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The nurse is caring for a client who has been admitted with a diagnosis of esophageal cancer. The client reports a pain level of 8 on a 0 to 10 pain scale, dysphagia, anorexia, anxiety, and a hoarse voice. Which nursing problem is the priority for this client?

A.

Anxiety and grieving related to progression of disease.

B.

Chronic pain related to tissue destruction by tumor.

C.

Risk for aspiration related to difficulty swallowing.

D.

Imbalanced nutrition less than body requirements.

Answer and Explanation

The Correct Answer is C

Choice A rationale

 

Anxiety and grieving are important issues but are not the priority when the client is at risk for aspiration.

 

Choice B rationale

 

Chronic pain is significant, but the immediate risk of aspiration due to dysphagia takes precedence.

 

Choice C rationale

 

Risk for aspiration related to difficulty swallowing is the priority nursing problem. Aspiration can lead to serious complications such as pneumonia.

 

Choice D rationale

 

Imbalanced nutrition is important but is secondary to the immediate risk of aspiration.


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View Related questions

Correct Answer is A

Explanation

Choice A rationale

Tiotropium is a long-acting bronchodilator used daily to manage chronic obstructive pulmonary disease (COPD). It helps to relax the muscles around the airways, making it easier to breathe. This medication is not intended for immediate relief of acute symptoms but for long-term control of COPD1.

Choice B rationale

Using another inhaler in between uses of tiotropium is not necessary unless prescribed by a healthcare provider. Tiotropium is meant to be used daily, and other inhalers may be prescribed for different purposes, such as rescue inhalers for sudden symptoms.

Choice C rationale

While tiotropium can help improve breathing and reduce symptoms over time, it is not specifically indicated to reduce the thickness of sputum. Other medications or treatments may be needed to address sputum consistency.

Choice D rationale

Tiotropium is not a rescue inhaler and should not be used for sudden shortness of breath. Rescue inhalers, such as albuterol, are designed for immediate relief of acute symptoms.

Correct Answer is B

Explanation

Choice A rationale

Ipratropium is a bronchodilator used to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. It does not have significant interactions with the medications prescribed for H. pylori treatment, so it is not a priority to review in this context.

Choice B rationale

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastrointestinal bleeding and ulcers, especially when combined with other medications that affect the stomach lining, such as bismuth subsalicylate and tetracycline. Reviewing the client’s use of aspirin is important to prevent potential adverse effects and complications.

Choice C rationale

Famotidine is an H2 receptor antagonist used to reduce stomach acid production. While it is relevant to gastrointestinal health, it does not have significant interactions with the H. pylori treatment regimen. Therefore, it is not a priority to review in this context.

Choice D rationale

Loperamide is an antidiarrheal medication used to manage diarrhea. It does not have significant interactions with the medications prescribed for H. pylori treatment, so it is not a priority to review in this context.

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