Chapter 54: Care of Patients with Esophageal Problems

Chapter 54: Care of Patients with Esophageal Problems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective?
   1. “I can only take this medicine at night.”
   2. “I should take this on a full stomach.”
   3. “This drug decreases stomach acid.”
   4. “This should be taken 1 hour before meals.”

ANS:   B

Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid.

DIF:     Evaluating/Synthesis                          REF: 1113                   KEY: Gastrointestinal disorders| antacids| patient education                              MSC:                         Integrated Process: Nursing Process: Evaluation                                         NOT:                          Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first?
   1. Document the findings in the chart.
   2. Notify the surgeon immediately.
   3. Reassess the drainage in 1 hour.
   4. Take a full set of vital signs.

ANS:   D

The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indicates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Documentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess.

DIF:     Applying/Application                         REF: 1116                   KEY: Gastrointestinal disorders| postoperative nursing| nursing assessment MSC:                             Integrated Process: Nursing Process: Assessment                                       NOT:                          Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching?
   1. “After the operation I can eat anything I want.”
   2. “I will have to eat smaller, more frequent meals.”
   3. “I will take stool softeners for several weeks.”
   4. “This surgery may not totally control my symptoms.”

ANS:           A

Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure. The other statements show good understanding.

DIF:            Evaluating/Synthesis                          REF:    1117                 KEY: Gastrointestinal disorders| patient education                                                    MSC: Integrated Process: Nursing Process: Evaluation                      NOT:                                                 Client Needs Category: Physiological Integrity: Physiological Adaptation

4. A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met?
   1. Choosing foods that are easy to swallow
   2. Lungs clear after meals and snacks
   3. Properly performing swallowing exercises
   4. Weight unchanged after 2 weeks

ANS:           B

All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallowing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met.

DIF:            Evaluating/Synthesis                          REF:    118                   KEY: Gastrointestinal disorders| respiratory assessment| patient safety  MSC:        Integrated Process: Nursing Process: Evaluation       NOT:          Client Needs Category: Physiological Integrity: Reduction of Risk Potential