Chapter 45: Management of Patients With Oral and Esophageal Disorders

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours? A.) 20 to 40 mL B.) 50 to 75 mL C.) 80 to 120 mL D.) 160 to 200 mL

Answer: C.) 80 to 120 mL

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.) Constipation, rectal bleeding following bowel movements C.) Persistent loose stools, chills, hiccups after eating D.) Weakness, diaphoresis, diarrhea 90 minutes after eating

Answer: D.) Weakness, diaphoresis, diarrhea 90 minutes after eating Rationale: 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 are functions of saliva? Select all that apply. - Lubrication - Protection against harmful bacteria - Digestion - Elimination - Metabolism

Answer; - Lubrication - Protection against harmful bacteria - Digestion

The nurse is caring for client scheduled to undergo radical neck dissection. During preoperative teaching, the nurse states that an associated complication is A.) shoulder drop. B.) neck distension. C.) venous engorgement. D.) clavicle fracture.

Answer; A.) shoulder drop. Rationale; 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 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.) Helping the client cope with body image changes B.) Ensuring adequate nutrition C.) Maintaining a patent airway D.) Preventing injury

Answer; C.) Maintaining a patent airway

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.) Summon assistance B.) Apply pressure to the bleeding site C.) Elevate the head of the patient's bed D.) Notify the surgeon to repair the vessel

Answer: B.) Apply pressure to the bleeding site

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? A.) Between 40 and 80 mL B.) Approximately 80 to 120 mL C.) Between 120 and 160 mL D.) Greater than 160 mL

Answer: B.) Approximately 80 to 120 mL

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? A.) "Lie down after meals to promote digestion." B.) "Avoid coffee and alcoholic beverages." C.) "Take antacids with meals." D.) "Limit fluid intake with meals."

Answer: B.) "Avoid coffee and alcoholic beverages."

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? A.) Dextrose and water B.) Baking soda and water C.) Full-strength peroxide D.) Mouthwash and water

Answer: B.) Baking soda and water

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

Answer: B.) Bradycardia

Which is an accurate statement regarding cancer of the esophagus? A.) It is three times more common in women than men in the United States . B.) It is seen more frequently in European Americans than in African Americans. C.) It usually occurs in the fourth decade of life. D.) Chronic irritation of the esophagus is a known risk factor.

Answer; D.) Chronic irritation of the esophagus is a known risk factor. Rationale: 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 than in women. It is seen more frequently in African Americans than in European Americans. It usually occurs in the fifth decade of life.

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? A.) Hiatal hernia B.) Gastroesophageal reflux disease C.) Gastritis D.) Esophageal tumor

Answer; D.) Esophageal tumor

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

Answer; D.) many oral cancers produce no symptoms in the early stages.

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

Answer: B.) Fowler

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

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

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. - Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. - Avoid beer, especially in the evening. - Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. - Elevate the head of the bed on 6- to 8-inch blocks. - Elevate the upper body on pillows.

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

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. What would be the first activity performed by the nurse? A.) Assess lung sounds bilaterally. B.) Administer prescribed morphine intravenously. C.) Obtain consent for the esophagogastroscopy. D.) Suction the oral cavity of the client.

Answer: A.) Assess lung sounds bilaterally.

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? A.) Dysphagia B.) Malnutrition C.) Pain D.) Regurgitation of food

Answer: A.) Dysphagia

Cancer of the esophagus is most often diagnosed by which of the following? A.) Esophagogastroduodenoscopy (EGD) with biopsy and brushings B.) X-ray C.) Barium swallow D.) Fluoroscopy

Answer: A.) Esophagogastroduodenoscopy (EGD) with biopsy and brushings

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.) Drinking fluoridated water C.) Eating fruits and cheese in diet D.) Using a soft-bristled toothbrush

Answer: A.) Exhibiting hemoglobin A1C 8.2 Rationale: 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 metoclopramide. The nurse identifies that this medication can be safely administered for which condition? A.) Gastroesophageal reflux disease B.) Peptic ulcer with melena C.) Diverticulitis with perforation D.) Gastritis

Answer: A.) Gastroesophageal reflux disease

A client is being evaluated for esophageal cancer. What initial manifestation of esophageal cancer should the nurse assess? A.) Increasing difficulty in swallowing B.) Sensation of a mass in throat C.) Foul breath D.) Hiccups

Answer: A.) Increasing difficulty in swallowing

A client who had oral cancer has had extensive surgery to excise the malignancy. Although surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to this client and family? A.) time to mourn, accept, and adjust to the loss B.) not giving in to anger C.) having a courageous attitude D.) knowing that everything will work out just fine

Answer: A.) time to mourn, accept, and adjust to the loss

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.) Reinforce the neck dressing when blood is present on the dressing. B.) Assess the graft for color and temperature. C.) Administer prescribed intravenous vancomycin at the correct time. D.) Cleanse around the drain using aseptic technique.

Answer: B.) Assess the graft for color and temperature. Rationale: Assessing the graft for color and temperature addresses circulation and is most important for the nurse to complete. Reinforcing the neck dressing is important, but not the priority. Administering medication and cleansing the drain site are not most important interventions with the client after graft reconstruction of the neck.

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

Answer: B.) Elevate the head of the bed 90 degrees during meals.

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? A.) Document the presence of stridor B,) Administer a breathing treatment C.) Notify the physician D.) Lower the head of the bed

Answer: C.) Notify the physician Rationale: 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.

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

Answer: C.) Protrusion of the upper stomach into the lower portion of the thorax. Rationale: 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 strategy should the nurse use to assist the client? A.) Urge the client to regularly rinse the mouth with tap water. B.) Recommend that the client drink a small glass of alcohol at the end of the day to kill germs. C.) Provide the client with an irrigating solution of baking soda and warm water. D.) Regularly wipe the outside of the client's mouth to prevent germs from entering.

Answer: C.) Provide the client with an irrigating solution of baking soda and warm water. Rationale: 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. Using tap water is not enough to promote oral hygiene. Drinking a small glass of alcohol will not provide oral hygiene. Wiping the outside of the mouth will not promote oral hygiene.

An older client is diagnosed with parotitis. What bacterial infection does the nurse suspect caused the client's parotitis? A.) Pseudomonas B.) Pneumococcus C.) Staphylococcus aureus D.) Streptococcus viridans

Answer: C.) Staphylococcus aureus Rationale: The elderly and debilitated clients 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. Pseudomonas, pneumococcus, and streptococcus are less likely to specifically affect the elderly or debilitated clients.

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

Answer: C.) Uncontrolled rhythmic movements of the face or limbs Rationale: Metoclopramide 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 for uncontrolled rhythmic movements of the face or limbs. Metoclopramide side effects are headache, confusion, and drowsiness. Anxiety, hyperactivity, and a dry mouth are not common side effects.

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

Answer: C.) dysphagia.