Nokea
The nurses comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?
- A. Dull pain radiating to the ears and teeth
- B. Presence of a painless sore with raised edges
- C. Areas of tenderness that make chewing difficult
- D. Diffuse inflammation of the buccal mucosa
Correct Answer: B
Rationale: Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently, and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom.
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A nurse is caring for a patient who has had surgery for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status?
- A. Ensure that none of the patients visitors has an infection.
- B. Arrange for a diet that is high in protein and low in fat.
- C. Administer colony stimulating factors (CSFs) as ordered.
- D. Prepare to administer chemotherapeutics as ordered.
Correct Answer: A
Rationale: Leukopenia reduces defense mechanisms, increasing the risk of infections. Visitors who might transmit microorganisms are prohibited if the patients immunologic system is depressed. Changes in diet, CSFs, and the use of chemotherapy do not resolve leukopenia.
A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patients priority need at this time?
- A. Emotional support from visitors and staff
- B. An effective means of communicating with the nurse
- C. Referral to a speech therapist
- D. Dietary teaching focused on consistency of food and frequency of feedings
Correct Answer: B
Rationale: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patients ability to communicate in writing before surgery. Emotional support and dietary teaching are critical aspects of the plan of care; however, the patients ability to communicate would be essential for both. Referral to a speech therapist will be required as part of the patients rehabilitation; however, it is not a priority at this particular time. Communication with the nurse is crucial for the delivery of safe and effective care.
A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis?
- A. A patient who is receiving intravenous antibiotic therapy in the home setting
- B. A patient who has a chronic venous ulcer
- C. An older adult whose medication regimen includes an anticholinergic
- D. A patient with poorly controlled diabetes who receives weekly wound care
Correct Answer: C
Rationale: Elderly, acutely ill, or debilitated people with decreased salivary flow from general dehydration or medications are at high risk for parotitis. Anticholinergic medications inhibit saliva production. Antibiotics, diabetes, and wounds are not risk factors for parotitis.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care?
- A. The patient will require an upper endoscopy every 6 months to detect malignant changes.
- B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.
- C. Small amounts of blood are likely to be present in the stools and are not cause for concern.
- D. Antacids may be discontinued when symptoms of heartburn subside.
Correct Answer: A
Rationale: In the patient with Barretts esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.
A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease?
- A. Perforation into the mediastinum
- B. Development of an esophageal lesion
- C. Erosion into the great vessels
- D. Painful swallowing
- E. Obstruction of the esophagus
Correct Answer: A,C,E
Rationale: In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.