A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of:
An intolerance to the feedings
Esophageal perforation with fistula formation into the lung
Extension of the tumor into the aorta
Leakage of fluids into the mediastinum
The Correct Answer is B
A. An intolerance to the feedings might cause discomfort, but it would not typically cause increasing pain, fever, and dyspnea. These symptoms are more indicative of a serious complication.
B. Esophageal perforation with fistula formation into the lung is the most likely cause of these symptoms. A perforation can lead to leakage of gastric contents into the pleural space or mediastinum, causing fever, pain, and respiratory distress. The formation of a fistula between the esophagus and the lung would lead to dyspnea.
C. Extension of the tumor into the aorta is a rare complication that would typically manifest with symptoms related to cardiovascular issues, not gastrointestinal symptoms like fever and dyspnea.
D. Leakage of fluids into the mediastinum is a possible cause of the symptoms, but esophageal perforation with a fistula into the lung is more directly linked to these specific symptoms, especially dyspnea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Chronic alcohol consumption can contribute to ulcers but is not the primary cause of duodenal ulcers. It can increase stomach acid and irritate the mucosal lining.
B. High intake of spicy foods is often blamed for ulcers, but it is not a direct cause. Spicy foods may exacerbate symptoms but do not cause ulcers.
C. Inadequate fiber intake is not a significant factor in the development of duodenal ulcers. Diet can influence overall digestive health but is not the main cause.
D. Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, are a leading cause of duodenal ulcers. They inhibit prostaglandin production, which protects the mucosal lining of the stomach and duodenum, leading to ulcer formation and increased risk of bleeding.
Correct Answer is A
Explanation
A. A fever following an upper gastrointestinal endoscopy can be a sign of a serious complication, such as perforation, which could cause peritonitis. The nurse should promptly assess the client for other signs of perforation, such as abdominal pain, rigidity, or changes in vital signs. This is a critical and potentially life-threatening situation that requires immediate attention.
B. While it is important to ensure accurate temperature readings, a fever of 101.8°F in a post-procedural patient is concerning and warrants further investigation rather than just retaking the temperature. It may indicate a complication such as infection or perforation.
C. Administering acetaminophen to reduce the fever is not the first step. The nurse should prioritize investigating the underlying cause of the fever, as it could indicate a more serious complication like perforation, which would not be resolved by medication alone.
D. Bathing the client with tap water is not appropriate. A fever after a procedure should be investigated thoroughly rather than treated symptomatically without understanding the cause. The nurse should focus on assessing for complications first.
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