Priority Decision: A patient with esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention is likely to be of highest priority preoperatively?

Correct Answer: C

Rationale: The correct answer is C) Encourage a high-calorie, high-protein diet. Rationale: Prior to a partial esophagectomy, the patient with esophageal cancer is at risk of malnutrition due to difficulty swallowing and the impending surgical intervention. A high-calorie, high-protein diet helps optimize the patient's nutritional status, promoting wound healing and overall recovery postoperatively. This intervention is crucial to enhance the patient's physiological reserves and reduce the risk of postoperative complications. Option A) Practice turning and deep breathing is important for postoperative care to prevent respiratory complications but is not the highest priority preoperatively for a patient undergoing a partial esophagectomy. Option B) Brush the teeth and mouth well each day is essential for oral hygiene but is not the highest priority preoperatively for a patient scheduled for surgery. Option D) Teach about postoperative tubes and cares is important for patient education but does not take precedence over addressing the patient's preoperative nutritional needs to optimize recovery. Educational Context: Understanding the priority nursing interventions for patients undergoing surgery is crucial for providing safe and effective care. Preoperative optimization, such as nutritional support, plays a vital role in enhancing patient outcomes and reducing the risk of complications. Nurses must prioritize interventions based on the patient's immediate needs to ensure holistic care and promote positive surgical outcomes.

Correct Answer: B

Rationale: In this question, the correct answer is B) Twisting of bowel on itself. Explanation of the correct answer: A volvulus is a condition where a loop of the bowel twists on itself, leading to obstruction and potential ischemia of the affected segment. This twisting can compromise blood flow and cause severe complications if not promptly addressed with surgical intervention. Explanation of why the other options are incorrect: A) Bowel folding on itself - This option does not fully capture the dynamic nature of a volvulus, which involves twisting rather than simply folding. C) Emboli of arterial supply to the bowel - This describes a different condition known as mesenteric ischemia, where a blockage in an artery leads to compromised blood supply to the bowel. D) Protrusion of bowel in weak or abnormal opening - This describes a hernia, where a portion of the bowel protrudes through a weakened area in the abdominal wall, which is different from a volvulus. Educational context: Understanding gastrointestinal disorders like volvulus is crucial for healthcare professionals, especially nurses, as they play a vital role in patient education and support. Providing accurate information to patients about their condition helps alleviate anxiety, promotes informed decision-making, and enhances overall patient outcomes. This question reinforces the importance of knowing the specific characteristics of different gastrointestinal disorders to facilitate timely and appropriate interventions.

Correct Answer: D

Rationale: After a hemorrhoidectomy, the nurse should advise the patient to take warm sitz baths several times a day to promote comfort and cleaning. This is the correct answer because warm sitz baths help reduce pain, inflammation, and promote healing by increasing blood flow to the area, keeping it clean, and soothing discomfort. Option A is incorrect as using daily laxatives can cause straining during bowel movements, which should be avoided after a hemorrhoidectomy to prevent complications and discomfort. Option B is incorrect because while ice packs can help reduce swelling, they are not the primary recommendation post-hemorrhoidectomy. Option C is incorrect as avoiding bowel movements can lead to constipation, which can worsen the condition and delay healing. In an educational context, it is crucial for nursing students to understand the appropriate postoperative care for patients undergoing a hemorrhoidectomy to ensure optimal recovery outcomes. Teaching patients the correct postoperative care, like taking sitz baths, is essential for managing their symptoms and preventing complications.

Correct Answer: B

Rationale: In a patient with cirrhosis, the correct laboratory test result to expect is option B) Total bilirubin: 3.2 mg/dL (54.7 mmol/L). Elevated levels of total bilirubin are indicative of impaired liver function, as the liver is unable to properly metabolize and excrete bilirubin. This occurs in cirrhosis due to the liver's reduced ability to process bilirubin effectively. Option A) Serum albumin: 7.0 g/dL (70 g/L) is not typically elevated in cirrhosis; instead, it is often decreased due to impaired liver synthesis. Option C) Serum cholesterol: 260 mg/dL (6.7 mmol/L) may be elevated in conditions like hyperlipidemia but is not a specific marker for cirrhosis. Option D) Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L) may be elevated in liver damage, but it is less specific for cirrhosis compared to elevated bilirubin levels. Educationally, understanding the significance of specific laboratory values in cirrhosis is crucial for nurses to assess and monitor patients effectively. Knowing the expected lab findings aids in early detection, appropriate intervention, and patient education regarding their condition. This knowledge enhances nurses' ability to provide optimal care and support for patients with gastrointestinal disorders like cirrhosis.

Correct Answer: B

Rationale: The correct answer is B) Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion. In a patient with an obstruction of the common bile duct, bile salts are unable to reach the intestine and duodenum due to the blockage. Bile salts are essential for emulsifying fats, aiding in their digestion and absorption. Without bile salts, fat digestion is impaired, leading to the passage of undigested fat in the stool, which presents as clay-colored and fatty stools. Option A is incorrect because soluble bilirubin in the blood being excreted into the urine is not directly related to the manifestation of clay-colored fatty stools in this scenario. Option C is incorrect as contraction of the gallbladder and obstructed ducts due to cholecystokinin stimulation do not explain the specific manifestation of clay-colored fatty stools. Option D is incorrect as it describes the consequences of the obstruction but does not directly address the pathophysiologic change leading to clay-colored fatty stools. Educationally, understanding the pathophysiology of gastrointestinal disorders is crucial for healthcare professionals to provide appropriate care and interventions for patients with these conditions. Recognizing the manifestations of common bile duct obstruction, such as clay-colored fatty stools, helps in diagnosing and managing patients effectively.