GERD- Pearson questions
The nurse is assessing a child for suspected gastroesophageal reflux disease (GERD). Which symptom should the nurse consider consistent with this disease? (Select all that apply.) A. Recurrent pneumonia B. Sore throat C. Obesity D. Asthma E. Weight gain
A,B,D Rationale: Children under the age of 12 years with GERD experience different symptoms than adults. These include asthma, sore throat, and recurrent pneumonia due to reflux of acidic gastric contents. Obesity is a risk factor, not a clinical manifestation. Weight loss, not weight gain, is more common.
The nurse is providing care to a pediatric client hospitalized for the treatment of severe gastroesophageal reflux disease (GERD). For which finding should the nurse provide immediate intervention? A. Tooth erosion B. Wheezing C. Regurgitation of sour material into the mouth D. Hoarseness
B. Wheezing Rationale: Pediatric clients diagnosed with GERD will exhibit different symptoms than do adult clients. The clinical manifestation of wheezing indicates a respiratory issue that can often occur in pediatric clients with GERD. This finding requires immediate intervention by the nurse. The other clinical manifestations do not require immediate intervention.
A client with a history of gastroesophageal reflux disease (GERD) who is being treated with proton pump inhibitors (PPIs) reports increased fatigue. The healthcare provider suspects anemia. Which other symptom should the nurse assess for in the client that supports this diagnosis? (Select all that apply.) A. Esophageal stricture B. Heartburn C. Dizziness D. Regurgitation E. Abnormal heart rate
C,E Rationale: Long-term use of PPIs can cause anemia. Clinical manifestations of anemia include fatigue, dizziness, and an abnormal heart rate. Heartburn, regurgitation, and esophageal strictures are manifestations of GERD.
A client with gastroesophageal reflux disease (GERD) is prescribed a proton pump inhibitor. Which information should the nurse provide when teaching the client about this medication? A. Stimulates gastric emptying B. Temporarily reduces gastric pain C. Reduces gastric acid secretion D. Neutralizes gastric acid secretion
C. Reduces gastric acid secretion Rationale: A proton pump inhibitor (PPI) reduces gastric acid secretion by inhibiting the action of the hydrogen-potassium-ATPase pump. Antacids neutralize gastric acid and relieve pain at the site of esophageal and gastric mucosa. Metoclopramide (Reglan), a promotility agent, stimulates gastric emptying.
The nurse is developing a plan of care for a client with gastroesophageal reflux disease (GERD) who is prescribed proton pump inhibitors (PPIs). Which client outcome should the nurse identify that indicates treatment is successful? A. The client is taking medications as prescribed. B. The client agrees to undergo fundoplication surgery. C. The client reports that pain is a 0/10. D. The client eats small frequent meals.
C. The client reports that pain is a 0/10. Rationale: A positive outcome for a client being treated for GERD would be reporting no pain. Eating small frequent meals and taking medications as prescribed are signs of understanding the treatment plan. When the client undergoes fundoplication surgery, this is a sign that the treatment with PPIs was unsuccessful.
A client reports the frequent use of over-the-counter antacids over the past several months for the treatment of heartburn. For which potential health issue should the nurse monitor this client? A. Gynecomastia B. Black, tarry stools C. Mental status changes D. Hypercalcemia
D. Hypercalcemia Rational: Long-term use of over-the-counter antacids can affect the calcium and phosphorus levels. Because of this, the nurse should assess for hypercalcemia. Mental status, gynecomastia, and black, tarry stools are side effects of other medications used for treating gastroesophageal reflux disease (GERD).
Which information should the nurse provide the client with gastroesophageal reflux disease (GERD) about lifestyle changes? A. Sleeping on a flat surface B. Eating three meals per day C. Decreasing caffeine intake D. Smoking cessation
D. Smoking cessation Rationale: Lifestyle changes are frequently necessary to alleviate symptoms of GERD. These include smoking cessation, eating small frequent meals, sleeping with the head of the bed elevated, and avoiding caffeine intake.
After reviewing a client's health history, the nurse decides to assess for symptoms of gastroesophageal reflux disease (GERD). Which factor caused the nurse to make this clinical decision? (Select all that apply.) A. Smoking B. Inguinal hernia C. Asthma D. Obesity E. Heart disease
A,D Rationale: Obesity and smoking are risk factors for the development of GERD. Regurgitation from GERD can cause atypical chest pain in adults and wheezing in children, but asthma and heart disease are not causative factors. Hiatal hernias, not inguinal hernias, are risk factors for the onset of GERD.
The nurse assesses assigned clients after receiving handoff communication. For which assessment finding for a client with gastroesophageal reflux disease (GERD) should the nurse provide immediate intervention? A. A client who complains of chest pain B. A client who vomits gastric acid after an evening snack C. A client who complains of a sore throat D. A client who complains of increasing heartburn while lying down
A. A client who complains of chest pain Rationale: It is not uncommon for a client with GERD to complain of chest pain. This assessment finding, however, should not be ignored and would require the nurse to provide immediate intervention. The other assessment findings are typical of GERD and do not require immediate attention
An older adult client with gastroesophageal reflux disease (GERD) is scheduled for a Nissen fundoplication and asks the nurse to explain the procedure to family members. Which information should the nurse provide? A. "Nissen fundoplication is surgery where the stomach is wrapped around the lower esophagus and sewn together." B. "Nissen fundoplication is antireflux surgery that decreases pressure to the upper esophagus inhibiting gastric content reflux." C. "Nissen fundoplication is also recommended to reduce risks associated with esophageal cancer." D. "Nissen fundoplication is suturing, burning spots on, and creating scarring of the muscle surrounding the sphincter."
A. "Nissen fundoplication is surgery where the stomach is wrapped around the lower esophagus and sewn together." Rationale: Nissen fundoplication includes open surgery where the stomach is wrapped around the lower esophagus and the edges are sutured. The other answers do not accurately describe a Nissen fundoplication
A client with gastroesophageal reflux disease (GERD) reports difficulty sleeping due to reflux and asks how to make this better. How should the nurse respond? A. "Sleep with the head of your bed elevated." B. "Have you tried a sleeping pill before bed?" C. "Take an antacid with your PPI at bedtime." D. "Try eating a snack before going to sleep."
A. "Sleep with the head of your bed elevated." Rationale: The nurse should instruct the client to sleep with the head of the bed elevated. This decreases reflux of gastric contents into the esophagus. Having a snack before bedtime is contraindicated as it can worsen reflux. A sleeping pill will not decrease the symptoms of GERD. An antacid should not be taken at the same time as a PPI because this will decrease its effectiveness.
The nurse evaluates care provided to a client to prevent the development of gastroesophageal reflux disease (GERD). Which client action should indicate to the nurse that teaching on lifestyle changes has been effective? A. Sleeping with the head of the bed flat B. Beginning a weight-loss regimen C. Decreasing alcohol to once a day D. Taking antacids 1 hour before meals
B. Beginning a weight-loss regimen Rationale: Beginning a weight-loss program is a lifestyle change that helps prevent the development of GERD. The client should stop alcohol consumption altogether, not just decrease it. The client should sleep with the head of the bed elevated, not flat. Antacids control reflux symptoms; they do not prevent GERD from occurring.
The nurse suspects a client is experiencing gastroesophageal reflux disease (GERD). Which assessment finding should the nurse identify that supports this health problem? A. Symptoms improving when the client bends down B. Difficulty swallowing C. Diarrhea after meals D. Symptoms improving with tight clothing
B. Difficulty swallowing Rationale: Difficulty swallowing is a symptom the nurse would expect to find while assessing a client with GERD. The client would report that symptoms worsen when bending down, not improve. Tight clothing will worsen symptoms, not improve symptoms. Diarrhea occurring after meals is not a symptom associated with GERD.
A client with gastroesophageal reflux disease (GERD) experiences discomfort during sleep. Which lifestyle modification should the nurse instruct the client to implement? A. Play relaxing music. B. Elevate the head of the bed. C. Take sleeping aids. D. Take antacids daily.
B. Elevate the head of the bed. Rationale: A client with GERD should sleep with the head of the bed elevated, as it decreases reflux. Sleeping aids and relaxing music do help with sleep, but will not control the symptoms of reflux. Antacids are helpful but are not a lifestyle modification.
The nurse is teaching the client with gastroesophageal reflux disease (GERD) about following treatment and taking medications to prevent complications. Which complication should the nurse emphasize can occur due to untreated GERD? A. Hiatal hernia B. Asthma C. Esophageal stricture D. Trisomy 21
C. Esophageal stricture Rationale: Esophageal strictures can occur from repeated irritation and ulceration from GERD. Asthma, trisomy 21, and hiatal hernias are risk factors, not complications.
A client is prescribed an H2-receptor blocker to treat gastroesophageal reflux disease (GERD). Which information should the nurse provide about the action of this medication? A. Enhances esophageal clearance and gastric emptying B. Protects and heals gastric mucosa C. Reduces the amount of gastric acid production D. Stimulates upper gastrointestinal motility and gastric emptying
C. Reduces the amount of gastric acid production Rationale: H2-receptor blockers reduce gastric acid production and are prescribed twice a day. But they may be prescribed frequently for prolonged periods of time. There are several over-the-counter FDA-approved H2-receptor blockers available for treatment.
A client newly diagnosed with gastroesophageal reflux disease (GERD) asks the healthcare provider about surgical treatment. Which response should the nurse make to this client? A. "Why do you want to put yourself through surgery when there are other treatments?" B. "We need to determine if your health insurance will cover the procedure." C. "Surgery is performed after other modalities are tried and are unsuccessful." D. "You can discuss this with the healthcare provider at your next visit."
C. "Surgery is performed after other modalities are tried and are unsuccessful." Rationale: Surgery is usually a treatment that is performed when lifestyle changes and medications are unsuccessful. It is not the first line of treatment. The nurse can inform the client to discuss this at the next healthcare provider visit, but this does not answer the client's question. Insurance coverage is not an issue with a new diagnosis of GERD. Asking a "why" question to the client is not therapeutic communication and is condescending, and therefore inappropriate.
A client with gastroesophageal reflux disease (GERD) is trying to conceive. Which medication prescription should the nurse question? A. Metoclopramide B. Famotidine C. Aluminum hydroxide D. Omeprazole
D. Omeprazole Rationale: The proton pump inhibitor omeprazole is contraindicated during pregnancy due to risk of fetal harm. Famotidine, metoclopramide, and aluminum hydroxide are safe during pregnancy.
Which collaborative intervention should the nurse expect to implement to help control the symptoms of gastroesophageal reflux disease (GERD)? A. Upper endoscopy B. Bernstein test C. 24-hour ambulatory pH monitoring D. Proton pump inhibitors (PPIs)
D. Proton pump inhibitors (PPIs) Rationale: The nurse would expect the healthcare provider to prescribe PPIs to control the symptoms of GERD. The Bernstein test, upper endoscopy, and 24-hour ambulatory pH monitoring are tests used to diagnose GERD.
A client with gastroesophageal reflux disease (GERD) is prescribed a test that introduces electrodes into the esophagus. For which diagnostic test should the nurse prepare teaching for this client? A. Bernstein test B. Barium swallow C. Upper endoscopy D. pH monitoring
D. pH monitoring Rationale: The diagnostic test that involves the insertion of a pH electrode into the esophagus is the 24-hour ambulatory pH monitoring test. The Bernstein test involves the instillation of acid and saline to determine the presence of reflux. A barium swallow and upper endoscopy involve the visualization of the esophagus and the stomach.
