Chapter 53 & 54 (med-surg), Ch 55 (med-surg)

A patient is prescribed sucralfate to treat symptoms of peptic ulcer disease. What information does the nurse include when teaching the patient about this medication?

"Consume a high-fiber diet to minimize constipation." The main side effect of sucralfate is constipation, so the nurse should teach the patient about measures to minimize this. Meals at bedtime are not recommended with peptic ulcer disease, and patients should avoid alcohol. Sucralfate should be taken on an empty stomach.

Which statements should the nurse include when teaching patients and their families regarding prevention of gastritis? Select all that apply.

"Eating a well-balanced diet is important." "Alcoholic beverages in excessive amounts should be avoided." "Excessive intake of coffee or even decaffeinated drinks should be avoided." "Protection against exposure to toxic substances in the workplace should be practiced." A healthy lifestyle comprising a well-balanced diet helps to prevent complications. Excessive alcohol and caffeinated and decaffeinated drinks can lead to gastritis in adults, and these drinks should be avoided. A patient who is exposed to toxic substances, such as lead or nickel, at his or her workplace is also susceptible to gastric problems. Foods with strong spices such as pepper and mustard should be avoided because they can cause gastric distress. The use of proton pump inhibitors is reserved for patients who are already suffering from severe gastritis.

A patient who currently takes phenytoin has been started on a multidrug regimen for treatment of peptic ulcer disease. What does the nurse tell this patient about taking these medications?

"Take the phenytoin 1 to 2 hours before or after the antacid." Antacids may interfere with the effectiveness of phenytoin, so patients should be taught to take them 1 to 2 hours apart. It is not necessary to discontinue the phenytoin; phenytoin does not increase the effects of the antacid.

A patient tells the nurse that calcium carbonate has been effective in treating the discomfort associated with peptic ulcer disease. What does the nurse tell this patient?

"Tums will cause rebound acid secretion, which will make symptoms worse." Calcium carbonate is a potent antacid, but it triggers gastrin release, which causes rebound acid secretion. Therefore it is not recommended for a patient with peptic ulcer disease. Calcium carbonate does not affect ulcer healing.

The nurse is caring for a patient who has just returned from an endoscopic procedure. His wife verbalizes that the patient must be hungry. Which initial action by the nurse is correct?

Assess for a gag reflex Following an endoscopic procedure, the patient should not be allowed any foods or fluids until the gag reflex has been assessed for prevention of aspiration. The patient's wife should be instructed to refrain from providing foods or fluids. It is not necessary to obtain a dietitian consult or an order for nasogastric tube insertion.

Which disorder in older adults may have a direct association with mucosa-associated lymphoid tissue (MALT) lymphoma?

Atrophic gastritis

Which area of the body is a location for gastric ulcers?

In the antrum of the stomach Gastric ulcers appear in the antrum of the stomach. Stress ulcers may be found on the proximal duodenum. Duodenal ulcers occur in the upper portion of the duodenum and penetrate through the mucosa and submucosa into the muscularis propria.

A patient who has chronic gastritis is at increased risk for which condition?

Pernicious anemia Patients with chronic gastritis lose function of the parietal cells and thus the source of intrinsic factor leading to vitamin B 12 deficiency and pernicious anemia. It does not cause an increased risk of appendicitis, chronic constipation, or irritable bowel syndrome.

The nurse is performing a dietary history on a patient who was admitted for evaluation of atypical chest pain lasting up to 2 hours that occurs after meals. Which foods does the nurse ask the patient about? a. High-protein foods b. Beans and legumes c. Foods containing gluten d. Tomato products and tomatoes

d. Tomato products and tomatoes Tomatoes are a food that can increase reflux symptoms. Beans, gluten, and proteins are not foods that contribute to decreased lower esophageal sphincter pressure.

Which organ is usually affected in chronic atrophic gastritis?

deeply located glands Chronic atrophic gastritis causes inflammation and destruction of deeply located glands and affects all layers of the stomach. Type B chronic gastritis usually affects the glands of the antrum and can also involve the entire stomach. Type A (nonerosive) chronic gastritis leads to inflammation of the fundus and body of the stomach.

The nurse is caring for a patient who has granular dark vomitus that resembles coffee grounds. Which type of ulcer does the nurse suspect in this patient?

gastric The vomitus of patients with a gastric ulcer is more likely to resemble coffee grounds. Patients with duodenal ulcers generally pass blood in the stool. Esophageal ulcer bleeding is usually bright red. Pyloric obstruction does present with vomiting, but not typically with blood in the vomitus.

A patient who will begin taking ranitidine to treat gastroesophageal reflux disease (GERD) asks the nurse if the medication will cure the disease. Which answer by the nurse is correct? a. "Ranitidine does not prevent actual reflux." b. "You will notice increased effects over time." c. "An increased dose may be necessary to cure GERD." d. "Your provider may order a proton pump inhibitor instead."

a. "Ranitidine does not prevent actual reflux." The drugs used to treat GERD act by reducing or preventing gastric acid secretion, thus improving symptoms, but they do not affect reflux itself. The drug dose may need to be increased to improve symptom relief, or the provider may order a proton pump inhibitor to improve symptoms, but not to cure the reflux.

After assessing a patient, the nurse suspects the diagnosis will be obstructive sleep apnea (OSA). Which other symptoms in addition to excessive daytime sleepiness should the nurse look for in the patient? Select all that apply. a. Indigestion b. Hoarseness c. Painful swallowing d. Breathlessness after eating e. Feeling of fullness after eating

a. Indigestion b. Hoarseness c. Painful swallowing Indigestion, hoarseness, and painful swallowing are the symptoms of gastroesophageal reflux disease (GERD), which occurs frequently with OSA. Breathlessness after eating and feeling full after eating are symptoms of hiatal hernia, which is not associated with OSA.

A patient diagnosed with gastroesophageal reflux disease (GERD) reports a sensation of fluid in the throat that does not have the bitter taste previously experienced with reflux. What symptom is this patient experiencing? a. Pyrosis b. Dyspepsia c. water brash d. Odynophagia

c. Water brash Water brash is a sensation of fluid in the throat with no bitter or sour taste. Pyrosis is heartburn. Dyspepsia is indigestion. Odynophagia is painful swallowing.

A patient is diagnosed with a duodenal ulcer caused by H. pylori infection. The patient asks the nurse how this infection was contracted. How does the nurse respond?

" H. pylori infection is thought to be transmitted by consuming raw or unwashed foods." Although it is not entirely clear how H. pylori is transmitted, it is believed to be spread through contaminated food or water. Studies have also suggested that contact with stool, vomit, and sometimes saliva of an infected person can spread the infection. Human immunodeficiency virus is contracted through contact with infected blood or body fluids. Mycobacterium tuberculosis, the organism that causes tuberculosis, is typically contracted via inhaled droplets.

A patient with extensive burns reports severe abdominal pain and blood-tinged vomitus. Which ulcers might be the reason behind the patient's condition?

Curling's ulcer Curling's ulcers occur due to excessive stress hormones in the body. A patient suffering from extensive burns would be under extreme stress and would be susceptible to Curling's ulcers. Peptic ulcers occur when the mucosal barrier is disrupted due to gastrointestinal problems. Ischemic ulcers are associated with patients suffering from sepsis. Cushing's ulcers are found in patients with increased intracranial pressure.

What statement about type A gastritis is most accurate?

It is associated with pernicious anemia. A genetic link to type A gastritis has been found in the relatives of those who have pernicious anemia. The gene has an autosomal dominant pattern of inheritance. Type B gastritis is most often caused by H. pylori infection. Atrophic gastritis may occur due to exposure to toxins such as benzene or lead.

A patient with a history of heart failure is to be prescribed an antacid to help with symptoms of peptic ulcer disease. Which antacid does the nurse expect the provider to order for this patient?

Magaldrate Magaldrate contains the lowest sodium concentration and should be ordered for this patient. Patients with a history of heart failure should avoid antacids with a high sodium content such as aluminum hydroxide and magnesium hydroxide. Calcium carbonate is not recommended as an antacid because of the risk of rebound acid secretion.

The nurse is performing a health history on a patient who is newly diagnosed with peptic ulcer disease (PUD). Which condition in the patient's history prompts the nurse to question the patient further?

Osteoarthritis Nonsteroidal anti-inflammatory drugs are a major cause of PUD and are often used by patients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the patient is using. Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose patients to PUD.

What symptom should be assessed for in a patient suspected of having gastroesophageal reflux disease (GERD)? a. Nausea b. Vomiting c. Eructation d. Unplanned weight loss

c. Eructation Eructation is a common finding in patients with GERD. Nausea and vomiting rarely occur. Unplanned weight loss is not common finding.

A patient with gastroesophageal reflux disease (GERD) has severe chest pain lasting for several hours after eating. Which common symptom of GERD is the patient experiencing? a. Eructation b. Dysphagia c. Odynophagia d. Regurgitation

c. Odynophagia Odynophagia (painful swallowing) manifests as pain that may persist for several hours after swallowing as a result of spasms in the esophagus. Dysphagia refers to difficulty swallowing not associated with pain. Eructation is belching. Regurgitation is reflux of stomach contents into the esophagus.

What is a common cause of secondary stomatitis? a. Traumatic ulcers b. Aphthous stomatitis c. Herpes simplex stomatitis d. Opportunistic viral infection

d. Opportunistic viral infection Secondary stomatitis generally results from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised. Aphthous stomatitis, herpes simplex stomatitis, and traumatic ulcers are all types of primary stomatitis.

The nurse is assessing a patient in the clinic. Which defect, if observed by the nurse, would prompt the nurse to contact the provider to the possibility of a basal cell carcinoma? a. Hard palate discoloration b. Enlarged cervical lymph nodes c. Thickening or lump in the cheek d. Ulcers with a raised, pearly border

d. Ulcers with a raised, pearly border A basal cell carcinoma lesion first resembles a raised scab and later develops into an ulcer with a raised, pearly border. Basal cell carcinoma primarily involves the lips rather than the hard palate. It does not cause enlargement of the cervical lymph nodes, as basal cell carcinomas do not metastasize. A thickening or lump in the cheek is a feature of squamous cell carcinoma.

A patient with peptic ulcer disease (PUD) asks the nurse whether a maternal history of gastric cancer will cause the patient to develop gastric cancer. What is the nurse's best response?

"If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." Genetic counseling will help the patient determine whether he or she is at exceptionally high risk to develop gastric cancer. The patient cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the patient what the provider has said is an evasive answer by the nurse and does not help answer the patient's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.

A patient asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the patient about this organism?

"It produces an enzyme that alters the pH of the gastric environment." H. pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism does not damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function.

The nurse inserts a nasogastric (NG) tube for gastric lavage in a patient who is vomiting blood. What is the appropriate practice for gastric lavage?

A large-bore NG tube is required for gastric lavage. A large-bore NG tube is required for gastric lavage to accommodate the large volumes of fluid flowing in and out of the tube. Water at room temperature is appropriate for lavage, not cold water. A sample of the gastric contents is aspirated using a 50-mL catheter-tipped syringe. There is no evidence that sterile saline is better than tap water for gastric lavage; either can be used.

The endoscopy of a patient reveals a reddened and thick mucosal membrane around the stomach with prominent rugae. What condition does the patient have?

Acute gastritis In acute gastritis, the gastric mucosa becomes red and thickened with prominent rugae due to inflammation from being exposed to local irritants. Chronic gastritis appears as a patchy, spread out inflammation of mucosal lining of the stomach. Atrophic gastritis is a type of chronic gastritis most often found in older adults. Type A chronic gastritis is also associated with inflammation of glands, whereas Type B chronic gastritis mainly involves the glands of the antrum.

Which self-management measure will the nurse teach the patient with gastritis?

Avoid exposure to lead Atrophic gastritis is a kind of chronic gastritis that is commonly seen in patients exposed to toxic substances such as lead. Therefore exposure to metals such as lead should be limited. The patient should avoid excessive intake of both caffeinated and decaffeinated coffee. The patient with gastritis should quit smoking or tobacco use entirely because it aggravates the condition. The patient may not need to completely avoid NSAIDs but should exercise caution when taking them.

Which is the most serious complication of peptic ulcer disease that a nurse should check for in an older patient?

Hemorrhage The most serious complication of peptic ulcer disease in older adults is hemorrhage. This hemorrhage can be worsened with H. pylori infection; this condition may result in tarry or dark sticky stools and bright red vomitus. Perforations can occur when the ulcer is deep enough to wear away the entire membrane of the stomach and duodenum. Pyloric obstruction occurs in a small percentage of patients. Intractable diseases can occur if there are a lot of stressors in a patient's lifestyle (such as alcoholic beverages) and if the patient is unable to adhere to long-term therapy.

A patient who has peptic ulcer disease has developed pyloric obstruction. The nurse monitors the patient's laboratory values closely to assess for which complication?

Metabolic alkalosis Metabolic alkalosis is a complication of pyloric obstruction due to persistent vomiting. Patients who develop pyloric obstruction will have vomiting and hypokalemia (not hyperkalemia). Hypernatremia and metabolic acidosis are not associated with pyloric obstruction.

The nurse is reviewing the medications prescribed for a patient with peptic ulcer disease (PUD). Which drug is the patient taking to treat Helicobacter pylori infection?

Metronidazole Metronidazole is an antimicrobial that treats H. pylori infection. Aluminum hydroxide is an antacid that deactivates pepsin and buffers the acid produced in the stomach. Pantoprazole is a proton pump inhibitor that suppresses the H, K-ATPase enzyme system and regulates gastric acid secretion. Nizatidine is an H 2 antagonist that blocks histamine receptors in parietal cells and decreases gastric acid secretion.

A patient has been diagnosed with rheumatoid arthritis and has a history of peptic ulcer disease (PUD). The physician has decided to prescribe misoprostol to help prevent further gastric damage. What concurrent condition should be ruled out prior to starting this medication?

Pregnancy Misoprostol has two indications: protection of stomach lining and induction of labor. Therefore, the drug should not be given to a pregnant patient unless she is under the care of an obstetrician. Rheumatoid arthritis is an autoimmune disorder. Anemia can accompany peptic ulcer disease and is not a contraindication for misoprostol use. Fecal incontinence is not a contraindication for misoprostol use.

A nutritionist is asked to assist in forming a plan for a patient with peptic ulcer disease (PUD). Which recommendation is most helpful for this patient?

Reducing caffeine intake Caffeine, specifically coffee, stimulates gastrin release, which worsens PUD. Marshmallow root is recommended for PUD treatment, but marshmallows do not contain marshmallow root. Ipecac induces vomiting, which is not beneficial to the patient with PUD. Spicy foods worsen most stomach disorders and diseases.

The nurse is assessing the nature of abdominal pain in a patient with a suspected peptic ulcer. What feature of the pain points towards a diagnosis of gastric ulcer?

The pain is worsened by the ingestion of food. Pain due to a gastric ulcer usually worsens after the intake of food. Pain on the right of the epigastrium is often due to a duodenal ulcer. Pain due to a gastric ulcer is often in the upper epigastrium with localization to the left of the midline. It usually occurs 30 to 60 minutes after a meal and is rare at night. Pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after a meal and the patient often wakes up between 1 and 2 AM due to pain.

A patient has undergone a radical neck dissection for cancer and is being discharged home while undergoing radiation therapy. Which community resource is likely to be the most important aspect of this patient's outpatient care? a. Dental care b. Nutrition services c. Infection prevention d.Support group for cancer survivors

dental care If radiation therapy is part of the treatment plan, dental care is an important aspect of home care management for these patients. Acute problems include stomatitis and mucositis, and long-term effects include dental decay and xerostomia. Infection prevention, nutrition services, and support groups are part of the overall treatment plan as well, but are not as important.

A patient with chronic gastritis who is ordered to take vitamin B 12 asks the nurse why this vitamin is necessary. What does the nurse tell the patient about vitamin B 12?

"It will prevent a type of anemia." Patients who have chronic gastritis usually develop pernicious anemia, which may be prevented or treated with vitamin B 12. Vitamin B 12 does not affect the symptoms of gastritis, protect stomach lining, or minimize reflux.

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response?

"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the patient should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The patient should not use over-the-counter medications without first discussing it with his or her provider.

The nurse is teaching a patient about self-management of gastritis. Which piece of education is appropriate?

"Use complementary and alternative therapies." Using complementary and alternative therapies such as relaxation and meditation can help manage stress and discomfort, both of which can cause gastritis to worsen. Drinking coffee, whether it is caffeinated or decaffeinated, should be avoided because coffee contains peptides that stimulate gastrin release. Tomato products and onions are common irritating foods and should be avoided. Aspirin and other NSAIDs should be avoided because they may enhance acid production and further agitate gastritis.

The nurse finds a patient vomiting coffee ground-type emesis. On assessment, the patient has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority?

Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H 2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the patient's change in mental status, which is hypovolemia.

The nurse is providing instructions to a patient who has a history of stomatitis. Which instructions does the nurse include in the patient's teaching plan? a. Eat acidic foods to decrease bacteria. b. Mouth care should be performed twice daily. c. Use a medium-bristled toothbrush for oral care. d.Rinse the mouth with warm saline or sodium bicarbonate.

Rinse the mouth with warm saline or sodium bicarbonate. Rinsing the mouth with warm saline or sodium bicarbonate or a combination of the two decreases inflammation and pain. Acidic foods increase inflammation and should be avoided. Mouth care should be done after each meal and as often as needed. If stomatitis is not controlled, mouth care may have to be done every 2 hours or more frequently. A soft toothbrush should be used for oral care.

A patient diagnosed with gastroesophageal reflux disease (GERD) reports taking antacids multiple times a day for the last couple of months. What lab value should be assessed in this patient? a. pH b. Platelet count c. Ammonia level d. White blood cell (WBC) count

a. pH Prolonged use of antacids may elevate the pH level of the gastric contents; therefore they should be used short-term. Antacids do not affect the patient's platelet count, ammonia level, or WBC count.

A patient presents with erythroplakia. What does the nurse expect to find upon assessment of the oral cavity? a. Inflammation and erosion of the oral mucosa b. Red, velvety mucosal lesion on the oral mucosa c. White, plaque-like lesions on the buccal mucosa d. Slightly raised white patches on the buccal mucosa

b. Red, velvety mucosal lesion on the oral mucosa A red, velvety mucosal lesion on the surface of the oral mucosa is seen in erythroplakia, which is considered precancerous. Candidiasis is observed as white, plaque-like lesions on the buccal mucosa. A patient with leukoplakia has thickened, firmly attached, slightly raised, white patches on the buccal mucosa. Inflammation and erosion of the oral mucosa is observed in stomatitis.

The nurse is caring for a patient and is monitoring the patient regularly for acute gastritis with bleeding. Which medication class most likely causes the nurse to believe the patient is at risk for this disorder?

Nonsteroidal antiinflammatory drugs (NSAIDs) Chronic use of NSAIDs can result in gastritis and, in serious cases, bleeding or hemorrhage. ACE inhibitors have no gastric side effects. PPIs are used to treat gastritis and ulcers; they do not cause either condition. Narcotic analgesics are not implicated in gastritis.

The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which characteristic is most significant in determining whether the patient's ulceration is gastric or duodenal in origin?

Pain occurs 1½ to 3 hours after a meal, usually at night. A key symptom of duodenal ulcers is that pain usually awakens the patient between 1 AM and 2 AM, occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

What are the key features of chronic gastritis? Select all that apply.

Pernicious anemia Nausea and vomiting Intolerance to fatty food

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN?

Reinforce the teaching about avoiding alcohol and caffeine for a patient with chronic gastritis Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

The nurse is assessing a patient who reports episodes of pain in the abdomen. What feature suggests the possibility of a duodenal ulcer?

The patient has type O blood. Patients with duodenal ulcers most often have type O blood. They are usually 50 years or older and are often well-nourished. Another key feature of a duodenal ulcer is a high secretion of gastric acid; abdominal pain due to a duodenal ulcer is therefore relieved by the ingestion of food. Pain usually occurs again about 90 minutes to 3 hours after eating food.

Which pathologic changes can occur in a patient with gastritis? Select all that apply.

Vascular congestion Acute inflammatory cell infiltration Degenerative changes in the superficial epithelium of the stomach lining In gastritis, due to the breakdown of the gastrointestinal barrier, hydrochloric acid diffuses into the mucosa and causes injury to small vessels. This can cause vascular congestion and acute inflammatory cell infiltration. This diffusion also causes erosion of the superficial epithelium of the stomach lining. Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting itself. Histamine release and vagus nerve stimulation are aggravating factors that may cause pathological changes in gastritis, but these are not changes caused by gastritis.

What risk factors are associated with the development of gastroesophageal reflux disease (GERD)? Select all that apply. a. Ascites b. Obesity c. Seizures d. Pregnancy e. Wearing tight girdles f. Continuous severe vomiting

a. Ascites b. Obesity d. Pregnancy e. Wearing tight girdles Risk factors associated with the development of GERD include ascites, pregnancy, obesity, and wearing tight girdles. These factors increase intra-abdominal and intragastric pressure, overcoming the gastroesophageal pressure gradient maintained by the lower esophageal sphincter (LES). This allows reflux to occur resulting in the development of GERD. Seizures and continuous severe vomiting may result in esophageal perforation by exerting excessive force on the esophageal mucosa.

The nurse is providing teaching to a patient with gastroesophageal reflux disease (GERD). What statement by the patient indicates a need for further teaching? a. "Antacids should help provide some relief." b. "It's important for me to stop drinking alcohol." c. "I should sit up for about 20 minutes after I eat." d. "The belching I've been experiencing is probably because of my GERD."

c. "I should sit up for about 20 minutes after I eat." The patient should sit upright for about 2 hours after eating, not 20 minutes, to reduce the symptoms of GERD. Antacids should help provide relief. Alcohol contributes to GERD; therefore it is recommended that the patient stop drinking. Burping or belching is a sign of GERD.

The nurse is teaching a patient with a hiatal hernia about how to prevent heartburn. What statement by the patient indicates a need for further teaching? a. "I should avoid excessive vigorous exercises." b. "I should lie down in the flat position following meals." c. "I should raise the head of the bed on a 6-inch block while sleeping." d. "I should avoid fatty foods, coffee, tea, cola, and chocolate in my diet."

b. "I should lie down in the flat position following meals." A hiatal hernia is the protrusion of a part of the stomach above the diaphragm where the esophagus is normally situated. Lying in the flat position after meals can further aggravate the patient's heartburn as a result of reflux. Therefore the patient should be taught to remain upright for several hours after meals. Excessive vigorous exercise increases intra-abdominal pressure. Raising the head of the bed on a 6-inch block prevents nighttime reflux. Fatty foods, coffee, tea, cola, and chocolate are avoided with hernias as they can contribute to reflux.

The nurse is providing discharge education to a patient who underwent chemotherapy for oral cancer. Which responses indicate effective understanding? Select all that apply. a. "I should include thin liquids in my diet." b. "I should rinse my mouth frequently to clean it." c. "I should add sauces and gravies to my meal plans." d. "I should include milk, eggs, and pudding in my diet." e. "I should change my chemobrush once every couple of days."

b. "I should rinse my mouth frequently to clean it." c. "I should add sauces and gravies to my meal plans." d. "I should include milk, eggs, and pudding in my diet." For a patient who underwent chemotherapy and is being discharged, the patient cleans his or her oral cavity with frequent mouth rinses to reduce microorganism load and maintain hydration. To make food palatable, the patient can add seasonings and use gravies or sauces on his or her meals. The patient should include high-protein foods such as cheese, milk, eggs, puddings, and legumes but he or she should avoid meat in the diet. The patient should plan a liquid diet that is thick in consistency rather than thin because thin liquids are difficult to control during swallowing. The patient should wash the chemobrush after every use and change the brush every week.

The nurse admits an immune-compromised patient who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? a. Nystatin b. Acyclovir c. Diphenhydramine d. Tetracycline syrup

b. Acyclovir Acyclovir is an antiviral agent that is prescribed for immune-compromised patients who contract herpes simplex stomatitis. Diphenhydramine is an antihistamine that is not indicated for treating this condition. Nystatin is indicated for treatment of fungal infection. Tetracycline syrup is indicated for treatment of recurrent aphthous ulcers.

Which instruction would the nurse provide to a patient diagnosed with gastroesophageal reflux disease (GERD) to promote health and control reflux? a. "Sleep on your back." b. "Avoid eating 1 hour prior to going to sleep." c. "Elevate the head of your bed 6 to 12 inches." d. "Avoid the use of continuous positive airway pressure (CPAP) treatments."

c. "Elevate the head of your bed 6 to 12 inches." It is important to elevate the head of the patient's bed 6 to 12 inches to prevent nighttime reflux. Patients should not sleep on their backs; it is better that they sleep on their sides to help with swallowing and oxygenation. Patients should not eat for 3 hours prior to sleep, not only 1 hour. CPAP treatments are indicated and encouraged for patients with sleep apnea, and should not be avoided in patients with GERD.

A patient newly diagnosed with gastroesophageal reflux disease (GERD) asks the nurse what the prescribed medications are intended to do. What does the nurse tell the patient? a. "Medications for GERD will eventually cure the disease." b. "Antacid medications will prevent worsening of the reflux." c. "One goal of drug therapy is to prevent severe complications." d. "GERD medications relieve symptoms but do not treat esophagitis."

c. "One goal of drug therapy is to prevent severe complications." GERD is a chronic disease that must be managed, not cured. The goal of therapy is to relieve symptoms, treat esophagitis, and prevent complications such as Barrett's esophagus or strictures. Antacids reduce acid, but do not alter reflux. Medications for GERD are not curative.

A patient with gastroesophageal reflux disease (GERD) reports a frequent sour taste in the back of the throat. What is a priority nursing action for this patient? a. Palpate the patient's abdomen b. Evaluate the patient's dietary habits c. Auscultate the patient's lung sounds d. Monitor the patient's ability to swallow

c. Auscultate the patient's lung sounds Patients who report sour or bitter taste in the back of the throat are often experiencing regurgitation of stomach contents into the throat and are at risk for aspiration. The nurse should auscultate the lungs for crackles. Dietary habits and swallowing ability will need to be evaluated, but are not the priority. The nurse will also assess the abdomen for bloating and flatulence, but this is not a priority.

A patient has undergone surgery to remove an oral tumor. What postoperative care does the nurse provide for the patient? a. Cool, solid foods when suture lines start healing b. Oral care twice a day until suture lines are healed c. Nothing by mouth (NPO) status for several days after surgery d. Placement in a supine position for the first few hours after surgery

c. Nothing by mouth (NPO) status for several days after surgery The patient must maintain NPO status for several days after surgery to remove an oral tumor. This allows sufficient time for the wound to heal before food comes in contact with the sutures. Gentle oral care is provided at least every 4 hours in the early postoperative stage, to clean away thick secretions and stimulate saliva production and to assess the oral cavity for possible infection. The head of the patient's bed is elevated to assist in decreasing edema by gravity. The patient is provided thickened fluids to prevent aspiration. Solid food is avoided to prevent strain on the sutures.

Which medications are the most potent inhibitors of acid secretion available and are used for long-term treatment of severe gastroesophageal reflux disease (GERD)? Select all that apply. a. Ranitidine b. Famotidine c. Omeprazole d. Pantoprazole e. Esomeprazole

c. Omeprazole d. Pantoprazole e. Esomeprazole Omeprazole, pantoprazole, and esomeprazole are all proton pump inhibitors (PPIs). This classification of drug produces the most potent inhibition of gastric acid secretion available and is widely used in the long-term management of severe GERD. Famotidine and ranitidine are histamine receptor antagonists.

The nurse is counseling a patient who has been diagnosed with mild gastroesophageal reflux disease (GERD). What does the nurse teach the patient initially about managing this condition? a. Changing sleeping positions b. Using proton pump inhibitors c. Taking over-the-counter antacids d. Altering dietary and eating habits

d. Altering dietary and eating habits Initial treatment for mild GERD involves nutrition therapy including changes in types of foods and changes in eating patterns. Lifestyle changes such as weight loss and sleeping habits are approached next. Medication therapy is used for more severe symptoms or for those who do not improve with dietary and lifestyle changes.

The nurse is assessing a patient who reports nausea, indigestion, and heartburn. Upon reviewing the patient's lab results, the nurse observes the patient's electrolyte levels are normal. Which condition does the nurse most expect the patient to have? a. Anorexia b. Depression c. Hypothyroidism d. Obstructive sleep apnea (OSA)

d. Obstructive sleep apnea (OSA) A patient with frequent indigestion, nausea, and heartburn is showing symptoms indicative of gastroesophageal reflux disease (GERD); OSA is associated with GERD. Anorexia is an eating disorder that is characterized by low weight and a fear of gaining weight. Because patients with anorexia do not have healthy diets, they are susceptible to symptoms of nausea, indigestion, and heartburn, but an anorexic patient's electrolytes would not be normal. Depression is associated with gastric ulcers but not dyspepsia or heartburn. Hypothyroidism may cause headache and weight gain.

A patient has experienced mucosal erythroplasia for a month. The nurse suspects that the symptom is indicative of what condition? a. Erythroplakia b. Acute sialadenitis c. Basal cell carcinoma d. Squamous cell carcinoma

d. Squamous cell carcinoma Mucosal erythroplasia is characterized by red, raised, eroded lesions on the oral mucosa. It is the earliest sign of squamous cell carcinoma. Erythroplakia is characterized by red, velvety lesions on the surface of the mucosa. Erythroplakia is precancerous. Acute sialadenitis is an inflammation of the salivary glands. Basal cell carcinoma occurs on the lips, not the oral mucosa.

A patient has been diagnosed with acute sialadenitis. What does the nurse understand about this disorder? a. Escherichia coli rarely causes acute sialadenitis. b. Excessive salivation is one of the most common features. c. Tetracycline is the drug of choice to treat acute sialadenitis. d. The submandibular gland is the most commonly affected gland.

d. The submandibular gland is the most commonly affected gland Acute sialadenitis is an inflammation of the salivary gland. It most commonly affects either the parotid or the submandibular gland. E. coli is a common cause. This disorder commonly causes a reduction in saliva production. Tetracycline may act as a trigger for the disorder; it is not used to treat the condition.

A patient has undergone extensive resection for oral cancer followed by skin grafting. What early postoperative care is important for this patient? a. Donor site inspection once every day b. Collaboration with a speech-language pathologist c. Management of difficulty swallowing or aspiration d. Pain management with oral oxycodone plus acetaminophen

Collaboration with a speech-language pathologist Patients who undergo extensive resection may have difficulty speaking due to the surgery, so collaborating with a speech-language pathologist is key. The donor site should be assessed every 8 hours for bleeding or signs of infection. IV morphine is usually the initial pain medication administered; Percocet may be given after morphine is discontinued and the patient is no longer NPO. In the early postoperative period, the patient remains NPO for several days; signs of difficulty in swallowing or aspiration are assessed when oral fluid intake is started.

A patient has been diagnosed with mild gastroesophageal reflux disease (GERD) and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? a. "Avoid caffeine-containing foods and beverages." b. "Peppermint lozenges help to reduce stomach upset." c. "Sleep on your left side with a pillow between your knees." d. "Eat three meals each day and avoid snacking between meals."

a. "Avoid caffeine-containing foods and beverages." Teach the patient to limit or eliminate foods that decrease lower esophageal sphincter (LES) pressure and that irritate inflamed tissue, causing heartburn, such as peppermint, chocolate, alcohol, fatty foods (especially fried), caffeine, and carbonated beverages. Large meals increase the volume of and pressure in the stomach and delay gastric emptying. Remind the patient to eat four to six small meals each day rather than three large ones. Peppermint decreases LES pressure and increases the risk of symptoms. Patients should be taught to elevate the head by 6 to 12 inches for sleep to prevent nighttime reflux.

Pantoprazole is prescribed to a patient with gastroesophageal reflux disease (GERD). What should the nurse teach the patient about the medication? a. "Do not crush the tablets." b. "Take the drug after meals." c. "Do not take this drug with tomato-based foods." d. "Be aware that this drug may cause hallucinations or ataxia."

a. "Do not crush the tablets." Pantoprazole is a proton pump inhibitor, a delayed-release medication that breaks down in the intestine to prevent its breakdown by stomach acids; therefore the nurse instructs the patient not to crush the tablet. Pantoprazole should be taken before meals. Histamine receptor antagonists are not taken with tomato-based foods or juices. Tomato-based foods or juices do not interact with pantoprazole. Prokinetic drugs may cause hallucinations or ataxia.

What dietary change does the nurse recommend to a patient with primary stomatitis? a. Avoid custards and puddings b. Take warm fluids for comfort c. Include salty foods in the diet d. Include foods rich in vitamin C

a. Avoid custards and puddings The patient should include foods rich in vitamin C to promote healing. Proteins promote healing, so the patient must include foods such as custards, puddings, scrambled eggs, and bananas in the diet. The patient must take cool or cold liquids, not warm fluids, to soothe the mouth. The patient must avoid hard, spicy, salty, acidic foods or fluids that can irritate the ulcers.

The nurse is preparing a health promotion and lifestyle changes chart for a patient with gastroesophageal reflux disease (GERD). Which teaching will the nurse include? a. "Avoid sleeping flat in the bed." b. "Eat three small meals in a day." c. "Consume small snacks in the evening." d. "Chew chewable antacids thoroughly without water."

a. Avoid sleeping flat in the bed." A patient with GERD should never sleep flat in bed in order to avoid complications. The patient should eat four to six small meals in a day, not three. The patient should avoid snacks in the evening. The patient should chew chewable antacids thoroughly with a glass of water.

A patient is prescribed liquid Maalox for the treatment of gastroesophageal reflux disease (GERD). What statement by the patient indicates a need for further teaching? a. "This should help with pain as well." b. "I will take the medication with food." c. "This antacid is a combination of two different types of antacids." d. "I should have fewer side effects with this than the antacid I was chewing."

b. "I will take the medication with food."

The nurse is providing discharge teaching to a patient who has completed radiation therapy for an oral tumor. What does the nurse teach the patient? a."Avoid seasoned foods." b. "Perform swallowing exercises." c. "Change chemobrushes every 2 weeks." d. "Eat solid foods; liquids are difficult to swallow."

b. "Perform swallowing exercises." The patient who has completed radiation therapy is likely to have a temporary or permanent swallowing impairment. Therefore, the patient should practice swallowing exercises taught by the speech-language therapist before discharge. The patient must have thickened liquids; solid foods can be painful if the patient develops stomatitis and liquids can be difficult to swallow. The patient must change chemobrushes every week and rinsed with hydrogen peroxide and water after every use. The patient will likely develop a change in taste, and certain foods may have a metallic taste. Therefore, the patient must add seasoning to food to make it more palatable.

A patient is newly diagnosed with tongue and esophageal cancer. Which response to the diagnosis does the nurse expect the patient to have? a. Fear about the chance of aspiration after surgery b. Depression about changes in the face and neck after surgery c. Concern about getting an infection caused by invasive procedures d.Anxiety from knowing that as a result of cancer and surgery, ingestion of food by mouth might become impossible

b. Depression about changes in the face and neck after surgery The patient will likely be depressed because of expected alterations to the body caused by cancer and probable surgery. Anxiety about nutritional intake, concern about infection, and fear of aspiration are not the patient's likely initial responses to a new diagnosis of tongue and esophageal cancer.

The nurse is teaching a patient how to maintain a healthy oral cavity. Which patient statement indicates effective understanding? a. "I should floss my teeth once every two days." b. "I should perform self-examination of my mouth at least twice every month." c. "I should tell the dentist if how my teeth fit together when I bite down changes." d. "I should rinse my mouth with a mouthwash containing alcohol at least once a day."

c. "I should tell the dentist if how my teeth fit together when I bite down changes." The patient should tell the dentist if there is any shifting of the teeth. The patient must floss the teeth every day to maintain good oral hygiene. The patient must perform self-examination of the oral cavity every week, not twice every month. The patient must avoid the use of mouthwashes that contain alcohol, as this may cause inflammation of the mouth.

A patient with oral cancer undergoing radiation therapy reports a rash at the site of irradiation. Which patient statement requires the nurse to intervene? a. "I'm using a chemobrush." b. "I'm avoiding sun exposure." c. "I'm using alcohol-based aftershave lotion." d. "I'm cleaning my face with nondeoderant soap."

c. "I'm using alcohol-based aftershave lotion." Patients undergoing radiation therapy should avoid alcohol-based products, which cause skin irritation. The remaining statements indicate understanding. Patients with oral cancer should use a chemobrush, an extra soft type of toothbrush. These patients should avoid sun exposure to help prevent skin reactions. Patients with oral cancer should cleanse their faces and necks with a gentle nondeodorant soap to help prevent skin reactions.

The nurse is teaching a patient about taking an antacid containing magnesium salts to treat heartburn associated with gastroesophageal reflux disease (GERD). What does the nurse include in the teaching? a. "You may develop severe constipation while taking this medication." b. "This medication will help resolve the reflux associated with GERD." c. "If you develop diarrhea, you may need to try an aluminum salt antacid." d. "Take this medication with food or just before eating to improve absorption."

c. "If you develop diarrhea, you may need to try an aluminum salt antacid." Antacids containing magnesium salts are likely to cause diarrhea, and those containing aluminum salts cause constipation. Patients are taught to either combine these two drugs or alternate them to combat these side effects. Antacids are best taken on an empty stomach when the hydrogen ion load is less. Antacids only reduce stomach acid; they do not affect reflux.

The nurse learns from reading a patient's chart that the patient has secondary stomatitis. The nurse knows this was most likely caused by which organism? a. Escherichia coli b. Cytomegalovirus c. Candida albicans d. Staphylococcus aureus

c. Candida albicans Candida albicans is the organism that commonly causes secondary stomatitis. Long-term antibiotic therapy can cause candida to overgrow in the mouth, causing secondary stomatitis. Cytomegalovirus and bacteria such as E. coli and S. aureus are common organisms that cause acute sialadenitis, or inflammation of the salivary glands.

Which symptoms should be assessed for in a patient suspected of having gastroesophageal reflux disease (GERD)? Select all that apply. a. Nausea b. Vomiting c. Eructation d. Flatulence e. Weight loss

c. Eructation d. Flatulence Eructation and flatulence are common findings in patients with GERD. Nausea and vomiting rarely occur in patients with GERD. Weight loss is not common in patients with GERD.

Which statement about salivary gland tumors is accurate? a. Submandibular tumors are painless. b. Initial malignant tumors are fast growing. c. They present as localized and firm masses. d. Tumor growth in the hypoglossal nerve causes facial paralysis.

c. They present as localized and firm masses. Salivary gland tumors usually present as localized and firm masses. Initially, malignant salivary gland tumors present as slow-growing and painless masses. Submandibular salivary gland tumors may be tender or painful. Tumor invasion of the hypoglossal nerve causes impaired movement of the tongue. It may also cause loss of sensation.

The student nurse is learning about premalignant lesions of the mouth. Which statement by the student indicates effective learning? a. "Leukoplakia becomes cancerous in most cases." b. "Leukoplakia tends to affect women more than men." c. "Erythroplakia may be a manifestation of human immunodeficiency virus (HIV) infection." d. "Erythroplakia demonstrates more malignant changes than leukoplakia."

d. "Erythroplakia demonstrates more malignant changes than leukoplakia." Erythroplakia is more malignant than leukoplakia and is termed "precancerous." Patients with erythroplakia should undergo biopsy. Leukoplakia is usually benign and tends to affect men more than women. Leukoplakia, not erythroplakia, may be an early manifestation of HIV infection.

A patient with gastroesophageal reflux disease (GERD) has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? a. "You may resume running and weight lifting if you wish." b. "You may stop taking your anti-reflux medications after 1 week." c. "Consume carbonated beverages if you experience stomach upset." d. "Remain on a soft diet for about a week and avoid raw fruits and vegetables."

d. "Remain on a soft diet for about a week and avoid raw fruits and vegetables." After LNF, patients should be taught to remain on a soft diet for one week. Carbonated beverages should be avoided. Patients may walk but should avoid heavy lifting. Anti-reflux medications should be taken for 1 month after the procedure.

Which symptoms alert the nurse that a patient may have a paraesophageal hiatal hernia? a. Dysphagia b. Eructation c. Regurgitation d. Breathlessness

d. Breathlessness Because a paraesophageal hiatal hernia involves protrusion of the fundus and other parts of the stomach into the thorax, patients often report breathlessness after a meal. The lower esophageal sphincter remains in place, so regurgitation is often not present. Dysphagia and eructation are associated with sliding hiatal hernia.

A patient with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? a. Explain the grieving process and listen to what the patient has to say b. Suggest that the patient talk with friends and family and seek their support c. Listen to the patient and then explain that it is normal to feel depressed about the diagnosis d. Listen to the patient's concerns and feelings, and then suggest that the patient join a community group of cancer survivors

d. Listen to the patient's concerns and feelings, and then suggest that the patient join a community group of cancer survivors

Which practice does the nurse include when teaching a patient about proper oral care? a. Brushing the teeth daily and flossing as needed b. Getting daily sun exposure that's essential to maintain good health c. Using drugs that reduce the flow of saliva unless lesions are present d. Performing self-examination of the mouth every week and reporting any unusual findings

d. Performing self-examination of the mouth every week and reporting any unusual findings Patients must be taught to perform self-examination of the mouth every week and to report any unusual findings. Patients should brush teeth and floss every day. Patients should be instructed to avoid, if possible, drugs that can cause inflammation of the mouth or that can reduce the flow of saliva. Patients must be instructed to avoid or limit sun exposure, which is a risk factor for skin cancer.

The nurse is caring for a postoperative patient who has a radical neck dissection, and the patient is describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this patient? a. Diphenhydramine b. Midazolam intravenously c. Morphine sulfate intravenously d. Oxycodone plus acetaminophen

Morphine sulfate intravenously Patients undergoing surgery for oral cancer describe their pain as throbbing or pounding. Intravenous morphine sulfate is indicated for severe pain and is given initially. Diphenhydramine is an anti-inflammatory agent and is not indicated for treatment of pain. Midazolam is used for conscious sedation and is not indicated for pain. Oxycodone/acetaminophen is given for systematic relief of moderate pain.

The nurse is preparing a patient for esophageal manometry testing. The nurse explains that this test is performed to assess which aspect of gastroesophageal reflux disease (GERD)? a. pH b. Reflux c. Motility d. Inflammation

c. Motility Manometry testing is performed to assess motility and is used when the diagnosis is uncertain. It does not evaluate inflammation, pH, or reflux.

What long-term effects of radiation therapy for oral cancer commonly occur in the head or neck? Select all that apply. a. Mucositis b. Stomatitis c. Xerostomia d. Dental decay e. Taste alterations

c. Xerostomia d. Dental decay Xerostomia (or excessively dry mouth) and dental decay are long-term effects of radiation therapy to the head or neck which require ongoing oral care and follow-up dental visits. Stomatitis, mucositis, and taste alterations are acute effects of radiation therapy, and often subside after therapy is complete.

The nurse is explaining to a patient the importance of maintaining good oral health. What does the nurse include in the teaching? Select all that apply. a. "Eat a well-balanced diet." b. "Keep the floss where it is visible." c. "Self-examine the mouth once a month." d. "Use commercially available mouthwash." e. "Manage stress with healthy coping mechanisms."

a. "Eat a well-balanced diet." b. "Keep the floss where it is visible." e. "Manage stress with healthy coping mechanisms."

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? a. Asks the patient about medications and dietary intake b. Teaches the patient about antacid effects and side effects c. Tells the patient to avoid drinking alcohol late in the evening d. Suggests that the patient sleep with the head elevated 6 inches

a. Asks the patient about medications and dietary intake The nurse's initial action should be further assessment of the patient's risk factors for gastroesophageal reflux disease (GERD). Before suggesting interventions or beginning patient teaching, the nurse must elicit more information about the patient's symptoms. The nurse needs additional data before telling the patient to avoid drinking alcohol late in the evening.

Which dietary modifications will be important for a patient newly diagnosed with gastroesophageal reflux disease (GERD)? Select all that apply. a. Avoidance of chocolate b. Incorporation of citrus fruits in the diet c. Increased intake of protein-rich foods d. Avoidance of tomatoes and tomato-based foods e. Switching to a soft diet of pureed vegetables f. Avoidance of coffee and other caffeinated beverages

a. Avoidance of chocolate d. Avoidance of tomatoes and tomato-based foods f. Avoidance of coffee and other caffeinated beverages Patients with GERD should avoid chocolate, tomatoes, and tomato products as well as caffeinated beverages such as coffee, tea, and cola. These foods contribute to decreased lower esophageal sphincter (LES) pressure, which occurs in GERD. The patient with GERD should avoid citrus fruits because of the amount of citric acid contained in them. Protein-rich foods should be maintained for a balanced diet but do not need to be increased. A soft diet is not a necessary dietary modification for a diagnosis of GERD.

A patient with gastroesophageal reflux disease (GERD) undergoes esophagoscopy that reveals increased esophageal erosion. Which is the priority intervention that the nurse teaches this patient? a. Avoiding eating 3 hours prior to bedtime b. Sitting upright for 30 minutes after eating c. Eating slowly and chewing foods thoroughly d. Restricting caffeine and chocolate in the diet

a. Avoiding eating 3 hours prior to bedtime Reflux episodes are most damaging at night, so patients should be taught to make changes that minimize nighttime reflux, such as avoiding eating 3 hours before bedtime. Eating slowly, chewing food thoroughly, and restricting caffeine and chocolate in the diet are also part of teaching, but are not the top priority. Patients should be taught to sit upright for 1 to 2 hours after eating.

What symptoms are suggestive of a sliding hiatal hernia? Select all that apply. a. Belching b. Heartburn c. Difficulty in swallowing d. Feeling of fullness after eating e. Backward flow of food into the throat f. Worsening of symptoms when lying down

a. Belching b. Heart burn c. Difficulty in swallowing e. Backward flow of food into the throat The symptoms of a sliding hiatal hernia are belching (eructation), heartburn, difficulty in swallowing (dysphagia), and the backward flow of food into the throat (regurgitation). A feeling of fullness after eating and worsening of symptoms when lying down are observed with a paraesophageal hiatal hernia.

What symptoms are suggestive of a sliding hiatal hernia? Select all that apply. a. Belching b. Heartburn c. Difficulty in swallowing d. Feeling of fullness after eating e. Backward flow of food into the throat f. Worsening of symptoms when lying down

a. Belching b. Heartburn c. Difficulty in swallowing e. Backward flow of food into the throat The symptoms of a sliding hiatal hernia are belching (eructation), heartburn, difficulty in swallowing (dysphagia), and the backward flow of food into the throat (regurgitation). A feeling of fullness after eating and worsening of symptoms when lying down are observed with a paraesophageal hiatal hernia.

The community health nurse is educating a group of adults about how to decrease their risk of oral cancer. The nurse instructs the group about which risk factors? Select all that apply. a. Chewing tobacco b. High alcohol intake c. Poor nutritional habits d. Inadequate sun exposure e. Candida albicans infection

a. Chewing tobacco b. High alcohol intake c. Poor nutritional habits High alcohol intake, tobacco in any form (whether smoking or chewing) and poor nutritional habits all increase the risk for oral cancer. Increased sun exposure and human papilloma virus (HPV16) infection are also contributors to oral cancer. Candida albicans infection may cause fungal stomatitis.

As a result of being treated with radiation for oral cancer, a patient is experiencing xerostomia. What community resource does the nurse suggest for this patient's care? a. Dentist b. Psychiatrist c. Speech therapist d. Occupational therapist

a. Dentist Xerostomia is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits. Occupational therapists, psychiatrists, and speech therapists are not the appropriate resource for a patient with xerostomia.

The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? Select all that apply. a. Dyspepsia b. Flatulence c. Regurgitation d. Excessive salivation e. Blood-tinged sputum

a. Dypepsia b. Flatulence c. Regurgitation d. Excessive salivation Dyspepsia, also known as heartburn, is one of the main symptoms of GERD. Flatulence is common after eating, as well as regurgitation (backward flow into the throat) of food and fluids. The patient may experience excessive salivation, or water brash with GERD. Blood-tinged sputum is not a symptom of GERD.

The nurse is instructing a patient on measures to maintain effective oral health. Which measures does the nurse include in the patient's teaching plan? Select all that apply. a. Eating a balanced diet b. Having regular dental checkups c. Managing stress as much as possible d. Using mouthwashes containing alcohol e. Ensuring that dentures are slightly loose-fitting

a. Eating a balanced diet b. Having regular dental checkups c. Managing stress as much as possible Regular dental checkups are important so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the patient's risk for infections such as Candida albicans. Eating a balanced diet can reduce the risk for dental caries and infections such as C. albicans or stomatitis. Mouthwashes that contain alcohol may cause inflammation and should be avoided. Dentures should be in good repair and should fit properly.

A patient with a salivary gland tumor is scheduled to undergo a parotidectomy. What may be affected as a result of this procedure? a. Facial nerve b. Cranial nerve XI c. Internal jugular vein d. Sternocleidomastoid muscle

a. Facial nerve Parotidectomy is the surgical removal of the parotid glands, a type of salivary gland. The facial nerve is usually affected during parotidectomy, as facial nerves course directly through the gland. A radical neck dissection in a patient with an oral tumor usually involves removing all of the affected cervical lymph nodes along with cranial nerve XI, the internal jugular vein, and the sternocleidomastoid muscle.

What nutritional information should be included in the teaching plan for a patient diagnosed with gastroesophageal reflux disease (GERD)? Select all that apply. a. Limit caffeine b. Eat a peppermint c. Decrease chocolate intake d. Eat three small meals a day e. Avoid drinking fluids at meals

a. Limit caffeine c. Decrease chocolate intake Caffeine and chocolate should be limited in patients with GERD. Peppermint may contribute to reflux and should be limited or avoided. The patient should eat six small meals a day, not three. Drinking fluids with meals is not restricted for patients with GERD.

Which of the following strategies should be taught to older adults regarding maintaining oral health? a. Maintain a well-balanced diet. b. Use mouthwashes that contain alcohol to kill germs. c. Perform self-examination of the mouth every 2 months. d. Oral hygiene should be minimized to avoid disrupting denture fit

a. Maintain a well-balanced diet Older adults are instructed to maintain a well-balanced diet for good oral hygiene. Self-examination of the mouth should occur weekly, with changes reported to the dentist. Brushing and flossing should occur at least daily. Mouthwashes that contain alcohol should be avoided due to the possibility of causing inflammation.

What postoperative measures are appropriate for a patient who has just undergone surgery for oral cancer? Select all that apply. a. Morphine administration as needed for pain b. Supine positioning for a few hours after surgery c. Cool, solid foods when suture lines start healing d. Oral care twice a day until suture lines are healed e. Nothing by mouth (NPO) status for several days after surgery

a. Morphine administration as needed for pain e. Nothing by mouth (NPO) status for several days after surgery The patient who has undergone oral surgery should remain NPO for several days afterward. This allows sufficient time for the wound to heal before food comes in contact with the sutures. Initially, morphine is administered to the patient to control pain; when the patient is no longer NPO, oral pain medications such as oxycodone/acetaminophen can be started. Gentle oral care is required at least every 4 hours in the early postoperative stage to clean away thick secretions and stimulate the saliva. Elevating the head of the patient's bed assists in decreasing edema by gravity. Thickened fluids are provided to prevent aspiration. Solid food is avoided to prevent strain on the sutures.

A patient diagnosed with gastroesophageal reflux disease (GERD) reports heartburn. Which drug classifications may cause heartburn? Select all that apply. a. Nitrates b. Prokinetic drugs c. Oral contraceptives d. Anticholinergic drugs e. Proton pump inhibitors f. Calcium channel blockers

a. Nitrates c. Oral contraceptives d. Anticholinergic drugs f. Calcium channel blockers Several drugs decrease lower esophageal sphincter (LES) pressure causing reflux of gastric content and heartburn in GERD. These include nitrates, oral contraceptives, anticholinergic drugs, and calcium channel blockers. Prokinetic drugs and proton pump inhibitors do not cause heartburn; they are used in the treatment of GERD.

Which medications should the nurse ask if a patient is taking if the patient has a new diagnosis of gastroesophageal reflux disease (GERD)? Select all that apply. a. Nitrates b. Salicylates c. Beta blockers d. Oral contraceptives e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

a. Nitrates d. Oral contraceptives e. Nonsteroidal anti-inflammatory drugs (NSAIDs) Nitrates, oral contraceptives, and NSAIDs can lead to lower esophageal sprinter pressure and cause reflux; therefore the nurse should ask the patient about taking any of these medications. Salicylates and beta blockers do not cause reflux

The nurse is caring for a patient diagnosed with aphthous ulcers. The nurse instructs the patient to avoid which foods? Select all that apply. a. Nuts b. Apples c. Cheese d. Bananas e. Potatoes

a. Nuts c. Cheese e. Potatoes Certain foods such as nuts, cheese, and potatoes may trigger allergic responses that cause aphthous ulcers. These foods should be avoided. Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers, so are acceptable for consumption.

When caring for a patient with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the home health aide? a. Provide oral care using disposable foam swabs b. Instruct the patient on how to use nystatin oral rinses c. Assist the patient in making appropriate dietary choices d. Inspect the oral mucosa for evidence of oral candidiasis

a. Provide oral care using disposable foam swabs Providing oral care for a patient with oral lesions is an appropriate assignment for a home health aide. Assessments, patient teaching, and assisting patients with oral problems in making appropriate dietary choices are the responsibilities of licensed nursing staff.

The nurse is planning care for a patient with acute sialadenitis. Which comfort measures should the nurse include? Select all that apply. a. Sialogogues b. Cool compresses c. Saliva substitues d. Elevating the head of bed e. Edematous gland massage

a. Sialogogues c. Saliva substitutes d. Elevating the head of bed e. Edematous gland massage Sialogogues such as lemon slices and citrus-flavored candy help to stimulate the flow of saliva. Saliva substitutes provide moisture for 2 to 4 hours at a time. Elevating the head of the bed promotes gravity drainage of the edematous gland. Massaging the edematous gland promotes purulent drainage. Warm compresses help to stimulate flow of saliva.

What are common complications associated with gastroesophageal reflux disease (GERD) in the older adult? Select all that apply. a. Sleep apnea b. Barrett's esophagus c. Esophageal strictures d. Aspiration pneumonia e. Esophageal diverticula f. Esophageal perforation

a. Sleep apnea b. Barrett's esophagus c. Esophageal strictures d. Aspiration pneumonia In Dolder adults with GERD the incidence of heartburn decreases and instead they develop more severe complications such as sleep apnea, Barrett's esophagus, esophageal strictures, and aspiration pneumonia. Esophageal diverticula can occur due to herniation of the esophageal mucosa and submucosa into the surrounding tissue. Esophageal perforation may occur when excessive force is exerted on the esophageal mucosa.

A portion of a patient's fundus and the esophagogastric junction has moved upward and through the esophageal hiatus. Which condition does this describe? a. Sliding hernia b. Esophageal reflux c. Esophageal diverticula d. Paraesophageal hernia

a. Sliding hernia In a sliding hiatal hernia, the esophagogastric junction of the esophagus and part of the fundus of the stomach move upward into the chest through the esophageal hiatus. Esophageal reflux is the reflux of gastrointestinal contents into the esophagus, which is observed in gastroesophageal reflux disease (GERD) and sliding hiatal hernias. In a paraesophageal hernia, the esophagogastric junction remains in the normal intra-abdominal location but the fundus and a portion of the greater curvature of the stomach moves into the chest through the esophageal hiatus. Esophageal diverticula are sacs that occur due to the herniation of esophageal mucosa and submucosa into surrounding tissue.

Which risk factors should be included when teaching about reducing the risk of proton pump inhibitors (PPIs) for a patient at risk for development of gastroesophageal reflux disease (GERD)? Select all that apply. a. Smoking b. Legumes c. Peppermint d. Aged cheeses e. Artificially sweetened beverages

a. Smoking c. Peppermint d. Aged cheeses Smoking, peppermint, and aged cheese that includes nitrates are all risk factors for contributing to decreased lower esophageal sphincter pressure. Legumes and artificially sweetened beverages do not affect the lower esophageal sphincter.

Which statements about oral cancers are correct? Select all that apply. a. The hard palate is the most common site of Kaposi's sarcoma. b. An oral lesion that does not heal within 3 weeks requires assessment. c. Basal cell carcinoma is more common than squamous cell carcinoma. d. Increase in age is a risk factor for squamous cell carcinoma of the mouth. e. Basal cell carcinoma of the mouth can metastasize to other parts of the body.

a. The hard palate is the most common site of Kaposi's sarcoma. c. Increase in age is a risk factor for squamous cell carcinoma of the mouth. In the mouth, the hard palate is the most common site of Kaposi's sarcoma, a malignant lesion in blood vessels. The risk for squamous cell carcinoma of the mouth increases with age as most cases occur in people older than 40 years. Oral lesions that do not heal within 2 weeks need to be assessed. Basal cell carcinoma of the mouth does not metastasize, but it aggressively involves the facial skin. Basal cell carcinoma is less common than squamous cell carcinoma.

What are key features of oral cancer? Select all that apply. a. Thick saliva b. Poor appetite c. Fungal infection d. Difficulty swallowing e. Painful, red oral lesion

a. Thick saliva b. Poor appetite d. Difficulty chewing Key features of oral cancer include bleeding from the mouth, poor appetite, difficulty chewing or swallowing, and thick or absent saliva. A painful oral lesion is indicative of stomatitis; cancerous lesions are typically painless. A fungal infection most often occurs with stomatitis.

A patient presents with signs and symptoms of gastroesophageal reflux disease (GERD). What common misdiagnosis should the nurse look for in the patient's recent history? a. Asthma b. Crohn's disease c. Sick sinus syndrome d. Uncontrolled hypertension

a. asthma Patients with GERD are often misdiagnosed with asthma because typical signs and symptoms of GERD are similar to those of asthma; therefore it is important to ask patients who have been newly diagnosed with GERD of any previous diagnosis. Crohn's disease does not have similar symptoms of GERD and is not likely to be misdiagnosed. Sick sinus syndrome and uncontrolled hypertension do not have similar characteristics as GERD.

The nurse is caring for a patient with an oral cavity tumor. Which interventions should the nurse perform to promote effective coughing in the patient? Select all that apply. a. Encourage deep breathing b. Prepare for brachytherapy c. Perform chest physiotherapy d. Use oral suction equipment with a tonsil tip e. Place the patient in a semi-Fowler's position

a. encourage deep breathing c. perform chest physiotherapy Effective coughing may help mobilize the patient's secretions and can be achieved if the patient is encouraged to perform deep breathing. Chest physiotherapy may help loosen secretions from the lungs and promote effective coughing and expectoration of secretions. Brachytherapy is performed to deliver the radiation dose to the tumor bed; it does not promote coughing. Placing the patient in a semi-Fowler's position helps increase air exchange, not promote coughing. Oral suction equipment with a tonsil tip can be used to remove the secretions that obstruct the airway.

The nurse is caring for a patient who just underwent a laparoscopic Nissen fundoplication procedure. Which symptoms, if demonstrated by the patient, would indicate to the nurse that complications are developing? Select all that apply. a. Sore throat b. Difficulty belching c. Abdominal distension d. Difficulty swallowing e. Soft stools after 6 days f. Temperature of 101° F

b. Difficulty belching c. Abdominal distension d. Difficulty swallowing f. Temperature of 101° F Complications related to fundoplication procedures are indicated by fever, dysphagia, difficulty belching, and abdominal distension. A temperature of 101° F or above may indicate infection, atelectasis, or pneumonia. The patient may have temporary difficulty swallowing (dysphagia) when oral feeding begins, and may have gas bloat syndrome, which is indicated by difficulty belching. The patient may also experience abdominal distension, nausea, and vomiting if the nasogastric tube (NGT) becomes obstructed. A sore throat is usually observed after LNF due to the presence of the NGT. Soft stools are passed for the first few weeks after surgery because the patient is given stool softeners or bulk laxatives to prevent constipation and abdominal strain.

Which nursing intervention is beneficial for a patient with a hiatal hernia? a. Advising to exercise strenuously twice a day b. Elevating the head of the bed to 6 inches at night c. Having the patient sleep in a semi-Fowler's position d. Recommending wearing tight clothing around the abdomen

b. Elevating the head of bed to 6 inches at night A patient with a hiatal hernia should sleep with the head of the bed elevated 6 inches. A patient who underwent bariatric surgery is instructed to sleep in semi-Fowler's position at night. A patient with a hiatal hernia is instructed to avoid exercises that strain the body and avoid wearing tight clothing around the abdomen.

The nurse is assessing a patient who has had his tongue removed. The nurse uses which term to document this procedure? a. Cryotherapy b. Glossectomy c. Mandibulectomy d. Commando procedure

b. Glossectomy Glossectomy is the surgical procedure where the tongue is removed. Cryotherapy is a procedure where extreme cold is applied to treat small, noninvasive lesions of the oral cavity. Mandibulectomy is a surgical procedure where the jaw is removed. Commando procedure involves the removal of a segment of the mandible with an oral lesion, and performing a radical neck dissection.

The nurse is caring for a patient with gastroesophageal reflux disease (GERD) who presents with retrosternal burning. What term does the nurse use to document this symptom? a. Globus b. Pyrosis c. Halitosis d. Water brash

b. Pyrosis Retrosternal pain, one of the symptoms of GERD, is also referred to as pyrosis. Globus is a feeling of something getting stuck in the back of throat. Halitosis refers to foul breath, and water brash refers to hypersalivation. Globus and water brash are usually observed in GERD, whereas halitosis is seen with hiatal hernia.

The nurse is caring for a patient with recurrent apthous ulcers (RAUs). What drugs are especially useful in treating RAUs? Select all that apply. a. Oral acyclovir b. Tetracycline syrup c. Nystatin oral suspension d. Oral dexamethasone elixir e. Chlorhexidine mouthwash

b. Tetracycline syrup d. Oral dexamethasone elixir e. Chlorhexidine mouthwash Tetracycline syrup is a topical and systemic treatment for RAUs. Chlorhexidine mouthwash is also used in RAU treatment. Oral dexamethasone elixir is used as a swish/expectorate preparation for RAUs as well. Oral acyclovir is used to treat herpes simplex stomatitis in patients who have healthy immune system. Nystatin oral suspension is particularly helpful in fungal infections like yeast.

While reviewing the medical history of a patient with inflammation of the salivary glands, the nurse finds that the patient was exposed to radioactive iodine treatment for thyroid cancer. The exposure may result in what condition? a. Stomatitis b. Xerostomia c. Leukoplakia d. Erythroplakia

b. Xerostomia Exposure to radioactive iodine may result in excessive dryness of the mouth due to reduced saliva flow. This condition is known as xerostomia. Stomatitis is inflammation within the oral cavity resulting from infections of pathogens or ulcers. Radioactive iodine treatment does not cause stomatitis. Leukoplakia is the development of white patches in the oral mucosal membrane. It results from long-term irritation of the mucosal membrane. Erythroplakia is the appearance of red lesions on the oral mucosa. It is caused by smoking, alcohol, and exposure to harsh chemicals.

The nurse is instructing a patient with gastroesophageal reflux disease (GERD) who underwent a stretta procedure about self-care. What statement indicates that the patient has understood the instructions? a. "I should maintain a soft diet for 24 hours after the procedure." b. "I need to avoid any nonsteroidal anti-inflammatory drugs (NSAIDs) for 6 days." c. "I should not allow a nasogastric tube to be inserted for 1 month after the procedure." d. "I can take over-the-counter medications as directed if I experience nausea and vomiting."

c. "I should not allow a nasogastric tube to be inserted for 1 month after the procedure." After an endoscopic procedure like stretta procedure, the patient should not allow a nasogastric tube to be inserted for at least 1 month after the procedure because the esophagus can be perforated. The patient should remain on clear liquids for 24 hours after procedure; a soft diet can be consumed after the first day. The patient should avoid taking NSAIDs and aspirin for 10 days after a gastroplication procedure. The patient should contact the provider immediately if nausea and vomiting occur, and should not take any over-the-counter medications to treat it.

A patient who has undergone a Stretta procedure is about to be discharged. What does the nurse teach this patient about postprocedure care? a. "Consume a soft diet for the first 24 hours after the procedure." b. "Discontinue taking prescribed proton pump inhibitors (PPIs)." c. "Report nausea, vomiting, or shortness of breath immediately." d. "Use a nonsteroidal anti-inflammatory drug (NSAID) for postprocedure pain."

c. "Report nausea, vomiting, or shortness of breath immediately." Patients who have undergone a Stretta procedure should report nausea, vomiting, chest or abdominal pain, and shortness of breath immediately, should they occur. They should be taught to consume clear liquids only for the first 24 hours and then soft foods. Patients should resume preprocedure medications, such as PPIs. NSAIDs and aspirin should be avoided for 10 days.

The nurse is teaching a group of nursing students about the postoperative interventions needed following laparoscopic Nissen fundoplication (LNF). Which statement by a nursing student indicates a need for further instruction? a. "A soft diet should be maintained for 1 week." b. "Driving is prohibited for 1 week after surgery." c. "Small dressings can be removed after 10 days." d. "Anti-reflux medication should be administered for 1 month."

c. "Small dressings can be removed after 10 days." LNF is a minimal invasive surgery used to correct hiatal hernia. The patient is allowed to remove small dressings 2 days after surgery and take a shower. However, Steri-Strips are not removed until 10 days after surgery. The patient is given a soft diet such as puddings, custards, and mashed potatoes for 1 week. Anti-reflux medications are prescribed for at least 1 month until healing occurs. It is not advisable to drive for at least 1 week after surgery as the patient is on medications.

Which measure is useful in preventing esophageal reflux? a. Taking medications with milk b. Eating a snack before bedtime c. Eating four to six small meals every day d. Increasing intake of fluids with each meal

c. Eating four to six small meals every day Eating four to six small meals per day as opposed to three large meals per day can help prevent esophageal reflux. Large meals increase the volume and pressure in the stomach, which can result in delayed gastric emptying and increased reflux. Fluid intake should be restricted during meals to reduce abdominal distension. Food intake in the evening such as a bedtime snack should be restricted to decrease nighttime reflux episodes. Milk increases gastric acid secretion, so it should be avoided to prevent reflux.

A hospitalized patient who is obese is at risk for aspiration pneumonia. What is the priority action by the nurse? a. Teach the patient to avoid alcohol and smoking b. Educate the patient about weight loss strategies c. Elevate the head of the bed to a 30-degree angle d. Perform a dietary history to identify problem foods

c. Elevate the head of the bed to a 30-degree angle Patients with gastroesophageal reflux disease (GERD) have an increased risk of aspiration, and symptoms are worse at night because of the supine position that allows prolonged contact of acid reflux with the esophagus. The nurse should elevate the head of the bed to 30 degrees to minimize this. The other actions should be performed, but will not have an immediate effect on this patient's symptoms.

A patient is diagnosed esophageal diverticula. Which nursing teaching will help the patient manage nocturnal reflux? a. Sleep in the prone position b. Do not sleep with weight on the arm c. Elevate the head of the bed while sleeping d. Sleep in a supine position for two hours after eating

c. Elevate the head of the bed while sleeping Sleeping with the head of the bed elevated can help manage nocturnal reflux associated with esophageal diverticula. The patient should avoid sleeping in the supine position for at least two hours after eating to help avoid nocturnal reflux. A patient who has had breast reconstruction, not who has nocturnal reflux, is advised to avoid sleeping in the prone position. A patient who underwent an arteriovenous graft is instructed to avoid sleeping with weight on the arm.

Which is a type of primary stomatitis? a. Moniliasis b. Denture stomatitis c. Herpes simplex stomatitis d. Chemotherapy-induced stomatitis

c. Herpes simplex stomatitis Inflammation of the oral cavity is referred to as stomatitis, and it is classified based on the cause of the inflammation. Primary stomatitis includes aphthous (noninfectious) stomatitis, herpes simplex stomatitis, and traumatic ulcers. Moniliasis, also known as candidiasis, is a painful fungal infection caused by the overgrowth of Candida albicans, and is a type of secondary stomatitis. Soft denture liners can be colonized by Candida albicans which contributes to denture stomatitis, also a type of secondary stomatitis. Chemotherapy-induced stomatitis is a type of secondary stomatitis.

Which method is used to determine if an oral lesion is malignant? Select all that apply. a. Computed tomography (CT) scan b. Needle biopsy c. Incisional biopsy d. Oral CDx brushing e. Magnetic resonance imaging (MRI)

c. Incisional biopsy e. Magnetic resonance imaging (MRI) Biopsy is the definitive method for diagnosis of oral cancer. Both needle and incisional biopsy can confirm a cancer diagnosis. CT can be used to determine cancer spread to other organs. Oral CDx brushing helps identify a precancerous lesion. MRI helps in detecting perineural involvement and evaluating the thickness of the lesion in cancers of the tongue.

Which statement about xerostomia as a consequence of oral radiation therapy is accurate? a. It is a temporary side effect. b. Methylcellulose is avoided in treating it. c. It usually happens within 24 hours of radiation. d. It is managed by frequent sips of water after meals.

c. It usually happens within 24 hours of radiation. Xerostomia is a very dry mouth which is caused by a severe reduction in the flow of saliva. The exposure of the salivary glands to radiation usually causes xerostomia within 24 hours of irradiation. It is either a temporary or permanent situation, depending on the dose of radiation and the percentage of total salivary gland tissue irradiated. It is managed by frequent sips of water before meals. Methylcellulose, glycerin, and saline solution are often used as a salivary substitute to provide moisture.

Which assessment finding indicates a risk for aspiration pneumonia in a patient? a. Soft denture liners b. Canker sores in the mouth c. Lesions along the pharynx d. White plaque-like lesions on the tongue

c. Lesions along the pharynx Lesions along the pharynx may extend down towards the esophagus which can cause the patient to choke and cough when swallowing food. This leads to dysphagia, which can cause numerous problems including aspiration pneumonia, airway obstruction, and malnutrition. Canker sores, or aphthous ulcers, that appear as inflammation and erosion of the protective lining of the mouth are a common form of stomatitis. White, plaque-like lesions on the tongue indicate the presence of candidiasis, a painful fungal infection, which is common in patients taking immunosuppressive therapy. Soft denture liners that provide comfort can be colonized by C. albicans, causing denture stomatitis.

When assessing the mouth of a patient, the nurse notices a thickened white patch on the floor of the mouth. What term is used to document this finding? a. Stomatitis b. Dysphasia c. Leukoplakia d. Erythroplakia

c. Leukoplakia Leukoplakia is a thickened white patch on the oral mucosa. Red, velvety lesions on the oral mucosa are documented as erythroplakia. Dysphagia is difficulty swallowing. Stomatitis is a broad term that refers to inflammation within the oral cavity.

What is a common cause of oral candidiasis? a. Malnutrition b. Allergy to gluten c. Long-term antibiotic therapy d. Deficiency of complex B vitamins

c. Long-term antibiotic therapy Long-term antibiotic therapy destroys normal flora in the mouth and allows Candida to overgrow. This causes candidiasis, a fungal infection that is very painful. Deficiency of B-complex vitamins, folate, zinc, and iron associated with malnutrition contributes to the formation of recurrent stomatitis. Foods that trigger allergic responses, such as gluten, cause aphthous ulcers.

Which initial treatment is typically recommended for a patient diagnosed with a sliding hiatal hernia? a. Swallowing therapy to help minimize reflux and discomfort b. Antacid therapy in conjunction with a histamine receptor antagonist c. Nonpharmacologic treatment such as positioning for sleep and eating d. Surgical intervention to prevent protrusion of the stomach into the thorax

c. Nonpharmacological treatment such as positioning for sleep and eating A sliding hiatal hernia is initially treated medically, as opposed to surgically. Nonpharmacologic management such as positioning during eating and sleeping would be tried first and continued throughout, even if/when additional therapy with antacids and histamine receptor antagonists is started. Surgical intervention may be required when medical treatment alone fails. Swallowing therapy is performed after surgery to overcome esophageal spasms.

The nurse is performing oral care on a patient with mouth ulcers. Which action does the nurse take? a. Avoids mouthwash with sodium bicarbonate b. Uses lemon-glycerin swabs to clean the mouth c. Rinses the mouth every 2 or 3 hours with warm saline d. Uses toothpaste containing sodium lauryl sulfate (SLS)

c. Rinses the mouth every 2 or 3 hours with warm saline Frequent, gentle mouth care promotes debridement of ulcerated lesions. Oral care should be provided to the patient every 2 or 3 hours by frequently rinsing the patient's mouth with warm saline or sodium bicarbonate solution. These solutions do not cause a burning sensation in ulcerated areas. Lemon-glycerin swabs must be avoided because they are acidic, cause irritation to ulcerated areas, and create a dry oral mucosa. Toothpastes containing SLS should also be avoided because SLS is known to cause various types of stomatitis.

A patient who has undergone a conventional fundoplication is preparing to be discharged home. To minimize the risk that the fundoplication will dehisce, what does the nurse include when teaching this patient about home management? a. The need to belch frequently to eliminate air from the stomach b. How to correctly insert a nasogastric tube to minimize bloating c. The need to contact the provider at the first sign of a respiratory infection d. The importance of eating three well-balanced meals daily to facilitate healing

c. The need to contact the provider at the first sign of a respiratory infection Patients recovering from fundoplication must be taught ways to minimize strain on the surgical incision. Coughing can cause the incision to dehisce, so patients should report respiratory infection to the provider. Nasogastric tubes are used during hospitalization to decompress the stomach; reinsertion can perforate the fundoplication and should not be done unless necessary, and should be performed by someone with expertise in the procedure. Patients should be taught to consume smaller, more frequent meals. Belching can strain the incision.

A patient with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? a. Suction the patient's oral secretions to clear the airway b. Place the patient on humidified oxygen per nasal cannula c. Assist the patient to an upright position to facilitate breathing d. Assess the respiratory effort and quantities and types of oral secretions

d. Assess the respiratory effort and quantities and types of oral secretions Assessment is the first step of the nursing process; the nurse should assess the patient's respiratory effort and quantities and types of oral secretions first. Suctioning the patient, placing the patient on humidified oxygen, and assisting the patient to an upright position are not the first steps in the nursing process. These interventions may or may not be necessary if the nurse follows the nursing process.

Which safety measure is appropriate for a patient with an oral tumor? a. Avoiding thickened fluids in the diet b. Placing the patient in supine position c. Using toothettes or a disposable foam brush d. Assessing the gag reflex before giving fluids

d. Assessing the gag reflex before giving fluids The patient's gag reflex and ability to swallow should be assessed before giving fluids. This helps to prevent the risk for aspiration. Toothettes or disposable foam brushes should be avoided because they do not adequately control bacteremia-promoting plaque. They also dry the oral mucosa. The patient should remain in a semi-Fowler's or high-Fowler's position to prevent aspiration. Liquids and thickened meals can be provided in small amounts to prevent aspiration.

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's hiatal hernia. Which change does the nurse recommend to this patient? a. Drink tea instead of coffee b. Eat only two or three meals daily c. Sleep flat in a left side-lying position d. Avoid working in a bent-over position

d. Avoid working in a bent-over position The patient should avoid working bent-over because this position presses on the diaphragm, causing discomfort. The patient with a hiatal hernia should eat four to six meals a day. The head of the patient's bed should be elevated approximately 6 inches. Both tea and coffee should be eliminated from this patient's diet because of the caffeine content.

A patient with a hiatal hernia is prescribed famotidine. What is the action of this drug in the treatment of hiatal hernia? a. Buffers acid in stomach b. Increases gastric emptying c. Increases pH of gastric contents d. Decreases gastric acid secretions

d. Decreases gastric acid secretions Famotidine is a histamine receptor antagonist that decreases gastric acid secretions by blocking the histamine receptors in the parietal cells of the stomach. A combination of alginic acid and sodium bicarbonate acts by buffering acid contents in the stomach. Aluminum- and magnesium-based antacids increase the pH of gastric contents by deactivating pepsin. Prokinetic drugs such as metoclopramide act by increasing gastric emptying.

Esomeprazole is prescribed to a patient with gastroesophageal reflux disease (GERD). What adverse effect might this medication cause? a. Constipation b. Hallucinations c. Abdominal cramps d. Gastrointestinal (GI) infection

d. Gastrointestinal (GI) infection Proton pump inhibitors, such as esomeprazole, are the main treatment for more severe GERD. These agents provide effective, long-acting inhibition of gastric acid secretion by affecting the proton pump of the gastric parietal cells. Long-term use may mask reflux symptoms, and stopping the drug determines if reflux has been resolved. Long-term use may also cause community-acquired pneumonia and GI infections. Constipation is often a side effect of aluminum-based antacids. Abdominal cramps can occur with omeprazole, a proton pump inhibitor. Hallucinations can be observed when taking metoclopramide, a prokinetic agent.

Which assessment findings are consistent with a diagnosis of leukoplakia? a. Inflammation and erosion of the oral mucosa b. White, plaque-like lesions on the buccal mucosa c. Red, velvety mucosal lesions on the oral mucosa d. Thickened white patches that are firmly attached

d. Thickened white patches that are firmly attached A patient with leukoplakia has thickened, white, firmly attached patches. Candidiasis is observed as white, plaque-like lesions on the buccal mucosa, but these can be easily scraped off, unlike the patches of leukoplakia. Red, not white, velvety lesions on the surface of the oral mucosa are seen in erythroplakia. Inflammation and erosion of the oral mucosa is observed in stomatitis, not in leukoplakia.

A patient who has undergone surgery and radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this patient about managing this symptom? a. This indicates a complication of therapy. b. This condition is common but is temporary. c. Use lozenges and hard candies to prevent dry mouth. d. Use saliva substitutes, especially when eating dry foods.

d. Use saliva substitutes, especially when eating dry foods. Xerostomia is a common effect of oral irradiation and may be permanent. Patients should be advised to use saliva substitutes. The condition is common, but often permanent. Lozenges and hard candies are not as effective as saliva substitutes. Dry mouth is a side effect of therapy, not a symptom of complications.

The nurse is caring for a patient with a hiatal hernia who had an open fundoplication yesterday. Which task does the nurse delegate to unlicensed assistive personnel (UAP)? a. Adjusting the position of the nasogastric (NG) tube b. Giving the patient sips of water once bowel sounds are heard c. Assessing the level of postoperative pain using a 0 to 10 scale d. Using a pillow to support the incision when the patient coughs

d. Using a pillow to support the incision when the patient coughs Assisting a patient to cough is a task within the education and skill level of UAP. NG tube maintenance, pain assessment, and assessment of bowel sounds require more knowledge of the potential complications associated with this surgical procedure and therefore are actions best performed by licensed nursing staff.