Chapter 45. management of patients with oral and esophageal disorders PrepU

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

A. Fowler Explanation: The client should be placed in the Fowler position to facilitate breathing and promote comfort. This position also promotes expansion of the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs. The other positions are not the position of choice postoperatively.

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

A. Increasing difficulty in swallowing Explanation: The client first becomes aware of intermittent and increasing difficulty in swallowing with esophageal cancer. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include the sensation of a mass in the throat, foul breath, and hiccups, but these are not the most common initial clinical manifestation with clients with esophageal cancer.

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

A. Lithotripsy Explanation: Lithotripsy uses shock waves to disintegrate stones. It may be used instead of surgical extraction for parotid stones and smaller submandibular stones. Radiation, chemotherapy, and biopsy do not use shock waves to disintegrate a stone.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? A. The client lying in a lateral position, with the head of bed flat B. Serosanguineous drainage on the dressing C. A piggyback infusion of levofloxacin D. Foley catheter bag containing 500 ml of amber urine

A. The client lying in a lateral position, with the head of bed flat Explanation: A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. Elevate the head of the bed on 6- to 8-inch blocks. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. Elevate the upper body on pillows. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. Avoid beer, especially in the evening.

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

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

B. Staphylococcus aureus Explanation: The elderly and debilitated clients experience decreased salivary flow from general dehydration or medications. The bacterial infection is usually caused by Staphylococcus aureus. The infecting organism travels from the mouth through the salivary gland. Pseudomonas, pneumococcus, and streptococcus are less likely to specifically affect the elderly or debilitated clients.

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

B. Uncontrolled rhythmic movements of the face or limbs Explanation: Metoclopramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely for uncontrolled rhythmic movements of the face or limbs. Metoclopramide side effects are headache, confusion, and drowsiness. Anxiety, hyperactivity, and a dry mouth are not common side effects.

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

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

Which of the following interventions would be most appropriate for a client with a hiatal hernia and nursing diagnosis of acute pain related to reflux of gastric secretions? A. Instruct the client to eat slowly and chew the food thoroughly. B. Instruct the client to avoid alcohol or tobacco products. C. Inform the client to remain upright for at least 2 hours after meals. D. Encourage the client to eat frequent, small, well-balanced meals.

C. Inform the client to remain upright for at least 2 hours after meals. Explanation: Because the client is showing signs of pain related to the pressure and the reflux of gastric secretions, it is essential to inform him or her to remain upright for at least 2 hours after meals because an upright position helps prevent reflux. Encouraging the client to eat frequent, small, well-balanced meals, to avoid alcohol and tobacco products, and to eat slowly and chew foods thoroughly would be appropriate for a nursing diagnosis of imbalanced nutrition, less than body requirements.

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

C. Sialolithiasis Explanation: Salivary stones are formed mainly from calcium phosphate. Parotitis refers to inflammation of the parotid gland. Sialadenitis refers to inflammation of the salivary glands. Stomatitis refers to inflammation of the oral mucosa.

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

C. dysphagia. Explanation: Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease: A. symptoms include oral bleeding. B. symptoms include mouth pain. C. there are usually no symptoms. D. symptoms include oral numbness.

C. there are usually no symptoms. Explanation: The early stage of oral cancer is characteristically asymptomatic.

The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state A. "A typical lesion is soft and craterlike." B. "Blood testing is used to diagnose oral cancer." C. "Most oral cancers are painful at the outset." D. "Many oral cancers produce no symptoms in the early stages."

D. "Many oral cancers produce no symptoms in the early stages." Explanation: The most frequent symptom of oral cancer is a painless sore that does not heal. The client may complain of tenderness and difficulty chewing, swallowing, or speaking as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless, hardened ulcer with raised edges.

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. How is aphthous stomatitis best described by the nurse? A. Acid indigestion B. An early sign of peptic ulcer disease C. An acute stomach infection D. A canker sore of the oral soft tissues

D. A canker sore of the oral soft tissues Explanation: Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? A. Pain B. Malnutrition C. Regurgitation of food D. Dysphagia

D. Dysphagia Explanation: Dysphagia (difficulty swallowing), the most common symptom of esophageal disease, may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute odynophagia (pain on swallowing).

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

D. Maintaining a patent airway Explanation: Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.

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

D. Provide the client with an irrigating solution of baking soda and warm water. Explanation: If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended. Using tap water is not enough to promote oral hygiene. Drinking a small glass of alcohol will not provide oral hygiene. Wiping the outside of the mouth will not promote oral hygiene.

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis? A. Pneumococcus B. Methicillin-resistant Streptococcus aureus (MRSA) C. Streptococcus viridans D. Staphylococcus aureus

D. Staphylococcus aureus Explanation: People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for parotitis. The infecting organisms travel from the mouth through the salivary duct. The organism is usually Staphylococcus aureus (except in mumps).

Select the assessment finding that the nurse should immediately report, post radical neck dissection. A. Temperature of 99°F B. Localized wound tenderness C. Pain D. Stridor

D. Stridor Explanation: Stridor is the presence of coarse, high-pitched sounds on inspiration. The nurse would auscultate frequently over the trachea. This finding must be immediately reported because it indicates airway obstruction.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? A .The client has normal gastric structures. B. The client doesn't exhibit rectal tenesmus. C. The client reports diminished duodenal inflammation. D. The client is free from esophagitis and achalasia.

D. The client is free from esophagitis and achalasia. Explanation: Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.