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Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patients knowledge of this new diagnosis. Which of the following should the nurse encourage?
- A. Eating several small meals daily rather than 3 larger meals
- B. Keeping the head of the bed slightly elevated
- C. Drinking carbonated mineral water rather than soft drinks
- D. Avoiding food or fluid intake after 6:00 p.m.
Correct Answer: B
Rationale: The patient with GERD is encouraged to elevate the head of the bed on 6- to 8-inch (15- to 20-cm) blocks. Frequent meals are not specifically encouraged and the patient should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided.
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A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient?
- A. Placing the patient in a left lateral position
- B. Administering opioids as ordered
- C. Placing the patient in Fowlers position
- D. Teaching the patient to use the patient-controlled analgesia (PCA) system
Correct Answer: C
Rationale: After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in Fowlers position to facilitate breathing and promote comfort. Lateral positioning does not facilitate oxygenation or comfort. Medications do not facilitate spontaneous breathing.
A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include?
- A. Muscle training to relieve dysphagia
- B. Relieving nerve paralysis in the cervical plexus
- C. Promoting maximum shoulder function
- D. Alleviating achalasia by decreasing esophageal peristalsis
Correct Answer: C
Rationale: Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the patients neck incision and graft, if present, were sufficiently healed. Nerve paralysis in the cervical plexus and other variables affecting swallowing would be managed by a speech therapist rather than a physical therapist.
A nurse is caring for a patient who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this patient, what would the nurse be sure to include?
- A. Increasing calcium intake to promote bone healing
- B. Avoiding chewing food for the specified number of weeks after surgery
- C. Techniques for managing parenteral nutrition in the home setting
- D. Techniques for managing a gastrostomy
Correct Answer: B
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. Increased calcium intake will not have an appreciable effect on healing. Enteral and parenteral nutrition are rarely necessary.
A nurse is caring for a patient who has had surgery for oral cancer. When addressing the patients long-term needs, the nurse should prioritize interventions and referrals with what goal?
- A. Enhancement of verbal communication
- B. Enhancement of immune function
- C. Maintenance of adequate social support
- D. Maintenance of fluid balance
Correct Answer: A
Rationale: Verbal communication may be impaired by radical surgery for oral cancer. Addressing this impairment often requires a long-term commitment. Immune function, social support, and fluid balance are all necessary, but communication is a priority issue for patients recovering from this type of surgery.
A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?
- A. Radiation therapy often results in secondary brain tumors.
- B. Surgical complications are exceedingly common.
- C. Diagnosis rarely occurs until the cancer is endstage.
- D. Metastases are common and respond poorly to treatment.
Correct Answer: D
Rationale: Deaths from malignancies of the head and neck are primarily attributable to local-regional metastasis to the cervical lymph nodes in the neck. This often occurs by way of the lymphatics before the primary lesion has been treated. This local-regional metastasis is not amenable to surgical resection and responds poorly to chemotherapy and radiation therapy. This high mortality rate is not related to surgical complications, late diagnosis, or the development of brain tumors.