Chapter 46: Management of Patients With Oral and Esophageal Disorders

A nurse caring for a patient who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. An expected normal amount of drainage is: Between 40 and 80 mL. Approximately 80 to 120 mL. Between 120 and 160 mL. Greater than 160 mL.

Correct response: Approximately 80 to 120 mL. Explanation: Between 80 to 120 mL may drain over the first 24 hours. Drainage of greater than 120 mL may be indicative of a chyle fistula or hemorrhage.

Which of the following is the primary symptom of achalasia? Difficulty swallowing Chest pain Heartburn Pulmonary symptoms

Correct response: Difficulty swallowing Explanation: The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication can be safely administered for which conditon? Gastroesophageal reflux disease Peptic ulcer with melena Diverticulitis with perforation Gastritis

Correct response: Gastroesophageal reflux disease Explanation: Metoclorpramide is a prokinetic agent that accelerates gastric emptying. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? Peptic ulcer disease Esophageal cancer Gastroesophageal reflux disease Diverticulitis

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

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are? Aphthous stomatitis Nicotine stomatitis Erythroplakia Hairy leukoplakia

Correct response: Hairy leukoplakia Explanation: Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough hairlike projections occur, typically found on lateral border of the tongue.

A group of students is reviewing the medications that may be used to treat esophageal reflux. The students demonstrate understanding of the information when they identify which of the following as an example of a proton-pump inhibitor? Ranitidine (Zantac) Sucralfate (Carafate) Omeprazole (Prilosec) Cisapride (Propulsid)

Correct response: Omeprazole (Prilosec) Explanation: Proton-pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid). Ranitidine (Zantac) is a histamine-2 antagonist; sucralfate (Carafate) is a cytoprotective agent; cisapride (Propulsid) is a gastrointestinal motility agent. Reference:

For a patient with salivary calculi, which of the following procedures uses shock waves to disintegrate the stone? Radiation Lithotripsy Chemotherapy Biopsy

Correct response: Lithotripsy Explanation: Lithotripsy uses shock waves to disintegrate the stone. 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.

Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland? Sialolithiasis Parotitis Sialadenitis Stomatitis

Correct response: 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 which of the following? Nausea Vomiting Dysphagia Odynophagia

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

Postoperatively, a patient with a radical neck dissection should be placed in which position? Supine Fowler's Prone Side-lying

Correct response: Fowler's Explanation: The patient should be placed in the Fowler's position to facilitate 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