A client has esophageal cancer.Which intervention by the nurse takes priority?
Allowing grieving
Preventing aspiration
Managing pain relief
Maintaining nutritional intake
The Correct Answer is B
Choice A rationale
While allowing grieving is an important aspect of holistic care for a client with esophageal cancer, it is not the priority nursing intervention. Emotional support and counseling are crucial, but they do not take precedence over interventions aimed at maintaining the client’s physical health.
Choice B rationale
Preventing aspiration is the priority nursing intervention for a client with esophageal cancer. Aspiration, or the inhalation of food, stomach acid, or saliva into the lungs, can lead to pneumonia and other serious complications. Therefore, measures to prevent aspiration, such as educating the client on safe swallowing techniques, elevating the head of the bed during meals, and monitoring for signs of aspiration, are crucial.
Choice C rationale
Managing pain relief is an important aspect of care for a client with esophageal cancer, but it is not the priority nursing intervention. Pain management strategies, such as administering prescribed analgesics and providing comfort measures, are part of a comprehensive care plan
but do not take precedence over interventions aimed at preventing immediate life-threatening complications like aspiration.
Choice D rationale
Maintaining nutritional intake is an important aspect of care for a client with esophageal cancer, but it is not the priority nursing intervention. Nutritional support, such as providing a balanced diet, encouraging small frequent meals, and possibly arranging for a consultation with a dietitian, are important but do not take precedence over interventions aimed at preventing immediate life-threatening complications like aspiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Administering appropriate antibiotic therapy is a common nursing intervention to manage H. pylori infection. The recommended treatment for H. pylori typically involves using a triple-
drug therapy regimen, including a proton pump inhibitor or PPI like omeprazole, and two antibiotics, which include clarithromycin plus either metronidazole or amoxicillin. This treatment helps eradicate the bacterial infection through different mechanisms of action.
Choice B rationale
While maintaining a high-fiber diet is generally beneficial for overall health, it is not specifically related to the management of H. pylori infection. The primary treatment for H. pylori is antibiotic therapy, not dietary changes.
Choice C rationale
Over-the-counter antacids can help to neutralize stomach acid and provide temporary relief from symptoms, but they do not treat the underlying H. pylori infection. Therefore, while they may be used as part of symptom management, they are not a primary treatment strategy.
Choice D rationale
Assisting the patient with proper hand hygiene is always important in healthcare settings to prevent the spread of infections. However, it is not specifically related to the management of H. pylori infection. The bacteria are typically contracted during childhood, and the exact modes of transmission are not fully understood.
Correct Answer is B
Explanation
Choice A rationale
Elevating the patient’s legs on two pillows is not typically a necessary action after a liver biopsy. This position does not directly aid in the recovery or prevention of complications related to a liver biopsy.
Choice B rationale
Positioning the patient on the right side after a liver biopsy is a common nursing intervention. This position applies pressure to the liver biopsy site, which can help minimize bleeding and facilitate clot formation at the biopsy site.
Choice C rationale
Keeping the patient in a high Fowler’s position is not typically recommended after a liver biopsy. This position does not provide direct benefits in terms of recovery or prevention of complications from a liver biopsy.
Choice D rationale
Ambulating the patient twice each shift is not typically recommended immediately after a liver biopsy. Rest is usually advised to allow the liver tissue to heal and to minimize the risk of bleeding.
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