Chapter 57: Care of Patients with Esophageal Problems Nursing School Test Banks

Chapter 57: Care of Patients with Esophageal Problems

Test Bank

MULTIPLE CHOICE

1. 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

ANS: D

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

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1204

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. 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.

ANS: 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.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1204

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning

3. 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

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Assessment)

4. 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

ANS: C

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

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1205

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Planning)

5. 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.

ANS: A

The client with regurgitation is at risk for aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for cracklesan 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities) MSC: Integrated Process: Nursing Process (Assessment)

6. The health care provider is prescribing medication to treat a clients 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)

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Planning)

7. 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

ANS: C

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

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1205

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Teaching/Learning

8. A client has Barretts 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

ANS: B

In Barretts 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

9. 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.

ANS: 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.

DIF: Cognitive Level: Comprehension/Understanding REF: Chart 57-2, p. 1206

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

10. 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 clients bed.

c.

Auscultate the clients lung sounds.

d.

Call the Rapid Response Team.

ANS: 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 clients 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

11. 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 clients 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.

ANS: B

Omeprazole is a proton pump inhibitor that acts to reduce gastric acid secretion. If once-daily dosing fails to control the clients 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 clients symptoms. Doubling the daily dose and adding antacids will not be as effective as obtaining an order for twice-a-day dosing.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

12. 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 clients 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Analysis)

13. 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

14. 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

ANS: C

A rolling hernia causes the fundus and portions of the stomachs 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

15. 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

16. 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

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

17. 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 nurses 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation)

18. 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 clients pain is monitored and treated.

c.

The client has vital signs taken routinely.

d.

The client verbalizes understanding of the discharge teaching.

ANS: 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 carerelated 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

19. 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

20. 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 clients pain.

d.

Administer antitussive medications.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Basic Care and ComfortNutrition and Oral Hydration) MSC: Integrated Process: Nursing Process (Assessment)

21. A client 2 hours postesophageal 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Assessment)

22. 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

ANS: 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.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1212

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

23. 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

24. 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

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Planning)

25. 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.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Basic Care and ComfortNutrition and Oral Hydration) MSC: Integrated Process: Nursing Process (Implementation)

26. 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

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Assessment)

27. A client has undergone an esophagogastrostomy for cancer of the esophagus. How will the nurse best support the clients respiratory status?

a.

Assessing the clients breath sounds every 4 hours

b.

Performing chest physiotherapy every 6 hours

c.

Maintaining the client in a supine position

d.

Administering analgesia regularly

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

28. 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 nurses 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 clients vital signs and abdomen.

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

29. 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 clients 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 clients supplemental oxygen.

ANS: 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 clients oxygen saturation before turning up the oxygen. Changing the clients position will not help.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

30. What does the nurse teach the client with esophageal diverticula about dietary needs?

a.

Eat soft foods and smaller meals.

b.

Only eat pured foods.

c.

Avoid drinking liquids with meals.

d.

Avoid dairy products.

ANS: 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 pured foods because he or she does not have difficulty swallowing or chewing foods.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1218

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Teaching/Learning

31. 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.

ANS: 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 clients esophagus has perforated, having the client drink can cause more problems.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Analysis)

32. 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

ANS: 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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Planning)

MULTIPLE RESPONSE

1. 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

ANS: A, C, D

Clients with sliding hernias often experience symptoms of reflux, pain, dysphagia, and belching. Some clients may experience breathlessness or a feeling of suffocation. Breathlessness after eating is a symptom of paraesophageal hernias. Bleeding should not be seen.

DIF: Cognitive Level: Knowledge/Remembering REF: Chart 57-5, p. 1209

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. 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

ANS: A, B, D

Unlicensed personnel can be responsible for charting fluid intake and output and food intake, keeping the calorie count, and taking/recording vital signs. They are not trained or allowed by law to assess, teach, or provide treatments.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareDelegation) MSC: Integrated Process: Nursing Process (Planning)

3. 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

ANS: B, D, F

The outcome is to keep the client as independent as possible. Providing a home health aide will help the client with normal self-care activities, shopping, and light housework, so the client can reserve energy for essential activities. Meals on Wheels will provide nutritious meals within the clients dietary restrictions. It is essential for the client to maintain adequate intake despite dysphagia. Transportation to treatments and the physicians office is essential for maintaining the clients health. The client may or may not need home infusion therapy or full housekeeping services. The client may or may not be eligible for Medicare or Medicaid.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareReferrals) MSC: Integrated Process: Nursing Process (Planning)

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