The nurse is planning care for a client with a direct (sliding) hiatal hernia. Nursing actions should be planned to meet which goal?
Promote effective swallowing.
Maintain intact oral mucosa.
Prevent esophageal reflux.
Increase intestinal peristalsis.
The Correct Answer is C
Choice A rationale
Promoting effective swallowing is important for patients with dysphagia, but it is not the primary goal for a client with a sliding hiatal hernia. The main concern with a sliding hiatal hernia is the prevention of gastroesophageal reflux, which can lead to complications such as esophagitis and Barrett’s esophagus.
Choice B rationale
Maintaining intact oral mucosa is crucial for patients with conditions affecting the mouth, such as oral mucositis or infections. However, it is not the primary goal for a client with a sliding hiatal hernia. The focus should be on preventing reflux and managing symptoms.
Choice C rationale
Preventing esophageal reflux is the primary goal for a client with a sliding hiatal hernia. This condition occurs when the stomach slides up into the chest through the diaphragm, leading to gastroesophageal reflux disease (GERD). Nursing actions should aim to reduce reflux symptoms by advising the client to eat smaller meals, avoid lying down after eating, and elevate the head of the bed.
Choice D rationale
Increasing intestinal peristalsis is important for patients with conditions like constipation or ileus. However, it is not the primary goal for a client with a sliding hiatal hernia. The focus should be on preventing reflux and managing symptoms.
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Correct Answer is B
Explanation
Choice A rationale
Ipratropium is a bronchodilator used to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. It does not have significant interactions with the medications prescribed for H. pylori treatment, so it is not a priority to review in this context.
Choice B rationale
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastrointestinal bleeding and ulcers, especially when combined with other medications that affect the stomach lining, such as bismuth subsalicylate and tetracycline. Reviewing the client’s use of aspirin is important to prevent potential adverse effects and complications.
Choice C rationale
Famotidine is an H2 receptor antagonist used to reduce stomach acid production. While it is relevant to gastrointestinal health, it does not have significant interactions with the H. pylori treatment regimen. Therefore, it is not a priority to review in this context.
Choice D rationale
Loperamide is an antidiarrheal medication used to manage diarrhea. It does not have significant interactions with the medications prescribed for H. pylori treatment, so it is not a priority to review in this context.
Correct Answer is C
Explanation
Choice A rationale
Lansoprazole, a proton pump inhibitor (PPI), typically requires several weeks to achieve its full therapeutic effect. Notifying the healthcare provider for a dosage change after only one week is premature and not supported by clinical guidelines.
Choice B rationale
Auscultating bowel sounds and measuring abdominal girth are not directly related to the effectiveness of lansoprazole in treating GERD. These actions are more relevant for assessing gastrointestinal motility and potential complications like bowel obstruction.
Choice C rationale
Healing of erosive esophagitis with PPIs like lansoprazole usually takes several weeks. Advising the client that healing typically takes several weeks to occur is appropriate and aligns with the expected therapeutic timeline.
Choice D rationale
Lansoprazole should be taken before meals, not after, to maximize its effectiveness. Confirming that the client is taking the medication one hour after meals would not address the issue of symptom persistence.