anesthesia for a surgical resection of an esophageal tumor, the client is placed in the Fowler's position. A common postoperative complication is aspiration pneumonia. The nurse assesses for this complication by assessing lung sounds. The nurse monitors the drainage in the closed chest drainage system. Because of irritation of the vagus nerve, the nurse assesses for the complication of atrial fibrillation. The nurse does not replace the nasogastric tube if it becomes dislodged

The nurse is creating a discharge teaching plan for a patient post surgery for oral cancer. Which of the following should be included in the teaching plan? Select all that apply.

• Oral hygiene • Follow-up dental appointment • Follow-up medical appointment • Use of humidification *Discharge teaching for a patient after oral surgery includes oral hygiene, follow-up dental and medical appointments, and the use of humidification to keep secretions moist.