Nokea
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.
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The nurse is caring for a patient who has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Elevate the head of the bed to at least 30 degrees.
- B. Reposition the nasogastric (NG) tube if drainage stops or decreases.
- C. Notify the doctor immediately about bloody NG drainage.
- D. Start oral fluids when the patient has active bowel sounds.
Correct Answer: A
Rationale: Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The patient should be in the Fowler's or semi-Fowler's position. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8-12 hours. A swallowing study is needed before oral fluids are started.
All of the following prescriptions are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?
- A. Insert a nasogastric (NG) tube and connect to suction.
- B. Administer intravenous (IV) famotidine
- C. Draw blood for type and crossmatch.
- D. Infuse 1000 mL of lactated Ringer's solution.
Correct Answer: D
Rationale: Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.
The nurse is caring for a patient with a peptic ulcer and a nasogastric (NG) tube who develops sudden, severe upper abdominal pain, diaphoresis, and a firm, rigid abdomen. Which of the following actions should the nurse take next?
- A. Irrigate the NG tube.
- B. Obtain the vital signs.
- C. Listen for bowel sounds.
- D. Give the ordered antacid.
Correct Answer: B
Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.
The nurse is caring for a patient who is receiving chemotherapy and develops Candida albicans oral infection. Which of the following actions should the nurse anticipate?
- A. Hydrogen peroxide rinses
- B. The use of antiviral agents
- C. Referral to a dentist for professional tooth cleaning
- D. Administration of nystatin oral tablets
Correct Answer: D
Rationale: Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.
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.