Chapter 39: Management of Patients with Oral and Esophageal Disorders

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

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

A) Catheter hub

The following appears on the medical record of a male patient receiving parenteral nutrition:WBC: 6500/cu mmPotassium 4.3 mEq/LMagnesium 2.0 mg/dLCalcium 8.8 mg/dLGlucose 190 mg/dLWhich finding would alert the nurse to a problem? A) Glucose level B) Magnesium level C) White blood cell count D) Potassium level

A) Glucose level

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

A) Greater than 200 mL.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? A) The client is free from esophagitis and achalasia. B) The client reports diminished duodenal inflammation. C) The client has normal gastric structures. D) The client doesn't exhibit rectal tenesmus.

A) The client is free from esophagitis and achalasia.

The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred? A) The nurse has inadvertently inserted the tube into the trachea. B) The tube is most likely defective and should be immediately removed. C) This is a normal occurrence and the tube should be left in place. D) The nurse has inserted a tube that is too large for the patient.

A) The nurse has inadvertently inserted the tube into the trachea.

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) diaphoresis, vomiting, and diarrhea. B) constipation, dehydration, and hypercapnia. C) manifestations of electrolyte disturbances. D) manifestations of hypoglycemia.

A) diaphoresis, vomiting, and diarrhea.

A nurse is interviewing a patient to determine suitability for home parenteral nutrition. Which patient statement would alert the nurse to a potential problem? A) "My son and daughter live just down the block, and my wife is home all day." B) "I have a telephone, but it has been shut off because my bill is overdue." C) "I'm willing to learn new things, so I can be as independent as possible." D) "I live in a one-story house with lots of closets and cabinets."

B) "I have a telephone, but it has been shut off because my bill is overdue."

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? A) 10 B) 4 C) 6 D) 8

B) 4

A client's enteral feedings have been determined to be too concentrated based on the client's development of dumping syndrome. What physiologic phenomenon caused this client's complication of enteral feeding? A) Mucosal irritation of the stomach and small intestine by the high concentration of the feed B) Entry of large amounts of water into the small intestine because of osmotic pressure C) Acid-base imbalance resulting from the high volume of solutes in the feed D) Increased gastric secretion of HCl and gastrin because of high osmolality of feeds

B) Entry of large amounts of water into the small intestine because of osmotic pressure

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed? A) When the residual is about 100 mL B) When the residual is greater than 200 mL C) When the residual is between 50 and 80 mL D) When the residual is about 50 mL

B) When the residual is greater than 200 mL

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

C) Clean the port with an alcohol pad before administering I.V. fluid through the catheter.

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) Esophageal cancer B) Peptic ulcer disease C) Gastroesophageal reflux disease D) Diverticulitis

C) Gastroesophageal reflux disease

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) Administering 15 to 30 mL of water every 4 hours. C) Keeping the client in a semi-Fowler's position at all times. D) Aspirating for residual contents every 4 to 8 hours.

C) Keeping the client in a semi-Fowler's position at all times.

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) Prevent aspiration

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length? A) A length of 50 cm (20 in) B) The distance determined by measuring from the tragus of the ear to the xiphoid process C) The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process D) A point that equals the distance from the nose to the xiphoid process

C) The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process

A nurse is preparing to assist a health care provider with a peripherally inserted central catheter. The nurse demonstrates understanding of this procedure by preparing which insertion site? A) Jugular vein B) Subclavian vein C) Metacarpal vein D) Basilic vein

D) Basilic vein

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

D) Bradycardia Rationale: Tachycardia, tachypnea, and hypotension may indicate hemorrhage and impending hypovolemic shock

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) Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration.