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During a clinic visit the client provides all of the following health history information. Which client statement should be most concerning to the nurse because it could describe a symptom of esophageal cancer?
- A. “I have been having a lot of indigestion lately.”
- B. “When I eat meat, it seems to get stuck halfway down.”
- C. “I have been waking up at night lately with chest pain.”
- D. “I gained weight, even though I have not changed my diet.”
Correct Answer: B
Rationale: A. Indigestion is not a symptom of esophageal cancer. B. Progressive dysphagia is the most common symptom associated with esophageal cancer, and it is initially experienced when eating meat. It is often described as a feeling that food is not passing. C. Chest pain is not a symptom of esophageal cancer. D. Weight loss rather than gain is a symptom of esophageal cancer.
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The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective?
- A. I will take my lipid-lowering medicine at the same time each night.
- B. I may experience some discomfort when I eat a high-fat meal.
- C. I need someone to stay with me for about a week after surgery.
- D. I should not splint my incision when I deep breathe and cough.
Correct Answer: B
Rationale: High-fat meals may cause discomfort post-cholecystectomy due to altered bile flow, indicating understanding of dietary adjustments. Lipid-lowering drugs, prolonged supervision, and avoiding splinting are incorrect.
The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next?
- A. Call the HCP and suggest he or she talk with the client.
- B. Determine what about the HCP is bothering the client.
- C. Notify the nursing supervisor to arrange a new HCP to take over.
- D. Explain the client cannot request another HCP until after discharge.
Correct Answer: B
Rationale: Determining the specific issue allows the nurse to address the concern effectively, whether through communication, advocacy, or escalation. Contacting the HCP or supervisor prematurely or dismissing the client’s request is less appropriate.
The client presents with a complete blockage of the large intestine from a tumor. Which healthcare provider's order would the nurse question?
- A. Obtain consent for a colonoscopy and biopsy.
- B. Start an IV of 0.9% saline at 125 mL/hr.
- C. Administer 3 liters of GoLYTELY.
- D. Give tap water enemas until it is clear.
Correct Answer: C
Rationale: GoLYTELY, a bowel prep, is contraindicated in complete bowel obstruction, as it could worsen the condition or cause perforation. Colonoscopy, IV fluids, and enemas (if cautious) may be appropriate depending on the clinical plan.
The client with cirrhosis is scheduled for a transjugular intrahepatic portosystemic shunt (TIPS) placement. The nurse realizes the client does not understand the procedure when the client makes which statement?
- A. “I hope the abdominal incision heals fast after this procedure so I can return home.”
- B. “My risk of bleeding from my esophagus again should be decreased after this procedure.”
- C. “The shunt they are placing could become occluded in the future; I hope it doesn’t happen.”
- D. “This procedure should keep me from getting so much fluid buildup in my abdomen.”
Correct Answer: A
Rationale: A. This statement indicates the client does not understand the procedure. There is no need for an abdominal incision. The TIPS is placed through the jugular vein and threaded down to the hepatic vein. B. The TIPS procedure will decrease pressure in the portal vein and thus decrease the risk of bleeding from esophageal varices. C. There is a risk that the stent that is placed will become occluded. D. The shunt will decrease ascites formation.
The client diagnosed with end-stage liver failure is admitted with esophageal bleeding. The HCP inserts and inflates a triple-lumen nasogastric tube (Sengstaken-Blakemore). Which nursing intervention should the nurse implement for this treatment?
- A. Assess the gag reflex every shift.
- B. Stay with the client at all times.
- C. Administer the laxative lactulose (Chronulac).
- D. Monitor the client's ammonia level.
Correct Answer: B
Rationale: The Sengstaken-Blakemore tube can dislodge or cause complications like aspiration, requiring constant monitoring. Gag reflex, lactulose, and ammonia are unrelated to this intervention.