Prep U- Chapter 45: Management of Patients With Oral and Esophageal Disorders

A client has a new order for metoclorpramide (Reglan). The nurse knows 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 the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following? -Dry mouth not relieved by sugar-free hard candy -Anxiety or irritability -Excessive drowsiness -Uncontrolled rhythmic movements of the face or limbs

Uncontrolled rhythmic movements of the face or limbs :Metoclorpramide is a prokinetic agent that accelerates gastric emptying.

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client? -Abdominal distention, elevated temperature, weakness before eating -Persistent loose stools, chills, hiccups after eating -Constipation, rectal bleeding following bowel movements -Weakness, diaphoresis, diarrhea 90 minutes after eating

Weakness, diaphoresis, diarrhea 90 minutes after eating

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? -"Take antacids with meals." -"Lie down after meals to promote digestion." -"Avoid coffee and alcoholic beverages." -"Limit fluid intake with meals."

"Avoid coffee and alcoholic beverages."

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? -"I'll gradually increase the amount of heavy lifting I do." -"I'll eat frequent, small, bland meals that are high in fiber." -"I'll lie down immediately after a meal." -"I'll eat three large meals every day without any food restrictions."

"I'll eat frequent, small, bland meals that are high in fiber."

During postoperative neck dissection assessment, the nurse notices excessive bleeding from the dressing site. She suspects possible carotid artery rupture and takes the immediate first step to: -Elevate the head of the patient's bed. -Summon assistance. -Notify the surgeon to repair the vessel. -Apply pressure to the bleeding site or major associated vessel.

Apply pressure to the bleeding site or major associated vessel. :The first action is to apply pressure on the bleeding site. Then summon assistance (do not leave the patient alone), elevate the head of the bed, and ask someone else to notify the surgeon.

A nurse inspects the Stensen duct of the parotid gland to determine inflammation and possible obstruction. What area in the oral cavity would the nurse examine? -Roof of the mouth next to the incisors -Dorsum of the tongue -Buccal mucosa next to the upper molars -Posterior segment of the tongue near the uvula

Buccal mucosa next to the upper molars

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? -Gastroesophageal reflux disease -Diverticulitis -Peptic ulcer disease -Esophageal cancer

Gastroesophageal reflux disease :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? - Erythroplakia -Hairy leukoplakia -Aphthous stomatitis -Nicotine stomatitis

Hairy leukoplakia

Which of the following is one of the first clinical manifestations of esophageal cancer? -Increasing difficulty in swallowing -Foul breath -Hiccups -Sensation of a mass in throat

Increasing difficulty in swallowing :As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include sensation of a mass in the throat, foul breath, and hiccups.

A client has a radical neck dissection to treat cancer of the neck. The nurse develops the care plan and includes all the following diagnoses. The nurse identifies the highest priority diagnosis as -Ineffective airway clearance related to obstruction by mucus -Risk for infection related to surgical intervention -Impaired tissue integrity related to surgical intervention -Imbalanced nutrition: less than body requirements, related to treatment

Ineffective airway clearance related to obstruction by mucus

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. What is the nurse's best intervention? -Encourage the client to ingest a soft or bland diet. -Remove the plaque from the mouth by rubbing with gauze. -Provide saline rinses prior to meals. -Instruct the client to swish prescribed nystatin solution for 1 minute.

Instruct the client to swish prescribed nystatin solution for 1 minute. :candidiasis- cheesy white plaque in the mouth that looks like milk curds and can be rubbed off The most effective treatment is anitfungal medication such as nystatin (Mycostatin)

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone? -Biopsy -Lithotripsy -Chemotherapy -Radiation

Lithotripsy :Lithotripsy uses shock waves to disintegrate stones. For parotid stones & smaller submandibular stones.

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? - Helping the client cope with body image changes -Preventing injury -Maintaining a patent airway -Ensuring adequate nutrition

Maintaining a patent airway

A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about? - Acyclovir -Nystatin -Cephalexin -Fluocinolone acetonide oral base gel

Nystatin

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an): -Twisting of the duodenum through an opening in the diaphragm. -Extension of the esophagus through an opening in the diaphragm. -Involution of the esophagus, which causes a severe stricture. -Protrusion of the upper stomach into the lower portion of the thorax.

Protrusion of the upper stomach into the lower portion of the thorax.

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

Provide the client with an irrigating solution of baking soda and warm water.

Which of the following refers to a bacterial or viral infection of the salivary glands? -Sialadenitis -Stomatitis -Parotitis -Mumps

Sialadenitis :

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? -Staphylococcus aureus -Methicillin-resistant Streptococcus aureus (MRSA) -Streptococcus viridans -Pneumococcus

Staphylococcus aureus

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

Stridor

A client comes to the clinic complaining of a sore throat. When assessing the client, the nurse observes a reddened ulcerated lesion on the lip. The client tells the nurse that it has been there for a couple of weeks but it does not hurt. What should the nurse consult with the health care provider about testing for? -Gonorrhea -Herpes simplex -HIV -Syphilis

Syphilis

The client has a chancre on the lips. What instruction should the nurse provide? - Apply warm soaks to the lip. -Gargle with an antiseptic solution. -Take measures to prevent spreading the lesion to other people. -Avoid foods that could irritate the lesion.

Take measures to prevent spreading the lesion to other people. :A chancre is a primary lesion of syphilis and very contagious. Other nursing considerations include cold soaks to the lip, good mouth care (brushing and flossing), and administration of antibiotics as prescribed.

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

The client is free from esophagitis and achalasia

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a(n) -lichen planus. -leukoplakia. -chancre. -actinic cheilitis.

chancre.

The most common symptom of esophageal disease is - dysphagia. - nausea. -vomiting. -odynophagia.

dysphagia. :Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing

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

"Many oral cancers produce no symptoms in the early stages." : Frequent symptom of oral cancer is a painless sore that does not heal. The client may complain of tenderness & 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.

Which is an accurate statement regarding cancer of the esophagus? - It usually occurs in the fourth decade of life. -Chronic irritation of the esophagus is a known risk factor. -It is three times more common in women than men in the United States. -It is seen more frequently in Caucasian Americans than in African Americans.

Chronic irritation of the esophagus is a known risk factor. :United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life.

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

Fowler

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

Difficulty swallowing : Primary symptom of achalasia is difficulty in swallowing both liquids & solids. Report chest pain & heartburn that may/may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

A patient has been NPO for two days anticipating surgery which has been repeatedly delayed. In addition to risks of nutritional and fluid deficits, the nurse determines that this patient is at the greatest risk for: - confusion. -altered oral mucous membranes. -ineffective social interaction. -physical injury.

altered oral mucous membranes. :Not drinking anything by mouth can result in drying of the oral mucous membranes, compromising their integrity.