Chapter 46 Management of Patients With Oral and Esophageal Disorders
A nurse is caring for a patient who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the patient's appetite?
A) Encourage the family to bring in the patient's favored foods.
A nurse is caring for a patient who has had surgery for oral cancer. When addressing the patient's long-term needs, the nurse should prioritize interventions and referrals with what goal?
A) Enhancement of verbal communication
A patient has received treatment for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status?
A) Ensure that none of the patient's visitors has an infection.
A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?
A) Indicates acceptance of altered appearance and demonstrates positive self-image
A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug?
A) Metoclopramide (Reglan)
A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply.
A) Perforation into the mediastinum C.) Erosion into the great vessels E.) Obstruction of the esophagus
A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patient's care?
A) Risk for Aspiration Related to Inhalation of Gastric Contents
A patient's neck dissection surgery resulted in damage to the patient's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize?
A) The patient's swallowing ability
The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?
A. Avoid applying suction on or near the suture line.
The school nurse is planning a health fair for a group of fifth graders and dental health is one topic that the nurse plans to address. What would be most likely to increase the risk of tooth decay?
A. Organic fruit juice
An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2ºF and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?
A. Palpate the patient's parotid glands to detect swelling and tenderness.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care?
A. The patient will require an upper endoscopy every 6 months to detect malignant changes.
A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer?
A.) A 65-year-old man with alcoholism who smokes
A nurse is caring for a patient who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this patient, what would the nurse be sure to include?
B) Avoiding chewing food for the specified number of weeks after surgery
Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patient's knowledge of this new diagnosis. Which of the following should the nurse encourage?
B) Keeping the head of the bed slightly elevated
A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?
B) Lower esophageal sphincter
A nurse in an oral surgery practice is working with a patient scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend which of the following actions?
B) Use warm saline to rinse the mouth as needed.
A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patient's priority need at this time?
B. An effective means of communicating with the nurse
The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?
B. Presence of a painless sore with raised edges
A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what?
B.) 60 mL of milky or cloudy drainage
A nurse is caring for a patient who has undergone neck resection with a radial forearm free flap. The nurse's most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse's most appropriate action?
B.) Promptly report these indications of venous congestion.
A patient has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the patient to describe what sign or symptom?
B.)Regurgitation of undigested food
A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis?
C) An older adult whose medication regimen includes an anticholinergic
A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?
C) Assess for a patent airway.
A nurse is providing health promotion education to a patient diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the patient to implement?
C) Avoid carbonated drinks.
A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?
C) Early diagnosis and treatment of gastroesophageal reflux disease
A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. Which of the following should be included in the patient's immediate postoperative plan of care?
C) Positioning the patient to prevent gastric reflux
A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include?
C) Promoting maximum shoulder function
A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this patient?
C) Respiratory status and airway clearance
A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient?
C.) Placing the patient in Fowler's position
A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patient's discharge education?
C.) Promotion of adequate nutrition
An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?
D) Glucagon
A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patient's plan of care. Why are patients who are ill at increased risk for developing dental caries?
D) Inadequate nutrition and decreased saliva production can cause cavities
A nurse is providing care for a patient whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis?
D) Ineffective Tissue Perfusion
A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?
D) Metastases are common and respond poorly to treatment.
A nurse is caring for a patient who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the patient and notes the presence of high-pitched adventitious sounds over the patient's trachea on auscultation. The patient's oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse's most appropriate action?
D) Report this finding promptly to the physician and remain with the patient.
A nurse is providing oral care to a patient who is comatose. What action best addresses the patient's risk of tooth decay and plaque accumulation?
D. Brushing the patient's teeth with a toothbrush and small amount of toothpaste
A radial graft is planned in the treatment of a patient's oropharyngeal cancer. In order to ensure that the surgery will be successful, the care team must perform what assessment prior to surgery?
D.) Assessing the patency of the ulnar artery
A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis?
D.) Imbalanced Nutrition: Less Than Body Requirements
A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?
D.) Instead of eating three meals a day, try eating smaller amounts more often.