Nutrition EAQ

Which family history would the nurse recognize as a risk factor for an infant developing hypertrophic pyloric stenosis (HPS)? A. A first cousin underwent surgery for HPS. B. The birth was preterm, and the birth weight was 4 lb (1814 g). C. An older brother had idiopathic vomiting during infancy. D. The older sister experienced an intestinal obstruction during early infancy.

A Rationale The higher incidence of hypertrophic pyloric stenosis among first-degree relatives seems to indicate a hereditary cause. Full-term infants are more likely to be affected than preterm infants. HPS is not related to other gastrointestinal disorders, even among close relatives.

Which interventions would the nurse include in the plan of care for a client with gastroesophageal reflux disease (GERD)? Select all that apply. One, some, or all responses may be correct. A. Encourage client to follow the prescribed treatment regimen. B. Keep the head of the bed elevated to approximately 30 degrees. C. Avoid placing the client in the supine position for 2 to 3 hours after a meal. D. Instruct the client to eat six small meals a day with the last just before bedtime. E. Instruct the client to take a proton pump inhibitor before the first meal of the day.

A, B, C Rationale: Clients should be encouraged to follow the prescribed regimen. Nursing care of the client includes keeping the head of the bed elevated to approximately 30 degrees and avoiding the supine position for 2 to 3 hours after meals. The client should avoid food and activities that cause reflux such as eating late at night. Proton pump inhibitors should be taken before the first meal of the day and are more common in treating peptic ulcer disease.

The nurse is providing discharge instructions for a client with a diagnosis of gastroesophageal reflux disease (GERD). Which recommendations would the nurse give to the client to limit symptoms of GERD? Select all that apply. One, some, or all responses may be correct. A. Avoid heavy lifting. B. Lie down after eating. C. Avoid drinking alcohol. D. Eat small, frequent meals. E. Increase fluid intake with meals. F. Wear an abdominal binder or girdle.

A, C, D Rationale Heavy lifting increases intra-abdominal pressure allowing gastric contents to move up through the lower esophageal sphincter (regurgitation) causing heartburn (pyrosis). Alcohol, in addition to peppermints, caffeine, and chocolate, decreases lower esophageal sphincter (LES) pressure, which permits gastric contents to move from the stomach into the esophagus. Eating small, frequent meals limits the amount of food in the stomach, which limits gastroesophageal reflux. Lying down after eating promotes reflux and should be avoided. Increasing fluids with meals increases gastric volume, causing distention and reflux. Constrictive garments, such as belts, binders, and girdles, increase intra-abdominal pressure and may lead to reflux.

A client with gastroesophageal reflux disease (GERD) needs to make dietary and lifestyle changes. Which instructions would the nurse include in the client's discharge teaching? Select all that apply.One, some, or all responses may be correct. A. Encourage the client to quit smoking. B. Elevate the foot of the bed. C. Avoid milk and dairy products. D. Eat three large, evenly spaced meals daily. E. Avoid lying down for 2 to 3 hours after eating.

A, D Rationale Smoking cessation should be encouraged. Advise the client not to lie down for 2 to 3 hours after eating; this can cause reflux. The head, not the foot, of the bed should be elevated to prevent nighttime reflux; at night, infrequent swallowing and a recumbent position can impair esophageal clearance. Milk and dairy products do not have to be eliminated unless the client has lactose intolerance. Eating three large meals increases volume pressure in the stomach, which delays gastric emptying; four to six smaller meals are preferable.

Which assessment would the nurse perform while caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS)? A. Quality of the cry B. Signs of dehydration C. Coughing up of feedings D. Characteristics of the stool

B Rationale Hypertrophic pyloric stenosis causes partial and then complete obstruction. Nonprojectile vomiting progresses to projectile vomiting, which rapidly leads to dehydration. The infant's cry is not affected by HPS; pain, except for the pain of hunger, does not appear to be associated with this condition. An infant with a tracheoesophageal fistula, not HPS, is expected to cough up feedings. The characteristics of the stool are not relevant in the assessment of an infant with HPS.

The nurse is obtaining a health history from a client with a diagnosis of peptic ulcer disease. The nurse identifies a possible contributory risk factor when the client makes which statement? A. "My blood type is A positive." B. "I smoke one pack of cigarettes a day." C. "I have been overweight most of my life." D. "My blood pressure has been high lately."

B Rationale: Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining. Blood type O is more frequently associated with duodenal ulcer, but type A has no significance. Being overweight is unrelated to peptic ulcer disease. High blood pressure is not directly related to peptic ulcer disease.

Which education would the nurse provide the parent of an infant with pyloric stenosis? A. It is unlikely that surgery will be necessary. B. This is a condition with an excellent prognosis. C. This condition results from an error of metabolism. D. Special feedings will be needed for a few weeks after surgery.

B. Rationale: In the absence of severe dehydration and malnutrition, the mortality rate is very low; immediate fluid and electrolyte replacement followed by surgery usually results in full recovery. Surgery usually is necessary; the success rate is high, and it produces a rapid recovery. Pyloric stenosis is a structural defect; hypertrophy of the circular muscle of the pylorus causes obstruction at the pyloric sphincter; this is not caused by an inborn error of metabolism. The infant usually resumes regular feedings within 48 hours of surgery.

Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)? A. As needed B. With meals C. At bedtime D. Before meals

C Rationale Ranitidine is typically administered in a single dose at bedtime. This medication is used for 4 to 6 weeks in combination with other therapy; it is not used as needed, with meals, or when indigestion occurs.

A client presents with gastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations. Laboratory results indicate metabolic alkalosis. A diagnosis of gastric ulcer is made. Which is the primary nursing concern? A. Chronic pain B. Risk for injury C. Electrolyte imbalance D. Inadequate gas exchange

C Rationale The stomach produces about 3 L of secretions per day. Fluid lost through vomiting can produce inadequate fluid volume and electrolyte imbalance, which can lead to dysrhythmias and death. Although pain is associated with gastric ulcers and requires intervention, it is not life threatening as an electrolyte imbalance would be. Although the risk for injury is a concern, it is not the priority. Although respirations may be shallow when the client is experiencing pain, this is not the priority.

A client is diagnosed with a peptic ulcer. The nurse instructs the client to contact the health care provider immediately if the client's stool has which appearance? A. Frothy B. Ribbon-shaped C. Pale or clay-colored D. Dark brown or black

D Rationale Dark brown or black stools ( melena) indicate gastrointestinal bleeding and need to be reported. Frothy stools are indicative of inadequate fat absorption and are associated with sprue. Ribbon- shaped stools indicate a bowel mass or obstruction. Clay-colored stools usually are related to problems that cause a decrease in bile.