Chapter 22: PrepU - Nursing Management: Patients With Oral and Esophageal Disorders and Patients Receiving Gastrointestinal Intubation, Enteral, and Parenteral Nutrition

The nurse caring for a patient who is being discharged home after a radical neck dissection has worked with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection? 1- Indicates acceptance of altered appearance and demonstrates positive self-image 2- Freely expresses needs and concerns related to postoperative pain management 3- Compensates effectively for alteration in ability to communicate related to dysarthria 4- Demonstrates effective stress management techniques to promote muscle relaxation

1

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is 1- loose, watery stools. 2- increased urination. 3- elevated blood pressure. 4- decreased pulse rate.

1

Which of the following is one of the first clinical manifestations of esophageal cancer? 1- Increasing difficulty in swallowing 2- Sensation of a mass in throat 3- Foul breath 4- Hiccups

1

A 54 year-old man is postoperative day 1 following neck dissection surgery. Which of the following nursing actions should the nurse prioritize in the care of this patient? 1- Teaching the patient about the signs and symptoms of major postoperative complications 2- Positioning the patient in a high Fowler's position to protect the airway 3- Ensuring that naloxone (Narcan) is available at the patient's bedside 4- Maintaining protective isolation for 24 to 36 hours after surgery

2

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? 1- Reinsert the nasogastric tube to the stomach. 2- Notify the surgeon about the tube's removal. 3- Place the nasogastric tube to the level of the esophagus. 4- Document the discontinuation of the nasogastric tube.

2

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? 1- Helping the client cope with body image changes 2- Ensuring adequate nutrition 3- Maintaining a patent airway 4- Preventing injury

3

The nurse prepares to administer all of a client's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes which type of oral medication on the client's medication administration record? 1- simple compressed tablets 2- buccal or sublingual tablets 3- enteric-coated tablets 4- soft, gelatin capsules filled with liquid

3

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? 1- Remove the tape from the nose of the client. 2- Withdraw the tube gently for 6 to 8 inches. 3- Provide oral hygiene. 4- Flush with 10 mL of water.

4

The nurse provides health teaching to inform the client with oral cancer that 1- most oral cancers are painful at the outset. 2- blood testing is used to diagnose oral cancer. 3- a typical lesion is soft and craterlike. 4- many oral cancers produce no symptoms in the early stages.

4

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and would make a recommendation when noticing which circumstance? 1- No land line; cell phone available and taken by family member during working hours 2- Water of low pressure that can be obtained through all faucets 3- Little food in the working refrigerator 4- Electricity that loses power, usually for short duration, during storms

1

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for? 1- diaphoresis, vomiting, and diarrhea. 2- manifestations of electrolyte disturbances. 3- manifestations of hypoglycemia. 4- constipation, dehydration, and hypercapnia.

1

An elderly patient comes into the emergency department complaining of an earache. The patient has an oral temperature of 100.2° F. Otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next? 1- Palpate the patient's parotid glands to detect swelling and tenderness. 2- Assess the temporomandibular joint for evidence of a malocclusion. 3- Test the integrity of the 12th cranial nerve by asking the patient to protrude his tongue. 4- Inspect the patient's gums for bleeding and hyperpigmentation.

1

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? 1- 4 2- 6 3- 8 4- 10

1

Select the assessment finding that the nurse should immediately report, post radical neck dissection. 1- Temperature of 99°F 2- Pain 3- Stridor 4- Localized wound tenderness

3

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. The client has the following oral medications prescribed: furosemide, digoxin, enteric coated aspirin, and vitamin E. The nurse would withhold which medication? 1- furosemide 2- digoxin 3- enteric coated aspirin 4- vitamin E

3

The most common symptom of esophageal disease is 1- nausea. 2- vomiting. 3- dysphagia. 4- odynophagia.

3

myocutaneous flap

This flap involves the transfer of intact muscle, subcutaneous tissue and skin as a single unit rotated on a relatively narrow blood supply of the muscle.

Which is the primary symptom of achalasia? 1- Difficulty swallowing 2- Chest pain 3- Heartburn 4- Pulmonary symptoms

1

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? 1- Instruct the client to swish prescribed nystatin solution for 1 minute. 2- Remove the plaque from the mouth by rubbing with gauze. 3- Provide saline rinses prior to meals. 4- Encourage the client to ingest a soft or bland diet.

1

A client has a new order for metoclorpramide. What potential side effects should the nurse educate the client about? 1- Extrapyramidal 2- Peptic ulcer disease 3- Gastric slowing 4- Nausea

1

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: 1- altered oral mucous membranes. 2- physical injury. 3- ineffective social interaction. 4- confusion.

1

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: 1- Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. 2- Digestive process occurs more rapidly as a result of the feedings not having to pass through the esophagus. 3- Feedings can be administered with the patient in the recumbent position. 4- The patient cannot experience the deprivational stress of not swallowing.

1

The nurse cares for a client who receivies continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? 1- Monitoring the feeding closely. 2- Increasing the feeding rate. 3- Lowering the head of the bed. 4- Flushing the feeding tube.

1

A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. What instruction will the nurse give to the client? 1- Use a hard-bristled toothbrush. 2- Rinse with an alcohol-based solution. 3- Brush and floss daily. 4- Continue with the usual diet.

3

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? 1- Dry skin 2- Slowed heart beat 3- Diarrhea 4- Hyperglycemia

3

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 1- Impaired tissue integrity related to surgical intervention 2- Imbalanced nutrition: less than body requirements, related to treatment 3- Risk for infection related to surgical intervention 4- Ineffective airway clearance related to obstruction by mucus

4

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? 1- Hiatal hernia 2- Gastroesophageal reflux disease 3- Gastritis 4- Esophageal tumor

4

The primary source of microorganisms for catheter-related infections are the skin and which of the following? 1- Catheter hub 2- Catheter tubing 3- IV fluid bag 4- IV tubing

1

A nurse is conducting morning assessments of several medical patients and has entered the room of a patient who has a nasogastric (NG) tube in situ. Immediately, the nurse observes that the tube has become unsecured from the patient's nose and the mark at the desired point of entry is now approximately 8 inches from the patient's nose. How should the nurse best respond to this assessment finding? 1- Reinsert the NG tube and arrange for x-ray confirmation of placement. 2- Remove the NG tube and obtain an order for reinsertion. 3- Reinsert the NG tube and monitor the patient closely for signs of aspiration. 4- Reinsert the NG tube and aspirate stomach contents to confirm correct placement.

1

A public health nurse is participating in a community health fair that is focused on health promotion and illness prevention. Which of the following older adults most likely faces the highest risk of developing oral cancer? 1- A man who describes himself as always having been a "heavy smoker and a heavy drinker." 2- A woman who is morbidly obese and has a longstanding diagnosis of systemic lupus erythematosus (SLE). 3- A woman who describes herself as a "proud breast cancer survivor for over 10 years." 4- A man who states that he enjoys good health, with the exception of "heartburn after nearly every meal."

1

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? 1- A canker sore of the oral soft tissues 2- An acute stomach infection 3- Acid indigestion 4- An early sign of peptic ulcer disease

1

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply. 1- Daily weights 2- Intake and output monitoring 3- Calorie counts for oral nutrients 4- Daily transparent dressing changes 5- Strict bedrest

1,2,3

A client experienced surgical resection of a tumor of the esophagus. After recovery from the anesthesia, what will the nurse include in the postoperative care plans? Select all that apply. 1- Assess lung sounds every 4 hours and prn. 2- Replace the nasogastric tube if the tube becomes dislodged. 3- Monitor drainage in the closed chest drainage system. 4- Verify rhythm on the cardiac monitoring system. 5- Maintain the client in a side-lying position.

1,3,4

A 59-year-old woman with a recent history of heartburn, regurgitation, and occasional dysphagia has been diagnosed with a sliding hiatal hernia following an upper GI series. The nurse is providing patient education about the management of this health problem. What should the nurse suggest as a management strategy to this patient? 1- Minimizing her intake of highly spiced foods and dairy products 2- Remaining upright for at least 1 hour following each meal 3- Abstaining from alcohol 4- Drinking one to two glasses of water before and after each meal

2

A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage? 1- Between 40 and 80 mL 2- Approximately 80 to 120 mL 3- Between 120 and 160 mL 4- Greater than 160 mL

2

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: 1- H2-receptor antagonists. 2- Antispasmodics 3- Proton pump inhibitors. 4- Antacids

3

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): 1- Extension of the esophagus through an opening in the diaphragm. 2- Involution of the esophagus, which causes a severe stricture. 3- Protrusion of the upper stomach into the lower portion of the thorax. 4- Twisting of the duodenum through an opening in the diaphragm.

3

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? 1- Methicillin-resistant Streptococcus aureus (MRSA) 2- Pneumococcus 3- Staphylococcus aureus 4- Streptococcus viridans

3

The nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate? 1- Document the presence of stridor 2- Administer a breathing treatment 3- Notify the physician 4- Lower the head of the bed

3

The nurse is checking placement of a nasogastric (NG) tube that has been in place for 2 days. The tube is draining green aspirate. What does this color of aspirate indicate? 1- The tube is in the pleural space. 2- The tube is the intestine. 3- The tube is in the stomach. 4- The tube is in the esophagus.

3

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length? 1- A length of 50 cm (20 in) 2- A point that equals the distance from the nose to the xiphoid process 3- The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process 4- The distance determined by measuring from the tragus of the ear to the xiphoid process

3

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? 1- Trapezius 2- Biceps 3- Pectoralis major 4- Sternomastoid

3

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? 1- Slow the current infusion rate so that it will last until the new solution arrives. 2- Hang a solution of dextrose 10% and water until the new solution is available. 3- Have someone go to the pharmacy to obtain the new solution. 4- Begin an infusion of normal saline in another site to maintain hydration.

2

A patient with a recent diagnosis of esophageal cancer has undergone an esophagectomy and is currently receiving care in a step-down unit. The nurse in the step-down unit is aware of the specific complications associated with this surgical procedure and is consequently monitoring the patient closely for signs and symptoms of: 1- Increased intracranial pressure (ICP) 2- Aspiration pneumonia 3- Abdominal aortic aneurysm (AAA) 4- Dyspepsia

2

Postoperatively, a client with a radical neck dissection should be placed in which position? 1- Supine 2- Fowler 3- Prone 4- Side-lying

2

The nurse confirms placement of a client's nasogastric (NG) tube using a combination of visual and pH assessment of the aspirate. The nurse determines that the NG tube remains properly placed when the pH of the aspirate is 1- alkaline 2- acidic 3- neutral 4- unmeasurable

2

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? 1- Dextrose and water 2- Baking soda and water 3- Full-strength peroxide 4- Mouthwash and water

2

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? 1- Ensure adequate hydration with additional water. 2- Provide frequent mouth care. 3- Keep the feeding formula refrigerated. 4- Flush the tube with water before adding the feedings.

2

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? 1- "Lie down after meals to promote digestion." 2- "Avoid coffee and alcoholic beverages." 3- "Take antacids with meals." 4- "Limit fluid intake with meals."

2

Which condition is caused by improper catheter placement and inadvertent puncture of the pleura? 1- air embolism 2- pneumothorax 3- sepsis 4- fluid overload

2

Rebound hypoglycemia is a complication of parenteral nutrition caused by 1- glucose intolerance. 2- fluid infusing rapidly. 3- feedings stopped too abruptly. 4- a cap missing from the port.

3

Total parenteral nutrition (TPN) has been ordered for a male patient who has been experiencing a severe and protracted exacerbation of Crohn's disease. Before TPN can be initiated, the patient requires: 1- A random blood glucose level of ≤160 mg/dL 2- Angiography to determine the patency of his vascular system 3- The insertion of a central venous access device 4- A fluid challenge to assess his renal function

3

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? 1- Serosanguineous drainage on the dressing 2- Foley catheter bag containing 500 ml of amber urine 3- A piggyback infusion of levofloxacin 4- The client lying in a lateral position, with the head of bed flat

4

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? 1- Aphthous stomatitis 2- Nicotine stomatitis 3- Erythroplakia 4- Hairy leukoplakia

4

Which is an accurate statement regarding cancer of the esophagus? 1- It is three times more common in women than men in the United States. 2- It is seen more frequently in Caucasian Americans than in African Americans. 3- It usually occurs in the fourth decade of life. 4- Chronic irritation of the esophagus is a known risk factor.

4

administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome? 1- Administer the feeding at a warm temperature to decrease peristalsis. 2- Administer the feeding by bolus to prevent continuous intestinal distention. 3- Administer the feeding with about 100 mL of fluid to dilute the high carbohydrate concentration. 4- Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.

4

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

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