Nokea
The nurse is caring for a patient with stomach cancer who had a recent 9.1 kg unintended weight loss. Which of the following nursing actions should be included in the plan of care?
- A. Refer the patient for hospice services.
- B. Infuse IV fluids through a central line.
- C. Teach the patient about antiemetic therapy
- D. Offer supplemental feedings between meals.
Correct Answer: D
Rationale: The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.
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The nurse is caring for a patient who is nauseated, vomiting up blood-streaked fluid and has acute gastritis. Which of the following assessments should the nurse ask the patient about to determine possible risk factors for gastritis?
- A. The amount of fat in the diet
- B. History of recent weight gain or loss
- C. Any family history of gastric problems
- D. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: D
Rationale: Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.
The nurse is caring for a patient with acute gastrointestinal (GI) bleeding who is receiving normal saline IV at a rate of 500 ml/hour. Which of the following findings obtained by the nurse is most important to communicate immediately to the health care provider?
- A. The patient's blood pressure (BP) has increased to 142/94 mm Hg.
- B. The nasogastric (NG) suction is returning coffee-ground material.
- C. The patient's lungs have crackles audible to the midline.
- D. The bowel sounds are very hyperactive in all four quadrants.
Correct Answer: C
Rationale: The patient's lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of the coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when the patient has GI bleeding.
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.
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).
The nurse is caring for a patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation and is to start oral intake. Which of the following menu choices should the nurse offer to the patient?
- A. A glass of orange juice
- B. A dish of lemon gelatin
- C. A cup of coffee with cream
- D. A bowl of hot chicken broth
Correct Answer: B
Rationale: Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.