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A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patients discharge education?
- A. Resumption of activities of daily living
- B. Pain control
- C. Promotion of adequate nutrition
- D. Strategies for promoting communication
Correct Answer: C
Rationale: The patient who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. The nature of this surgery threatens the patients nutritional status; this physiologic need would likely supersede the resumption of ADLs. Pain should be under control prior to discharge and communication is not precluded by this surgery.
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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 with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this patient?
- A. Presence of acute pain and anxiety
- B. Tissue integrity and color of the operative site
- C. Respiratory status and airway clearance
- D. Self-esteem and body image
Correct Answer: C
Rationale: Postoperatively, the patient is assessed for complications such as altered respiratory status, wound infection, and hemorrhage. The other assessments are part of the plan of care for a patient who has had a radical neck dissection, but are not the nurses chief priority.
A nurse is caring for a patient who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the patients appetite?
- A. Encourage the family to bring in the patients favored foods.
- B. Limit visitors at mealtimes so that the patient is not distracted.
- C. Avoid offering food unless the patient initiates.
- D. Provide thorough oral care immediately after the patient eats.
Correct Answer: A
Rationale: Family involvement and home-cooked favorite foods may help the patient to eat. Having visitors at mealtimes may make eating more pleasant and increase the patients appetite. The nurse should not place the complete onus for initiating meals on the patient. Oral care after meals is necessary, but does not influence appetite.
The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?
- A. Avoid applying suction on or near the suture line.
- B. Position patient on the non operative side with the head of the bed down.
- C. Assess the patients ability to perform self-suctioning.
- D. Evaluate the patients ability to swallow saliva and clear fluids.
Correct Answer: A
Rationale: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Self-suctioning may be unsafe because the patient may damage the suture line. Following a modified radical neck dissection with graft, the patient is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the patients ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the patients need for suctioning.
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.