Title: Exam 4
Course: NUR 1210C Adult Health

Q: The nurse is caring for a client who is receiving radiation treatment for oral cancer. Which problem does the nurse anticipate for this client?
- Failure to absorb nutrients from the stomach
- Inability to digest protein
- Impaired ability to soften and break down food
- Difficulty swallowing food
A: Impaired ability to soften and break down food
If right: Saliva is responsible for the softening of food in the mouth and contains an enzyme, salivary amylase (ptyalin), which assists in the breakdown of carbohydrates. Radiation to the oral cavity can result in reduction of saliva production. Radiation to the mouth will not impair swallowing, ability to digest protein, or ability to absorb nutrients from the stomach.
If wrong: Saliva is responsible for the softening of food in the mouth and contains an enzyme, salivary amylase (ptyalin), which assists in the breakdown of carbohydrates. Radiation to the oral cavity can result in reduction of saliva production. Radiation to the mouth will not impair swallowing, ability to digest protein, or ability to absorb nutrients from the stomach.

Q: Which question best assists the nurse in assessing a client with acute diarrhea?
- “Have you traveled outside the country recently?”
- “Have you had a colonoscopy lately?”
- “Do you have any trouble swallowing?”
- “Do you have any allergies?”
A: “Have you traveled outside the country recently?”
If right: A history of recent travel may help pinpoint an infectious source for the client’s diarrhea. A colonoscopy will not cause acute diarrhea. Trouble swallowing is not related to diarrhea. Allergic reactions do not typically cause acute diarrhea.
If wrong: A history of recent travel may help pinpoint an infectious source for the client’s diarrhea. A colonoscopy will not cause acute diarrhea. Trouble swallowing is not related to diarrhea. Allergic reactions do not typically cause acute diarrhea.

Q: A client has been taking naproxen (Naprosyn) for several months. Which assessment question is important for the nurse to ask?
- “Have you experienced any constipation?”
- “Have you had any stomach pain or indigestion?”
- “Have you had any difficulty swallowing?”
- “Have you noticed any weight loss lately?”
A: “Have you had any stomach pain or indigestion?”
If right: Long-term use of NSAIDs for chronic pain can precipitate peptic ulcer formation through inhibition of prostaglandins, which normally protects the gastric mucosa. The client should be assessed for stomach pain or indigestion. This medication does not typically cause constipation or difficulty swallowing. Weight loss would not be related to this medication.
If wrong: Long-term use of NSAIDs for chronic pain can precipitate peptic ulcer formation through inhibition of prostaglandins, which normally protects the gastric mucosa. The client should be assessed for stomach pain or indigestion. This medication does not typically cause constipation or difficulty swallowing. Weight loss would not be related to this medication.

Q: The nurse is screening clients at a health fair. Which client is at highest risk for the development of colon cancer?
- Older white client with irritable bowel syndrome
- Middle-aged African-American client who smokes cigars
- Middle-aged Asian client who travels and eats out frequently
- Older American Indian client taking hormone replacement therapy
A: Middle-aged African-American client who smokes cigars
If right: Colon cancer is more prevalent among African Americans and smokers. Irritable bowel syndrome, travel, and hormone replacement therapy do not increase the risk for colon cancer.
If wrong: Colon cancer is more prevalent among African Americans and smokers. Irritable bowel syndrome, travel, and hormone replacement therapy do not increase the risk for colon cancer.

Q: When performing an assessment, the nurse detects a fruity odor on the client’s breath. What does the nurse do next?
- Assess the client’s blood sugar level.
- Assess the client’s stool for occult blood.
- Instruct the client in oral hygiene techniques.
- Assess the client for petechiae, itching, and jaundice.
A: Assess the client’s blood sugar level.
If right: A fruity odor to the breath may indicate uncontrolled or undiagnosed diabetes mellitus. The client’s blood sugar level should be checked immediately for hyperglycemia. The nurse may perform the other assessment tests for the client, but they will not be helpful in determining the cause of the fruity breath.
If wrong: A fruity odor to the breath may indicate uncontrolled or undiagnosed diabetes mellitus. The client’s blood sugar level should be checked immediately for hyperglycemia. The nurse may perform the other assessment tests for the client, but they will not be helpful in determining the cause of the fruity breath.

Q: The nurse is preparing to perform an abdominal assessment on a client with suspected cholecystitis. In what sequence does the nurse palpate the client’s abdomen?
- Palpate the lower quadrants only.
- Palpate the upper quadrants last.
- Palpate the upper quadrants only.
- Defer palpation and use percussion only.
A: Palpate the upper quadrants last.
If right: The client with cholecystitis will report pain in the right upper quadrant of the abdomen. Tender or painful areas should be palpated last to prevent the client from tensing his or her abdominal muscles because of pain, thereby making the examination more difficult. All quadrants should be palpated. Palpation is an important assessment tool that should not be deferred for this client.
If wrong: The client with cholecystitis will report pain in the right upper quadrant of the abdomen. Tender or painful areas should be palpated last to prevent the client from tensing his or her abdominal muscles because of pain, thereby making the examination more difficult. All quadrants should be palpated. Palpation is an important assessment tool that should not be deferred for this client.

Q: The nurse is caring for a client who has just returned from abdominal surgery. When auscultating the client’s abdomen, the nurse does not hear any bowel sounds. Which is the nurse’s best action?
- Notify the health care provider.
- Percuss the abdomen.
- Document the finding.
- Insert a nasogastric tube.
A: Document the finding.
If right: Absent bowel sounds are expected immediately following abdominal surgery. The finding should be noted in the client’s record for later reference. The provider does not need to be notified at this time. The nurse should insert a nasogastric tube if ordered by the physician if the ileus persists. Percussion may be performed but may be uncomfortable for the client and will not reveal the cause of the ileus.
If wrong: Absent bowel sounds are expected immediately following abdominal surgery. The finding should be noted in the client’s record for later reference. The provider does not need to be notified at this time. The nurse should insert a nasogastric tube if ordered by the physician if the ileus persists. Percussion may be performed but may be uncomfortable for the client and will not reveal the cause of the ileus.

Q: The nurse assesses dullness at the left anterior axillary line. The nurse is concerned about which condition that the client may have?
- Cirrhosis
- Splenomegaly
- Bowel obstruction
- Abdominal aortic aneurysm
A: Splenomegaly
If right: Dullness in front of the tenth intercostal space, at the left anterior axillary line, is indicative of splenomegaly, which is commonly seen with mononucleosis. Cirrhosis would be noted with percussion in the client’s left upper quadrant, indicating hepatomegaly. The nurse may note tympanic sounds with bowel obstruction. Percussion would not be used to assess abdominal aortic aneurysm.
If wrong: Dullness in front of the tenth intercostal space, at the left anterior axillary line, is indicative of splenomegaly, which is commonly seen with mononucleosis. Cirrhosis would be noted with percussion in the client’s left upper quadrant, indicating hepatomegaly. The nurse may note tympanic sounds with bowel obstruction. Percussion would not be used to assess abdominal aortic aneurysm.

Q: The nurse finds a positive Blumberg’s sign in a client with abdominal pain. Which action does the nurse plan?
- Have the client be NPO in preparation for surgery.
- Document this normal finding in the client’s record.
- Immediately auscultate the client’s abdomen for bowel sounds.
- Repeat the maneuver with the client in a supine position, with the knees flexed.
A: Have the client be NPO in preparation for surgery.
If right: A positive Blumberg’s sign (rebound tenderness), an abnormal sign, is indicative of peritoneal inflammation, which commonly accompanies appendicitis. The client should be made NPO in preparation for surgery to remove the appendix. The maneuver should not be repeated with the client in the supine position. The nurse should perform auscultation before percussion for the abdominal assessment.
If wrong: A positive Blumberg’s sign (rebound tenderness), an abnormal sign, is indicative of peritoneal inflammation, which commonly accompanies appendicitis. The client should be made NPO in preparation for surgery to remove the appendix. The maneuver should not be repeated with the client in the supine position. The nurse should perform auscultation before percussion for the abdominal assessment.

Q: Which laboratory finding does the nurse expect to find on assessment of a client with advanced cirrhosis?
- Amylase, 129 IU/L; alkaline phosphate, 45 U/L
- Reticulocyte count, 1%; magnesium, 1.5 mEq/L
- Hemoglobin, 14 g/dL; direct bilirubin, 0.2 mg/dL
- Prothrombin time (PT), 17.5 seconds; albumin, 1.6 g/dL
A: Prothrombin time (PT), 17.5 seconds; albumin, 1.6 g/dL
If right: Cirrhosis frequently results in impaired production of clotting factors, with increased PT and partial thromboplastin time (PTT). Serum albumin is decreased with cirrhosis because protein formation within the liver is impaired. The other laboratory values are within normal limits and would not be expected with advanced cirrhosis.
If wrong: Cirrhosis frequently results in impaired production of clotting factors, with increased PT and partial thromboplastin time (PTT). Serum albumin is decreased with cirrhosis because protein formation within the liver is impaired. The other laboratory values are within normal limits and would not be expected with advanced cirrhosis.

Q: The nurse is caring for a client who just completed an upper GI radiographic series with oral barium contrast. Which instructions does the nurse provide to the client?
- “Drink plenty of fluids over the next few days.”
- “Do not eat or drink anything for 6 hours after the test.”
- “You may not drive or operate heavy machinery today.”
- “Do not take any blood thinners for 24 hours after the test.”
A: “Drink plenty of fluids over the next few days.”
If right: The client is encouraged to drink plenty of fluids after a barium swallow to help eliminate the barium from the colon. Limiting the diet as the barium is being cleared is not necessary. The test will not make the client drowsy, so driving should not be limited. Similarly, blood thinners will not affect the client.
If wrong: The client is encouraged to drink plenty of fluids after a barium swallow to help eliminate the barium from the colon. Limiting the diet as the barium is being cleared is not necessary. The test will not make the client drowsy, so driving should not be limited. Similarly, blood thinners will not affect the client.

Q: The client is scheduled for a colonoscopy. Which statement indicates that the client needs additional teaching about the procedure?
- “I may have gas and abdominal cramps after the test.”
- “I will take strong laxatives the afternoon before the test.”
- “I will take my Coumadin with a sip of water tomorrow morning.”
- “I will take nothing by mouth after midnight on the day of the test.”
A: “I will take my Coumadin with a sip of water tomorrow morning.”
If right: Blood thinners should not be taken before colonoscopy because bleeding may occur if polyps are removed. The client should stop taking warfarin (Coumadin) approximately 2 weeks before the colonoscopy. The other answers describe accurate complications of the colonoscopy and preparation for the procedure.
If wrong: Blood thinners should not be taken before colonoscopy because bleeding may occur if polyps are removed. The client should stop taking warfarin (Coumadin) approximately 2 weeks before the colonoscopy. The other answers describe accurate complications of the colonoscopy and preparation for the procedure.

Q: The nurse is preparing the client for a computed tomography (CT) scan of the abdomen with IV contrast. Which question does the nurse ask the client before the examination?
- “Are you allergic to shrimp, scallops, or shellfish?”
- “Have you had anything to eat or drink in the past 12 hours?”
- “Did you finish taking all the prescribed laxatives?”
- “Can you tolerate being tilted from side to side?”
A: “Are you allergic to shrimp, scallops, or shellfish?”
If right: Allergies to iodine or seafood can cause a cross-allergic reaction to the contrast dye used for CT scans. Clients reporting such allergies should be scheduled for CT without contrast to avoid anaphylactic reactions. The client does not need to be NPO for this test and does need not to take laxatives. The client is not tilted during the CT scan.
If wrong: Allergies to iodine or seafood can cause a cross-allergic reaction to the contrast dye used for CT scans. Clients reporting such allergies should be scheduled for CT without contrast to avoid anaphylactic reactions. The client does not need to be NPO for this test and does need not to take laxatives. The client is not tilted during the CT scan.

Q: An abdominal ultrasound is scheduled for the client. Which statement by the client indicates that the nurse’s teaching about the procedure was effective?
- “The IV contrast may burn when it is injected.”
- “I will drive myself home after the test is completed.”
- “I will empty my bladder completely before the test.”
- “I may have to take a laxative to pass the barium afterward.”
A: “I will drive myself home after the test is completed.”
If right: Because sedation is not used for this test, clients may drive themselves home after the abdominal ultrasound is completed. Barium and IV contrast are not needed. The client’s bladder should be full for accurate visualization.
If wrong: Because sedation is not used for this test, clients may drive themselves home after the abdominal ultrasound is completed. Barium and IV contrast are not needed. The client’s bladder should be full for accurate visualization.

Q: While a health history is obtained from a client with a new diagnosis of advanced pancreatic cancer, the client begins to cry. Which is the nurse’s best response?
- “I am so sorry for making you cry!”
- “I will step out for a few minutes until you feel better.”
- “I can see that you are upset about this. It is all right to cry.”
- “I can see that I am upsetting you. Let’s move on to something else.”
A: “I can see that you are upset about this. It is all right to cry.”
If right: The nurse should recognize the client’s feelings and should allow the client to cry. Moving on to another topic shows disregard for the client’s feelings. The nurse should not leave the room but should stay to offer support. Apologizing to the client does not place the focus on the client or acknowledge the client’s feelings and emotions in this situation.
If wrong: The nurse should recognize the client’s feelings and should allow the client to cry. Moving on to another topic shows disregard for the client’s feelings. The nurse should not leave the room but should stay to offer support. Apologizing to the client does not place the focus on the client or acknowledge the client’s feelings and emotions in this situation.

Q: The nurse is performing an abdominal assessment on an older client. Which assessment finding does the nurse expect as a normal consequence of aging?
- Increased salivation and drooling
- Hyperactive bowel sounds and loose stools
- Increased gastric acid production and heartburn
- Impaired sensation to defecate and constipation
A: Impaired sensation to defecate and constipation
If right: Older adults may lose the sensation to defecate, resulting in constipation. Salivation decreases with aging, along with peristalsis and gastric acid production.
If wrong: Older adults may lose the sensation to defecate, resulting in constipation. Salivation decreases with aging, along with peristalsis and gastric acid production.

Q: The nurse is caring for a client who just had an esophagogastroduodenoscopy (EGD) completed. The client tells the nurse that her mouth is very dry after the procedure. Which is the nurse’s best action?
- Keep the client NPO (nothing by mouth).
- Check the client’s gag reflex.
- Offer the client sips of clear liquids.
- Provide the client with a few ice chips.
A: Check the client’s gag reflex.
If right: The back of the throat is numbed for the EGD, impairing the gag reflex. Therefore the client is initially NPO postoperatively. The nurse should check the gag reflex before offering any type of liquid to the client. The client may be given ice chips or sips of fluids once the gag reflex has returned.
If wrong: The back of the throat is numbed for the EGD, impairing the gag reflex. Therefore the client is initially NPO postoperatively. The nurse should check the gag reflex before offering any type of liquid to the client. The client may be given ice chips or sips of fluids once the gag reflex has returned.

Q: A client has a family history of colon cancer. Which laboratory tests are ordered to rule out colon cancer?
- Cholesterol
- Serum lipase
- Carcinoembryonic antigen
- Xylose absorption
A: Carcinoembryonic antigen
If right: The carcinoembryonic antigen can indicate colorectal, stomach, or pancreatic cancer if elevated. Elevated cholesterol and serum lipase may indicate pancreatitis. Decreased xylose absorption may indicate malabsorption in the small intestine.
If wrong: The carcinoembryonic antigen can indicate colorectal, stomach, or pancreatic cancer if elevated. Elevated cholesterol and serum lipase may indicate pancreatitis. Decreased xylose absorption may indicate malabsorption in the small intestine.

Q: What is the pH range of the distal esophagus?
- 1.5 to 2.0
- 3.0 to 4.5
- 4.5 to 6.0
- 6.0 to 7.0
A: 6.0 to 7.0
If right: The pH of the lower esophagus is neutral (normal).
If wrong: The pH of the lower esophagus is neutral (normal).

Q: An obese client has reflux and asks how being overweight could cause this condition. Which response by the nurse is best?
- “You eat more food, more often, than nonobese people do.”
- “The weight adds extra pressure, which helps push stomach contents up.”
- “Obese people tend to eat more high-fat food, which presents a risk.”
- “Obesity is not related to reflux, but losing weight would be healthy.”
A: “The weight adds extra pressure, which helps push stomach contents up.”
If right: 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.
If wrong: 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.

Q: Which client does the nurse assess most carefully for the development of gastroesophageal reflux disease?
- Client with atrial fibrillation who drinks decaffeinated coffee
- Client who has lost 20 pounds through diet and exercise
- Diabetic client taking oral hypoglycemic agents
- Postoperative client who has a nasogastric (NG) tube
A: Postoperative client who has a nasogastric (NG) tube
If right: 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.
If wrong: 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.

Q: A client with esophageal reflux who experiences regurgitation while lying flat is at risk for which complication?
- Erosion
- Bleeding
- Aspiration
- Odynophagia
A: Aspiration
If right: Regurgitation of stomach contents while the client is recumbent poses a risk of aspiration for the client.
If wrong: Regurgitation of stomach contents while the client is recumbent poses a risk of aspiration for the client.

Q: A client just experienced an episode of reflux with regurgitation. What assessment by the nurse is the priority?
- Auscultate the lungs for crackles.
- Inspect the oral cavity.
- Check the oxygen saturation.
- Teach the client to sleep sitting up.
A: Auscultate the lungs for crackles.
If right: The client with regurgitation is at risk for aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles—an 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.
If wrong: The client with regurgitation is at risk for aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles—an 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.

Q: The health care provider is prescribing medication to treat a client’s severe gastroesophageal reflux disease (GERD). Which medication does the nurse anticipate teaching the client about?
- Magnesium hydroxide (Gaviscon)
- Ranitidine (Zantac)
- Nizatidine (Axid)
- Omeprazole (Prilosec)
A: Omeprazole (Prilosec)
If right: 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.
If wrong: 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.

Q: 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?
- Endoscopy
- Schilling test
- 24-Hour ambulatory pH monitoring
- Stool testing for occult blood
A: 24-Hour ambulatory pH monitoring
If right: The most accurate method of diagnosing gastroesophageal reflux disease is 24-hour ambulatory pH monitoring.
If wrong: The most accurate method of diagnosing gastroesophageal reflux disease is 24-hour ambulatory pH monitoring.

Q: A client has Barrett’s esophagus. Which client assessment by the nurse requires consultation with the health care provider?
- Sleeping with the head of the bed elevated
- Coughing when eating or drinking
- Wanting to eat several small meals during the day
- Chewing antacid tablets frequently during the day
A: Coughing when eating or drinking
If right: In Barrett’s 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.
If wrong: In Barrett’s 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.

Q: The nurse is teaching a client about self-management of gastroesophageal reflux. Which statement by the nurse is most appropriate?
- “Eat four to six small meals each day.”
- “Eat a small evening snack 1 to 2 hours before bed.”
- “No specific foods or spices need to be cut from your diet.”
- “You may include orange or tomato juice with your breakfast.”
A: “Eat four to six small meals each day.”
If right: 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.
If wrong: 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.

Q: 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?
- Have the client roll to the side.
- Raise the head of the client’s bed.
- Auscultate the client’s lung sounds.
- Call the Rapid Response Team.
A: Raise the head of the client’s bed.
If right: 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 client’s 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.
If wrong: 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 client’s 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.

Q: 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?
- Document the finding in the client’s chart.
- Obtain an order for omeprazole twice daily.
- Instruct the client to double the daily dose.
- Tell the client to take antacids with omeprazole.
A: Obtain an order for omeprazole twice daily.
If right: Omeprazole is a proton pump inhibitor that acts to reduce gastric acid secretion. If once-daily dosing fails to control the client’s 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 client’s symptoms. Doubling the daily dose and adding antacids will not be as effective as obtaining an order for twice-a-day dosing.
If wrong: Omeprazole is a proton pump inhibitor that acts to reduce gastric acid secretion. If once-daily dosing fails to control the client’s 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 client’s symptoms. Doubling the daily dose and adding antacids will not be as effective as obtaining an order for twice-a-day dosing.

Q: 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?
- Consult with the health care provider because the dose is too high.
- Check the client’s kidney function tests before administering the drug.
- Ask the pharmacist to recommend another histamine receptor agonist.
- Give the medication as ordered and monitor for effectiveness.
A: Ask the pharmacist to recommend another histamine receptor agonist.
If right: 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.
If wrong: 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.

Q: 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?
- “I will no longer need any medication for my GERD.”
- “I will avoid spicy foods because they can irritate the suture line.”
- “I should take anti-reflux medications when I eat a large meal.”
- “I will need to continue to watch my diet and may still need medication.”
A: “I will need to continue to watch my diet and may still need medication.”
If right: 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.
If wrong: 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.

Q: Which symptom indicates a need for immediate intervention in a client with a rolling hernia?
- Reflux
- Crackles in the lungs
- Distended and firm abdomen
- Two episodes of diarrhea
A: Distended and firm abdomen
If right: A rolling hernia causes the fundus and portions of the stomach’s 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.
If wrong: A rolling hernia causes the fundus and portions of the stomach’s 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.

Q: Which statement indicates that the client understands the management of his or her sliding hiatal hernia?
- “I will lie flat for 30 minutes after each meal.”
- “I will remain upright for several hours after each meal.”
- “I will have my blood count done in 2 weeks to check for anemia.”
- “I will sleep at night while lying on my left side to prevent reflux.”
A: “I will remain upright for several hours after each meal.”
If right: 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.
If wrong: 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.

Q: A client has returned to the nursing unit after a sliding hernia repair. Which action by the nurse is most important in preventing complications?
- Range of motion to the lower extremities
- Elevating the head of the bed to 30 degrees
- Monitoring input and output
- Assessing for bowel sounds
A: Elevating the head of the bed to 30 degrees
If right: 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.
If wrong: 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.

Q: 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 nurse’s priority action?
- Assess the placement of the tube.
- Document the finding and continue to monitor.
- Clamp the nasogastric tube for 30 minutes.
- Irrigate the nasogastric tube with normal saline.
A: Document the finding and continue to monitor.
If right: 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.
If wrong: 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.

Q: 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?
- The client uses the spirometer during the shift.
- The client’s pain is monitored and treated.
- The client has vital signs taken routinely.
- The client verbalizes understanding of the discharge teaching.
A: The client’s pain is monitored and treated.
If right: 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 care–related 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.
If wrong: 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 care–related 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.

Q: 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?
- “You can take laxatives for constipation.”
- “Eat three normal-sized meals daily.”
- “Notify your health care provider if you get a cough.”
- “You can go back to work in about a week.”
A: “Notify your health care provider if you get a cough.”
If right: 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.
If wrong: 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.

Q: A client is admitted with progressive dysphagia. What intervention by the nurse takes priority?
- Weigh the client daily.
- Instruct the client on a high-protein diet.
- Assess and treat the client’s pain.
- Administer antitussive medications.
A: Weigh the client daily.
If right: 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.
If wrong: 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.

Q: A client 2 hours post–esophageal dilation develops increasing pain in the throat. Which is the best action of the nurse?
- Administer an analgesic.
- Document the finding.
- Reposition the client.
- Assess the client for perforation.
A: Assess the client for perforation.
If right: 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.
If wrong: 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.

Q: Which factor places a client at risk for esophageal cancer?
- High-stress occupation
- Preference for high-fat foods
- 20-pack-year smoking history
- History of myocardial infarction
A: 20-pack-year smoking history
If right: 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.
If wrong: 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.