A patient with metastatic cancer of the colon experiences severe vomiting and diarrhea following each administration of chemotherapy. Which nursing intervention is most effective?

Teach about the importance of nutrition after treatment

Offer dry crackers and carbonated fluids during the treatments

Administer prescribed antiemetic 1 hour before the treatments

Have the patient eat large meals when nausea is not present

Answer and Explanation

The Correct Answer is C

A. Teach about the importance of nutrition after treatment: While nutrition education is important for long-term recovery and maintaining strength, it does not prevent or control acute chemotherapy-induced nausea and vomiting during or immediately after treatment. This intervention alone is insufficient to manage the patient’s severe symptoms.

B. Offer dry crackers and carbonated fluids during the treatments: Small, bland snacks may provide some comfort, but offering them during chemotherapy is unlikely to prevent severe vomiting and diarrhea. The patient’s ability to tolerate oral intake is limited during active emesis, so this is supportive rather than preventive care.

C. Administer prescribed antiemetic 1 hour before the treatments: Prophylactic administration of antiemetics is the most effective strategy for controlling chemotherapy-induced nausea and vomiting. Giving the medication before treatment allows peak drug levels to coincide with chemotherapy exposure, reducing the severity and frequency of emesis and improving patient comfort.

D. Have the patient eat large meals when nausea is not present: Large meals can be difficult to tolerate and may exacerbate nausea or vomiting. Smaller, frequent meals are generally recommended for patients with chemotherapy-induced gastrointestinal upset, making this approach less effective than timely antiemetic therapy.

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Correct Answer is D

Explanation

A. Pulse oximetry: Pulse oximetry provides continuous monitoring of oxygen saturation but does not measure carbon dioxide levels or acid-base status. In ventilatory failure, hypoventilation can cause hypercapnia even if oxygen saturation is normal, making pulse oximetry insufficient for full assessment.

B. Chest x-rays: Chest x-rays can identify structural lung changes, infiltrates, or complications such as pneumothorax, but they do not provide real-time information about gas exchange or the effectiveness of ventilatory support.

C. Pulmonary artery pressure monitoring: Pulmonary artery catheters assess cardiac output and pulmonary pressures, which may be helpful in some critically ill patients, but they do not directly measure ventilation or gas exchange, which are central to evaluating ventilatory failure.

D. Arterial blood gas (ABG) analysis: ABGs provide direct measurement of PaO₂, PaCO₂, and pH, offering critical information about oxygenation, ventilation, and acid-base balance. These parameters are essential for determining the effectiveness of therapies such as mechanical ventilation, supplemental oxygen, or pharmacologic interventions in patients with ventilatory failure.

A. Maintain head of bed elevation at 15 degrees or less. B. Provide oxygen therapy to maintain oxygen saturation above 92 C. Keep lights dim in client's room to accommodate photophobia D. Assess the client for headaches and behavior changes frequently E. Minimize suctioning or hyper-oxygenate client before suctioning

Correct Answer is ["B","D","E"]

Explanation

A. Maintain head of bed elevation at 15 degrees or less: For a patient with increased intracranial pressure (ICP), the head of the bed should typically be elevated 30 degrees, not limited to 15 degrees. Proper elevation promotes venous drainage from the brain and helps reduce ICP, making 15 degrees insufficient for effective ICP management.

B. Provide oxygen therapy to maintain oxygen saturation above 92: Maintaining adequate oxygenation is critical in patients with neurological injury. Hypoxia can worsen cerebral ischemia and increase ICP, so oxygen therapy should be titrated to keep SpO₂ within the prescribed safe range, typically above 92%, to support cerebral perfusion and prevent secondary brain injury.

C. Keep lights dim in client's room to accommodate photophobia: While dim lighting can increase comfort in patients with migraine or photophobia, it does not directly affect ICP management. This action is supportive but not a priority intervention in caring for a patient with increased ICP.

D. Assess the client for headaches and behavior changes frequently: Frequent neurological assessment, including monitoring for changes in level of consciousness, behavior, and headache, is essential for early detection of worsening ICP or complications. These assessments guide timely interventions and are critical in intensive care management of post-stroke patients.

E. Minimize suctioning or hyper-oxygenate client before suctioning: Suctioning can stimulate coughing and increase ICP. To prevent sudden spikes in ICP, suctioning should be minimized and performed only when necessary, with pre-oxygenation to maintain cerebral oxygenation and reduce secondary brain injury risk.

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A patient with metastatic cancer of the colon experiences severe vomiting and diarrhea following each administration of chemotherapy. Which nursing intervention is most effective?

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Explanation

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