Med Surg: Upper GI GERD Questions/Rationales

The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

1. 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.

Which of the following dietary measures would be useful in preventing Esophageal reflux? 1. Eating small, frequent meals 2. increasing fluid intake 3. avoiding air swallowing with meals 4. Adding a bedtime snack to the dietary plan

1. Esophageal reflux worsens when the stomach is over-distended with food. Therefore, an important measure is to eat small,frequent meals.

The client attends two sessions with the dietitian to learn about diet modifications to minimize GERD. The teaching would be considered successful if the client decreases the intake of which of the following foods? 1. fats 2. high-sodium foods 3. Carbohydrates 4. high calcium foods

1. Fats are associated with decreased esophageal sphincter tone.

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 of the following symptoms? 1. Heartburn 2. Jaundice 3. Anorexia 4. Stomatitis

1. 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.

The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1. Take a laxative 2. follow a clear liquid diet 3. Administer an enema 4. Take an antiemetic

1. The client should take a laxative after an upper GI series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction.

The physician prescribes metoclopramide hyrochloide (Reglan) for the client with a hiatal hernia. This drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter 2. Neutralize gastric secretions 3. delay gastric emptying 4. reduce secretion of digestive juices

1. This medicaiton increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids 2. Antihypertensives 3. Anticoagulants 4. Alcohol

4. This drug can cause sedation. Alcohol and other CNS depressants add to this sedation. A client taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. having a sedentary desk job 2. being 5 feet, 3 inches tall and weighing 190 lbs 3. using laxatives frequently 4. being 40 years old

2. 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.

In developing a teaching plan for the client with a hiatal hernia, the nurses assessment of which work-related factors would be most useful? 1. number and length of breaks 2. body mechanics used in lifting 3. temperature in the work area 4. Cleansing solvents used

2. Bending, especially after eating, can cause GERD. 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.

The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be the MOST accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modification, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery is performed only when these attempts fail.

Which of the following lifestyle modifications should the nurse encourage the client with hiatal hernia to include in ADLs? 1. Daily aerobic exercise 2. eliminating smoking and alcohol use 3. balancing activity and rest 4. avoiding high-stress situation

2. Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia.

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day 2. Do not lie down for 2 hours after eating 3. Follow a low-protein diet 4. Take medications with milk to decrease irritation

2. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux.

Bethanechol (Urecholine) has been prescribed for a client with GERD. The nurse should assess the client for which of the following adverse effects? 1. Constipation 2. Urinary urgency 3. Hypertension 4. Dry oral mucosa

2. This is a cholinergic drug that may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.

The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium based antacids? 1. anorexia 2. weight gain 3. diarrhea 4. constipation

3. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea.

A client who has been diagnosed with GERD has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef 2. Air-popped popcorn 3. Hot chocolate 4. Raw vegetables

3. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1. Introduce the client to other people who are successfully managing their care. 2. Include the client's daughter in the teaching so that she can help implement the plan 3. Ask the client to identify other situation in which the client changed health care habits 4. Provide reassurance that the client will be able to implement all aspects of the plan successfully.

3. self-responsibility is the key to individual health maintenance. Using examples of situation in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits.

The client with GERD has a chronic cough. This symptom may be indicative of which of the following? 1. Development of laryngeal cancer 2. Irritation of the esophagus 3. Esophageal scar tissue formation 4. Aspiration of gastric contents

4. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

A client is taking cemetidine (Tagament) to treat a hiatal herna. The nurse should evaluate the client to determine that the drug has been effective in preventing which of the following? 1. esophageal reflux 2. dysphagia 3. esophagitis 4. ulcer formation

A histamine receptor blocker 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.