Nokea
Which of the following findings should the nurse anticipate in a patient with an upper GI bleed?
- A. Increased urinary output
- B. Black, tarry stool
- C. Constipation
- D. Diaphoresis
- E. Epigastric pain
Correct Answer: B,D,E
Rationale: A patient with an upper GI bleed may have a black tarry stool, diaphoresis, and epigastric pain. The patient would have complaints of diarrhea, not constipation. The patient would have a decreased urinary output, not an increased one.
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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.
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.
Which of the following information is best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?
- A. Avoid foods that cause pain after you eat them.
- B. High-protein foods are least likely to cause pain.
- C. You will need to remain on a bland diet indefinitely.
- D. You should avoid eating many raw fruits and vegetables.
Correct Answer: A
Rationale: The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa; however, some patients tolerate by chewing well. High-protein foods not only help to neutralize acid but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.
The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications. Which of the following diet choices for a snack 2 hours before bedtime indicates that the teaching has been effective?
- A. Chocolate pudding
- B. Glass of low-fat milk
- C. Peanut butter sandwich
- D. Cherry gelatin and fruit
Correct Answer: D
Rationale: Cherry gelatin and fruit is a suitable choice as it is low in fat and not likely to trigger reflux, unlike chocolate, milk, or high-fat foods like peanut butter, which can exacerbate GERD symptoms.
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.