A nurse is caring for a client who has stomatitis following radiation therapy. Which of the following is an appropriate intervention for the nurse to take?
Serve foods without sauces or gravies.
Instruct the client to drink liquids without a straw.
Offer mouth rinses with normal saline and water.
Serve foods while still at a hot temperature.
The Correct Answer is A
An appropriate intervention for a nurse caring for a client with stomatitis following radiation therapy would be to serve foods without sauces or gravies. Stomatitis is the inflammation of the mucous membranes in the mouth, which can cause pain and discomfort. Foods with sauces or gravies can irritate the affected areas and exacerbate the symptoms. Serving plain or bland foods can help alleviate discomfort and promote healing.
Instructing the client to drink liquids without a straw is not specifically related to stomatitis. The use of a straw may not have a direct impact on the condition. However, it is generally recommended to avoid using a straw when there are mouth sores or ulcers to prevent further irritation.
Serving foods while still at a hot temperature is not appropriate for a client with stomatitis. Hot foods can cause additional discomfort and may further irritate the inflamed tissues. It is advisable to serve foods at a cooler or lukewarm temperature to provide relief.
Offering mouth rinses with normal saline and water is not specifically related to stomatitis following radiation therapy. While mouth rinses can be helpful in maintaining oral hygiene and soothing oral tissues, the choice of rinse solution may vary depending on the client's condition and healthcare provider's recommendations. In some cases, a healthcare provider may prescribe a specific mouth rinse or provide instructions on the appropriate solution to use.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Throat cancer and radiation therapy can cause various side effects, including nausea, stomatitis (inflammation of the mouth), and weight loss. In this situation, it is important to focus on nutritional support and addressing the client's symptoms.
Selecting foods high in protein is recommended for this client. Protein is essential for tissue repair and maintaining muscle mass, which is crucial for recovery and preventing further weight loss. Foods high in protein include lean meats, poultry, fish, dairy products, eggs, legumes, and tofu. The nurse can work with a registered dietitian to develop a meal plan that incorporates protein-rich foods while considering the client's preferences and any specific dietary restrictions.
Regarding the other options:
● Increase intake of liquids at mealtime: While it is important for the client to maintain hydration, increasing liquid intake at mealtime may contribute to a feeling of fullness and exacerbate nausea. It is generally recommended to consume liquids between meals rather than with meals.
● Serve foods hot: Serving foods hot may not directly address the client's symptoms. The temperature of the food is unlikely to alleviate nausea, stomatitis, or weight loss.
● Consume foods high in fat content: Foods high in fat content may be difficult to tolerate for a client experiencing nausea and stomatitis. Additionally, focusing on increasing protein intake is generally a higher priority than increasing fat intake for a client experiencing weight loss
Correct Answer is A
Explanation
Check for gastric residual: Gastric residual refers to the volume of formula or contents in the stomach before the next feeding. Checking for gastric residual helps determine if the client is tolerating the feeding properly. If the gastric residual is high, it may indicate delayed gastric emptying or intolerance to the feeding, which can lead to cramping and abdominal distention. The nurse can assess the gastric residual volume and consult with the healthcare provider to determine the appropriate course of action.
Apply low intermittent suction: Applying low intermittent suction is not typically indicated for a client receiving a continuous enteral tube feeding. Suction is more commonly used for clients who have an aspiration risk or need intermittent gastric decompression. In the given scenario, the client is experiencing cramping and abdominal distention, which may require a different approach.
Request a higher-fat formula: Requesting a higher-fat formula may not be the appropriate action at this time. High-fat formulas can contribute to gastrointestinal issues such as increased risk of diarrhea or malabsorption. It is important to assess the client's tolerance to the current formula before considering changes.
Increase the rate of the feeding: Increasing the rate of the feeding may worsen the client's symptoms. Rapid administration of enteral feedings can overwhelm the gastrointestinal system and lead to complications such as cramping, distention, and diarrhea. It is generally recommended to start at a low rate and gradually increase it based on the client's tolerance.

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