A client who is receiving radiation treatment for laryngeal cancer has developed xerostomia and mucositis.
The nurse determines the client has an imbalanced nutritional intake and is consuming less than body requirements.
Which factor is the most likely cause for this problem?
Nausea.
Fatigue.
Pain when eating.
Altered taste sensation.
The Correct Answer is C
Choice A rationale:
Nausea can be a significant factor contributing to decreased food intake, but it is not the most likely cause in this scenario. Xerostomia (dry mouth) and mucositis are mentioned as symptoms in the question stem. Nausea alone does not explain why the client is consuming less than their body requirements.
Choice B rationale:
Fatigue can also contribute to decreased food intake, but it is not the most likely cause in this case. While fatigue can be a side effect of cancer treatment and may lead to reduced appetite, the question specifically mentions xerostomia and mucositis as issues contributing to imbalanced nutritional intake.
Choice C rationale:
Pain when eating is the most likely cause of imbalanced nutritional intake in this scenario. The client's laryngeal cancer and the development of mucositis indicate that eating is likely painful for them. This discomfort can significantly deter the client from eating, leading to decreased nutritional intake.
Choice D rationale:
Altered taste sensation can affect food preferences, but it is not the most likely cause in this case. Pain when eating is a more direct and immediate barrier to food intake, especially in the context of mucositis and laryngeal cancer.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Emphasize that using safe sex practices removes the risk of STIs. Rationale: While promoting safe sex practices is essential in preventing STIs, this response is not directly addressing the client's situation. The client already reports having unprotected sex, so this choice does not provide relevant information or address the potential consequences.
Choice B rationale:
Explain that reinfections occur from sex with untreated partners. Rationale: This is the correct response. Syphilis is a sexually transmitted infection that can be treated with antibiotics, but reinfections can occur if sexual partners are not treated. This response provides essential information about the potential consequences of unprotected sex with untreated partners.
Choice C rationale:
Clarify that all STIs are transmitted through sexual intercourse. Rationale: While this statement is accurate in a general sense, it does not specifically address the client's situation or the risks associated with syphilis. It lacks the focus needed to educate the client effectively about their current situation.
Choice D rationale:
Provide counseling that most contraceptives protect against infection. Rationale: This response is inaccurate. Contraceptives primarily aim to prevent pregnancy, not protect against STIs. Therefore, it does not address the client's concern or provide relevant information about syphilis.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale:
Monitoring ETT markings between 22 and 26 cm at the teeth line is essential to ensure proper placement of the endotracheal tube (ETT). This helps confirm that the ETT is positioned correctly in the trachea.
Choice B rationale:
Checking for capillary refill is not a reliable method for verifying the placement of an ETT. It is more indicative of peripheral circulation and not related to airway management.
Choice C rationale:
Obtaining a portable chest x-ray is a crucial step to verify the exact placement of the ETT within the trachea and to rule out potential complications such as pneumothorax.
Choice D rationale:
Assessing for symmetrical chest movement is important because unequal chest rise and fall could indicate an issue with ETT placement or lung function.
Choice E rationale:
Auscultating for bilateral breath sounds is another method to confirm that the ETT is correctly positioned in the trachea and that both lungs are being ventilated adequately.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.