The nurse is caring for a client receiving radiation therapy for treatment of oral cancer. Which new finding is the greatest concern?
Stomatitis
Stridor
Nausea
Xerostomia
The Correct Answer is B
A. Stomatitis is a common side effect of radiation therapy for oral cancer, and while it requires management, it is not immediately life-threatening.
B. Stridor indicates potential airway obstruction, which is a critical and urgent condition that requires immediate intervention, making it the greatest concern among the options presented.
C. Nausea is a typical side effect of cancer treatment but is usually manageable and not considered an immediate threat.
D. Xerostomia, or dry mouth, is another common side effect of radiation to the head and neck, but it is not as urgent as the risk of airway compromise indicated by stridor.
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View Related questions
Correct Answer is A
Explanation
A. The initial assessment describes a state of confusion where the patient is awake but experiencing forgetfulness and difficulty following commands. The subsequent assessment indicates lethargy, as the patient is now sleepy and has slow responses, which aligns with the definitions of confusion and lethargy.
B. While confusion is present in the first assessment, stupor describes a state of near-unconsciousness, which does not match the second assessment.
C. Although lethargy is appropriate for the second assessment, obtunded refers to a state where the patient is less aware and has difficulty arousing, which is not accurately described here.
D. The first assessment indicates confusion, but the patient is not fully conscious as described in the second assessment, which does not align with this option.
Correct Answer is A
Explanation
A. Reaction time is slower in older adults due to changes in the central nervous system and decreased neuronal processing speed, which can impact their overall response to stimuli.
B. Pain sensation is not typically heightened in older adults; rather, they may experience a decreased sensitivity to pain due to changes in the nervous system.
C. Higher basal body temperature is generally not associated with aging; older adults often have a lower baseline temperature.
D. While confusion can occur in older adults, it is not considered a normal age-related change and should be further evaluated for underlying causes rather than being expected.