CH 39 Management of Patients with Oral and Esophageal Disorders

The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs? A) 4 B) 2 C) 6 D) 1

C

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client? A) Weakness, diaphoresis, diarrhea 90 minutes after eating B) Constipation, rectal bleeding following bowel movements C) Persistent loose stools, chills, hiccups after eating D) Abdominal distention, elevated temperature, weakness before eating

A

A nurse has obtained an order to remove a client's NG tube that was placed for feeding. What is the nurse's best initial action? A) Apply topical anesthetic to the client's nares as prescribed. B) Explain the process clearly to the client. C) Assess the client's appetite. D) Assist the client into a supine position.

B

A nurse is admitting a client to the postsurgical unit following a gastrostomy. When planning assessments, the nurse should be aware of what potential postoperative complication of a gastrostomy? A) Development of peptic ulcer disease (PUD) B) Premature removal of the G tube C) Constipation D) Bowel perforation

B

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate? A) "It works as a marker to make sure that the tube stays in place." B) "It is a vent that prevents backflow of the secretions." C) "It helps regulate the pressure on the suction machine." D) "It acts as a siphon, pulling secretions into the clear tubing."

B

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery? A) Vestibulocochlear B) Vagus C) Trigeminal D) Hypoglossal

B

The school nurse is planning a health fair for a group elementary school students and dental health is one topic that the nurse plans to address. When teaching the children about the risk of tooth decay, the nurse should caution them against consuming large quantities of A) roasted nuts. B) organic fruit juice. C) cheddar cheese. D) red meat that is high in fat.

B

A client is postoperative day 1 following gastrostomy. The nurse is planning interventions to address the nursing diagnosis of Risk for Infection Related to Presence of Wound and Tube. What intervention is most appropriate? A) Cleanse the skin within 2 cm of the insertion site with hydrogen peroxide once per shift. B) Administer antibiotics via the tube as prescribed. C) Wash the area around the tube with soap and water daily. D) Irrigate the skin surrounding the insertion site with normal saline before each use.

C

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? A) Diverticulitis B) Peptic ulcer disease C) Gastroesophageal reflux disease D) Esophageal cancer

C

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time? A) 8 p.m. to 10 p.m. B) 4 p.m. to 6 p.m. C) 6 p.m. to 8 p.m. D) 10 p.m. to 12 a.m.

C

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration? A) Giving the feedings at room temperature. B) Aspirating for residual contents every 4 to 8 hours. C) Administering 15 to 30 mL of water every 4 hours. D) Keeping the client in a semi-Fowler's position at all times.

D

A nurse is inserting a nasogastric tube for feeding a client. Place in order the steps from 1 to 6 for correctly inserting the tube. A) Apply water-soluble lubricant to the tip of the tube B) Instruct the client to lower the head and swallow C) Tilt the client's nose upward D) Sit the client in an upright position E) Measure the length of the tube that will be inserted F) Apply gloves to the nurse's hands

D, F, E, A, C, and B

The primary source of microorganisms for catheter-related infections are the skin and which of the following? A) Catheter tubing B) IV tubing C) Catheter hub D) IV fluid bag

C

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration? A) Administering 15 to 30 mL of water every 4 hours. B) Giving the feedings at room temperature. C) Keeping the client in a semi-Fowler's position at all times. D) Aspirating for residual contents every 4 to 8 hours.

C

A client had a central line inserted for parenteral nutrition and is awaiting transport to the radiology department for catheter placement verification. The client reports feeling anxious and has a respiratory rate of 28 breaths/minute. What is the next action of the nurse? A) Auscultate lung sounds B) Position client flat in bed C) Apply nasal cannula oxygen D) Consult with the healthcare provider

A

A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition? A) Gastroesophageal reflux disease B) Gastritis C) Peptic ulcer with melena D) Diverticulitis with perforation

A

The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every A) shift. B) 12 hours. C) hour. D) 24 hours.

A

The nurse is caring for a client receiving a tube feeding. Which assessments will the nurse prioritize for this client? Select all that apply. A) Signs of dehydration B) Placement of the tube C) Neurological assessment D) Blood glucose level E) Body weight

A, B, D, and E

The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply. A) Encourage the client to eat frequent, small, well-balanced meals. B) Encourage the client to eat later in the day before bedtime rather than early in the morning. C) Instruct the client to eat slowly and chew the food thoroughly. D) Inform the client to remain upright for at least 2 hours after meals. E) Instruct the client to avoid alcohol or tobacco products.

A, C, D, and E

A client has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client? A) Anxiety or irritability B) Hyperactivity C) Uncontrolled rhythmic movements of the face or limbs D) Dry mouth not relieved by sugar-free hard candy

C

A client receives tube feedings after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which measure should the nurse include in the care plan to reduce the risk of aspiration? A) Administer 15 to 30 mL of water before and after medications and feedings. B) Use semi-Fowler position during, and 60 minutes after, an intermittent feeding. C) Avoid cessation of feedings and adjust patient head of bed. D) Change the tube feeding container , tubing , and adjust patient head of bed.

B

A client receiving tube feedings to the duodenum develops nausea, cramping, and diarrhea. For which condition should the nurse plan care for this client? A) Small bowel obstruction B) Dumping syndrome C) Diverticulosis D) Paralytic ileus

B

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for? A) manifestations of hypoglycemia. B) diaphoresis, vomiting, and diarrhea. C) manifestations of electrolyte disturbances. D) constipation, dehydration, and hypercapnia.

B

When assessing whether a client is a candidate for home parenteral nutrition, what would be important to address? Select all that apply. A) Marital status B) Family support C) Motivation for learning D) Telephone access E) Health status

B, C, D, and E

A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply. A) Decreased bowel sounds B) Diarrhea C) Tachycardia D) Hypertension E) Diaphoresis

B, C, and E

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply. A) Daily transparent dressing changes B) Strict bedrest C) Calorie counts for oral nutrients D) Intake and output monitoring E) Daily weights

C, D, and E

A client's new onset of dysphagia has required insertion of an NG tube for feeding. What intervention should the nurse include in the client's plan of care? A) Confirm placement of the tube prior to each scheduled feeding. B) Connect the tube to continuous wall suction when not in use. C) Keep the client in a low Fowler position when at rest. D) Have the client sip cool water to stimulate saliva production.

A

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? A) Provide frequent mouth care. B) Keep the feeding formula refrigerated. C) Flush the tube with water before adding the feedings. D) Ensure adequate hydration with additional water.

A

Residual content is checked before each intermittent tube feeding. The patient would be reassessed if the residual, on two occasions, was: A) About 50 mL. B) Between 50 and 80 mL. C) Greater than 200 mL. D) About 100 mL.

C

The nurse is caring for a client who has a gastrostomy tube feeding. Upon initiating care, the nurse aspirates the gastrotomy tube for gastric residual volume (GRV) and obtains 200 mL of gastric contents. What is the priority action by the nurse? A) Discontinue the infusion. B) Remove the aspirated fluid and do not reinstill. C) Place the client in a semi-Fowler's position with the head of the bed at 45 degrees. D) Dilute the gastric tube feeding solution with water and continue the feeding.

C

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): A) Extension of the esophagus through an opening in the diaphragm. B) Involution of the esophagus, which causes a severe stricture. C) Twisting of the duodenum through an opening in the diaphragm. D) Protrusion of the upper stomach into the lower portion of the thorax.

D

The nurse is to administer a cyclic feeding through a gastric tube. It is most important for the nurse to A) Elevate the head of the bed to 45 degrees. B) Check the residual volume before the feeding. C) Accurately assess the amount of fluid infused. D) Change the tube feeding container and tubing.

A

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? A) "Avoid coffee and alcoholic beverages." B) "Lie down after meals to promote digestion." C) "Limit fluid intake with meals." D) "Take antacids with meals."

A

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? A) Have the patient eat a cracker as the tube is being inserted. B) Spray the oropharynx with an anesthetic spray. C) Allow the patient to sip water as the tube is being inserted. D) Have the patient maintain a backward tilt head position.

C

A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following is no longer considered appropriate to use to unclog the tube? A) Digestive enzyme mixed with warm water B) Commercial enzyme product C) Air insufflation D) Cranberry juice

D

A nurse is caring for a client with a long-term central venous catheter. Which care principle is correct? A) If the needle becomes contaminated before accessing the port, clean the needle with povidone-iodine solution. B) Use clean technique when accessing the port with a needle. C) If unsuccessful with the first attempt to access the catheter, reuse the needle and try again. D) Clean the port with an alcohol pad before administering I.V. fluid through the catheter.

D

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is A) Inserted into the lungs B) Irritating the epiglottis C) Coiling in the client's mouth D) Passing into the esophagus

A

A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely? A) Excess fluid volume B) Risk for imbalanced nutrition, more than body requirements C) Impaired urinary elimination D) Deficient fluid volume

A

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? A) Staphylococcus aureus B) Pneumococcus C) Methicillin-resistant Streptococcus aureus (MRSA) D) Streptococcus viridans

A

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication? A) Fluid volume deficit B) Mucous membrane irritation C) A cardiac dysrhythmia D) Pulmonary complications

A

The nurse cares for a client who receives continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? A) Monitoring the feeding closely. B) Flushing the feeding tube. C) Increasing the feeding rate. D) Lowering the head of the bed.

A

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? A) Allow the patient to sip water as the tube is being inserted. B) Spray the oropharynx with an anesthetic spray. C) Have the patient maintain a backward tilt head position. D) Have the patient eat a cracker as the tube is being inserted.

A

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? A) Document the discontinuation of the nasogastric tube. B) Notify the surgeon about the tube's removal. C) Reinsert the nasogastric tube to the stomach. D) Place the nasogastric tube to the level of the esophagus.

B

A patient is receiving continuous tube feedings. The nurse would maintain the patient in which position at all times? A) Supine with a small pillow under the patient's head B) Semi-Fowler's with the head of the bed elevated 30 to 45 degrees C) High Fowler's with the patient sitting erect D) Side-lying with the head slightly lower than the chest

B

The nurse is caring for a patient who has dumping syndrome from high-carbohydrate foods being administered over a period of fewer than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome? A) Administer the feeding by bolus to prevent continuous intestinal distention. B) Administer the feeding with the patient in semi-Fowler's position to decrease the effect of gravity on transit time. C) Administer the feeding with about 100 mL of fluid to dilute the high-carbohydrate concentration. D) Administer the feeding at a warm temperature to decrease peristalsis.

B

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? A) Notify the physician. B) Remove the dressing, clean the site, and apply a new dressing. C) Draw a circle around the moist spot and note the date and time. D) Remove the catheter, check for catheter integrity, and send the tip for culture. SUBMIT ANSWER

B

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and would make a recommendation when noticing which circumstance? A) Little food in the working refrigerator B) Electricity that loses power, usually for short duration, during storms C) No land line; cell phone available and taken by family member during working hours D) Water of low pressure that can be obtained through all faucets

C

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to A) Change the nasal tape every 2 to 3 days. B) Apply water-based lubricant to the nares daily. C) Auscultate lung sounds every 4 hours. D) Inspect the nose daily for skin irritation.

C

A nurse is providing care for a client with a diagnosis of late-stage Alzheimer disease. The client has just returned to the medical unit to begin supplemental feedings through an NG tube. Which of the nurse's assessments addresses this client's most significant potential complication of feeding? A) Vigilant monitoring of the frequency and character of bowel movements B) Frequent assessment of the client's abdominal girth C) Frequent lung auscultation D) Assessment for hemorrhage from the nasal insertion site

C

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? A) Slow the current infusion rate so that it will last until the new solution arrives. B) Have someone go to the pharmacy to obtain the new solution. C) Hang a solution of dextrose 10% and water until the new solution is available. D) Begin an infusion of normal saline in another site to maintain hydration.

C

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly? A) Tape the tube to the head of the bed to avoid dislodgement. B) Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. C) Keep the vent lumen above the patient's waist to prevent gastric content reflux. D) Irrigate only through the vent lumen.

C

The nurse is preparing to check for tube placement in the client's stomach as well as measure the residual volume. What is the main purpose of these nursing actions? A) Prevent gastric ulcers B) Prevent abdominal distention C) Prevent aspiration D) Prevent diarrhea

C

The school nurse is planning a health fair for a group elementary school students and dental health is one topic that the nurse plans to address. When teaching the children about the risk of tooth decay, the nurse should caution them against consuming large quantities of A) roasted nuts. B) red meat that is high in fat. C) organic fruit juice. D) cheddar cheese.

C

Which clinical manifestation is not associated with hemorrhage? A) Tachycardia B) Tachypnea C) Bradycardia D) Hypotension

C

A nurse practitioner, who is treating a patient with GERD, knows that this type of drug helps treat the symptoms of the disease. The drug classification is: A) Antispasmodics B) Antacids C) H2-receptor antagonists. D) Proton pump inhibitors.

D

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: A) Feedings can be administered with the patient in the recumbent position. B) The patient cannot experience the deprivational stress of not swallowing. C) Digestive process occurs more rapidly as a result of the feedings not having to pass through the esophagus. D) Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration.

D

The nurse is caring for a client receiving enteral nutrition with a standard polymeric formula. For which reason will the nurse question using this formula for the client? A) Polyps removed during a colonoscopy B) History of diverticulitis C) Treatment for internal hemorrhoids D) Diagnosed with malabsorption syndrome

D

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? A) Regurgitation of food B) Pain C) Malnutrition D) Dysphagia

D

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? A) Provide oral hygiene. B) Remove the tape from the nose of the client. C) Withdraw the tube gently for 6 to 8 inches. D) Flush with 10 mL of water.

D

The nurse is to insert a postpyloric feeding tube. How can the nurse aid in placement of the tube past the pylorus? A) Have the client lay on the left side. B) Assist the client to drink 8 ounces of water. C) Instruct the client to swallow several times. D) Administer prescribed metoclopramide.

D