Hinkle 39 Flashcards
- A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett
esophagus with minor cell changes. What principle should be integrated into the client’s
subsequent care?
A. The client will be monitored closely to detect malignant changes.
B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause
hepatic damage.
C. Small amounts of blood are likely to be present in the stools and are not cause
for concern.
D. Antacids may be discontinued when symptoms of heartburn subside.
ANS: A
Rationale: In the client with Barrett esophagus, the cells lining the lower esophagus have
undergone change and are no longer squamous cells. The altered cells are considered
precancerous and are a precursor to esophageal cancer, necessitating close monitoring.
H2 receptor antagonists are commonly prescribed for clients with GERD; however,
monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding
or that are tarry are not expected and should be reported immediately. When antacids
are prescribed for clients with GERD, they should be taken as prescribed whether or not
the client is symptomatic.
- A client has been diagnosed with an esophageal diverticulum after undergoing
diagnostic imaging. When taking the health history, the nurse should expect the client to
describe what sign or symptom?
A. Burning pain on swallowing
B. Regurgitation of undigested food
C. Symptoms mimicking a myocardial infarction
D. Chronic parotid abscesses
ANS: B
Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa that
protrudes through the esophageal musculature. Food becomes trapped in the pouch and
is frequently regurgitated when the client assumes a recumbent position. The client may
experience difficulty swallowing; however, burning pain is not a typical finding.
Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid
abscesses are not associated with a diagnosis of esophageal diverticulum.
- A nurse is addressing the prevention of esophageal cancer in response to a question
posed by a participant in a health promotion workshop. What action should the nurse
recommend as having the greatest potential to prevent esophageal cancer?
A. Promotion of a nutrient-dense, low-fat diet
B. Annual screening endoscopy for clients over 50 with a family history of
esophageal cancer
C. Early diagnosis and treatment of gastroesophageal reflux disease
D. Adequate fluid intake and avoidance of spicy foods
ANS: C
Rationale: There are numerous risk factors for esophageal cancer but chronic esophageal
irritation or GERD is among the most significant. This is a more significant risk factor than
dietary habits. Screening endoscopies are not recommended solely on the basis of family
history.
- An emergency department nurse is admitting a 3-year-old brought in after
swallowing a piece from a wooden puzzle. The nurse should anticipate the administration
of what medication in order to relax the esophagus to facilitate removal of the foreign
body?
A. Haloperidol
B. Prostigmine
C. Epinephrine
D. Glucagon
ANS: D
Rationale: Glucagon is given prior to removal of a foreign body because it relaxes the
smooth muscle of the esophagus, facilitating insertion of the endoscope. Haloperidol is an
antipsychotic drug and is not indicated. Prostigmine is prescribed for clients with
myasthenia gravis. It increases muscular contraction, an effect opposite that which is
desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma
attack and bronchospasm.
- A client who underwent surgery for esophageal cancer is admitted to the critical care
unit following postanesthetic recovery. What should the nurse include in the client’s
immediate postoperative plan of care?
A. Teaching the client to self-suction
B. Performing chest physiotherapy to promote oxygenation
C. Positioning the client to prevent gastric reflux
D. Providing a regular diet as tolerated
ANS: C
Rationale: After recovering from the effects of anesthesia, the client is placed in a low
Fowler position, and later in a Fowler position, to help prevent reflux of gastric secretions.
The client is observed carefully for regurgitation and dyspnea because a common
postoperative complication is aspiration pneumonia. In this period of recovery,
self-suctioning is also not likely realistic or safe. Chest physiotherapy is contraindicated
because of the risk of aspiration. Nutrition is prioritized, but a regular diet is
contraindicated in the immediate recovery from esophageal surgery.
- A client with GERD has undergone diagnostic testing and it has been determined that
increasing the pace of gastric emptying may help alleviate symptoms. The nurse should
anticipate that the client may be prescribed what drug?
A. Metoclopramide
B. Omeprazole
C. Lansoprazole
D. Calcium carbonate
ANS: A
Rationale: Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole
and lansoprazole are proton pump inhibitors that reduce gastric acid secretion. Calcium
carbonate does not affect gastric emptying.
- A client seeking care because of recurrent heartburn and regurgitation is
subsequently diagnosed with a hiatal hernia. Which of the following should the nurse
include in health education?
A. “Drinking beverages after your meal, rather than with your meal, may bring
some relief.”
B. “It’s best to avoid dry foods, such as rice and chicken, because they’re harder to
swallow.”
C. “Many clients obtain relief by taking over-the-counter antacids 30 minutes
before eating.”
D. “Instead of eating three meals a day, try eating smaller amounts more often.”
ANS: D
Rationale: Management for a hiatal hernia includes frequent, small feedings that can
pass easily through the esophagus. Avoiding beverages and particular foods or taking
OTC antacids are not noted to be beneficial.
- A nurse is caring for a client in the late stages of esophageal cancer. The nurse should
plan to prevent or address what characteristic(s) of this stage of the disease? Select all
that apply.
A. Perforation into the mediastinum
B. Development of an esophageal lesion
C. Erosion into the great vessels
D. Painful swallowing
E. Obstruction of the esophagus
ANS: A, C, E
Rationale: In the later stages of esophageal cancer, obstruction of the esophagus is
noted, with possible perforation into the mediastinum and erosion into the great vessels.
Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.
- A nurse is preparing to place a client’s prescribed nasogastric tube. What anticipatory
guidance should the nurse provide to the client?
A. Insertion is likely to cause some gagging.
B. Insertion will cause some short-term pain.
C. A narrow-gauge tube will be inserted before being replaced with a larger-gauge
tube.
D. Topical anesthetics will be used to reduce discomfort during insertion.
ANS: A
Rationale: Insertion may cause gagging until the tube has passed beyond the throat.
Insertion is often unpleasant, but not normally painful. Anesthetic is not usually applied
and there is no initial need for a small-gauge tube.
