Med Surg. Chapter 46 Management of Patients With Oral and Esophageal Disorders

A nurse is performing health assessment with a client during an outpatient clinic visit. The most -----------concerning client statement to the nurse is:

"Food seems to be getting stuck in my throat."

An adolescent client with multiple dental caries is discussing his diet with the nurse. The nurse explores the client's behaviors and identifies a risk factor for ----------dental caries when the client states:

"I drink a can of carbonated soda at lunch every day."

One way for the nurse to confirm placement of a nasogastric tube is to test the pH of the tube aspirate. The nurse knows that tube placement in the lungs is indicated with a pH of:

6

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:

Apply pressure to the bleeding site or major associated vessel.

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:

Approximately 80 to 120 mL.

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to

Assess the graft for color and temperature.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Assist client to increase dietary fiber.

The nurse is caring for a patient with a history of bulimia. The patient complains of ----------retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which of the following conditions?

Boerhaave syndrome

Which of the following is an accurate statement regarding cancer of the esophagus?

Chronic irritation of the esophagus is a known risk factor.

Cancer of the esophagus is most often diagnosed by which of the following?

Esophagogastroduodenoscopy (EGD) with biopsy and brushings

Amanda Ford, a 53-year-old actress, is being seen by a physician in your oncology group for a diagnosis of oral cancer. She is in the initial stages of diagnosis and is frightened about the side effects of treatment and subsequent prognosis. She also has many questions regarding the type of cancer she has been diagnosed with and asks -------where oral cancer typically occurs. What is your response?

Floor of the mouth

Postoperatively, a patient with a radical neck dissection should be placed in which position?

Fowler's

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

A patient is experiencing painful, inflamed, and swollen gums, and when brushing the teeth, the -------gums bleed. What common disease of the oral tissue does the nurse understand these symptoms indicate?

Gingivitis

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?

Hairy leukoplakia

Which of the following is one of the -----first clinical manifestations of ------esophageal cancer?

Increasing difficulty is swallowing

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

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. The best nursing intervention is to

Instruct the client to swish prescribed nystatin (Mycostatin) solution for 1 minute.

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

Lithotripsy

Tyrone Freeman is a 49-year-old male being treated for --------GERD at the gastroenterology office where you work. During his visit, he states that his reflux is much improved, but now, he is having --------diarrhea. In addition to his prescribed treatment for GERD, he has been taking an antacid. Which of the following components of an antacid might be causing his diarrhea?

Magnesium

The nurse working in the recovery room is caring for a patient who had a radical neck dissection. The nurse notices that the patient has a -------=-----coarse, high-pitched sound on inspiration. Which of the following is the appropriate intervention by the nurse?

Notifying the physician

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?

Omeprazole (Prilosec)

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:

Proton pump inhibitors.

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):

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?

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

An elderly patient is diagnosed with ----------parotitis. The nurse is aware that this bacterial infection is most likely caused by:

Staphylococcus aureus.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?

Take long, slow breaths

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?

The client lying in a lateral position, with the head of bed flat

James Jaeger, a 59-year-old carpenter, is being seen by a physician in your oncology group with a diagnosis of oral cancer. During your client education, Mr. Jaeger tells you that he is upset that he didn't recognize any early signs or symptoms of his disease. What do you tell Mr. Jaeger about the early stage of his cancer?

There are usually no symptoms.

Paul Cavanagh, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. Although his surgery was deemed successful,-------- it was quite disfiguring and incapacitating. What is essential to Mr. Cavanagh and his family?

Time to mourn, accept, and adjust to the loss

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?

Uncontrolled rhythmic movements of the face or limbs

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?

Vagus

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?

Weakness, diaphoresis, diarrhea 90 minutes after eating

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. -------Aphthous stomatitis is best described as:

a canker sore of the oral soft tissues.

The most common symptom of esophageal disease is

dysphagia.

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has ---------difficulty swallowing, the nurse should assign highest priority to:

maintaining a patent airway.

Regarding oral cancer, the nurse provides health teaching to inform the patient that

many oral cancers produce no symptoms in the early stages.

A patient is brought to the emergency department by a family member, who states that the patient "drank drain cleaner." What intervention does the nurse anticipate providing to treat this patient? (Select all that apply.)

• Aspirating secretions from the pharynx if respirations are affected • Neutralizing the chemical • Washing the esophagus with large volumes of water

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:

Put on gloves.

A nurse is preparing a presentation for a local community group for older adults on nutrition and anorexia in this population. Which of the following would the nurse include in the presentation as a possible contributing factor for --------anorexia in the older adult?

Reduction in and atrophy of taste buds

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a

chancre.