Nokea
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.
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Which of the following symptoms should the nurse anticipate in a patient with a duodenal ulcer?
- A. Decreased gastric secretion
- B. Nausea and vomiting
- C. Pain about 1 hour after a meal
- D. Middle of the night pain
- E. Relief from pain with administration of an antacid
Correct Answer: B,D,E
Rationale: A patient with a duodenal ulcer may have nausea and vomiting, pain in the middle of the night, and relief from pain with an administration of an antacid. Decreased gastric secretion is not typical; duodenal ulcers are often associated with increased acid secretion.
A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. Which of the following information should the nurse include in the teaching plan?
- A. Substitution of acetaminophen for the NSAID
- B. Use of enteric-coated NSAIDs to reduce gastric irritation
- C. Reasons for using corticosteroids to treat the rheumatoid arthritis
- D. The benefits of misoprostol in protecting the gastrointestinal (GI) mucosa
Correct Answer: D
Rationale: Misoprostol, a prostaglandin analogue, reduces acid secretion and incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.
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.
The nurse is counselling a patient with a family history of stomach cancer about risk factors. Which of the following is a risk factor for the development of stomach cancer?
- A. Type A blood
- B. Persistent abdominal distension
- C. Long-term use of H2 blocking medications
- D. Exposure to emotionally or physically stressful situations
Correct Answer: A
Rationale: Patients with Type A blood have an increased risk for stomach cancer. Use of H2 blockers, stressful situations, and abdominal distension are not associated with an increased incidence of stomach cancer.
Which of the following information about a patient who has just been admitted to the hospital with nausea and vomiting requires the most rapid intervention by the nurse?
- A. The patient has taken only sips of water.
- B. The patient is lethargic and difficult to arouse.
- C. The patient's chart indicates a recent resection of the small intestine.
- D. The patient has been vomiting several times a day for the last 4 days.
Correct Answer: B
Rationale: A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information also is important to collect, but it does not require as quick action as the risk for aspiration.