NUR 304 Chapter 46 Concepts of Care for Patients with Oral Cavity and Esophageal Conditions
A nurse studying cancer knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.) a. Coal miner b. Electrician c. Metal worker d. Plumber e. Textile worker
a,c,d,e
A client has a large oral tumor. What assessment by the nurse takes priority? a. Airway b. Breathing c. Circulation d. Nutrition
a
A client is having a temporary tracheostomy placed during surgery for oral cancer. What action by the nurse is best to relieve anxiety? a. Agree on a postoperative communication method. b. Explain that staff will answer the call light promptly. c. Give the client a Magic Slate to write on postoperatively. d. Reassure the client that you will take care of all of his or her needs.
a
A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the clients neck. What action by the nurse takes priority? a. Assess the clients oxygenation. b. Facilitate a STAT chest x-ray. c. Prepare for immediate surgery. d. Start two large-bore IVs.
a
A client is prescribed cetuximab (Erbitux) for oral cancer and asks the nurse how it works. What response by the nurse is best? a. It blocks epidermal growth factor. b. It cuts off the tumors blood supply. c. It prevents tumor extension. d. It targets rapidly dividing cells.
a
A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? a. After the operation I can eat anything I want. b. I will have to eat smaller, more frequent meals. c. I will take stool softeners for several weeks. d. This surgery may not totally controlmy symptoms.
a
A nurse is caring for four clients. Which individual does the nurse identify as being at the highest risk for development of oral cancer? A. 28-year-old with human papillomavirus (HPV) infection B. 30-year-old with recurrent aphthous stomatitis (RAS) C. 55-year-old who quit chewing tobacco 5 years ago D. 76-year-old who is sometimes negligent in denture care
a
The nurse reads a clients chart and sees that the health care provider assessed mucosal erythroplasia .What should the nurse understand that this means for the client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor
a
Which question will the nurse ask as the priority to a client suspected of having leukoplakia? a. "Do you smoke, dip, or chew tobacco produce» b. "How much alcohol do you drink each day?" c. "Do you consume many fast food meals?» d. "How often do you have dental checkups?"
a
A client has been discharged to an inpatient rehabilitation center after an esophagogastrectomy. What menu selections by the client at the rehabilitation center indicate a good understanding of dietary instructions? (Select all that apply.) a. Boost supplement b. Greek yogurt c. Scrambled eggs d. Whole milk shake e. Whole wheat toast
a,b,c,d
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. I just joined a gym, so I hope that helps me lose weight. b. I sure hate to give up my coffee, but I guess I have to. c. I will eat three small meals and three small snacks a day. d. Sitting upright and not lying down after meals will help. e. Smoking a pipe is not a problem and I dont have to stop.
a,b,c,d
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections
a,b,c,d
Which action will the nurse teach a client with GERD to minimize symptoms? Select all that apply. a. Restrict caffeinated or carbonated beverages. b. Eat slowly and chew food thoroughly. c. Consume 4 to 6 small meals each day. d. Do not eat for 3 hours before going to bed. e. Sleep on your side to prevent regurgitation.
a,b,c,d
A client who had the Stretta procedure to treat severe GERD is being discharged. Which client statement requires further nursing teaching? Select all that apply. A. "Dysphagia after this procedure is normal." B. "It's important to stop my proton pump inhibitor." C. "I will not take NSAIDs and aspirin for at least 10 days." D. "I might cough up some blood following this procedure." E. "Today I will drink clear liquids and tomorrow I can eat soft food."
a,b,d
A nurse is caring for a 34-year-old client newly diagnosed with GERD. Which lifestyle change will the nurse suggest? Select all that apply. A. Lose weight if needed. B. Do not eat before bed. C. Elevate the foot of your bed by 6 to 12 inches. D. Avoid pants with a tight waistband or belt. E. Eat fay foods to minimize ongoing hunger.
a,b,d
The nurse is caring for a client who had an esophagectomy 3 days ago and was extubated yesterday. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assisting with position changes and getting out of bed b. Keeping the head of the bed elevated to at least 30 degrees c. Reminding the client to use the spirometer every 4 hours d. Taking and recording vital signs per hospital protocol e. Titrating oxygen based on the clients oxygen saturations
a,b,d
The nurse is caring for a client with sialadenitis. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Applying warm compresses b. Massaging salivary glands c. Offering fluids every hour d. Providing lemon-glycerin swabs e. Reminding the client to avoid speaking
a,c
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce
a,c,d,e
When providing discharge teaching about mouth care, which substance will the nurse teach the client with oral cancer to avoid? Select all that apply. A. Mouthwash B. Lip lubricant C. Warm saline rinses D. Ultrasoft toothbrush E. Disposable foam brushes F. Bicarbonate mouth rinse
a,e
A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first? a. Notify the surgeon. b. Put on a pair of gloves. c. Reinsert the NG tube. d. Take a set of vital signs.
b
A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective? a. I can only take this medicine at night. b. I should take this on a full stomach. c. This drug decreases stomach acid. d. This should be taken 1 hour before meals.
b
A client is scheduled for a traditional esophagogastrostomy. All preoperative teaching has been completed and the client and family show good understanding. What action by the nurse is best? a. Arrange an intensive care unit tour. b. Assess the clients psychosocial status. c. Document the teaching and response. d. Have the client begin nutritional supplements.
b
A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? a. Choosing foods that are easy to swallow b. Lungs clear after meals and snacks c. Properly performing swallowing exercises d. Weight unchanged after 2 weeks
b
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client? a. Enteral tube feeding b. Esophageal dilation c. Nissen fundoplication d. Photodynamic therapy
b
A community health nurse is screening clients for esophageal cancer. Which client is identified as being at highest risk? A. 22-year-old who drinks a glass of beer weekly B. 44-year-old who smokes a pack of cigarettes daily C. 50-year-old who takes over-the-counter omeprazole D. 63-year-old who uses protein supplements regularly
b
A nurse has conducted a community screening event for oral cancer. What client is the highest priority for referral to a dentist? a. Client who has poor oral hygiene practices b. Client who smokes and drinks daily c. Client who tans for an upcoming vacation d. Client who occasionally uses illicit drugs
b
A nurse is caring for a client with recurrent aphthous stomatitis (RAS) who asks about food choices while healing. Which food will the nurse suggest? A. Half of an orange B. Chocolate pudding C. Chips with hummus D. Glass of tomato juice
b
A nurse is caring for four clients. After receiving the hand-off report, which client should the nurse see first? a. Client having a radial neck dissection tomorrow who is asking questions b. Client who had a tracheostomy 4 hours ago and needs frequent suctioning c. Client who is 1 day postoperative for an oral tumor resection who is reporting pain d. Client waiting for discharge instructions after a small tumor resection
b
A public health nurse is assessing community clients for oral health disorders. Which client is identified at highest risk? A. 23-year-old with three dental fillings B. 34-year-old with schizophrenia C. 55-year-old with stable angina D. 62-year-old with irritable bowel syndrome
b
A student nurse is providing care to an older client with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene? a. Assisting the client to perform oral care every 2 hours b. Preparing to administer a viscous lidocaine gargle c. Reminding the client not to swallow nystatin (Mycostatin) d. Teaching the client to use a soft-bristled toothbrush
b
The nurse is working with clients who have esophageal disorders. The nurse should assess the clients for which manifestations? (Select all that apply.) a. Aphasia b. Dysphagia c. Eructation d. Halitosis e. Weight gain
b,c,d
Which client statement about GERD triggers requires further nursing teaching? Select all that apply. A. "I will decrease my alcohol intake." B. "Smoking one or two cigarettes a day won't hurt." C. "My plan is to eat six small meals daily." D. "Tomato-based foods should be avoided."' E. "I love soda but I'm going to stop drinking it." F. "Our family eats tacos and burritos several times weekly."
b,f
A client had an oral tumor removed this morning and now has a tracheostomy. What action by the nurse is the priority? a. Delegate oral care every 4 hours. b. Monitor and record the clients intake. c. Place the client in a high-Fowlers position. d. Remove the inner cannula for cleaning.
c
A client has a nasogastric (NG) tube. What action by the nursing student requires the registered nurse to intervene? a. Checking tube placement every 4 to 8 hours b. Monitoring and documenting drainage from the NG tube c. Pinning the tube to the gown so the client cannot turn the head d. Providing oral care every 4 to 8 hours
c
A client has gastro esophageal reflux disease(GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)
c
A client is 1 day postoperative after having Zenkers diverticula removed. The client has a nasogastric (NG) tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate? a. Document the findings as normal. b. Irrigate the NG tube with sterile saline. c. Notify the surgeon about this finding. d. Remove and reinsert the NG tube.
c
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first? a. Client who underwent diverticula removal with a pulse of 106/min b. Client who had esophageal dilation and is attempting first post procedure oral intake c. Client who had an esophagectomy with a respiratory rate of 32/min d. Client who underwent hernia repair, reporting incisional pain of 7/10
c
A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? a. Document the findings in the chart. b. Notify the surgeon immediately. c. Reassess the drainage in 1 hour. d. Take a full set of vital signs.
d
A female client hospitalized for an unrelated problem has a large pearly-white lesion on her lip, to which she continues to apply lipstick that she will not remove for inspection. The client refuses to discuss the lesion with the nurse or health care provider. What action by the nurse is best? a. Ask the client why her appearance is so important. b. Ignore the lesion since the client will not discuss it. c. Inform the client that early-stage cancer is curable. d. Work with the client to establish a trusting relationship.
d
After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? a. Bacteria can often cause ulcers. b. This operation often causes ulcers. c. The medication keeps your blood pH low. d. It prevents stress-related ulcers.
d
Which cause does the nurse recognize as a potential intentional cause for a clients esophageal trauma? a. Nasogastric (NG) tube placement b. Esophageal ulcers c. Struck by a foreign object d. Chemical injury
d
The nurse is caring for a client with esophageal cancer who is scheduled for surgery. When the client asks, "Is this treatment going to cure me?" which nursing response is appropriate? Select all that apply. A. "The surgery has been useful for many patients so it should work for you." B. "You can beat this disease if you just put your mind to it and do not give up." C. "Yes, and you have the best surgeon around who specializes in cancer treatment." D. "Your surgeon can give more information about the effectiveness of this treatment." E. "It sounds like you are concerned about surgical outcomes; let's talk about your feelings."
d,f