Nokea
A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?
- A. Promotion of a nutrient-dense, low-fat diet
- B. Annual screening endoscopy for patients over 50 with a family history of esophageal cancer
- C. Early diagnosis and treatment of gastroesophageal reflux disease
- D. Adequate fluid intake and avoidance of spicy foods
Correct Answer: C
Rationale: There are numerous risk factors for esophageal cancer but chronic esophageal irritation or GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening endoscopies are not recommended solely on the basis of family history.
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A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?
- A. Indicates acceptance of altered appearance and demonstrates positive self-image
- B. Freely expresses needs and concerns related to postoperative pain management
- C. Compensates effectively for alteration in ability to communicate related to dysarthria
- D. Demonstrates effective stress management techniques to promote muscle relaxation
Correct Answer: A
Rationale: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the patients appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Patients who have had head and neck surgery generally report less pain as compared with other postoperative patients; however, the nurse must assess each individual patients level of pain and response to analgesics. Patients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.
A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis?
- A. A patient who is receiving intravenous antibiotic therapy in the home setting
- B. A patient who has a chronic venous ulcer
- C. An older adult whose medication regimen includes an anticholinergic
- D. A patient with poorly controlled diabetes who receives weekly wound care
Correct Answer: C
Rationale: Elderly, acutely ill, or debilitated people with decreased salivary flow from general dehydration or medications are at high risk for parotitis. Anticholinergic medications inhibit saliva production. Antibiotics, diabetes, and wounds are not risk factors for parotitis.
A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patients care?
- A. Risk for Aspiration Related to Inhalation of Gastric Contents
- B. Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired Absorption
- C. Risk for Decreased Cardiac Output Related to Vasovagal Response
- D. Risk for Impaired Verbal Communication Related to Oral Trauma
Correct Answer: A
Rationale: Achalasia can result in the aspiration of gastric contents. It is not normally an acute risk to the patients nutritional status and does not affect cardiac output or communication.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care?
- A. The patient will require an upper endoscopy every 6 months to detect malignant changes.
- B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.
- C. Small amounts of blood are likely to be present in the stools and are not cause for concern.
- D. Antacids may be discontinued when symptoms of heartburn subside.
Correct Answer: A
Rationale: In the patient with Barretts esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.
A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. Which of the following should be included in the patients immediate postoperative plan of care?
- A. Teaching the patient to self-suction
- B. Performing chest physiotherapy to promote oxygenation
- C. Positioning the patient to prevent gastric reflux
- D. Providing a regular diet as tolerated
Correct Answer: C
Rationale: After recovering from the effects of anesthesia, the patient is placed in a low Fowlers position, and later in a Fowlers position, to help prevent reflux of gastric secretions. The patient is observed carefully for regurgitation and dyspnea because a common postoperative complication is aspiration pneumonia. In this period of recovery, self-suctioning is also not likely realistic or safe. Chest physiotherapy is contraindicated because of the risk of aspiration. Nutrition is prioritized, but a regular diet is contraindicated in the immediate recovery from esophageal surgery.