Which assessment finding requires an immediate intervention by the nurse for the patient after surgery for the treatment of gastric cancer?

Anorexia

Pain

Diaphoresis

Nausea

Answer and Explanation

The Correct Answer is C

A. Anorexia is a common symptom after surgery and may be due to the stress of surgery, anesthesia, or the body's adjustment to changes in digestion. While it requires monitoring, it is not an immediate concern unless it worsens or is accompanied by other signs of complications.
B. Mild to moderate pain is expected after surgery, especially following major procedures like gastric cancer surgery. Pain management is important, but it is not usually an immediate concern unless it is severe, unmanageable, or worsens suddenly.
C. Excessive sweating (diaphoresis) after surgery could indicate a serious complication, such as hypovolemic shock, infection, or a cardiovascular event. It is critical for the nurse to assess for other signs, such as low blood pressure, rapid heart rate, or fever, and take immediate action.
D. Nausea can occur after surgery and is a common side effect from anesthesia, pain medications, or the digestive system adjusting. While it requires management, it is typically not as urgent as diaphoresis, unless it is persistent or associated with other concerning symptoms like vomiting or dehydration.

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Correct Answer is D

Explanation

A. Pain management is an important aspect of postoperative care, particularly after a thoracotomy and lobectomy. However, it is not the highest priority compared to monitoring for potential complications, such as bleeding or respiratory distress, which are more immediately life-threatening.

B. Urinary output is an important indicator of renal function and hydration status. However, in the immediate postoperative period following thoracotomy and lobectomy, monitoring chest tube drainage for excessive bleeding or signs of a complication, like pneumothorax, is more critical for the patient's immediate stability than monitoring urinary output.

C. Tactile fremitus refers to the palpable vibration on the chest wall when a patient speaks. It is helpful in assessing lung consolidation or other lung issues, but it is not as critical to assess immediately in the postoperative phase as monitoring for complications related to chest tube drainage, which is directly linked to the patient's respiratory and hemodynamic status.

D. After a thoracotomy and lobectomy, monitoring chest tube drainage is of utmost importance. The nurse should assess the color, amount, and consistency of drainage to detect any excessive bleeding or signs of a complication like a pneumothorax or hemothorax. Significant drainage (especially >100 mL/hr for several hours) could indicate bleeding, which is a critical postoperative complication that requires immediate intervention.

A. anatomic placement B. portal hypertension C. It’s blood supply D. presence of tumor markers

Correct Answer is C

Explanation

A. While the liver is centrally located and plays a significant role in filtering blood, its location alone does not directly explain why it's a common site for metastasis.
B. Portal hypertension refers to increased pressure within the portal vein system, usually due to liver disease, not metastasis.
C. The liver has a dual blood supply from the portal vein and the hepatic artery, which makes it a key organ for filtering blood coming from the digestive tract. This provides a route for cancer cells from the gastrointestinal tract and other organs to travel to the liver, making it a common site for metastasis.
D. Tumor markers are substances that may be found in higher amounts in the blood or tissues of people with cancer. However, they do not directly explain why the liver is a common site for metastasis.

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Which assessment finding requires an immediate intervention by the nurse for the patient after surgery for the treatment of gastric cancer?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority?

Correct Answer is D

Explanation

A nurse knows that the liver is a common site for metastasis from other primary cancers due to:

Correct Answer is C

Explanation

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