Med-Surg Chapters 56,57, & 58 GI

The nurse is caring for a client who has received multiple serious injuries in a motor vehicle accident. The client asks the nurse why ranitidine (Zantac) is prescribed because she does not have any abdominal pain. Which is the nurse's best response? a. "It will help prevent the development of a stomach ulcer from the stress of your injuries." b. "It will help prevent aspiration pneumonia when you are anesthetized during surgery tomorrow." c. "It will help your throat heal after it was irritated from the nasogastric tube." d. "It will help prevent nausea and vomiting from the narcotic pain medications that you are taking."

A Clients who have sustained traumatic injuries are at risk for development of stress ulcers during recovery. H2-antagonist medications may be prescribed to prevent stress ulcers. Zantac will not prevent aspiration pneumonia, esophageal healing after nasogastric intubation, or nausea from narcotic pain medications.

A client is admitted with progressive dysphagia. What intervention by the nurse takes priority? a. Weigh the client daily. b. Instruct the client on a high-protein diet. c. Assess and treat the client's pain. d. Administer antitussive medications.

A Clients with progressive dysphagia can lose weight as a result of their inability to take adequate nutrition. Weighing the client daily is an important intervention to gauge the effectiveness of interventions designed to meet nutritional needs. Increased protein in the diet is important, but if the client has trouble swallowing, this is not the best option. The other two interventions do not relate to dysphagia.

An older client is admitted to the hospital with acute gastritis. The health care provider orders magnesium hydroxide (Mylanta) 1 hour and 3 hours after meals and at bedtime. Which action by the nurse is most appropriate? a. Check the client's renal function studies before giving the drug. b. Call the health care provider and ask for a different antacid for the client. c. Assess the client's pain and treat pain if present. d. Assist the client in ordering bland food from the menu.

A Hypermagnesemia can develop if the client's kidneys are not functioning well because Mylanta contains magnesium, which is excreted via the kidneys. Kidney function declines as a normal age-related change, so the nurse should be cautious to check kidney function before administering this medication. The client may be able to take the medication; without further information, the nurse should not yet call the provider. Assessing and treating pain and helping the client choose appropriate foods are good interventions, but they are not specific to ensuring safety regarding the medication ordered.

A client is admitted with a chemical injury to the esophagus after ingestion of an alkaline substance. The client states, "I am having trouble breathing because of these air bubbles in my neck." Which action by the nurse is most appropriate? a. Continue assessing the client while another nurse calls the health care provider. b. Ask the client to rate the pain and prepare to administer pain medication. c. Have the client cough and deep breathe, then assess his or her lung sounds. d. Give the client small sips of water to see whether he or she has dysphagia.

A Ingestion of alkaline substances is dangerous because of their potential to fully penetrate the esophagus, leading to perforation. "Air bubbles" in the neck (subcutaneous emphysema) would lead the nurse to suspect this complication. The nurse needs to continue assessing the client and must stay with him or her, but because this is an emergency, someone else must notify the provider immediately. The nurse should not administer pain medication at this time. Coughing and deep-breathing exercises will not be beneficial to the client. If the client's esophagus has perforated, having the client drink can cause more problems.

The nurse is teaching a health promotion class about preventing cancer. Which statement by a student indicates understanding of gastric cancer development? a. "I should skip my morning bacon and egg sandwich to reduce my risk of gastric cancer." b. "I have been lactose intolerant for many years, so I should have a yearly test for gastric cancer." c. "I should switch from regular to decaffeinated coffee to reduce my risk of gastric cancer." d. "I am at low risk for developing gastric cancer because I am a vegetarian and I eat only organic produce."

A Regular consumption of processed foods with nitrates (including bacon) can increase risk for gastric cancer. Lactose intolerance, coffee intake, and vegetarian diet are not factors in gastric cancer development.

The nurse is caring for a client with chronic gastritis. The client asks the nurse how to prevent another flare-up of gastritis. Which is the nurse's best response? a. "Join a support group to help you stop smoking." b. "Take a multivitamin with iron and folic acid every day." c. "Make sure to include plenty of fresh vegetables in your diet." d. "Make sure that your weight stays within normal limits."

A Smoking and stress contribute to the development of gastritis, so the client should join a support group to help him quit smoking. Multivitamins, fiber, and weight management do not help prevent gastritis development.

What does the nurse teach the client with esophageal diverticula about dietary needs? a. "Eat soft foods and smaller meals." b. "Only eat puréed foods." c. "Avoid drinking liquids with meals." d. "Avoid dairy products."

A Soft foods and smaller meals assist in reducing the symptoms of pressure and reflux that accompany diverticula. The client does not have to avoid liquids or dairy products because these do not cause symptoms. The client does not have to eat puréed foods because he or she does not have difficulty swallowing or chewing foods.

The home care nurse is caring for a client who has recently undergone a subtotal gastrectomy. The nurse notes that the client's tongue is shiny and beefy red. Which assessment question does the nurse ask the client regarding this finding? a. "Have you been taking your multivitamin every day?" b. "How much weight have you lost since your surgery?" c. "Have you been experiencing heartburn or nausea after eating?" d. "What kind of mouthwash do you use after you brush your teeth?"

A Symptoms of atrophic glossitis are caused by a decrease in vitamin B12, which results from lack of intrinsic factor secondary to surgical resection of a portion of the stomach. The nurse should check to see whether the client has been taking the prescribed multivitamin every day. The other questions will not help the nurse discover the cause of this finding.

The nurse is caring for a client who has just completed treatment for basal cell carcinoma on the lower lip. The client says to the nurse, "Cigarettes are ruining my life. I'll do anything to quit smoking." Which is the nurse's best response? a. "Here is some information about smoking cessation programs in the area. Let's discuss the options." b. "Here are some pamphlets that show the financial benefits of quitting smoking." c. "If you quit smoking, your risk for developing cancer again will decrease dramatically." d. "Your chest x-ray is still clear, so you could prevent permanent lung damage if you quit smoking now."

A The client has indicated a readiness to quit smoking; therefore, the nurse should help the client choose the best course of action by taking time to discuss the options. The other responses provide good rationales for why quitting smoking would be a positive outcome, but no help is being offered in preparing a plan to quit.

The nurse is teaching a client about self-management of gastroesophageal reflux. Which statement by the nurse is most appropriate? a. "Eat four to six small meals each day." b. "Eat a small evening snack 1 to 2 hours before bed." c. "No specific foods or spices need to be cut from your diet." d. "You may include orange or tomato juice with your breakfast."

A The client is instructed to eat four to six small meals daily rather than three larger meals to avoid pressure in the stomach and delayed gastric emptying, which can increase reflux. Evening snacks and acidic foods also should be avoided. The client should keep a diary to assess for foods or spices that increase symptoms, and those items need to be avoided.

A client just experienced an episode of reflux with regurgitation. What assessment by the nurse is the priority? a. Auscultate the lungs for crackles. b. Inspect the oral cavity. c. Check the oxygen saturation. d. Teach the client to sleep sitting up.

A The client with regurgitation is at risk for aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles—an indication of aspiration. If abnormalities are found, the nurse can then check the oxygen saturation. The nurse should teach the client to sleep with the head of the bed elevated, however; this is not a priority action. Inspecting the oral cavity probably is not needed.

The nurse is caring for a client who recently has undergone a partial gastrectomy. Two hours after eating lunch, the client becomes dizzy, diaphoretic, and confused. Which is the nurse's priority action? a. Check the client's blood sugar level. b. Increase the client's IV infusion rate. c. Auscultate the client's bowel sounds. d. Place the client in high Fowler's position.

A The client's symptoms are consistent with late dumping syndrome, in which hypoglycemia is caused by increased insulin levels. The client's blood sugar level should be checked immediately. The other actions are not necessary.

A client has been diagnosed with early esophageal cancer. The nurse plans care by implementing measures designed to address which priority concern? a. Nutritional support b. Pulmonary toileting c. Fluid and electrolyte balance d. Educational needs

A The major concern for a client with esophageal cancer is weight loss secondary to dysphasia. Therefore, nutritional support is required, with intake monitored and weight maintained. The other concerns are important, but they are not the priority.

The nurse is caring for a client who just had a radical jaw and neck resection. The nurse is developing a teaching plan for the client and spouse about care after discharge from the hospital. Which is an effective teaching objective for this client and spouse? a. The client's spouse will be able to change the client's tracheostomy ties correctly after three teaching sessions. b. The client and spouse will verbalize the signs of readiness for oral feedings following placement of the tracheostomy. c. The client's spouse will correctly administer the client's tube feedings twice daily. d. The client and spouse will understand incision care and the importance of infection prevention.

A The objective is action oriented, specific, achievable, and measurable. The other responses are not as clear and measurable.

The nurse is caring for a client with suspected upper GI bleeding. The nurse inserts a nasogastric (NG) tube for gastric lavage and checks placement of the tube in the stomach. When fluid is aspirated from the tube, the pH is found to be 6. Which is the priority action of the nurse? a. Obtain an order for a stat chest x-ray. b. Auscultate over the lung fields bilaterally. c. Assess whether the tube is coiled in the client's throat. d. Auscultate over the epigastric area while instilling air.

A The pH of gastric contents should be below 3.5. A stat chest x-ray should be obtained whenever any doubt arises regarding NG tube placement. The other methods are not appropriate for confirming placement.

The nurse is caring for a client who has just undergone a partial glossectomy and partial mandibulectomy for oral cancer. Which is the highest priority for this client? a. Maintenance of the airway b. Ability to communicate c. Adequate body image d. Pain management

A The priority problem for a client with oral cancer surgery is possible ineffective airway clearance. Airway obstruction can result from the presence of edema or secretions and could be life threatening. Communication is another problem postoperatively because of the tracheostomy tube, but a communication process should be established preoperatively. Emotional support should be given to help the client adjust to the new body image, and pain management should be maintained with IV medications.

Which interventions can the nurse delegate to unlicensed personnel when caring for a client with esophageal cancer? (Select all that apply.) a. Maintaining intake and output b. Maintaining calorie count c. Administering tube feeding d. Obtaining vital signs e. Teaching changes in daily activities f. Changing the incision dressing

A, B, D

The nurse is caring for a client with stomatitis. Which items reported during the history of the client may contribute to the reoccurrence of this condition? (Select all that apply.) a. Drinking two glasses of wine nightly b. Smoking three cigarettes each day c. Vitamin A deficiency d. Drinking four cups of coffee daily e. Fruits and nuts as the mainstay of the diet f. Vitamin C deficiency

A, B, D, E

The nurse is obtaining the history of a client with a sliding hernia. Which symptoms does the nurse expect to see in this client? (Select all that apply.) a. Reflux b. Bleeding c. Dysphagia d. Belching e. Breathlessness f. Vomiting

A, C, D

The nurse is caring for a client who will undergo a gastrectomy the following day. Which interventions are included in the postoperative plan of care for the client? (Select all that apply.) a. Monitor and record accurate intake and output (I&O). b. Remind the client to use the incentive spirometer twice daily. c. Change abdominal dressings daily using medical asepsis. d. Remind the client daily to use patient-controlled analgesia (PCA) before pain becomes severe. e. Keep the head of the client's bed elevated whenever possible. f. Irrigate the nasogastric tube with normal saline every 8 hours PRN.

A, D, E

The nurse is caring for a client with peptic ulcer disease. Which assessment finding indicates to the nurse that the client most likely has an ulcer in the stomach rather than in the duodenum? a. Body mass index (BMI) is 16.6. b. Stool is positive for occult blood. c. Client has had four ulcers in the last 5 years. d. Hemoglobin is 13 g/dL and hematocrit is 42%.

A A BMI of 17.6 indicates that the client is underweight (<18.5 is underweight in adults). This finding is more commonly seen with gastric ulcers than with duodenal ulcers because the pain is made worse with food ingestion. Occult blood and low hemoglobin and hematocrit levels may be seen with both gastric and duodenal ulcers. Recurrence is more commonly seen with duodenal than with gastric ulcers.

The nurse is caring for a client who has been brought to the emergency department with upper GI bleeding. The client is vomiting copious amounts of bright red blood. Which is the nurse's priority action? a. Ensure that the client has a patent airway. b. Start a normal saline IV infusion. c. Gather equipment to start a saline lavage. d. Assess the client for causative factors.

A Airway always comes first. The client must have a patent airway. The client does need an IV and a saline lavage via nasogastric (NG) tube, but these actions are not as important as maintaining the airway. Assessing for causative factors will be important after the client has stabilized.

A client has been taking an antacid for several weeks without improvement in symptoms. Which response by the nurse is most helpful? a. "Tell me exactly how you take your antacid." b. "Would you be willing to try a more expensive medication?" c. "Are you sure you are taking this exactly as ordered?" d. "Let's ask the health care provider if the dose can be doubled."

A Antacids can be effective anywhere from 30 minutes to 3 hours after eating. Their neutralizing effect is eliminated when they are taken on an empty stomach. However some people take them before eating to prevent symptoms. The nurse should first discover how the client takes the medication before suggesting other medications or increasing the dose. Asking the client whether the medication is being taken exactly as ordered is a closed-ended question, which is not a good communication tool. Also, the way the statement is phrased is likely to place the client on the defensive.

An older client is 1 day post-esophagectomy. The nurse finds the client short of breath with a heart rate of 120 beats/min. Which action by the nurse takes priority? a. Assess the client's lungs and oxygen saturation. b. Ask the client to rate pain, and treat if needed. c. Help the client change to a side-lying position. d. Increase the client's supplemental oxygen.

A Clients can have many complications from this operation, and older clients are especially vulnerable to fluid overload. The nurse should first assess lung sounds and oxygen saturation. Although pain can cause tachycardia, it usually does not cause shortness of breath. If the client has pain, it should be treated, but it is not the priority. The nurse needs to know the client's oxygen saturation before turning up the oxygen. Changing the client's position will not help.

The nurse is caring for a client who has just arrived in the emergency department reporting epigastric pain. The client says that emesis earlier in the day looked like coffee grounds. What does the nurse prepare to do for the client first? a. Check the client's stool for occult blood. b. Insert 18-gauge IV lines with normal saline infusions. c. Insert a nasogastric tube and prepare for gastric lavage. d. Determine whether the client has a history of ulcers.

B "Coffee ground" emesis is indicative of bleeding in which the blood has been partially digested by gastric acid. This client is at risk for hemorrhage and severe volume depletion and requires two large-bore IVs immediately. The client next will most likely need a saline lavage. Checking the stool and obtaining a history can be done later when the client is stable.

A client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care unit with a nasogastric tube draining dark brown fluid. Which is the nurse's priority action? a. Assess the placement of the tube. b. Document the finding and continue to monitor. c. Clamp the nasogastric tube for 30 minutes. d. Irrigate the nasogastric tube with normal saline.

B After fundoplication, drainage from the nasogastric tube is initially dark brown with old blood. This finding is expected and requires only documentation. The drainage should become yellow-green within 8 hours after surgery.

A client with Zollinger-Ellison syndrome will be admitted to the medical unit. Which intervention does the nurse include in the client's nursing plan of care? a. Performing a urine test for ketones every morning before breakfast b. Performing perineal care and applying a moisture barrier twice daily c. Assessing the abdomen for fluid wave and shifting dullness every 8 hours d. Keeping 2 units of packed red blood cells on hold at all times

B Clients with Zollinger-Ellison syndrome often experience severe diarrhea and steatorrhea, so the nurse should include careful perineal care in the plan of care. Abdominal fluid wave testing and shifting dullness checks for ascites, which is not seen with Zollinger-Ellison syndrome. Ketones are not associated with this condition either. Blood transfusions are not part of the typical management plan for clients with Zollinger-Ellison syndrome, and blood would not be kept on hand unless the client was bleeding.

Which statement indicates that the client understands the management of his or her sliding hiatal hernia? a. "I will lie flat for 30 minutes after each meal." b. "I will remain upright for several hours after each meal." c. "I will have my blood count done in 2 weeks to check for anemia." d. "I will sleep at night while lying on my left side to prevent reflux."

B Clients with hiatal hernia experience gastroesophageal reflux disease (GERD). Positioning is an important intervention. The client should be taught to sleep with the head of the bed elevated, to remain upright after meals for 2 to 3 hours, and to avoid straining or restrictive clothing. The other actions are not consistent with managing a sliding hiatal hernia.

The nurse is caring for a client with stomatitis. Which statement does the nurse include in teaching about oral care for this client? a. "Rinse your mouth out twice a day with mouthwash." b. "Clean your mouth frequently during the day with a gentle foam sponge." c. "Use lemon-glycerin swabs to clean your mouth after meals and at bedtime." d. "Suck on ice cubes to minimize the discomfort."

B During painful, acute episodes of stomatitis, gentle mouth care using a gauze sponge dipped in warm normal saline or normal saline plus sodium bicarbonate is most appropriate. Commercial mouthwashes containing alcohol, acidic foods such as lemon-glycerin swabs, and techniques that may cause bleeding such as sucking on ice cubes should be avoided.

The nurse is caring for a client who presents with chronic epigastric pain, heartburn, and anorexia. The client asks the nurse how the doctor can best determine whether the symptoms are caused by gastritis. Which is the nurse's best response? a. "You will be asked to drink a barium solution while x-rays are taken of your stomach." b. "The doctor will take a look inside your stomach using a tube with a light on the end of it." c. "A CT scan of your abdomen will show whether inflammation is present in your stomach." d. "A blood sample will be sent to the laboratory to determine whether you have a stomach infection or bleeding."

B Endoscopy (esophagogastroduodenoscopy) with biopsy is the best method for diagnosing gastritis. Computed tomography (CT) scans, upper GI series, and blood samples are less accurate for making the diagnosis of gastritis.

An obese client has reflux and asks how being overweight could cause this condition. Which response by the nurse is best? a. "You eat more food, more often, than nonobese people do." b. "The weight adds extra pressure, which helps push stomach contents up." c. "Obese people tend to eat more high-fat food, which presents a risk." d. "Obesity is not related to reflux, but losing weight would be healthy."

B Esophageal reflux can occur when intra-abdominal pressure is elevated, or when the sphincter tone of the lower esophageal sphincter (LES) is decreased. Obesity can increase intra-abdominal pressure. The other statements are not accurate explanations of the connection between obesity and reflux.

A client with esophageal cancer is receiving radiation therapy. Which finding alerts the nurse to a possible complication in this client? a. Redness of the skin at the site of radiation b. Worsening of dysphagia or odynophagia c. Development of nausea or vomiting d. A profound feeling of tiredness

B Esophageal stricture is a complication of radiation therapy to the esophagus. This would manifest with worsening dysphagia or odynophagia. Redness is an expected result. Nausea and vomiting are common side effects, as is profound fatigue.

A client has Barrett's esophagus. Which client assessment by the nurse requires consultation with the health care provider? a. Sleeping with the head of the bed elevated b. Coughing when eating or drinking c. Wanting to eat several small meals during the day d. Chewing antacid tablets frequently during the day

B In Barrett's esophagus (a complication of gastroesophageal reflux disease [GERD]), fibrosis and scarring that accompany the healing process can cause esophageal stricture, leading to difficulty in swallowing. This can be manifested by coughing when the client eats or drinks and requires consultation with the health care team. The other assessments are typical of clients trying to control their GERD.

The nurse is caring for a client who has just undergone surgery for oral cancer. What advice does the nurse give the client to assist in maintaining the airway? a. "Limit your fluids to 3 cups of water a day." b. "Take deep breaths, hold, then cough to mobilize any secretions." c. "Lying flat in bed will be more comfortable for breathing." d. "Usually suctioning is not needed after oral surgery."

B Maintaining an airway after oral surgery is a priority. The client must be taught to deep breathe and mobilize the secretions by coughing effectively. The other responses are incorrect. Fluids should be increased, a semi-Fowler's or high Fowler's position should be maintained, and the client should be taught how to suction the oral cavity.

The nurse is caring for a client who will be undergoing a radical jaw and throat resection for oral cancer. Which statement by the client indicates that further teaching is needed? a. "I will have a temporary tracheostomy placed in my neck to help me breathe." b. "I will not be able to get out of bed for 3 days after surgery." c. "The doctor will put in a feeding tube for nutrition until I can swallow and eat." d. "My speech may be slurred for a long time after the surgery."

B Mobility should not be extensively limited. The client should not be on bedrest for 3 days. A temporary tracheostomy will be inserted to maintain a patent airway postoperatively. A nasogastric tube may be needed until oral nutrition can begin. Slurred speech is a common outcome if extensive resection has taken place and nerve damage has occurred.

A client with severe gastroesophageal reflux disease (GERD) is still having symptoms of reflux despite taking omeprazole, (Prilosec) 20 mg daily. What does the nurse do next? a. Document the finding in the client's chart. b. Obtain an order for omeprazole twice daily. c. Instruct the client to double the daily dose. d. Tell the client to take antacids with omeprazole.

B Omeprazole is a proton pump inhibitor that acts to reduce gastric acid secretion. If once-daily dosing fails to control the client's symptoms, the nurse should obtain an order for the client to take omeprazole twice daily for better symptom control. This finding should be documented, but the nurse should do more than merely record the client's symptoms. Doubling the daily dose and adding antacids will not be as effective as obtaining an order for twice-a-day dosing.

A client had an open fundoplication 2 days ago. Which assessment by the nurse indicates that an important National Patient Safety Goal is being met for this client? a. The client uses the spirometer during the shift. b. The client's pain is monitored and treated. c. The client has vital signs taken routinely. d. The client verbalizes understanding of the discharge teaching.

B Pain must be monitored and aggressively treated after an open fundoplication because the high incision makes breathing very painful. If the client does not participate in deep-breathing exercises and will not use the spirometer, the chance of respiratory complications is quite high. National Patient Safety Goals include goals selected to reduce/prevent health care-related infection. Using the spirometer will help prevent pneumonia and atelectasis, but the client must use it hourly. Taking vital signs may help the nurse notice an infection but will not prevent the infection. Understanding discharge teaching is important, but preventing respiratory complications takes priority.

The nurse is caring for a client with advanced gastric cancer who is scheduled for palliative surgery to relieve gastric outlet obstruction. The client asks the nurse why he should bother having the surgery, because he will not be cured. Which is the nurse's best response? a. "It will allow the doctors to determine more accurately how long you have to live." b. "It will relieve the obstruction so you will be more comfortable and able to eat again." c. "It will remove much of the tumor so that chemotherapy will be more effective." d. "It will help prevent the tumor from spreading to other parts of your body."

B Palliative surgery will relieve the gastric outlet obstruction and allow the client to eat again, thus improving quality of life. The surgery will not provide physicians with an accurate prognosis, make chemotherapy more effective, or prevent metastasis.

A client has returned to the nursing unit after a sliding hernia repair. Which action by the nurse is most important in preventing complications? a. Range of motion to the lower extremities b. Elevating the head of the bed to 30 degrees c. Monitoring input and output d. Assessing for bowel sounds

B Prevention of respiratory complications is the primary focus of postoperative care. The high incision makes taking deep breaths extremely painful for this client. By elevating the head of the bed to at least 30 degrees, the nurse promotes lung expansion in the client. The other activities are important too but do not take priority over preventing respiratory complications.

The nurse is caring for a client with a history of heart failure and chronic gastritis. The client tells the nurse about taking 2 teaspoons of sodium bicarbonate every night before going to bed to prevent heartburn. Which is the nurse's best response? a. "You should let the doctor know right away if you develop diarrhea." b. "I will let your doctor know so a safer antacid can be prescribed for you." c. "Do not take that with milk, because the combination can cause kidney stones." d. "Make sure that you mix the sodium bicarbonate with at least 8 ounces of water."

B Sodium bicarbonate can cause fluid retention and edema, which can be dangerous for clients with heart failure. The provider should be notified so that an alternative antacid can be prescribed. The other statements do not reflect an accurate concern with sodium bicarbonate.

The nurse is caring for a client with a gastric ulcer who suddenly develops sharp mid-epigastric pain. The nurse notes that the client's abdomen is hard and very tender to light palpation. Which is the priority action of the nurse? a. Place the client in a knee-chest position. b. Prepare the client for emergency surgery. c. Insert a nasogastric (NG) tube to low intermittent suction. d. Assess the client's pain and administer analgesics.

B Sudden, sharp mid-epigastric pain is indicative of perforation, which is a surgical emergency. Pain medication should not be administered just now because the surgeon will need to assess the client's abdomen, and the client will need to sign an operative permit. The client may assume the knee-chest position in an attempt to relieve pain. The provider may order placement of an NG tube, but this would not take priority over getting the client ready for surgery.

The nurse is caring for a client who has just received a diagnosis of advanced oral cancer and has learned that a glossectomy with jaw resection will have to be scheduled. The client states to the nurse, "I would rather die than have half of my face removed. My life is over." Which is the best description of the client's response to the diagnosis? a. Refusal of any more treatment b. Grief over the diagnosis c. Acceptance of the diagnosis d. Denial about the diagnosis

B The client is grieving the loss of his health and present appearance. Because the client has just learned of the diagnosis and treatment, the client is reacting in a negative way. This behavior demonstrates grief, not necessarily refusal of treatment, nor denial or acceptance of the diagnosis.

The nurse is in the room of a client who is sleeping in bed. The client experiences an episode of reflux with regurgitation. Which action does the nurse take first? a. Have the client roll to the side. b. Raise the head of the client's bed. c. Auscultate the client's lung sounds. d. Call the Rapid Response Team.

B The immediate danger for this client is aspiration. The nurse first should raise the head of the bed to reduce this risk. Asking the client to roll to the side will take too much time. The nurse can auscultate the client's lungs after raising the head of the bed. Calling the Rapid Response Team may or may not be necessary but would be done after the client is in a safer position.

The spouse of a client has just completed tracheostomy care for the first time, with minimal assistance from the nurse. Which statement offers the most constructive feedback from the nurse? a. "I see that you had a tough time, but you will do better with practice." b. "You were able to clean the inner cannula well. Now, let's change the ties again." c. "You seem to have had a tough time because it was your first attempt." d. "You seem to understand what I said. Is there anything else I can help you with?"

B The statement that provides the most positive feedback concerns what the client's spouse did well and identifies a skill that needs more practice. The other responses by the nurse give negative overtones to the teaching environment and do not empower the spouse.

The nurse is assessing a client with a salivary gland tumor for facial nerve involvement. Which movements does the nurse ask the client to perform? (Select all that apply.) a. Open the mouth wide. b. Raise the eyebrows. c. Smile or frown. d. Pucker the lips. e. Blow the nose. f. Puff out the cheeks.

B, C, D, F

The nurse is performing oral health screenings at a local community center. Which clients are at higher risk for developing oral cancer? (Select all that apply.) a. Female who has taken oral contraceptives for the last 4 years b. Adult client with a history of alcoholism c. Adult client who regularly eats spicy foods d. Middle-aged male who smokes a pipe e. Adult client who goes to a tanning salon weekly f. Client who frequently chews gum

B, D, E

Which referrals does the nurse make for an older adult client who is being discharged with esophageal cancer? (Select all that apply.) a. IV infusionist b. Home health aide c. Medicare or Medicaid d. Meals on Wheels e. Housecleaning service f. Transportation to and from treatment

B, D, F

The nurse is caring for a client with a nasogastric (NG) tube after an episode of GI bleeding. Which interventions are included in the nursing care plan? (Select all that apply.) a. Monitor and record intake and output every 8 hours. b. Monitor hemoglobin and hematocrit laboratory values. c. Ensure that suction is set on high continuous for Levin tubes. d. Measure the client's girth and/or assess for distention daily. e. Pin the tube to the client's gown, so it cannot be dislodged. f. Check vital signs and orthostatic blood pressure every 4 hours and PRN.

B, E, F

Which symptom indicates a need for immediate intervention in a client with a rolling hernia? a. Reflux b. Crackles in the lungs c. Distended and firm abdomen d. Two episodes of diarrhea

C A rolling hernia causes the fundus and portions of the stomach's greater curvature to roll into the thorax next to the esophagus, predisposing the client to volvulus, obstruction, and strangulation. A firm, distended abdomen may indicate a bowel obstruction. This is a serious situation and the provider must be notified immediately. Crackles and diarrhea also warrant intervention, but not as a priority. Reports of reflux would be the lowest-level priority.

A client has esophageal cancer. Which intervention by the nurse takes priority? a. Maintaining nutritional intake b. Allowing grieving c. Preventing aspiration d. Managing pain relief

C Although nutrition and pain are both high on the list of priorities, prevention of aspiration is the highest. When a client aspirates, his or her respiratory system is compromised, thereby causing further deterioration, which increases nutritional needs. Grieving, although also important, does not take priority over physical needs and safety.

The nurse is caring for a female client who has just undergone excision of a parotid gland tumor. The client tells the nurse that she is experiencing facial weakness on the operative side. Which is the nurse's best response? a. "You may be experiencing a slight stroke, and I will notify the doctor." b. "This is a temporary condition that will resolve once radiation treatment is begun." c. "You are experiencing weakness because the facial nerve was irritated during the surgery." d. "You probably have a pinched nerve after lying on the operating room table for so long."

C Cranial nerve V involvement is a possible outcome of this type of surgery. The client presents with facial weakness and possibly with loss of sensation to the affected side. The other choices regarding facial weakness following this type of surgery are not accurate.

The nurse is caring for a client who has undergone a radical jaw and neck resection. The client tells the nurse that the area feels very swollen and painful. Which is the best intervention for the nurse to make this client more comfortable? a. Frequently suction the client's mouth and airway. b. Apply warm moist compresses to the area. c. Elevate the head of the client's bed to semi-Fowler's. d. Administer ibuprofen (Motrin) 600 mg every 6 hours around the clock.

C Elevating the head of the bed will help to reduce edema by using gravity. Ibuprofen can affect blood clotting, leading to bleeding from the incisions. Intravenous morphine is a better choice than ibuprofen. Suctioning should be completed only when necessary because this will be uncomfortable. Moist compresses are used with salivary gland inflammation, not with postoperative radical jaw and neck resection.

The nurse is caring for a client who will be discharged from the hospital following surgery for advanced gastric cancer. The client's daughter verbalizes the fear that she will not be able to manage her parent's symptoms adequately at home. Which is the nurse's best response? a. "The nurses have taught you everything you need to know to care for your parent." b. "Don't worry, the pain pills will keep your parent comfortable until the end." c. "I will ask the social worker to arrange for a hospice nurse to help you at home." d. "I will ask the health care provider to review the care instructions with you again."

C Hospice nurses can assist family members with caring for clients who are terminally ill. The nurse should not belittle the daughter's concerns, nor should she ask the provider to review the discharge instructions again. The hospice nurse can provide not only physical care, but support for the family as they care for a loved one at home.

Which factor places a client at risk for esophageal cancer? a. High-stress occupation b. Preference for high-fat foods c. 20-pack-year smoking history d. History of myocardial infarction

C In the United States, the two most important factors for the development of esophageal cancer are tobacco use and alcohol ingestion. The other factors do not increase the risk for developing esophageal cancer.

The nurse is leading a teaching session about methods to decrease the risk of mouth cancer. Which client statement indicates that the nurse was successful in teaching the information? a. "I will chew tobacco rather than smoke it." b. "I will use sugar rather than artificial sweeteners." c. "I will regularly use a lip balm that contains sunscreen." d. "I will use a tanning salon rather than sunbathing at the beach."

C Lip balms that contain sunscreen can help prevent the development of oral cancer. The rest of the client choices can promote cancer, such as chewing tobacco and tanning. Using sugar rather than artificial sweeteners is not applicable to the risk of mouth cancer.

The nurse is caring for a client who will be going home after a radical jaw and neck resection. The client's spouse will be the primary caregiver at home and will need to care for the client's feeding tube and tracheostomy. Which skill is the highest priority for the nurse to teach the client's spouse before discharge from the hospital? a. Monitoring the incision lines for infection or leakage of saliva b. Assessing the client for readiness to resume oral feedings c. Cleaning the tracheostomy and suctioning as needed d. Administering tube feedings and cleaning the feeding tube site

C Maintaining a patent airway is the highest priority for this client and spouse. The other responses are next in importance because they reflect needed knowledge regarding infection control and knowledge of proper technique for nutritional support of the client.

The nurse is caring for a female client who has just received a prescription for misoprostol (Cytotec). Which instructions does the nurse provide to the client regarding this medication? a. "You may dissolve the contents of the capsule in warm water if it is difficult for you to swallow." b. "Take this medication on an empty stomach just before going to bed every evening." c. "You will need to stop taking your magnesium hydroxide (Mylanta) now that you are on this drug." d. "You should add extra fiber to your diet because this medication may cause constipation."

C Misoprostol is a prostaglandin analogue. Clients on this medication need to avoid magnesium-containing antacids; Mylanta contains magnesium. Clients should not dissolve the pill, should take misoprostol with food, and do not need to take precautions against constipation while on this drug.

A client is admitted to the cardiac monitoring unit for a suspected myocardial infarction. The client reports long-standing nighttime reflux, and the health care provider orders nizatidine (Axid) 150 mg twice a day. Which action by the nurse is most appropriate? a. Consult with the health care provider because the dose is too high. b. Check the client's kidney function tests before administering the drug. c. Ask the pharmacist to recommend another histamine receptor agonist. d. Give the medication as ordered and monitor for effectiveness.

C Nizatidine, a histamine receptor agonist, can cause dysrhythmias. Because the client has a heart condition that may cause rhythm problems, the nurse should consult with the pharmacist for another drug in the same class to recommend to the provider. The dose is appropriate. Kidney function does not need to be monitored while on this drug. The nurse should monitor all drugs given for effectiveness, but this drug should not be given as prescribed

A client with esophageal reflux who experiences regurgitation while lying flat is at risk for which complication? a. Erosion b. Bleeding c. Aspiration d. Odynophagia

C Regurgitation of stomach contents while the client is recumbent poses a risk of aspiration for the client.

The nurse is caring for a client with peptic ulcer disease. The client vomits a large amount of undigested food after breakfast. Which intervention does the nurse prepare to provide for the client? a. Administer a soap suds cleansing enema. b. Change the client's diet to clear liquids only. c. Insert a nasogastric (NG) tube to low intermittent suction. d. Administer prochlorperazine (Compazine) 10 mg IM.

C Symptoms of abdominal distention and nausea and vomiting of undigested food signal pyloric obstruction. Treatment is aimed at decompression of the stomach by an NG tube and restoration of fluid and electrolyte balance. The client should remain NPO, and a soap suds cleansing enema is not indicated. Decompressing the stomach should alleviate the nausea, but if antiemetics are ordered, they would not take priority over decompressing the stomach.

A client who has undergone an open fundoplication hernia repair is preparing for discharge. Which information is most important for the nurse to include in discharge instructions? a. "You can take laxatives for constipation." b. "Eat three normal-sized meals daily." c. "Notify your health care provider if you get a cough." d. "You can go back to work in about a week."

C The client is instructed to report cold or flu-like symptoms because persistent coughing associated with these conditions can cause dehiscence of the incision in the early postoperative stage. Constipation can be caused by narcotic medications, but the client should be instructed to use fiber, water, and stool softeners first before using laxatives. The client must continue eating six small meals a day. After the open procedure, activity restrictions continue for up to 6 weeks.

A client is undergoing diagnostic testing for gastroesophageal reflux disease (GERD). Which test does the nurse tell the client is best for diagnosing this condition? a. Endoscopy b. Schilling test c. 24-Hour ambulatory pH monitoring d. Stool testing for occult blood

C The most accurate method of diagnosing gastroesophageal reflux disease is 24-hour ambulatory pH monitoring.

The nurse is to insert a nasogastric (NG) tube for a client with upper GI bleeding. Which instruction does the nurse give to the client before starting the procedure? a. "You may take some sips of water when I begin to insert the tube into your nose." b. "Please hold your breath when I insert the tube through your nose." c. "Tilt your head down to your chest when the tube gets to the back of your throat." d. "The distance from the end of your nose to your navel tells me which size tube to use."

C Tilting the head down toward the chest after the NG tube has reached the back of the throat will facilitate intubation of the esophagus rather than the trachea. The client should be encouraged to mouth-breathe and swallow during the procedure. The tube should be measured from the nose to the earlobe to the xiphoid process. Sips of water should be encouraged once the tube is at the back of the throat, not at the beginning of the procedure.

The nurse is assessing a client during a routine physical examination. Which statement made by the client concerning the risk of oral cancer indicates that further teaching is needed? a. "I will brush my teeth and floss regularly." b. "I will begin a smoking cessation program." c. "I can still use chewing tobacco since I stopped smoking." d. "I will limit my intake of alcoholic beverages."

C Tobacco in any form increases the risk of oral cancer. The client should be educated to eliminate all tobacco products. The other statements concerning brushing the teeth, flossing, smoking cessation, and decreasing alcohol intake are healthy choices to maintain good oral health.

The nurse is caring for a client who has recently undergone a partial gastrectomy. The client asks the nurse which foods would be best for him to have for breakfast. Which menu items does the nurse recommend for the client? (Select all that apply.) a. Blueberry pancakes with maple syrup b. A half-grapefruit with a blueberry muffin c. Plain bagel with margarine or butter d. Raisin bran with milk and artificial sweetener e. Scrambled eggs with cheese and a slice of bacon f. One half cup of cottage cheese with canned pears

C, E, F

A client who has undergone Nissen fundoplication for gastroesophageal reflux disease (GERD) is ready for discharge home. Which statement made by the client indicates understanding of the disease? a. "I will no longer need any medication for my GERD." b. "I will avoid spicy foods because they can irritate the suture line." c. "I should take anti-reflux medications when I eat a large meal." d. "I will need to continue to watch my diet and may still need medication."

D A high percentage of recurrence of reflux has been noted after this type of surgery, so clients are encouraged to continue anti-reflux regimens of medication and diet control. These include taking medications, eating small meals, and avoiding spicy or acidic foods.

Which client does the nurse assess most carefully for the development of gastroesophageal reflux disease? a. Client with atrial fibrillation who drinks decaffeinated coffee b. Client who has lost 20 pounds through diet and exercise c. Diabetic client taking oral hypoglycemic agents d. Postoperative client who has a nasogastric (NG) tube

D A nasogastric tube keeps the cardiac sphincter open, allowing acidic contents from the stomach to enter the esophagus. The other clients do not have increased risk for gastroesophageal reflux.

The nurse is caring for a client who is being discharged following surgery for oral cancer. Which sign is the client instructed to watch for that indicates possible metastasis of the cancer? a. Fragile gums that bleed easily b. White patches on the tongue and the back of the throat c. Painful ulcerated lesions on the gums or inside of the cheek d. Small hard lumps on the side of the neck or under the chin

D Cervical lymph nodes that become hardened, enlarged, and fixed in position are indications of metastatic disease. An older adult or a client with a dry mouth may develop fragile gums that bleed easily. White patches on the tongue and the back of throat could be leukoplakia—precancerous lesions that are normally benign. Stomatitis or inflammation of the oral cavity can lead to fragile gums, white patches (candidiasis), and painful open sores throughout the oral cavity, but these conditions are not cancerous.

The nurse is caring for a client who is receiving radiation therapy for treatment of oral cancer. The client reports a constant dry mouth. Which is the nurse's best response? a. "Massage the area just over the lower jaw twice a day." b. "Use lemon and glycerin swabs to clean your mouth and help keep it moist." c. "Suck on lemon slices to help increase saliva production." d. "Rinse your mouth out often with warm saline or sodium bicarbonate solution."

D Clients should avoid agents that can irritate the oral mucosa and should keep their mouth moist with frequent rinses of warm saline or sodium bicarbonate solution. Massage is recommended only for acute sialadenitis—inflammation of a salivary gland. Lemon slices and lemon and glycerin swabs are acidic and can further dry the mucosa, causing a burning sensation. The use of lemon slices after radiation therapy is discontinued may promote saliva production.

The nurse is performing an assessment of a client with suspected esophageal cancer. Which statement made by the client does the nurse correlate with advanced disease? a. "I have difficulty swallowing solids." b. "I usually have a sticking feeling in my throat." c. "I have difficulty swallowing soft foods." d. "I have difficulty swallowing liquids."

D Dysphagia is a common sign of esophageal cancer, but it often does not present until late in the disease. Clients first notice swallowing problems with solid foods, then liquids; they can even choke on saliva. Sometimes they have the feeling of food sticking in their throats.

The nurse is providing discharge teaching for a client who has peptic ulcer disease caused by Helicobacter pylori infection. Which statement by the client indicates that additional teaching is needed? a. "I will avoid drinking coffee, even if it is decaffeinated." b. "I will take a multivitamin every morning with breakfast." c. "I will go to my tai chi class to wind down after a busy day." d. "I will take my medication every day until my heartburn is gone."

D Long-term medication compliance is crucial to eradicate Helicobacter pylori and prevent recurrence. The nurse stresses the importance of continuing medications for the entire time prescribed. Decaffeinated coffee is a better choice than caffeinated coffee for the client with peptic ulcer disease. Stress management should also be part of the treatment plan. Good nutrition is always important.

The nurse is caring for a client who is at risk for developing gastritis. Which finding from the client's history leads the nurse to this conclusion? a. Client is lactose intolerant and cannot drink milk. b. Client recently traveled to Mexico and South America. c. Client works at least 60 hours per week in a stressful job. d. Client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.

D Motrin and other NSAIDs can cause gastritis, even if symptoms are not yet apparent. Stress, travel, and spicy foods do not increase the risk for gastritis.

The nurse is caring for a client who will be taking nystatin (Mycostatin) for treatment of oral candidiasis. Which instructions does the nurse provide for the client before administering the medication? a. "Let the tablet dissolve slowly in your mouth." b. "Take the medicine with a snack or a light meal." c. "Swallow the pills whole, followed by a full glass of water." d. "Swish the liquid around your mouth before swallowing it."

D Mycostatin (nystatin) is a liquid medication that should be swished around the mouth for a minute before swallowing. The other responses do not reflect accurate administration of nystatin.

The nurse is caring for a client with gastritis who will undergo a nuclear medicine GI bleeding study in the morning. What instruction for preparation does the nurse give the client? a. "You cannot eat anything after midnight." b. "You should drink several glasses of water in the morning." c. "You must make arrangements for transportation home." d. "No special preparations are required for this test."

D No special preparations are required for this test, so the client is not required to be NPO or to drink several glasses of water. Sedation is not used, so the client does not need to find transportation home.

A client 2 hours post-esophageal dilation develops increasing pain in the throat. Which is the best action of the nurse? a. Administer an analgesic. b. Document the finding. c. Reposition the client. d. Assess the client for perforation.

D Pain may be indicative of perforation, which is a known complication of dilation and requires immediate intervention. An analgesic should not be administered until the problem is diagnosed. Repositioning will not help the nurse determine what is wrong. Documentation should be done after the nurse finishes assessing the client.

The nurse is caring for a client who reports persistent epigastric pain, heartburn, and nausea, despite faithfully taking ranitidine (Zantac), aluminum hydroxide (Amphojel), and metronidazole (Flagyl) as prescribed. Which is the nurse's best response? a. "Is your pain better or worse after you eat?" b. "Have you tried elevating the head of your bed at night?" c. "Have you been taking the Amphojel and Flagyl together?" d. "Have you been experiencing foul-smelling diarrhea lately?"

D Peptic ulcer disease (PUD) symptoms that are not alleviated by medications may indicate Zollinger-Ellison syndrome, a similar condition that is often refractory to treatment. A hallmark of Zollinger-Ellison syndrome is diarrhea and steatorrhea, with frothy, foul-smelling diarrhea.

The health care provider is prescribing medication to treat a client's severe gastroesophageal reflux disease (GERD). Which medication does the nurse anticipate teaching the client about? a. Magnesium hydroxide (Gaviscon) b. Ranitidine (Zantac) c. Nizatidine (Axid) d. Omeprazole (Prilosec)

D Proton pump inhibitors such as omeprazole are the main treatment for more severe cases of GERD. Gaviscon, Axid, and Zantac can be used to treat less severe cases.

A client has undergone an esophagogastrostomy for cancer of the esophagus. How will the nurse best support the client's respiratory status? a. Assessing the client's breath sounds every 4 hours b. Performing chest physiotherapy every 6 hours c. Maintaining the client in a supine position d. Administering analgesia regularly

D Respiratory care is the highest postoperative priority. Incisional support and adequate analgesia are crucial for effective coughing and deep breathing. As long as vital signs are stable, the nurse administers analgesia regularly to assist the client in performing deep breathing, turning, and coughing routines. Assessing breath sounds is a vital nursing assessment but will not help support respiratory function. The client may or may not need chest physiotherapy. The client should not be kept in a supine position, but rather sit up in the chair and ambulate as much as possible.

The nurse is caring for a client who has just received a diagnosis of advanced oral cancer that will require extensive surgery. Which statement by the client indicates that the diagnosis is accepted? a. "The biopsy test results will be confirmed again next week." b. "Of all the bad things to happen to me, now I have cancer on top of it all." c. "If I can live long enough to see my son get married, everything will be alright." d. "I don't like it, but I have cancer and that's the way it is."

D The client has accepted the diagnosis. He is not happy about it but has acknowledged the reality of the situation. The other responses indicate denial, anger, or bargaining responses to the diagnosis.

A client has returned to the nursing unit after esophagogastroduodenoscopy (EGD). Which action by the nurse takes priority? a. Keep the client on strict bedrest for 8 hours. b. Delegate taking vital signs to the nursing assistant. c. Increase the IV rate to flush the kidneys. d. Assess the client's gag reflex.

D The client will receive moderate sedation and a numbing agent during the procedure. The client may temporarily lose his or her gag reflex; this should be checked before the client is permitted to eat anything by mouth. The client does not require strict bedrest for 8 hours or increased fluid to flush the kidneys. The nurse can delegate the taking of vital signs to unlicensed assistive personnel (UAP) such as the nursing assistant, but this is not the priority.

A client with esophageal cancer and dysphagia states that it has become more difficult to swallow, and the client has experienced several choking episodes during meals. Which strategy would the nurse recommend to assist this client in obtaining adequate nutrition? a. Monitor caloric intake and weigh the client daily. b. Instruct the client to drink only clear liquids. c. Tell the client that artificial feeding will now be required. d. Encourage the client to eat semisoft foods and thickened liquids.

D The client with dysphagia usually is able to tolerate swallowing semisoft foods and/or thickened liquids to obtain adequate intake. Monitoring caloric intake and weighing the client are good for monitoring response to therapy but will not help the client obtain nutrition. Clear liquids alone may not provide enough calories or nutrients. Efforts are made to preserve swallowing ability as long as possible, although in the case of complete obstruction, a feeding tube may be necessary.

The nurse is caring for a client who has recently undergone a partial gastrectomy. The client reports becoming dizzy and sweaty with heart palpitations about 2 hours after eating. The client is now afraid to eat anything. Which is the nurse's best response? a. "Drink at least 6 ounces of fluid before each meal." b. "Try a clear liquid diet for the next few days." c. "You probably should avoid dairy products." d. "Limit carbohydrate intake with meals."

D The client's symptoms are consistent with late dumping syndrome, which is caused by a rapid rise in insulin secretion in response to increased glucose levels after eating. Eliminating sugary foods and eating low to moderate carbohydrates with meals helps manage this problem. Liquids should be taken between meals. Clear liquids and limited dairy products are not needed.

The nurse is caring for a client who just had a radical jaw and neck resection for oral cancer. The nurse has just completed teaching for the spouse and client about tracheostomy care. Which notation in the client's chart is the most accurate documentation of the teaching that occurred? a. "The client and spouse were instructed regarding management of mucous plugs and thick secretions." b. "Information about home oxygen therapy and equipment was provided for the client and spouse." c. "The client and spouse were shown how to suction the tracheostomy and change the ties." d. "Correct suctioning procedure was demonstrated, and the client's spouse verbalized two instances when suctioning needs to occur."

D The documentation should include teaching actions, as well as the spouse's response to the instructions. The other choices do not indicate the response by the client and spouse to the teaching. A return demonstration would be beneficial.

The nurse notes frank red blood in the drainage container from the nasogastric (NG) tube of a client who is 2 days post-esophagogastrostomy. Which is the nurse's priority intervention? a. Irrigate the NG tube with cold saline. b. Document the drainage in the chart. c. Reposition the tube in the opposite nostril. d. Assess the client's vital signs and abdomen.

D The initial nasogastric drainage appears bloody but should turn yellow-green by the end of the first postoperative day. If the bloody color continues, this may indicate bleeding at the suture line. The nurse should assess the client further, then should notify the provider. If the tube is draining, it is not necessary to irrigate it. Repositioning the tube will not change the drainage. In addition, repositioning the tube might cause more damage to the suture line.

What is the pH range of the distal esophagus? a. 1.5 to 2.0 b. 3.0 to 4.5 c. 4.5 to 6.0 d. 6.0 to 7.0

D The pH of the lower esophagus is neutral (normal).