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. Parenteral nutrition (PN) should not be left out for extended periods. Generally, unused PN should be discarded after 24 hours, not 12 hours, to prevent contamination and bacterial growth.
B. The flow rate of PN should be monitored and adjusted carefully, but it should not be increased without orders. Rapid adjustments could cause complications such as fluid overload or electrolyte imbalances.
C. PN solution should be removed from the refrigerator 1 to 2 hours before use to allow it to come to room temperature, but 2 hours may be too long. It should be done cautiously to avoid bacterial growth at room temperature.
D. Monitoring daily laboratory values is essential for assessing the client's nutritional status, electrolytes, liver function, and kidney function. These values help guide ongoing care and detect complications of PN, such as electrolyte imbalances or liver dysfunction.
Correct Answer is C
Explanation
A. A rosebud-like stoma orifice is a normal finding. It refers to a stoma that has a rounded, pink appearance, which is healthy and typical after surgery.
B. A shiny, moist stoma is a normal finding. This appearance indicates good circulation and healing.
C. A purplish-colored stoma is abnormal and should be reported to the provider immediately. This color suggests possible ischemia or poor circulation, which may require intervention to prevent complications such as necrosis of the stoma.
D. Stoma oozing red drainage is normal, especially in the early postoperative period. It indicates that the stoma is healing properly. However, if the drainage is excessive or if the client shows signs of infection, it would need further evaluation.
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