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19 Cards in this Set
- Front
- Back
- 3rd side (hint)
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1. The nurse is working with the dietitian to plan a menu for the client who has persistent difficulty swallowing. What is a suitable breakfast selection for this client? |
* Scrambled eggs and toast * Oatmeal and orange juice * Pureed fruit and English muffin * Cream of wheat and applesauce |
Cream of wheat and applesauce Correct Correct: Both cream of wheat and applesauce are foods of semi-solid consistency and are appropriate for this client. |
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2. The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with the client's hiatal hernia. Which change will the nurse recommend to this client? |
* Eat only two or three meals daily. |
Avoid working while bent over the computer. Correct Correct: The client should avoid working in a bent-over position because this position presses on the diaphragm, causing discomfort. |
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3. The client is being discharged after a minimally invasive esophagectomy. Which teaching point does the nurse consider to be of the highest priority during the predischarge teaching session? |
* Instruct the client to eat three meals daily. * Emphasize the importance of lying down after meals. * Encourage the client to ask his or her physician for antidepressant medication. * Report the presence of fever and a swollen, painful neck incision. |
Report the presence of fever and a swollen, painful neck incision. Correct Correct: Wound management and prevention of infection are major concerns because the client who has had an esophagectomy typically has multiple drains and incisions |
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4. The client has been diagnosed recently with esophageal cancer. The client states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? |
* "I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." * "Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." * "Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." * "You need to talk to your doctor about your concerns. The doctor may recommend that you enter a support group for cancer victims |
"Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." Correct Correct: This response provides psychosocial support to the client and assists the client with finding a solution to the problem. |
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5. The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to the client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? |
* Place the food at the back of the mouth as you eat. * Do not be overly concerned with tongue or lip movements. * Before swallowing, tilt your head back to straighten the esophagus. * Do not attempt to reach food particles that are on your lips or around your mouth. |
Place the food at the back of the mouth as you eat. Correct Correct: Placing the food at the back of the mouth when eating will help the client avoid aspirating. |
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6. The nurse is assessing a client with gastroesophageal reflux disease (GERD). Which findings will the nurse expect to observe? Select all that apply. |
* Blood-tinged sputum * Dyspepsia * Excessive salivation * Flatulence * Regurgitation |
* Blood-tinged sputum * Dyspepsia Correct * Excessive salivation * Flatulence Correct * Regurgitation Correct Correct Feedback: Correct: Dyspepsia, also known as heartburn, is one of the main symptoms of GERD. Incorrect Feedback: Incorrect: Blood-tinged sputum is not a symptom of GERD. |
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7. The client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? |
* Ensure that the client takes adequate amounts of fluids with meals. * Advance the diet to solid food and encourage the client to eat as much as possible at meals. * Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal. * Encourage the client to take fluids between meals rather than with meals. |
Encourage the client to take fluids between meals rather than with meals. Correct Correct: Diarrhea is believed to be the result of vagotomy syndrome and can be managed by taking fluids between meals rather than with meals. |
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8. The client with gastroesophageal reflux disease (GERD) is being treated with lansoprazole (Prevacid) and has been experiencing difficulty swallowing. Which is the highest priority nursing intervention? |
* Crushing the capsule and mixing the granules in water * Opening the capsule and mixing the granules in applesauce * Crushing the capsule and mixing the granules in tomato juice * Opening the capsule and administering the granules through a nasogastric tube |
Opening the capsule and mixing the granules in applesauce Correct Correct: Mixing the granules in applesauce is the correct method of administering lansoprazole (Prevacid) to the client who is experiencing difficulty swallowing. |
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9. The client has been diagnosed with terminal esophageal cancer. The client is interested in obtaining support from hospice but expresses concern that pain management will not be adequate. What is the nurse's best response? |
* "Haven't you received adequate pain management in the hospital?" * "Would you like me to get a nurse from hospice to come talk with you?" * "Do you want me to call the hospital chaplain to explain hospice to you?" * "Talk to your health care provider about hospice services." |
"Would you like me to get a nurse from hospice to come talk with you?" Correct Correct: The best way to alleviate the client's concerns would be to have a hospice nurse talk with the client and answer any questions. |
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10. The nurse is caring for a client with a hiatal hernia who had an open fundoplication yesterday. Which task will the nurse delegate to unlicensed assistive personnel (UAP)? |
* Using a pillow to support the incision when the client coughs * Adjusting the position of the nasogastric (NG) tube * Assessing the level of postoperative pain using a 1 to 10 scale * Giving the client sips of water once bowel tones are heard |
Using a pillow to support the incision when the client coughs Correct Correct: Assisting a client to cough is a task within the education and skill level of a nursing assistant. The other interventions require more knowledge of the potential complications associated with this surgical procedure. |
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11. A client with an inoperable esophageal tumor is receiving swallowing therapy. Which task will the home health nurse delegate to an experienced home health aide? |
* Teaching family members how to determine whether the client is obtaining adequate nutrition * Assessing lung sounds for possible aspiration when the client is swallowing clear liquids * Reminding the client to use the chin tuck technique each time a swallowing attempt is made * Instructing family members about what symptoms may indicate a need to call the physician |
Reminding the client to use the chin tuck technique each time a swallowing attempt is madeCorrect Correct: The role of a home health aide when caring for a client with swallowing difficulty includes reinforcement of previously taught swallowing techniques. |
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12. Which of these assigned clients will the nurse assess first after receiving change-of-shift report? |
* Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography scan in 30 minutes * Adult with gastroesophageal reflux disease who is describing epigastric pain at a level 6 (0 to 10 pain scale) * Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright red drainage from the nasogastric (NG) tube * Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as needed (PRN) basis |
Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright red drainage from the nasogastric (NG) tube Correct Correct: The presence of blood in the NG drainage is an unexpected finding 2 days after esophagogastrectomy and requires immediate investigation. |
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13. The nurse is reviewing requests for a client with possible esophageal trauma after a car accident. Which request will the nurse implement first? |
* Give total parenteral nutrition (TPN) through a central venous catheter. * Administer cefazolin (Kefzol) 1 g IV. * Obtain computed tomography (CT) scan of chest and abdomen. * Keep the client nothing by mouth (NPO) for possible surgery. |
Keep the client nothing by mouth (NPO) for possible surgery. Correct Correct: Clients with possible esophageal tears should be made NPO until diagnostic testing is completed, because leakage of anything taken orally into the sterile mediastinum could occur. In addition, esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing. |
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14. A client in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action will the nurse take first? |
* Teach the client about antacid effects and side effects. * Ask the client about medications and dietary intake. * Suggest that the client sleep with the head elevated 6 inches. * Tell the client to avoid drinking alcohol late in the evening. |
Ask the client about medications and dietary intake. Correct Correct: The nurse's initial action should be further assessment of the client's risk factors for GERD. |
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15. The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium). The nurse plans to contact the health care provider if the client is taking which medication? |
* Acetaminophen (Tylenol) * Furosemide (Lasix) * Iron salts * Prednisone (Deltasone) |
Iron salts Correct Correct: Iron salts may alter the effects and absorption of esomeprazole (Nexium). |
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16. A client has been prescribed nizatidine (Axid) for treatment of gastroesophageal reflux disease (GERD). In which beverage will the nurse instruct the client to mix nizatidine? |
* Apple juice * Grapefruit juice * Orange juice * Tomato juice |
Apple juice Correct Correct: Apple juice is the preferred choice because it is not acidic and does not interact with nizatidine (Axid). |
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17. The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? |
* Loperamide (Imodium) * Mesalamine (Pentasa) * Minocycline (Minocin) * Pantoprazole (Protonix) |
Loperamide (Imodium) Correct Correct: Diarrhea can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide (Imodium). Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery. |
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18. The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker will require the nurse to intervene? Select all that apply. |
* Checking tube placement every 12 hours * Keeping the bed flat * Placing the client upright when taking sips of water * Providing mouth care every 8 hours * Securing the tube |
* Checking tube placement every 12 hours Correct * Keeping the bed flat Correct * Placing the client upright when taking sips of water * Providing mouth care every 8 hours Correct * Securing the tube Correct Feedback: Correct: The tube should be checked every 4 to 8 hours. Incorrect Feedback: Incorrect: The client should be placed upright when taking sips or small amounts of water to prevent choking and to allow observation of the client for dysphagia. |
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19. The nurse is caring for a client with esophageal cancer who has received photodynamic therapy (PDT) using porfimer sodium (Photofrin). What instructions will the nurse include in teaching the client about porfimer sodium? Select all that apply. |
* Avoid sunlight for 2 weeks. * Cover all exposed body areas. * Follow a full liquid diet for 3 to 5 days after the procedure. * Monitor for hypertension. * Tissue particles may be found in the sputum. |
* Avoid sunlight for 2 weeks. * Cover all exposed body areas. Correct * Follow a full liquid diet for 3 to 5 days after the procedure. Correct * Monitor for hypertension. Incorrect * Tissue particles may be found in the sputum. Correct Correct Feedback: Correct: Porfimer sodium (Photofrin) causes photosensitivity, and sunglasses and protective clothing covering all exposed body areas are essential. Incorrect Feedback: Incorrect: Sunlight should be avoided for 1 to 3 months. |
