NUR 170: Exam 8 (2025 / 2026 Updated) Concepts of MedicalSurgical Nursing Review Guide Questions and Verified Answers, 100% Correct- (Galen)

NUR 170: Exam 8 ( Updated) Concepts of Medical-
Surgical Nursing Review Guide Questions and Verified Answers,
100% Correct- (Galen)

● GastroesophagealtRefluxtDiseaset(GERD)
○ Patho:tbackflowtoftgastrictcontentstintotthetesophagus.
○ Causes:timcompenenttweakentlowertesophagealtsphincter,tincreasedtintraabdominaltpressuret-
(pregnancy,tovereating,tobesity,tHH),tpylorictstenosis,tcertaintmedicationst(antihistamines,tCCBstsedatives),t
t


ortmobilitytdisorder.
○ Risktfactors:tdietstthattaretchronicallytlowtintfreshtproduce.taffectstalltages-
buttelderlytaretmoretpronettotcomplicationst,tfoodtirritantst-
t


t Caffeine,tchocolate,tcitrus,ttamoties,tsmoking/tobacco,tCCBs,tnitrates,tmint,talcohol.tMedications:tantich
olinergicst(delaytgastrictemptying),thightestrogen/tprogesterone,tNGttubetplacement.
○ s/s:tPyrosist(heartburn),tepigastrictpain,tdyspepsiat(indigestion),tpaintandtdifficultytswallowingt(dysphagia
),thypersalivation,tbitterttastetintmouth,tregurgitationt(aspirationtrisk),tDrytcoughing/wheezingt(worstt attnight
),tbelching,t nausea,tpharyngitis,tdentaltcariest(serve).
○ elederyts/s:tatypicaltchesttpain,tear,tnosetthroattinfections,tpulmonarytproblemst(aspirationtpneumonia,tslee
ptapnea,tasthma)tmoretattrisktfortdevelopingtseveretcomplications-
HHtandtmedts/e,tbarrett'stesophagustorterosion
t


○ Labs:
○ Diagnostics:tesophagogastroduodenoscopyt(EGD)endoscopyt-
assesstesophagustforts/stoftnarrowingtandtulcers.tEsophagealtmanometryt-
t


assessestfunctiontandtabilitytoftesophagusttotsqueezetfoodtdowntandthowtLEStcloses.t.tpHtmonitoringt-
t


measurestacidtamounttintesophagustfort24thourst(smallttubetstaystintesophagustduring.
t


○ Interventions:tnutrientttherapytistusuallytenough.
■ Eatt4-6tsmalltmealstatday.tLowtfatt-thightfiber
■ Limittorteliminatetfattytfoods,tcoffee,ttea,tcola,tcarbonatedtdrinkst,tmint,tchocolate
■ Reducetorteliminatetfromtyourtdiettanytfoodtthattincreasestgastric
■ acidtandtcausestpain
■ Limittorteliminatetalcoholtandttobacco,tandtreducetexposuretto
■ secondhandtsmoke**SmokingtandtalcoholtdecreasetLEStpressuretandtirritatettissues.**
■ Dotnotteatt2-3thourstbeforetbed
■ Eattslowlytandtchewtyourtfoodtthoroughlyttotreducetbelching
■ Remaintuprightt1-2thourstaftertmeals,tiftpossible
■ ElevatetHOBt6-12tinchestusingtwoodentblocks,tortelevatetyour
■ headtusingtfoamtwedges.tNevertsleeptflattintbed.
■ Iftyoutaretoverweight,tlosetweight.
■ Dotnottweartconstrictivetclothing.
■ Avoidtheavytlifting,tstraining,tandtworkingtintatbent-overtposition.
■ Chewt“chewable”tantacidstthoroughly,tandtfollowtwithtatglasstoftwater
■ Dotnotttaketanticholinergicst(dalaytstomachtemptying),tNSAIDst(containstacetylsalicylictacid).

, ■ Surgery:tlaparoscopictnissentfundoplicationt(LNF),
○ Medications:tTaketantacidst(calciumtcarbonate)t(whenttakingtwaitt1-
2thourstbeforettakingtH2tblocker,tantibiotics,tortcaratate)t,tH2treceptortantagonistt(IVtFamotidine)(reducestg
astrictacid)
,tPPIst(IVtprotonix)t(reducestacid,thelpstesophagustheal,tcantbetgiventlongtterm,tlongttermtusetcomplicationt=tbonetfra
ctures;tmosttcommontintelderly).tProkineticst(toraltmetoclopramide)
○ Surgical:textremetcasestonlyt-tfundoplication,twrappingtgastrictfundustaroundtsphinctertareatoftesophagus.
○ Complications:tEsphogitist-
wheretthetesophagustcellststartttoterodetandtbecometinflamedtduettotacid.tBarrett'stesophagust-
t


resultstfromtexposurettotacidtandtpepsint(sometimestnitrosamines)twhichtchangestthetcellstDNAtmakingtthemt
t


precancerous.tStrictures-tbuildtuptscarttissuetintthetesophagustcausingtnarrowing.tLaryngopharynealtrefluxt-
acidtgoingtintotthetpharynxtgoingtintotrespiratorytsystemtcausingtlungtinfections,teartinfections,tcoughing.tcom
t


plicationstaretmosttcommontinteledery.

,● HiataltHernia

, ● IncreasestrisktoftGERDtbecausetoftincreasetoftintratabdominaltpressure.tIt'statherniatthattistformedtattthettoptoftthetstom
achtneartthetLEStputtingtpressuretontittcausingtitttotnottoperatetproperly.
● Typests/s:
○ Sliding:theartburn,tregurgitation,tchesttpain,tdysphagia,tbelching.
○ Paraesophageal:tfeelingtoftfullnesstortbreathlessnesstafterteating,tfeelingtoftsuffocation.tChesttpaintthattmi
micstangina,ts/stworsetintrecumbenttposition.
● Patho:t(esophageal/tdiaphragmaticthernia)tportiontoftstomachtherniatestthroughtdiaphragmtintotthorax.
● Risktfactors:tHerniationtresultstfromtweakeningtoftmusclestoftdiaphragmtaggravatedtbytthattincreasetabdominaltpr
essuret(pregnancy,tascites,tobesity,ttumors,theavytlifting)
● Complications:tulceration,themorrhage,tregurgitationtandtaspirationtoftstomachtcontents,tstrangulation,tandtincarceratio
ntoftthetstomachtintthetchesttwithtnecrosis,tperitonitis,tmediastinitis.
● Interventions:tThetmosttimportanttroletoftatnursetisthealthtteachingtfortHH.tsmalltfrequenttmeals,tavoidteatingtattnight,tav
oidtfoodtirritants.tSleeptwithtthetheadtoftthetbedtelevatedt6tinches,tremaintuprighttfortseveralthours,tavoidtstrainingtort
excessivetexercise,tandtavoidtrestrictivetclothing.tTeachtpatientstandtfamiliestthatttheytneedttotfollowtatstricttdiettandt
exercisetandtshouldtreducetbodytweightttotreducetintratabdominaltpressure.
● Medications:tavoidtanticholinergicst(delaytstomachtemptying)




● Herniation
● Patho:tweaknesstintabdominaltmuscletwalltthroughtwhichtatsegmenttoftboweltprotrudes
● Causes:tcongenitaltortacquiredtmuscletweaknesstandtincreasedtintratabdominaltpressuretcontributettotherniatform
ation.
● Types:
● Assessment:tpatienttshouldtbetlyingtdowntandtthentassesstwhentpatienttiststanding.tIftherniatistreducibletittmaytdisappear
whentthetpatienttistlyingtflat.tListentfortboweltsoundst(absencet=tGItobstruction)
t


● Interventions:ttruss-tpadtwithtfirmtsupporttfortpeopletwhotcan’tthavetsurgery.tHerniorrhapyt-
replacestcontentstoftthetherniatsactintotthetabdominaltcavitytandtclosingtthetopening.tHernioplastyt-
t


reinforcestthetweakenedtmusculartwalltwithtatmeshtpatch.
t


○ Pre/posttcare:tavoidtcoughingt-tbuttdeeptbreath.tInguinaltrepairt-
weartscrotaltsupporttandtelevatetscrotumtwithtpillowtintbed.tAvoidtboweltortboweltdistensiontbyt-
t


stimulatingtvoidingttechniquest(standingtthemtup),tavoidtconstipationt(tavoidtstrainingtduringthealing)
t




● Intestinaltobstructiont=tcompromisestelimination

● Patho:tantobstructiontcantbetpartialtortcompletetandtcantoccurtinteithertthetsmalltortlargetintestine.
● Typestandts/s:
○ Small:tabdominaltdiscomforttortpaintbytvisibletwavestintmiddletabdomen,tuppertortepigastrictabdominalt
distention,tnausea,tprofusetvomiting,tobstipation,tsevertF&Etimbalances,tmetabolictalkalosis.
○ Large:tintermittenttlowertabdominaltcramping,tlowertabdominaltdistention,tnotvomiting,

constipationtortribbontliketstools,tsometimestmetabolictacidosis.
○ Diagnostics:tnotdefinitivettestttotconfirm.tCTtscant,tabdominaltultrasound

● Interventions:tdecompresstGIttracttbytinsertingtatgastricttubet(oraltortnasal)t**tmusttchecktplacement,tpatency,toutp