Chapter 45 Coursepoint

A client is postoperative following a graft reconstruction of the neck. What intervention is the most important for the nurse to complete with the client? A. Assess the graft for color and temperature. B. Cleanse around the drain using aseptic technique. C. Administer prescribed intravenous vancomycin at the correct time. D. Reinforce the neck dressing when blood is present on the dressing.

A

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): A. Protrusion of the upper stomach into the lower portion of the thorax. B. Twisting of the duodenum through an opening in the diaphragm. C. Extension of the esophagus through an opening in the diaphragm. D. Involution of the esophagus, which causes a severe stricture.

A

An elderly client states, "I don't understand why I have so many caries in my teeth." What assessment made by the nurse places the client at risk for dental caries? A. Exhibiting hemoglobin A1C 8.2 B. Eating fruits and cheese in diet C. Drinking fluoridated water D. Using a soft-bristled toothbrush

A

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery? A. Vagus B. Vestibulocochlear C. Trigeminal D. Hypoglossal

A

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. A. Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. B. Check tube placement and gastric residual prior to feedings. C. Administer 15 to 30 mL of water before and after medications and feedings. D. Change the tube feeding container and tubing.

A B

The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply. A. Instruct the client to eat slowly and chew the food thoroughly. B. Encourage the client to eat later in the day before bedtime rather than early in the morning. C. Instruct the client to avoid alcohol or tobacco products. D. Encourage the client to eat frequent, small, well-balanced meals. E. Inform the client to remain upright for at least 2 hours after meals.

A C D E

A client has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client? A. Hyperactivity B. Uncontrolled rhythmic movements of the face or limbs C. Anxiety or irritability D. Dry mouth not relieved by sugar-free hard candy

B

A nurse inspects the Stensen duct of the parotid gland to determine inflammation and possible obstruction. What area in the oral cavity would the nurse examine? A. Dorsum of the tongue B. Buccal mucosa next to the upper molars C. Roof of the mouth next to the incisors D. Posterior segment of the tongue near the uvula

B

A nurse is completing an assessment on a client with a postoperative neck dissection. The nurse notices excessive bleeding from the dressing site and suspects possible carotid artery rupture. What action should the nurse take first? A. Elevate the head of the patient's bed B. Apply pressure to the bleeding site C. Summon assistance D. Notify the surgeon to repair the vessel

B

An older adult client seeks medical attention for a report of general difficulty swallowing. Which assessment finding is most significant as related to this symptom? A. Hiatal hernia B. Esophageal tumor C. Gastritis D. Gastroesophageal reflux disease

B

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? A. Streptococcus viridans B. Staphylococcus aureus C. Methicillin-resistant Streptococcus aureus (MRSA) D. Pneumococcus

B

Postoperatively, a client with a radical neck dissection should be placed in which position? A. Prone B. Fowler C. Side-lying D. Supine

B

The nurse provides health teaching to inform the client with oral cancer that A. blood testing is used to diagnose oral cancer. B. many oral cancers produce no symptoms in the early stages. C. a typical lesion is soft and craterlike. D. most oral cancers are painful at the outset.

B

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client? A. Abdominal distention, elevated temperature, weakness before eating B. Weakness, diaphoresis, diarrhea 90 minutes after eating C. Constipation, rectal bleeding following bowel movements D. Persistent loose stools, chills, hiccups after eating

B

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. What is the nurse's best intervention? A. Remove the plaque from the mouth by rubbing with gauze. B. Encourage the client to ingest a soft or bland diet. C. Instruct the client to swish prescribed nystatin solution for 1 minute. D. Provide saline rinses prior to meals.

C

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which strategy should the nurse use to assist the client? A. Urge the client to regularly rinse the mouth with tap water. B. Regularly wipe the outside of the client's mouth to prevent germs from entering. C. Provide the client with an irrigating solution of baking soda and warm water. D. Recommend that the client drink a small glass of alcohol at the end of the day to kill germs.

C

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge? A. Hold his breath B. Pant like a dog C. Take long, slow breaths D. Bear down as if having a bowel movement

C

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? A. Esophageal cancer B. Peptic ulcer disease C. Gastroesophageal reflux disease D. Diverticulitis

C

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone? A. Radiation B. Chemotherapy C. Lithotripsy D. Biopsy

C

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? A. Erythroplakia B. Chancre C. Actinic cheilitis D. Herpes simplex 1

C

When caring for a client with the impaired swallowing related to neuromuscular impairment, what is the nurse's priority intervention? A. Encourage thin liquids for dietary intake. B. Encourage the client to remove dentures. C. Elevate the head of the bed 90 degrees during meals. D. Place the client in a supine position.

C

A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition? A. Peptic ulcer with melena B. Gastritis C. Diverticulitis with perforation D. Gastroesophageal reflux disease

D

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, what should the nurse assign highest priority to? A. Ensuring adequate nutrition B. Helping the client cope with body image changes C. Preventing injury D. Maintaining a patent airway

D

The most common symptom of esophageal disease is A. nausea. B. vomiting. C. odynophagia. D. dysphagia.

D

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. How is aphthous stomatitis best described by the nurse? A. Acid indigestion B. An early sign of peptic ulcer disease C. An acute stomach infection D. A canker sore of the oral soft tissues

D

Which clinical manifestation is not associated with hemorrhage? A. Tachypnea B. Hypotension C. Tachycardia D. Bradycardia

D

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland? A. Sialadenitis B. Stomatitis C. Parotitis D. Sialolithiasis

D