Chapter 49: Concepts of Care for Patients with Oral Cavity and Esophageal Problems
Which most accurate diagnostic test will the nurse expect to be ordered for a client to verify the diagnosis of gerd? a. Esophagogastroduodenoscopy (EGD) b. Espohangeal manometry c. Ambulatory esopharyngeal pH monitoring d. motility testing
C
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 control my symptoms.
A Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure. The other statements show good understanding.
which action will the nurse teach a client with guard to use to prevent harm? SATA a. Do not consume caffeinated or carbonated beverages b. avoid peppermint chocolate and fried foods c. eat slowly and chew food thoroughly d. consume four to six small meals each day e. do not eat for three hours before going to bed f. sleep on your side to prevent regurgitation
A B C D E
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 Lifestyle modifications can help control GERD and include losing weight if needed; avoiding chocolate, caffeine, and carbonated beverages; eating frequent small meals or snacks; and remaining upright after meals. Tobacco is a risk factor for GERD and should be avoided in all forms
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 Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided
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 The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens. Electricians do not have this risk.
which client will the nurse carefully assess for high risk of oral cavity disorders? SATA A. Clients who are homeless or who live in instituitions b. clients with sexually transmitted infections c. clients who are developmentally disabled d. clients who consume an unhealthy diet. e. clients who work in coal mines f. clients who regularly use alcohol and tobacco.
A, C, D, F the nurse will careful asses the clients for increased risk of oral cavity disorders with these conditions, having developmental delays or mental health disorders, having limited access to care due to homelessness or health disparities, residing in instituitions, using tobacco and or alcohol, consuming an unhealthy diet, having a type of oral cancer, and consuming dietary excess.
which signs and symptoms WILL a nurse expect to assess when a client is diagnosed with a paraesophageal hernia? a. regurgitation b. feeling of fullness after eating c. dyspepsia d. breathlessness after eating e. Dysphasia f. chest pain that mimics angina
B D F
Which actions will the nurse teach a client with severe GERD that causes pain after each meal, last for at least minutes, and worseNs when he or she lies down? SATA a. "Drink fluids right away" b. " When you lie down, try lying on your side" c. "take an antacid as prescribed by the health care provider" d. "eat something bland such as a slice of white bread e. "maintain an upright position for at least an hour after you eat" f. "try pressing over abdomen to mobilize the food in your stomach"
C D
for which reason will the nurse carefully examine the mouth of an older adult for candidiasis? a. Older clients are more likely to wear dentures which increase the risk for candid isis b. older adults on fixing comes consume fewer fresh vegetables and fruits c. older adults is immune systems decline with aging increasing their risk for Candidiasis d. older clients are less likely to see a dentist and have healthy oral hygiene
C older adults on fixing comes consume fewer fresh vegetables and fruits
which diagnostic test will the nurse expect the client to undergo to the best identify a hiatal hernia a. esophagogastroduodenoscopy (EGD) b. 24 hour ambulatory pH monitoring c. Eosphageal manometry d. Barium swallow with fluoroscopy
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 Clients with oral cancers often have body image difficulties due to the location of the tumor or the results of surgical treatment. This client appears to be using denial to cope with this problem. The nurse should work to establish a helping-trusting relationship in hopes that the client will be amenable to future discussions about the lesion. Asking why questions often puts people on the defensive and should be avoided. Ignoring the lesion is not being an advocate for the client. Education is important, but right now the client is in denial, so this information will not seem relevant to her.
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 After surgery, anti-ulcer medications such as pantoprazole are often given to prevent stress-related ulcers. The other responses are incorrect.
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 The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indicates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Documentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess.
what is the most common symptom the nurse expect clients with esophageal cancer to report A. Difficulty with swallowing B. Shortness of breath C. Reflux especially at night D. Productive cough
a
which client does the nurse assist has at highest risk for development of esophageal cancer A. 45 years on a high fiber diet B. 50 year old worth a seditary lifestyle C. 55 year old who smokes and is 25 lbs overweight D. 60 year old who is presented famotidine for reflux
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 The client should be able to turn his or her head to prevent pulling the tube out with movement. The other actions are appropriate.
Which question will the nurse be sure to ask a client suspected of having leukoplakia? a. "do you smoke,dip, or chew tobacco products" 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
which drug does the nurse expect to administer to client in order to decrease hydrochloric acid secretion in the stomach? a. famotidine b. Gaviscon c. Mylanta d. Anna biotic
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 The priorities of care are airway, breathing, and circulation. The priority option is to assess oxygenation. This occurs before diagnostic or therapeutic procedures. The client needs two large-bore IVs as a trauma client, but oxygenation comes first.
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 Before surgery that interrupts the clients ability to communicate, the nurse, client, and family (if possible) agree upon a method of communication in the postoperative period. The client may or may not prefer a slate and may not be able to communicate in writing. Reassuring the client and telling him or her you will take care of all of his or her needs does not help the client be an active participant in care. Ensuring that the staff will answer the call light promptly will not guarantee this will occur.
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 Cetuximab (Erbitux) targets and blocks the epidermal growth factor, which contributes to the growth of oral cancers. The other explanations are not correct.
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 Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor.
Which post op instructions will the nurse provide for a client after laparoscopic Nissen fundoplication (LNF) Sata a. Consume a soft diet for about a week ; avoid carbonated beverages, tough foods, and raw vegitable that are difficult to swallow. b. You will no longer need to take atireflux medications after your surgery is over c. You must not drive for a week after surgery; especially do not drive after taking an opioid pain medication d. Walk everyday but do not do any heavy lifting e. Remove the small dressings and closure strips 2 days after surgery and then may shower f. Report fever above 101 nausea, vomiting, or uncontrollable bloating or pain
A C D E F
which non-surgical treatment option for cancer of the esophagus will the nurse discuss with a client? Sata A. Swallowing therapy B. Smoking cessation program C. Nutrition therapy D. Chemoradiation E. Photodynamic therapy F. Eosphageal dilation
A C D E F
Which drug will the nurse expect the health care provider to prescribe for a client after esophageal trauma? A. Broad spectrum antibiotics B. Loop diuretics C. Corticosteroids D. Antacid's E. Pain medications F. Viscous lidocaine
A C E F
How does the nurse expect a clients nasogastric (NG) tube drainage to appear immediately after Nissen fundoplication surgery? a. Bright red mixed with brown b. Dark brown c. Yellowish to green d. Green to clear
B
which oral disorder does the nurse suspect when assessment findings reveal white plaque light lesions that when wiped away show an underlying red and sore surface a. Leukoplakia b. candidiasis c. erythroplakia d. kaposi's sarcoma
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 Esophageal dilation can provide immediate relief of esophageal strictures that impair swallowing. Enteral tube feeding is a method of providing nutrition when dysphagia is severe, but esophageal dilation would be attempted before this measure is taken. Nissen fundoplication is performed for severe gastroesophageal reflux disease. Photodynamic therapy is performed for esophageal cancer.
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 Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid.
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 Common signs of esophageal disorders include dysphagia, eructation, halitosis, and weight loss. Aphasia is difficulty with speech, commonly seen after stroke.
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 To promote airway clearance, this client should be placed in a semi- or high-Fowlers position. Oral care can be delegated, but that is not the priority. Intake and output should also be recorded but again is not the priority. The inner cannula may or may not need to be cleaned, and the tracheostomy may or may not have a disposable cannula.
After esophagectomy for esophageal cancer, what is the nurse's priority for client care? A. Wound care B. Nutrition management C. Respiratory care D. Hydration status
C
what does the nurse suspect when assessing a client mouth and bonding and oral cavity tumor that appears as a red, velvety lesion on the tongue, palette, floor of the mouth, or mandibular mucosa? a. Kaposi's Sarcoma b. Basal Cell Carcinoma c. Erythroplakia d. Leukoplakia
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 NG tubes placed during surgery should not be irrigated or moved unless prescribed by the surgeon. The nurse should notify the surgeon about this finding. Documentation is important, but this finding is not normal.
A client has gastroesophageal 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 Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.
What is the nurse's best response when a client asks which diagnostic test will determine if an oral tumor is cancerous? a. "MRI is the only test that you will need at the time" b. "No single test will make the diagnosis on its own" c. "aqueous toluidine blue will be absorbed by malignancies" d. "biopsy is the definitive method for diagnosing oral cancer"
D
what manifestation of it and esophageal cancer does the nurse recognize when a client describes experiencing adult and steady sub sternal pain after drinking cold liquids A. Angina B. Aspiration C. Dysphagia D. Odynophagi
d painful swallowing
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 Malnutrition is a serious problem after this procedure. The client needs high-protein, high-calorie foods that are easy to chew and swallow. The Boost supplement, Greek yogurt, scrambled eggs, and whole milk shake are all good choices. The whole wheat bread, while heart healthy, is not a good choice as it is dry and not easy to chew and swallow.
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 UAP can assist with mobility, keep the head of the bed elevated, and take and record vital signs. The client needs to use the spirometer every 1 to 2 hours. The nurse titrates oxygen.
2. A client has a large oral tumor. What assessment by the nurse takes priority? a. Airway b. Breathing c. Circulation d. Nutrition
A Airway always takes priority. Airway must be assessed first and any problems resolved if present.
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 Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.
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 The UAP can apply warm compresses and offer fluids. Massaging salivary glands can be done, but not by the UAP. Lemon-glycerin swabs are drying and should not be used. Speaking has no effect on this condition.
Which important information will the nurse include when teaching clients how to maintain healthy oral cavities? Select all that apply A perform a monthly self examination of the mouth looking for changes b. eat a well balanced diet and stay hydrated by drinking water c. If you were dentures, make sure that they are in good repair and fit properly d. thoroughly brush and floss your teeth parentheses or brush dentures parentheses consistently twice daily e. use mouthwashes that contain alcohol to destroy organisms that live in the mouth f. see the dentist regularly and have dental repair as soon as possible
A, C, D. F
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 The client who needs frequent suctioning should be seen first to ensure that his or her airway is patent. The client waiting for pain medication should be seen next. The nurse may need to call the surgeon to see the client who is asking questions. The client waiting for discharge instructions can be seen last.
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 All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallowing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met.
A nurse has conducted a community screening event for oral cancer. What client is the highest priority for referral to a dentist? Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 441 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 Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk factor, but short-term exposure does not have the same risk as daily exposure to tobacco and alcohol. Illicit drugs are not related to oral cancers.
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 Clients facing this long, difficult procedure are often anxious and fearful. The nurse should now assess the clients psychosocial status and provide the care and teaching required based on this assessment. An intensive care unit tour may help decrease stress but is too limited in scope to be the best response. Documentation should be thorough, but the nurse needs to do more than document. The client should begin nutritional supplements prior to the operation, but again this response is too limited in scope.
10. A nurse assesses a clients oral cavity and observes the condition depicted in the photo below: What action by the nurse is best? a. Ask about the clients human immunodeficiency virus (HIV) status. b. Assess the client for dysphagia. c. Listen to the clients lung sounds. d. Refer the client to an oncologist.
B This client has oral candidiasis. If the infection extends down the pharynx, the client could have difficulty swallowing. Therefore, the nurse should assess the client for dysphagia. HIV status may or may not be related but is not the priority. Listening to the lungs is unrelated. Since oral candidiasis is an infectious condition, referral to an oncologist is not needed.
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 postprocedure 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 The client who had an esophagectomy has a respiratory rate of 32/min, which is an early sign of sepsis; this client needs to be assessed first. The client who underwent diverticula removal has a pulse that is out of the normal range (106/min), but not terribly so. The client reporting pain needs pain medication, but the client with the elevated respiratory rate needs investigation first. The nurse should see the client who had esophageal dilation prior to and during the first attempt at oral feedings, but this can wait until the other clients are cared for.
Which cause does the nurse recognize as a potential intentional cause for a clients esophageal trauma? A. NG tube placement B. Esophageal ulcers C. Struck by a foreign object D. Chemical injury
d
Which action will the nurse teach a client to avoid to prevent harm after Nissen fundoplication surgery when gas bloat syndrome occurs? Sata a. Drink carbonated beverages b. Passing flatus or belching c. Eating gas producing foods d. Chewing gum e. Drinking through a straw f. Changing positions frequently
A C D E
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 Viscous lidocaine gargles or mouthwashes are sometimes prescribed for clients with stomatitis and pain. However, the numbing effect can lead to choking or mouth burns from hot food. This client already has difficulty swallowing, so this medication is not appropriate. Therefore, the nurse should intervene when the student prepares to administer this preparation. The other options are correct actions.
which priority teaching will the nurse provide to an older client with guard who is prescribed omeprazole for symptom relief? a. "older adults taking this drug may be at increased risk for hip fracture because it interferes with calcium absorption" b. " because of this drug's side effect of decreasing potassium, you may be prescribed a potassium supplement" c. "this drug causes sodium retention, so you might be prescribed a dietary sodium restriction" d. "a pacemaker may be necessary because this drug changes magnesium levels which can lead to life threatening dysrhythmias
A
which priority teaching will the nurse provide to prevent harm when a client with an oral problem is prescribed viscous lidocaine? a. "lidocaine causes an anesthetic effect so you may not feel burns from hot liquid" b. "you should avoid drinking either cool or cold liquids which can damage the tongue" c. "when you take viscous lidocaine you should swish it around your mouth then spit it out d. "viscous lidocaine will decrease the pain in your mouth when you use it regularly"
A
Which signs and symptoms will the nurse assess when a client is diagnosed with oral cancer? SATA a. Bleeding from the mouth b. Painful oral lesions that are red, raised , or eroded c. Difficulty chewing or swallowing d. Unplanned weight gain e. Thick or absent saliva f. Thickening or lump in check
A C E F
Which action will the nurse assign to the assistive personnel who will be helping to care for a client with stomatitis? a. providing oral care every two hours or more if stomatitis is not controlled b. teaching the client to use a soft toothbrush or gauze and to avoid commercial mouthwashes and lemon glycerin swabs which can irritate mucosa c. encouraging frequent rinsing of the mouth with warm saline, sodium bicarb solution, or a combination of these solutions d. applying topical analgesics or anesthetics as prescribed by the Primary Health care provider and documenting effectiveness e. instructing the client on how to select soft, bland, and non acidic foods f. removing dentures if the client has severe stomatitis or oral pain
A, C, F
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 To avoid exposure to blood and body fluids, the nurse first puts on a pair of gloves. Taking vital signs and notifying the surgeon are also appropriate, but the nurse must protect himself or herself first. The surgeon will reinsert the NG tube either at the bedside or in surgery if the client needs to go back to the operating room.
