A nurse is reinforcing teaching about an endoscopy with a client who has dysphagia. Which of the following statements should the nurse include in the teaching?

You will remain NPO for 8 hours before the procedure.

A flexible tube is introduced through the nose during the procedure.

During the procedure, a contrast dye will be administered via IV.

You will be awake while the procedure is performed.

Answer and Explanation

The Correct Answer is A

Choice A Reason: For an endoscopy, the client must remain NPO (nothing by mouth) for 6 to 8 hours before the procedure to reduce the risk of aspiration and ensure a clear view of the esophagus and stomach.

Choice B Reason: A flexible tube is not introduced through the nose during the procedure, but through the mouth and down the esophagus.

Choice C Reason: During the procedure, a contrast dye is not administered via IV, but a sedative and an anesthetic spray are given to help you relax and numb your throat.

Choice D Reason: Clients undergoing an EGD typically receive moderate sedation (such as midazolam or propofol) to help them relax. They are usually drowsy and unaware during the procedure.

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Correct Answer is A

Explanation

Choice A Reason: Contacting the health care provider is the first nursing action that the nurse should perform, as it indicates that the client may have compartment syndrome, which is a medical emergency that requires immediate intervention to prevent tissue necrosis and nerve damage.

Choice B Reason: Administering PRN pain medication is not the first nursing action that the nurse should perform, as it may not relieve the pain and may mask the symptoms of compartment syndrome.

Choice C Reason: Documenting the findings is not the first nursing action that the nurse should perform, as it may delay the treatment and worsen the outcome of compartment syndrome.

Choice D Reason: Elevating the extremity is not the first nursing action that the nurse should perform, as it may decrease blood flow and increase tissue ischemia in compartment syndrome.

A. Keeping scissors at the bedside B. Providing good mouth care C. Deflating the balloon on a regular basis D. Monitoring IV fluid intake

Correct Answer is A

Explanation

Choice A Reason: Keeping scissors at the bedside is the most important safety intervention for this client, as it allows for quick removal of the tube in case of airway obstruction or bleeding.

Choice B Reason: Providing good mouth care is an important intervention for this client, but it is not the most important, as it helps to prevent oral infections and discomfort.

Choice C Reason: Deflating the balloon on a regular basis is not an appropriate intervention for this client, as it may cause bleeding or displacement of the tube.

Choice D Reason: Monitoring IV fluid intake is an important intervention for this client, but it is not the most important, as it helps to prevent fluid overload or dehydration.

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