Hernia

The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be most accurate? "Surgery is usually required, although medical treatment is attempted first." "Hiatal hernia symptoms can usually be successfully managed with diet modifications medications, and lifestyle changes." "Surgery is not performed for this type of hernia." "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

Correct answer "Hiatal hernia symptoms can usually be successfully managed with diet modifications medications, and lifestyle changes." Feedback Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery to correct a hiatal hernia, which commonly produces complications, is performed only when medical therapy fails to control the symptoms.

The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal hernia. Which statement would indicate that the client has understood the instructions? "I will avoid lying down after a meal." "I can still enjoy my potato chips and cola at bedtime." "I wish I did not have to give up swimming." "If I wear a girdle, I will have more support for my stomach."

Correct answer "I will avoid lying down after a meal." Feedback A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided. Excessive vigorous exercise also should be avoided, especially after meals, but there is no reason why the client must give up swimming. Wearing tight, constrictive clothing such as a girdle can increase intra-abdominal pressure and thus lead to reflux of gastric juices.

Which nursing intervention would most likely promote self-care behaviors in the client with a hiatal hernia? Introduce the client to other people who are successfully managing their care. Include the client's daughter in the teaching so that she can help implement the plan. Ask the client to identify other situations in which the client changed health care habits. Provide reassurance that the client will be able to implement all aspects of the plan successfully.

Correct answer Ask the client to identify other situations in which the client changed health care habits. Feedback Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits. Meeting other people who are managing their care and involving family members can be helpful, but individual motivation is more important. Reassurance can be helpful but is less important than individualization of care.

Which risk factor would most likely contribute to the development of a hiatal hernia? having a sedentary desk job being 5 feet, 3 inches tall (160 cm) and weighing 190 lb (86.2 kg) using laxatives frequently being 40 years old

Correct answer being 5 feet, 3 inches tall (160 cm) and weighing 190 lb (86.2 kg) Feedback Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? number and length of breaks body mechanics used in lifting temperature in the work area cleaning solvents used

Correct answer body mechanics used in lifting Feedback Bending, especially after eating, can cause gastroesophageal reflux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications. Number and length of breaks, temperature in the work area, and cleaning solvents used are not directly related to treatment of hiatal hernia.

The nurse should instruct the client to avoid taking which drug while taking metoclopramide hydrochloride? antacids antihypertensives anticoagulants central nervous system depressants

Correct answer central nervous system depressants Feedback Metoclopramide hydrochloride can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.

The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia symptoms. The nurse should assess the client for which condition most commonly associated with the ongoing use of magnesium- based antacids? anorexia weight gain diarrhea constipation

Correct answer diarrhea Feedback The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain.

Which lifestyle modification should the nurse encourage the client with a hiatal hernia to include in activities of daily living? engaging in daily aerobic exercise eliminating smoking and alcohol use balancing activity and rest avoiding high-stress situations

Correct answer eliminating smoking and alcohol use Feedback Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia. Daily aerobic exercise, balancing activity and rest, and avoiding high-stress situations may increase the client's general health and well-being, but they are not directly associated with hiatal hernia.

A client is taking cimetidine to treat a hiatal hernia. The nurse should evaluate the client to determine that the drug has been effective in preventing which health problem? esophageal reflux dysphagia esophagitis ulcer formation

Correct answer esophagitis Feedback Cimetidine is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux. Cimetidine is not used to prevent reflux, dysphagia, or ulcer development.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which symptom? heartburn jaundice anorexia stomatitis

Correct answer heartburn Feedback Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, which results from a high concentration of bilirubin in the blood, is not associated with hiatal hernia. Anorexia is not a typical symptom of hiatal hernia. Stomatitis is inflammation of the mouth.