Chapter 46 Prep U (Hard ones)

A client has oral cancer and is recovering from extensive surgery to excise the malignancy. What are the goals for this client's nursing management while in the hospital? Select all that apply. A. Maintain the client's airway. B. Promote adequate caloric and fluid intake. C. Encourage the client to sleep on their back to reduce edema. D. Irrigate the client's mouth frequently with mouthwash to decrease bad tastes and odors.

A, D R:General nursing management of the client with oral cancer is much the same as for any client with cancer. The focus of attention, however, is on maintaining a patent airway, promoting adequate fluid and food intake, and supporting communication that the tumor or treatment may have impaired.

Which of the following are functions of saliva? Select all that apply A. Lubrication B. Metabolism C. Elimination D. Digestion E. Protection against harmful bacteria

A, D, E R: The three main functions of saliva are lubrication, protection against harmful bacteria, and digestion. Elimination and metabolism are not functions of saliva.

The nurse is standing next to the bed of a client who is experiencing a hemorrhage from the neck area following a neck dissection. The first intervention of the nurse is to: A. Call for assistance. B. Put on gloves. C. Apply pressure to the site. D. Elevate the head of the bed.

B R:If the carotid artery hemorrhages following a neck dissection, the nurse will probably do all these interventions. The nurse is to follow recommendations from the Centers for Disease Control in regards to protecting self, and this is to follow universal precautions.

The nurse is caring for patient scheduled to undergo radical neck dissection. During preoperative teaching, the nurse includes that which of the following as associated complications? A. Neck distension B. Venous engorgement C. Shoulder drop D. Clavical fracture

C R:The nurse should include shoulder drop as an associated complication of radical neck dissection. Another associated complication includes poor cosmesis, which is a visible depression in the neck. Clavicle fracture, venous engorgement, and neck distension are not complications associated with radical neck dissection.

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. A. Ensuring intake of food and fluids 2 to 3 hours before bedtime B. Sleeping in a supine position C. Avoiding foods that intensify symptoms D. Maintaining an upright position following meals

C, D R: Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.

During a psychotic episode, a client with schizophrenia swallows a small wooden spoon. Which of the following medications would the nurse in the emergency department be most likely to administer to facilitate removal of the foreign body? A. Epinephrine B. Haloperidol C. Insulin D. Glucagon

D R: Glucagon is administered before removing a foreign body because it relaxes the smooth muscle of the esophagus, thereby facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Insulin and epinephrine would not assist with foreign body removal.

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. A.Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. B. Elevate the head of the bed on 6- to 8-inch blocks. C. Elevate the upper body on pillows. D. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. E. Avoid beer, especially in the evening.

B,C,E

The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease? A. Minimize intake of caffeine, beer, milk, and foods containing peppermint and spearmint. B. Avoid eating or drinking 2 hours before bedtime. C. Eat a low-carbohydrate diet. D. Elevate the foot of the bed on 6- to 8-inch blocks.

B R:The patient should not recline with a full stomach. The patient should be instructed to avoid the listed foods and food components. The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks. The patient is instructed to eat a low-fat diet.

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort? A. Positioning the client flat on the abdomen or side. B. Providing a tracheostomy tray near the bed. C. Keeping the head of the bed elevated. D. Turning the client's head to the side.

C R:It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out.

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has what type of potential side effect? A. Nausea B. Gastric slowing C. Peptic ulcer disease D. Extrapyramidal

D R: Metoclorpramide 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. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

A client with peptic ulcer disease complains of sharp mid-epigastric pain. Which assessment finding is most important to the care of this client? A. Rigid abdomen B. Pain is relieved with food. C. Explosive diarrhea D. Pain returns 1 hour after eating.

A R: Sudden sharp mid-epigastric pain and abdominal rigidity are symptoms of perforation and needs immediate intervention. Pain relieved with food only to return an hour later is typical of peptic ulcer disease. Explosive diarrhea without further symptoms bears attention but not immediate.

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. A. avoiding foods that intensify symptoms B. ensuring intake of food and fluids 2 to 3 hours before bedtime C. maintaining an upright position following meals D. sleeping in a supine position

A, C R: Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.

A client with esophageal cancer has difficulty in swallowing. Which of the following would be appropriate to help the client achieve improved nutrition? A. Encourage small, frequent meals B. Give high-protein, semiliquid foods C. Give liquid supplements for meals D. Provide oral liquids through a straw

B R: A major goal for a client with esophageal cancer is adequate or improved nutrition and eventually stable weight. Because he has difficulty in swallowing, the nurse should ensure that the client receives soft foods or high-calorie, high-protein, semiliquid foods to get improved nutrition. Providing oral liquids alone will not provide improved nutrition. Using a straw leads to bloating and should be avoided. Providing liquid supplements are used in between meals, not as meals. Encouraging small, frequent meals will give improved nutrition to a client who does not have any difficulty in swallowing.

The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route? A. nasoenteric intubation B. nasogastric intubation C. gastrostomy D. orogastric intubation

B R: The nasal route is the preferred route for passing a tube when the client's nose is intact and free from injury.

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. A. Famotidine (Pepcid) B. Nizatidine (Axid) C. Lansoprazole (Prevacid) D. Rabeprazole (AcipHex) E. Esomeprazole (Nexium)

C, D,E

The nurse is reviewing the chart of a client with swallowing problems. Which of the following factors would raise suspicion that the client has cancer of the esophagus? Choose all that apply. A. Age 72 years B. Caucasian race C. Smoking history of 20 years D. Previous treatment for gastroesophageal reflux disease E. Male gender

C,D, E R: In the United States, carcinoma of the esophagus occurs more than three times as often in men as in women. It is seen more frequently in African Americans than in Caucasians and usually occurs in the fifth or sixth decade of life. Cancer of the esophagus has been associated with ingestion of alcohol and the use of tobacco. There is an apparent association between GERD and adenocarcinoma of the esophagus.

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, the nurse plans postoperative care to include the following: (Select all that apply.) A. Monitor drainage in the closed chest drainage system. B. Replace the nasogastric tube if the tube becomes dislodged. C. Assess lung sounds every 4 hours and prn. D. Verify rhythm on the cardiac monitoring system. E. Maintain the client in a side-lying position.

A,C, D R: Following recovery from anesthesia for a surgical resection of an esophageal tumor, the client is placed in the Fowler's position. A common postoperative complication is aspiration pneumonia. The nurse assesses for this complication by assessing lung sounds. The nurse monitors the drainage in the closed chest drainage system. Because of irritation of the vagus nerve, the nurse assesses for the complication of atrial fibrillation. The nurse does not replace the nasogastric tube if it becomes dislodged.

A client with oral cancer informs the nurse that he has been experiencing dryness of the mouth. The best action of the nurse is to A. State, "This is a normal consequence of oral cancer." B. Provide a humidifier for the client to use while sleeping. C. Allow the client to continue with his usual diet. D. Ensure that the client maintains a fluid intake of 2000 mL per day.

B R: Dryness of the mouth (xerostomia) is a frequent sequeala of oral cancer. While explaining this to the client provides information, it does nothing to help solve the problem. The nurse should encourage this client to increase intake of fluids to 2000 to 3000 mL per day. Providing a humidifier will assist in moisturizing the oral cavity. The client needs to be instructed to avoid dry, bulking, and irritating foods and fluids.

The nurse is caring for an older adult who complains of xerostomia. The nurse evaluates for use of which of the following medications? A. Steroids B. Diuretics C. Antibiotics D. Antiemetics

B R:Diuretics, frequently taken by older adults, can cause xerostomia (dry mouth). This is uncomfortable, impairs communication, and increases the patient's risk for oral infection. Antibiotics, antiemetics, and steroids are not medications typically taken orally by adults that cause dry mouth.

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is: A. Antacids B. H2-receptor antagonists. C. Proton pump inhibitors. D. Antispasmodics

C R: Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful.

A patient has been diagnosed with Zenker's diverticulum. What treatment does the nurse anticipate educating the patient about? A. A low-residue diet B. Radiation therapy C. Surgical removal of the diverticulum D. Chemotherapeutic agents

C R:Because Zenker's diverticulum is progressive, the only means of cure is surgical removal of the diverticulum.