NUR 303 - Chapter 46: Management of Patients With Oral and Esophageal Disorders

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

"Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

An adolescent client with multiple dental caries is discussing his diet with the nurse. The nurse explores the client's behaviors and identifies a risk factor for dental caries when the client states:

"I drink a can of carbonated soda at lunch every day." Measures to prevent dental caries include brushing teeth after meals, flossing daily, and having regular dental visits. Other factors increase risk, such as drinking the refined sugars found in carbonated soda.

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching?

"I need to drink 8 oz of water before eating." After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withhold fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly; keeping total serving sizes to less than 1 cup; and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

"I'll eat frequent, small, bland meals that are high in fiber." In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, the nurse plans postoperative care to include the following: (Select all that apply.)

- Assess lung sounds every 4 hours and prn. - Monitor drainage in the closed chest drainage system. - Verify rhythm on the cardiac monitoring system. Following recovery from anesthesia for a surgical resection of an esophageal tumor, the client is placed in the Fowler's position. A common postoperative complication is aspiration pneumonia. The nurse assesses for this complication by assessing lung sounds. The nurse monitors the drainage in the closed chest drainage system. Because of irritation of the vagus nerve, the nurse assesses for the complication of atrial fibrillation. The nurse does not replace the nasogastric tube if it becomes dislodged.

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply.

- Avoid beer, especially in the evening. - Elevate the head of the bed on 6- to 8-inch blocks. - Elevate the upper body on pillows. Milk should be avoided, as should eating before bed. Advise the patient not to eat or drink 2 hours before bedtime.

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply.

- Lansoprazole (Prevacid) - Rabeprazole (AcipHex) - Esomeprazole (Nexium)

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours?

80 to 120 mL Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours.

The nurse is conducting a community education session on the prevention of oral cancers. The nurse includes which cancer as being a type of premalignant squamous cell skin cancer?

Actinic cheilitis Actinic cheilitis is a type of premalignant squamous cell skin cancer that presents as scaling, crusty fissures or a white overgrowth of the horny layer of the epidermis. Herpes simplex 1 is an opportunistic infection frequently seen in immunosuppressed clients. Chancres are reddened circumscribed lesions that ulcerate and become crusted and are the primary lesions of syphilis. Krythoplakia is a red patch on the oral mucous membrane that is frequently seen in the elderly.

The nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care?

Baking soda and water When a client is unable to tolerate teeth brushing, the following irrigating solutions are recommended: 1 tsp baking soda in 8 oz warm water, half-strength hydrogen peroxide, or normal saline solution.

A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. The nurse instructs the client to

Brush and floss daily. The description of erythema, edema, and pain of the mouth following radiation treatment describes stomatitis. Nursing considerations include prophylactic mouth care such as brushing and flossing daily. A soft-bristled toothbrush is recommended. The client is to avoid alcohol-based mouth rinses and hot or spicy foods that may be part of the client's usual diet.

Which is an accurate statement regarding cancer of the esophagus?

Chronic irritation of the esophagus is a known risk factor. In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life.

Which is the primary symptom of achalasia?

Difficulty swallowing The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The client may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

The nurse is assessing the skin graft site of a client who has undergone a radical neck dissection. The skin graft site is pink. The nurse documents which result?

Healthy graft A healthy graft site is pink and warm to the touch. A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion.

Which of the following is one of the first clinical manifestations of esophageal cancer?

Increasing difficulty in swallowing The patient first becomes aware of intermittent and increasing difficulty in swallowing. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include sensation of a mass in the throat, foul breath, and hiccups.

A patient has been taking a 10-day course of antibiotics for pneumonia. The patient has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the patient about?

Nystatin (Mycostatin) Candidiasis is a fungal infection that results in a cheesy white plaque in the mouth that looks like milk curds. It commonly occurs in antibiotic therapy. Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed.

A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland?

Parotid The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:

Proton pump inhibitors. Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful.

The nurse notes that a client has inflammation of the salivary glands. The nurse documents which finding?

Sialadenitis Sialadenitis is inflammation of the salivary glands. Parotitis is inflammation of the parotid glands. Stomatitis is inflammation of the oral mucosa. Pyosis is pus.

Which term describes an inflammation of the salivary glands?

Sialadenitis Sialadenitis is inflammation of the salivary glands. Parotitis is inflammation of the parotid glands. Stomatitis is inflammation of the oral mucosa. Pyosis is pus.

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland?

Sialolithiasis Salivary stones are formed mainly from calcium phosphate. Parotitis refers to inflammation of the parotid gland. Sialadenitis refers to inflammation of the salivary glands. Stomatitis refers to inflammation of the oral mucosa.

A client with GERD develops espophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis?

Upper endoscopy with biopsy Upper endoscopy with biopsy confirms esophagitis. Barium-swallow would reveal inflammation or stricture formation from chronic esophagitis. Tests of stool may show positive findings of blood. Ambulatory 24-hour esophageal pH monitoring allows for observation of the frequency of reflux episodes and their associated symptoms.

The nurse provides health teaching to inform the client with oral cancer that

many oral cancers produce no symptoms in the early stages. The most frequent symptom of oral cancer is a painless sore that does not heal. The client may complain of tenderness, and difficulty with chewing, swallowing, or speaking occur as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless, hardened ulcer with raised edges.

The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department for chest pain. The client was diagnosed as having gastroesophageal reflux disease. The nurse notes in the client's record that the client is taking carbidopa/levodopa (Sinemet). The nurse questions the physician's order for

metoclopramide The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa, which is used for Parkinson's disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson's disease.

The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route?

nasogastric intubation The nasal route is the preferred route for passing a tube when the client's nose is intact and free from injury.

A client with gastroesophageal reflux disease (GERD) comes to the physician's office reporting a burning sensation in the esophagus. The nurse documents that the client is experiencing

pyrosis. Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain upon swallowing is termed odynophagia.

The nurse is caring for client scheduled to undergo radical neck dissection. During preoperative teaching, the nurse states that an associated complication is

shoulder drop. The nurse should include shoulder drop as an associated complication of radical neck dissection. Another associated complication is poor cosmesis, which is a visible depression in the neck. Clavicle fracture, venous engorgement, and neck distension are not complications associated with radical neck dissection.

A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease:

there are usually no symptoms. The early stage of oral cancer is characteristically asymptomatic.

The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state

"Many oral cancers produce no symptoms in the early stages." The most frequent symptom of oral cancer is a painless sore that does not heal. The client may complain of tenderness and difficulty chewing, swallowing, or speaking as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless, hardened ulcer with raised edges.

While stripping wax from surfboards, a client accidentally ingested a refrigerated strong base cleaning solution, thinking it was water. The nurse plans to include all the following in the care plan: (Select all that apply.)

- Administer medication for report of pain. - Insert an intravenous (IV) catheter for administration of IV fluids. - Maintain nothing by mouth status. - Assess respiratory status every 4 hours and prn. The client who has a chemical burn of the oral mucosa and esophagus will experience pain and may experience respiratory distress. The nurse will administer medication for pain and assess respiratory status. The client will be NPO, and IV fluids will be administered. Vomiting is avoided to prevent additional trauma from the caustic agent.

Which of the following are functions of saliva? Select all that apply.

- Lubrication - Protection against harmful bacteria - Digestion The three main functions of saliva are lubrication, protection against harmful bacteria, and digestion. Elimination and metabolism are not functions of saliva.

The nurse is creating a discharge teaching plan for a client after surgery for oral cancer. Which should be included in the teaching plan? Select all that apply.

- Oral hygiene - Follow-up dental appointment - Follow-up medical appointment - Use of humidification Discharge teaching for a client after oral surgery includes oral hygiene, follow-up dental and medical appointments, and the use of humidification to keep secretions moist.

Tube feedings are advised for a client who is recovering from oral surgery. The nurse manages the tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to reduce the risk of aspiration? Select all that apply.

- Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. - Check tube placement and gastric residual prior to feedings. Proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting.

A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate?

Achalasia Achalasia is absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing. Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the esophagus in the upper chest. The main symptom is difficulty in swallowing both liquids and solids. The patient has a sensation of food sticking in the lower portion of the esophagus.

The nurse is performing an assessment for a patient who presents to the clinic with a lip lesion. The lesion is erythemic, is fissuring, and has white hyperkeratosis. What does the nurse suspect that these findings are characteristic of?

Actinic cheilitis Actinic cheilitis is an irritation of the lips associated with scaling, crusting, fissure; white overgrowth of horny layer of epidermis (hyperkeratosis).

During postoperative neck dissection assessment, the nurse notices excessive bleeding from the dressing site. She suspects possible carotid artery rupture and takes the immediate first step to:

Apply pressure to the bleeding site or major associated vessel. The first action is to apply pressure on the bleeding site. Then summon assistance (do not leave the patient alone), elevate the head of the bed, and ask someone else to notify the surgeon.

While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit?

Approximately 80 to 120 mL Wound drainage tubes are usually inserted during surgery to prevent the collection of fluid subcutaneously. The drainage tubes are connected to a portable suction device (e.g., Jackson-Pratt), and the container is emptied periodically. Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours.

A nurse caring for a patient who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. An expected normal amount of drainage is:

Approximately 80 to 120 mL. Between 80 to 120 mL may drain over the first 24 hours. Drainage of greater than 120 mL may be indicative of a chyle fistula or hemorrhage.

A client has undergone a radical neck dissection. His skin graft site is pale. This indicates which condition?

Arterial thrombosis A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion.

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. The first activity of the nurse is to:

Assess lung sounds bilaterally. All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment.

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to

Assess the graft for color and temperature. The nurse may do all these activities related to the neck wound and dressing. Airway, breathing, circulation (ABCs) take priority. Assessing the graft for color and temperature addresses circulation.

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease?

Avoid eating or drinking 2 hours before bedtime. The client should not recline with a full stomach. The client should be instructed to avoid caffeine, beer, milk, and foods containing peppermint or spearmint, and to eat a low-fat diet. The client should be instructed to elevate the head of the bed on 6- to 8-inch blocks.

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. The client has understood the recommended dietary changes by:

Avoiding chocolate and coffee. Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis?

Chancre A chancre is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis. Lichen planus is a white papule at the intersection of a network of interlacing lesions. Actinic cheilitis is an irritation of the lips associated with a scaling, crusting fissure. Leukoplakias are white patches usually found in the buccal mucosa.

The nurse is caring for an older adult who reports xerostomia. The nurse evaluates for use of which medication?

Diuretics Diuretics, frequently taken by older adults, can cause xerostomia (dry mouth). This is uncomfortable, impairs communication, and increases the client's risk for oral infection. Antibiotics, antiemetics, and steroids are not medications typically taken orally by adults that cause dry mouth.

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease?

Dysphagia Dysphagia (difficulty swallowing), the most common symptom of esophageal disease, may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute odynophagia (pain on swallowing).

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom?

Esophageal tumor Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer.

An elderly client states, "I don't understand why I have so many caries in my teeth." The nurse assesses the following as placing the client at risk:

Exhibiting hemoglobin A1C 8.2 Measures used to prevent and control dental caries include controlling diabetes. A hemoglobin A1C of 8.2 is not controlled. It is recommended for hemoglobin A1C to be less than 7 for people with diabetes. Other measures to prevent and control dental caries include drinking fluoridated water; eating foods that are less cariogenic, which include fruits, vegetables, nuts, cheese, or plain yogurt; and brushing teeth evenly with a soft-bristled toothbrush.

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has what type of potential side effect?

Extrapyramidal Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

Postoperatively, a client with a radical neck dissection should be placed in which position?

Fowler The client should be placed in the Fowler position to facilitate breathing and promote comfort. This position expands the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs. The other positions are not the position of choice postoperatively.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

Gastroesophageal reflux disease Symptoms may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

A patient is experiencing painful, inflamed, and swollen gums, and when brushing the teeth, the gums bleed. What common disease of the oral tissue does the nurse understand these symptoms indicate?

Gingivitis Gingivitis is a gum disease that results in painful, inflamed, swollen gums that bleed in response to light contact.

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are?

Hairy leukoplakia Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough hairlike projections occur, typically found on lateral border of the tongue.

A client with oral cancer informs the nurse that he has been experiencing dryness of the mouth. The best action of the nurse is to

Provide a humidifier for the client to use while sleeping. Dryness of the mouth (xerostomia) is a frequent sequeala of oral cancer. While explaining this to the client provides information, it does nothing to help solve the problem. The nurse should encourage this client to increase intake of fluids to 2000 to 3000 mL per day. Providing a humidifier will assist in moisturizing the oral cavity. The client needs to be instructed to avoid dry, bulking, and irritating foods and fluids.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus and has been admitted to a medical unit. The nurse is writing a care plan for this patient. What information is essential to include?

He will need to undergo an upper endoscopy every 6 months to detect malignant changes. In the patient with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. To facilitate early detection of malignant cells, upper endoscopies may be performed every 6 to 12 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or which are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

A client has a radical neck dissection to treat cancer of the neck. The nurse develops the care plan and includes all the following diagnoses. The nurse identifies the highest priority diagnosis as

Ineffective airway clearance related to obstruction by mucus All the nursing diagnoses are appropriate for a client who has a radical neck dissection. According to Maslow's hierarchy of needs, physiological needs take priority. Under physiological needs, airway, breathing, circulation (ABCs) take highest priority. Thus, ineffective airway clearance is the highest priority nursing diagnosis.

Which of the following interventions would be most appropriate for a client with a hiatal hernia and nursing diagnosis of acute pain related to reflux of gastric secretions?

Inform the client to remain upright for at least 2 hours after meals. Because the client is showing signs of pain related to the pressure and the reflux of gastric secretions, it is essential to inform him or her to remain upright for at least 2 hours after meals because an upright position helps prevent reflux. Encouraging the client to eat frequent, small, well-balanced meals, to avoid alcohol and tobacco products, and to eat slowly and chew foods thoroughly would be appropriate for a nursing diagnosis of imbalanced nutrition, less than body requirements.

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. The best nursing intervention is to

Instruct the client to swish prescribed nystatin (Mycostatin) solution for 1 minute. A cheesy white plaque in the mouth that looks like milk curds and can be rubbed off is candidiasis. The most effective treatment is anitfungal medication such as nystatin (Mycostatin). When used as a suspension, the client is to swish vigorously for at least 1 minute and then swallow. Other measures such as providing saline rinses or ingesting a soft or bland diet are comfort measures. The nurse does not remove the plaques; doing so will cause erythema and potential bleeding.

Which mouth condition is associated with HIV infection?

Kaposi sarcoma Kaposi sarcoma appears first on the oral mucosa as a red, purple, or blue lesion. It is associated with HIV infection. Stomatitis is associated with chemotherapy and radiation therapy. Krythoplakia is caused by a nonspecific inflammation. Candidiasis is caused by fungus.

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort?

Keeping the head of the bed elevated. It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out.

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone?

Lithotripsy Lithotripsy uses shock waves to disintegrate stones. It may be used instead of surgical extraction for parotid stones and smaller submandibular stones. Radiation, chemotherapy, and biopsy do not use shock waves to disintegrate a stone.

The nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate?

Notify the physician The presence of stridor, a coarse, high-pitched sound upon inspiration, in the immediate postoperative period following radical neck dissection, indicates obstruction of the airway, and the nurse must report it immediately to the physician.

The nurse is preparing to assess the donor site of a client who underwent a myocutaneous flap after a radical neck dissection. The nurse prepares to assess the most commonly used muscle for this surgery. Which muscle should the nurse assess?

Pectoralis major The most common donor site for a myocutaneous flap after radical neck dissection is the pectoralis major muscle, so the nurse should prepare to assess this site unless a different donor site is documented on the client's chart.

The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. It is most important for the nurse to

Place the client in the Fowler's position. All the options are activities the nurse may do; however, the nurse has to prioritize according to Maslow's hierarchy of needs. Physiological needs are addressed first. Under physiological needs, ABCs (airway, breathing, circulation) take priority. Placing the client in the Fowler's position facilitates breathing and promotes comfort.

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an):

Protrusion of the upper stomach into the lower portion of the thorax. It is important for the patient and his family to understand the altered association between the esophagus and the stomach. The diaphragm opening, through which the esophagus passes, becomes enlarged and part of the upper stomach moves up into the lower portion of the thorax. The abnormality is not an involuntary, protruding, or twisted segment.

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client?

Provide the client with an irrigating solution of baking soda and warm water. If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended.

A 59-year-old woman with a recent history of heartburn, regurgitation, and occasional dysphagia has been diagnosed with a sliding hiatal hernia following an upper GI series. The nurse is providing patient education about the management of this health problem. What should the nurse suggest as a management strategy to this patient?

Remaining upright for at least 1 hour following each meal Management for a sliding hernia includes frequent, small feedings that can pass easily through the esophagus. The patient is advised not to recline for 1 hour after eating, to prevent reflux or movement of the hernia, and to elevate the head of the bed on 4- to 8-inch (10- to 20-cm) blocks to prevent the hernia from sliding upward. Fluid intake is encouraged, but this should be ingested throughout a meal, not just before and after the meal. It is not necessary to refrain from drinking alcohol, spicy foods, or dairy products.

Which of the following refers to a bacterial or viral infection of the salivary glands?

Sialadenitis Sialadenitis refers to the bacterial or viral infection of the salivary glands. Parotitis (inflammation of the parotid gland) is the most common inflammatory condition of the salivary glands. Mumps (epidemic parotitis), a communicable disease caused by viral infection and most commonly affecting children, is an inflammation of a salivary gland, usually the parotid. Stomatitis involves inflammation and breakdown of the oral mucosa; it is often a side effect of chemotherapy or radiation therapy.

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis?

Staphylococcus aureus People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for parotitis. The infecting organisms travel from the mouth through the salivary duct. The organism is usually Staphylococcus aureus (except in mumps).

An elderly patient is diagnosed with parotitis. The nurse is aware that this bacterial infection is most likely caused by:

Staphylococcus aureus. The elderly and debilitated experience decreased salivary flow from general dehydration or medications. The bacterial infection is usually caused by Staphylococcus aureus. The infecting organism travels from the mouth through the salivary gland.

Select the assessment finding that the nurse should immediately report, post radical neck dissection.

Stridor Stridor is the presence of coarse, high-pitched sounds on inspiration. The nurse would auscultate frequently over the trachea. This finding must be immediately reported because it indicates airway obstruction.

A patient has been diagnosed with Zenker's diverticulum. What treatment does the nurse anticipate educating the patient about?

Surgical removal of the diverticulum Because Zenker's diverticulum is progressive, the only means of cure is surgical removal of the diverticulum.

A patient comes to the clinic complaining of a sore throat. When assessing the patient, the nurse observes a reddened ulcerated lesion on the lip. The patient tells the nurse that it has been there for a couple of weeks but it does not hurt. What should the nurse consult with the physician about testing for?

Syphilis The primary lesion of syphilis is a chancre, which is a reddened circumscribed lesion that ulcerates and becomes crusted.

Which are accurate clinical manifestations associated with hemorrhage? Select all that apply.

Tachycardia Hemorrhage may occur from carotid artery rupture as a result of necrosis of the graft or damage to the artery itself from tumor or infection. Tachycardia, tachypnea, and hypotension may indicate hemorrhage and impending hypovolemic shock.

The client has a chancre on his lips. The nurse instructs the client to

Take measures to prevent spreading the lesion to other people. A chancre is a primary lesion of syphilis and very contagious. It is important to instruct the client about ways to prevent spreading the lesion to others. Other nursing considerations include cold soaks to the lip, good mouth care (brushing and flossing), and administration of antibiotics as prescribed.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

The client is free from esophagitis and achalasia. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

The client lying in a lateral position, with the head of bed flat A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

A client has a new order for metoclorpramide (Reglan). The nurse knows that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following?

Uncontrolled rhythmic movements of the face or limbs Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?

Weakness, diaphoresis, diarrhea 90 minutes after eating Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome.

Which of the following is the most common type of diverticulum?

Zenker's diverticulum The most common type of diverticulum, which is found three times more frequently in men than women, is Zenker's diverticulum (also known as pharyngoesophageal pulsion diverticulum or a pharyngeal pouch).

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as:

a canker sore of the oral soft tissues. Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a(n)

chancre. A chancre is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis. Lichen planus are white papules at the intersection of a network of interlacing lesions. Actinic cheilitis is an irritation of the lips associated with a scaling, crusting fissure. Leukoplakias are white patches usually found in the buccal mucosa.

The most common symptom of esophageal disease is

dysphagia. This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

A client is in the initial stages of oral cancer diagnosis and is frightened about the side effects of treatment and subsequent prognosis. The client has many questions regarding this type of cancer and asks where oral cancer typically occurs. What is the nurse's response?

floor of the mouth Malignant growths can be found anywhere in the oral cavity, but cancers usually occur on the lips, sides of the tongue, or floor of the mouth.

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:

maintaining a patent airway. Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.