Nokea
The nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer. Which of the following findings is of most concern?
- A. Bleeding during tooth brushing
- B. Painful blisters at the border of the lips
- C. Red, velvety patches on the buccal mucosa
- D. White, curdlike plaques on the posterior tongue
Correct Answer: C
Rationale: A red, velvety patch suggests erythroplasia, which has a high incidence (90%) of progression to malignant cancer. The other lesions are suggestive of acute processes (gingivitis, oral candidiasis, and herpes simplex).
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The nurse is caring for an older-adult patient who has been diagnosed with esophageal cancer and the patient tells the nurse, 'I know that my chances are not very good, but I do not feel ready to die yet.' Which of the following responses by the nurse is best?
- A. You may have quite a few years still left to live.
- B. Thinking about dying will only make you feel worse.
- C. Having this new diagnosis must be very hard for you.
- D. It is important that you be realistic about your prognosis.
Correct Answer: C
Rationale: This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a low survival rate, so the response 'You may have quite a few years still left to live' is misleading. The response beginning, 'Thinking about dying' indicates that the nurse is not open to discussing the patient's fears of dying. And the response beginning, 'It is important that you be realistic,' discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.
Cobalamin injections have been prescribed for a patient with persistent atrophic gastritis. Which of the following patient statements indicate that the teaching regarding the injections has been effective?
- A. The cobalamin injections will prevent me from becoming anemic.
- B. These injections will increase the hydrochloric acid in my stomach.
- C. These injections will decrease my risk for developing stomach cancer.
- D. The cobalamin injections need to be taken until my inflamed stomach heals.
Correct Answer: A
Rationale: Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in patients with persistent gastritis, but cobalamin does not reduce the risk for stomach cancer. Persistent gastritis may cause achlorhydria, but cobalamin does not increase hydrochloric acid production or heal stomach inflammation.
Which of the following information should the nurse plan to teach to a patient with newly diagnosed achalasia?
- A. A liquid or blenderized diet will be necessary.
- B. Drinking fluids with meals should be avoided.
- C. Endoscopic procedures may be used for treatment.
- D. Lying down and resting after meals is recommended.
Correct Answer: C
Rationale: Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Patients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisolid diet is recommended to improve esophageal emptying.
To decrease the risk for cancers of the tongue and buccal mucosa, which of the following information should the nurse include when teaching a patient who is seen for an annual physical examination in the outpatient clinic?
- A. Avoid use of cigarettes and smokeless tobacco.
- B. Use sunscreen when outside even on cloudy days.
- C. Complete antibiotics used to treat throat infections.
- D. Use antivirals to treat herpes simplex virus (HSV) infections.
Correct Answer: A
Rationale: Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase risk for oral cancer, although persistent irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with increased risk, but HSV infection is not a risk factor for oral cancer.
After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient who was admitted yesterday with gastrointestinal (GI) bleeding and has melena
- B. A patient who is crying after receiving a diagnosis of esophageal cancer
- C. A patient with esophageal varices who has a blood pressure of 90/54 mm Hg
- D. A patient with nausea who has a dose of metoclopramide (Reglan) scheduled
Correct Answer: C
Rationale: The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.