Oral & Esophageal Disorders

A nurse is completing an assessment on a client with a postoperative neck dissection. The nurse notices excessive bleeding from the dressing site and suspects possible carotid artery rupture. What action should the nurse take first? A) Apply pressure to the bleeding site B) Notify the surgeon to repair the vessel C) Summon assistance D) Elevate the head of the patient's bed

A) Apply pressure to the bleeding site

T or F: The patient with a hiatal hernia should be instructed to lie down for at least 1 hr after eating.

False

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

C) "Many oral cancers produce no symptoms in the early stages."

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? A) Malnutrition B) Regurgitation of food C) Dysphagia D) Pain

C) Dysphagia

The nurse is assessing the skin graft site of a client who has undergone a radical neck dissection. The skin graft site is pink. The nurse documents which result? A) Healthy graft B) Venous congestion of graft C) Infection of graft D) Possible necrosis of graft

A) Healthy graft

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours? A) 160-200mL B) 80-120mL C) 20-40mL D) 50-75mL

B) 80-120mL

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? A) Hold his breath B) Take long, slow breaths C) Pant like a dog D) Bear down as if having a bowel movement

B) Take long, slow breaths

Which of the following refers to a bacterial or viral infection of the salivary glands? A) Stomatitis B) Parotitis C) Sialadenitis D) Mumps

C) Sialadenitis

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: A) Imbalanced nutrition: less than body requirements, related to treatment B) Risk for infection related to surgical intervention C) Impaired tissue integrity related to surgical intervention D) Ineffective airway clearance related to obstruction by mucus

D) Ineffective airway clearance related to obstruction by mucus

The most frequent symptom of oral cancer is a _____ sore or mass that bleeds easily and does not heal.

Painless

_____ is a frequently occurring side effect of chemotherapy or radiation therapy.

Stomatitis

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? A) The client lying in a lateral position, with the head of bed flat B) Serosanguineous drainage on the dressing C) Foley catheter bag containing 500 ml of amber urine D) A piggyback infusion of levofloxacin

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

A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document? A) Erythroplakia B) Nicotine stomatitis C) Hairy leukoplakia D) Aphthous stomatitis

C) Hairy leukoplakia

A client is being evaluated for esophageal cancer. What initial manifestation of esophageal cancer should the nurse assess? A) Foul breath B) Hiccups C) Sensation of mass in throat D) Increasing difficulty in swallowing

D) Increasing difficulty in swallowing

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? A) Gastroesophageal reflux disease B) Hiatal hernia C) Gastritis D) Esophageal tumor

D) Esophageal tumor

T or F: Barrett esophagus is a condition in which the lining of the esophageal mucosa is altered.

True

The nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care? A) Dextrose and water B) Mouthwash and water C) Full-strength peroxide D) Baking soda and water

D) Baking soda and water

Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis? A) Actinic cheilitis B) Leukoplakia C) Lichen planus D) Chancre

D) Chancre

_____ is the most common symptom of esophageal disease and may vary from an uncomfortably feeling in the upper esophagus to acute pain on swallowing.

Dysphagia

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? A) Maintaining a patent airway B) Helping the client cope with body image changes C) Ensuring adequate nutrition D) Preventing injury

A) Maintaining a patent airway

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. How is aphthous stomatitis best described by the nurse? A) An early sign of peptic ulcer disease B) A canker sore of the oral soft tissues C) Acid indigestion D) An acute stomach infection

B) A canker sore of the oral soft tissues

Which clinical manifestation is not associated with hemorrhage? A) Tachypnea B) Bradycardia C) Hypotension D) Tachycardia

B) Bradycardia

The most common symptom of esophageal disease is: A) Nausea. B) Dysphagia. C) Vomiting. D) Odynophagia.

B) Dysphagia.

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? A) Acyclovir B) Cephalexin C) Nystatin D) Fluocinolone acetonide oral base gel

C) Nystatin

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? A) Methicillin-resistant Streptococcus aureus (MRSA) B) Pneumococcus C) Streptococcus viridans D) Staphylococcus aureus

D) Staphylococcus aureus

The nurse is examining the mouth of a client who is HIV positive. On the inner side of the lip, the nurse sees a shallow ulcer with a yellow center and red border. The client says the area has been painful for about 5 days or so. Which condition is most consistent with these findings? A) Aphthous stomatitis B) Chancre C) Hairy leukopenia D) Kaposi's sarcoma

A) Aphthous stomatitis

A client is postoperative following a graft reconstruction of the neck. What intervention is the most important for the nurse to complete with the client? A) Assess the graft for color and temperature. B) Cleanse around the drain using aseptic technique. C) Administer prescribed intravenous vancomycin at the correct time. D) Reinforce the neck dressing when blood is present on the dressing

A) Assess the graft for color and temperature.

When caring for a client with the impaired swallowing related to neuromuscular impairment, what is the nurse's priority intervention? A) Elevate the head of the bed 90 degrees during meals. B) Place the client in a supine position C) Encourage thin liquids for dietary intake. D) Encourage the client to remove dentures

A) Elevate the head of the bed 90 degrees during meals.

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

A) Fowler

Which mouth condition is most associated with HIV infection? A) Kaposi sarcoma B) Krythoplakia C) Candidiasis D) Stomatitis

A) Kaposi sarcoma

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone? A) Lithotripsy B) Biopsy C) Radiation D) Chemotherapy

A) Lithotripsy

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland? A) Sialothiasis B) Stomatitis C) Parotits D) Sialadenitis

A) Sialothiasis

A client has been diagnosed with Zenker's diverticulum. What treatment does the nurse include in the client education? A) Surgical removal of diverticulum B) Radiation therapy C) A low-residue diet D) Chemotherapeutic agents

A) Surgical removal of diverticulum

The nurse is preparing to assess the donor site of a client who underwent a myocutaneous flap after a radical neck dissection. The nurse prepares to assess the most commonly used muscle for this surgery. Which muscle should the nurse assess? A) Trapezius B) Pectoralis major C) Sternomastoid D) Biceps

B) Pectoralis major

A client who had oral cancer has had extensive surgery to excise the malignancy. Although surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to this client and family? A) Having a courageous attitude B) Time to mourn, accept, and adjust to the loss C) Not giving in to anger D) Knowing that everything will work out just fine

B) Time to mourn, accept, and adjust to the loss

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? A) Peptic ulcer disease B) Esophageal cancer C) Gastroesophageal reflux disease D) Diverticulitis

C) Gastroesophageal reflux disease

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): A) Twisting of the duodenum through an opening in the diaphragm. B) Involution of the esophagus, which causes a severe stricture. C) Protrusion of the upper stomach into the lower portion of the thorax. D) Extension of the esophagus through an opening in the diaphragm

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

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

C) Weakness, diaphoresis, diarrhea 90 minutes after eating

While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit? A) Between 120 and 160mL B) Greater than 160mL C) Between 40 and 80mL D) Approximately 80 to 120mL

D) Approximately 80 to 120mL

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? A) Wear tight-fitting clothing B) Eat a low-carbohydrate diet C) Elevate the foot of the bed on 6-8 in blocks D) Avoid eating of drinking 2 hr before bedtime

D) Avoid eating of drinking 2 hr before bedtime

Which is the primary symptom of achalasia? A) Chest pain B) Pulmonary symptoms C) Heartburn D) Difficulty swallowing

D) Difficulty swallowing

A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition? A) Gastritis B) Diverticulitis with perforation C) Peptic ulcer with melena D) Gastroesophageal reflux disease

D) Gastrointestinal reflux disease

T or F: In a radical neck dissection, the tumor and surrounding musculature are removed but the cervical lymph nodes are left intact.

False

Elderly, acutely ill, or debilitated people with decreased salivary gland secretion from general dehydration or medications are at high risk for _____ which is characterized by swelling.

Parotitis

In the immediate postoperative period following a neck dissection the nurse must assess for _____ which can be heard over the trachea with a stethoscope.

Tridor

T or F: Herpes simplex is an abnormal condition of the lips that is frequently seen in immunosuppressed patients.

True

T or F: Nursing interventions for impaired oral mucous membranes for the patient with oral cancer include gentle brushing and flossing, encourage fluid intake, and the use of synthetic saliva.

True