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Galen medsurg exam| Questions with Complete Solutions
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Galen medsurg exam| Questions withComplete Solutions
A 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 eating 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. - ANSWER Diarrhea
is believed to be the result of vagotomy syndrome and can be managed by taking fluids
between meals rather than with meals. For this client, fluids with meals can lead to the
development of diarrhea immediately after eating. The client may not be physically ready to
advance to a solid diet. The client should eat six to eight small meals daily. Magnesium
hydroxide is a magnesium-based antacid that can cause diarrhea.
The nurse is reviewing orders for a client with possible esophageal trauma after a car crash.
Which request does the nurse implement first?
Give total parenteral nutrition (TPN) through a central venous catheter.
Administer cefazolin (Kefzol) 1 g intravenously.
Obtain a computed tomography (CT) scan of the chest and abdomen.
, Keep the client nothing by mouth (NPO) for possible surgery. - ANSWER Clients with possible
esophageal tears should be 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. TPN
is prescribed to provide calories and protein for wound healing; although this is important, it is
not a priority for the nurse to implement first. Antibiotics may be requested to prevent possible
infection, but this is not the priority. A CT of the chest and abdomen will be needed, but is not
the nurse's initial action.
A client in the outpatient clinic tells the nurse about experiencing heartburn and
nighttime coughing episodes. Which action does 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. - ANSWER The nurse's initial action
should be further assessment of the client's risk factors for gastroesophageal reflux disease.
Before suggesting interventions or beginning client teaching, the nurse must elicit more
information about the client's symptoms. The nurse needs additional data before telling the
client to avoid drinking alcohol late in the evening.
The nurse is reviewing the medication history for a client diagnosed with gastroesophageal
reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports
that the drug doesn't completely control the symptoms. The nurse contacts the provider to
discuss which intervention?
Adding a second proton pump inhibitor medication
Increasing the dose of esomeprazole
Changing to a twice-daily dosing regimen
Switching to omeprazole (Prilosec) - ANSWER The proton pump inhibitors are usually effective
when given once daily, but can be given twice daily if symptoms are not well controlled. Adding
a second medication, increasing the dose, or switching to another proton pump inhibitor is not
recommended.
,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) - ANSWER 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. It can occur 20 minutes to 2 hours after eating and can be symptomatically managed
with loperamide. Mesalamine is used to treat clients with mild to moderate ulcerative colitis.
Minocycline is an antibiotic used for treatment of infection. Pantoprazole is used to treat
gastroesophageal reflux disease.
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 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 - ANSWER The nasogastric tube should be checked every 4 to 8 hours. The
head of the bed should be elevated at least 30 degrees. Oral hygiene should be provided every
2 to 4 hours. 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. The tube should be
secured to prevent dislodgment.
The nurse has been assigned to provide care for four clients at the beginning of the day shift.
In what order does the nurse assess these clients?
A. A client planned for an esophagogastroduodenoscopy (EGD) at 1 PM (1300)
B. A client requesting pain medication 2 days after a partial gastrectomy
C. A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain
D. A client who is NPO for tests to rule out gastric cancer - ANSWER Answer: C, B, A, D
, Rationale: A client with peptic ulcer disease experiencing a sudden onset of acute stomach
pain is at risk for local gastric mucosal injury. Peptic ulcer perforation is a surgical emergency
and can be life threatening; therefore, this client should be seen first. The client who had a
gastrectomy is not expected to have moderate to severe pain 2 days after surgery and may be
experiencing a complication. Therefore, this client should be assessed next. Although the client
scheduled for an EGD and the client who is NPO are both scheduled for testing and do not
require immediate attention, the client having an EGD needs to receive pretest care in
preparation for this invasive procedure for which moderate sedation will be required. The last
client to be assessed is the one who is not yet scheduled for testing at a specific time.
When taking a history of a client diagnosed with a gastric ulcer, which assessment findings does
the nurse expect? Select all that apply.
A. Vomiting
B. Weight loss
C. Epigastric pain at night
D. Relief of epigastric pain after eating
E. Melena - ANSWER Answer: A, C, E
Rationale: Clients with ulcer disease may experience nausea and vomiting, most commonly with
pyloric sphincter dysfunction. Weight loss is most commonly associated with gastric cancer, not
gastric ulcer. Duodenal ulcer pain occurs 90 minutes to 3 hours after eating and often awakens
the client at night. However, eating does not lessen the pain; it actually is exacerbated
(worsened) by certain foods and drugs. Minimal bleeding from ulcers is manifested by occult
blood (melena).
A client has undergone a subtotal (partial) gastrectomy for gastric cancer and is scheduled to
begin radiation therapy. What is the most important information for the nurse to include in
the teaching plan for this client?
A. Management of alopecia
B. Medication management
C. Nutritional intake
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