Chapter 45: Management of patients with oral and esophageal disorders

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

"Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

A client who has occasional gastric symptoms is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching? "Eating two large meals a day, instead of three." "Sleeping flat without pillows is beneficial." "Taking a nap after meals, when possible." "Eliminating bothersome foods will help."

"Eliminating bothersome foods will help." Irritating foods such as spices, caffeine, and alcohol should be avoided because these will assist in decreasing gastric acidity. Eating smaller meals is recommended to avoid lower pressure in the lower esophageal sphincter. Gastric reflux of acid is more likely to occur with positioning flat and lying down after a meal, so this should be avoided.

An adolescent client with multiple dental caries is discussing diet with the nurse. What client statement identifies a risk factor for dental caries? "I brush my teeth in the morning & evening." "I floss before I go to bed each night." "I visit my dentist every year."d) "I drink a can of carbonated soda at lunch every day."

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

The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state "Most oral cancers are painful at the outset." "Blood testing is used to diagnose oral cancer." "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.

A patient tells the nurse that it feels like food is "sticking" in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate? Achalasiab Diffuse spasmc Gastroesophageal reflux diseased Hiatal hernia

Achalasia failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed

The nurse is conducting a community education session on the prevention of oral cancers. The nurse includes which cancer as being a type of premalignant squamous cell skin cancer? Krythoplakia Actinic cheilitis Chancre Herpes simplex 1

Actinic cheilitis Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1266 Actinic cheilitis is a type of premalignant squamous cell skin cancer that presents as scaling, crusty fissures or a white overgrowth of the horny layer of the epidermis. Herpes simplex 1 is an opportunistic infection frequently seen in immunosuppressed clients. Chancres are reddened circumscribed lesions that ulcerate and become crusted and are the primary lesions of syphilis. Erythroplakia is a red patch on the oral mucous membrane that is frequently seen in the elderly.

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?

Apply pressure to the bleeding site Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 The first action for the nurse is to apply pressure to the bleeding site. The nurse will need to obtain assistance, elevate the head of the bed, and notify the surgeon, but client care is most important initially.

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? Cleanse around the drain using aseptic technique. Assess the graft for color and temperature. Reinforce the neck dressing when blood is present on the dressing. Administer prescribed intravenous vancomycin at the correct time.

Assess the graft for color and temperature. Explanation: Assessing the graft for color and temperature addresses circulation and is most important for the nurse to complete. Reinforcing the neck dressing is important, but not the priority. Administering medication and cleansing the drain site are not most important interventions with the client after graft reconstruction of the neck.

A client with achalasia recently underwent pneumatic dilation. The nurse intervenes after the procedure by Preparing for a barium swallow Assessing lung sounds Providing fluids to drink Administering the prescribed analgesic

Assessing lung sounds Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1279 Esophageal perforation is a risk following dilation of the esophagus. One way to assess is auscultating lung sounds. Airway and breathing are priorities according to Maslow's hierarchy of needs. The client is kept NPO until the gag reflex has returned. A barium swallow may be performed after as esophageal dilation if a perforation is suspected. Pain medication is administered for the procedure, but the client should have little pain after the procedure. Pain could indicate perforation.

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? Elevate the foot of the bed on 6- to 8-inch blocksb) Avoid eating or drinking 2 hours before bedtime Minimize intake of caffeine, beer, milk, and foods containing peppermint and spearmint Eat a low carbohydrate diet

Avoid eating or drinking 2 hours before bedtime 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.

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? Eliminating spicy foods. Avoiding chocolate and coffee. Eliminating cucumbers and other foods with seeds. Avoiding steamed foods.

Avoiding chocolate and coffee. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1283 Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

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? Mouthwash and water Dextrose and water Baking soda and water Full-strength peroxide

Baking soda and water Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1272 When a client is unable to tolerate teeth brushing, the following irrigating solutions are recommended: 1 tsp baking soda in 8 oz warm water, half-strength hydrogen peroxide, or normal saline solution.

The nurse is caring for a client with a history of bulimia. The client complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which condition? Periapical abscess Boerhaave syndrome Zenker diverticulum Halitosis

Boerhaave syndrome Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1282 Boerhaave syndrome, a spontaneous rupture of the esophagus after forceful vomiting (may occur after eating a large meal), is characterized by retrosternal pain, dysphagia, infection, fever, and severe hypotension. Halitosis (bad breath) is a symptom of pharyngoesophageal pulsion diverticulum, also known as Zenker diverticulum. A periapical abscess (an abscessed tooth) is characterized by dull, gnawing continuous pain, cellulitis, and edema and mobility of the involved tooth.

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? Posterior segment of the tongue near the uvula Dorsum of the tongue Roof of the mouth next to the incisors Buccal mucosa next to the upper molars

Buccal mucosa next to the upper molars Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1269 The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

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

Difficulty swallowing Explanation: The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The client may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

The nurse is caring for an older adult who reports xerostomia. The nurse evaluates for use of which medication? Steroids Diuretics Antibiotics Antiemetics

Diuretics :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.

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? Dysphagia Malnutrition Pain Regurgitation of food

Dysphagia Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1279 Dysphagia (difficulty swallowing), the most common symptom of esophageal disease, may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute odynophagia (pain on swallowing).

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

Elevate the head of the bed 90 degrees during meals. The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent position — not a supine position — when lying down to reduce the risk of aspiration. The nurse should encourage the client to wear properly fitted dentures to enhance his chewing ability. Thick liquids — not thin — decrease the risk of aspiration.

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? Gastroesophageal reflux disease Hiatal hernia Gastritis Esophageal tumor

Esophageal tumor Explanation: Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer.

An elderly client states, "I don't understand why I have so many caries in my teeth." What assessment made by the nurse places the client at risk for dental caries? Using a soft-bristled toothbrush Eating fruits and cheese in diet Drinking fluoridated water Exhibiting hemoglobin A1C 8.2

Exhibiting hemoglobin A1C 8.2 Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1265 Measures used to prevent and control dental caries include controlling diabetes. A hemoglobin A1C of 8.2 is not controlled. It is recommended for hemoglobin A1C to be less than 7 for people with diabetes. Other measures to prevent and control dental caries include drinking fluoridated water; eating foods that are less cariogenic, which include fruits, vegetables, nuts, cheese, or plain yogurt; and brushing teeth evenly with a soft-bristled toothbrush.

A client has a new order for metoclopramide. What potential side effects should the nurse educate the client about? Peptic ulcer disease Gastric slowing Extrapyramidal Nausea

Extrapyramidal Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284 Metoclopramide (Reglan) 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 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 Peptic ulcer disease Esophageal cancer Diverticulitis

Gastroesophageal reflux disease Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1283 Symptoms may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

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? Candidiasis Gingivitis Herpes simplex Cancer of the oral mucosa

Gingivitis Gingivitis is a gum disease that results in painful, inflamed, swollen gums that bleed in response to light contact.

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

Glucagon 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

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? Healthy graft Infection of graft Venous congestion of graft Possible necrosis of graft

Healthy graft Explanation: A healthy graft site is pink and warm to the touch. A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion

The nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician? crackles that clear after coughing temp of 99.0 F serous drainage on dressing high epigastric pain/discomfort

High epigastric pain and/or discomfort Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1278 The nurse should report high epigastric pain and/or discomfort because this can be a sign of impending rupture. Crackles that clear after coughing, serous drainage on the dressing, and a temperature of 99.0°F are normal findings in the immediate postoperative period and do not need to be reported to the physician.

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

Increasing difficulty in swallowing Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1287 The client first becomes aware of intermittent and increasing difficulty in swallowing with esophageal cancer. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include the sensation of a mass in the throat, foul breath, and hiccups, but these are not the most common initial clinical manifestation with clients with esophageal cancer.

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

Ineffective airway clearance related to obstruction by mucus Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 All the nursing diagnoses are appropriate for a client who has a radical neck dissection. According to Maslow's hierarchy of needs, physiological needs take priority. Under physiological needs, airway, breathing, circulation (ABCs) take highest priority. Thus, ineffective airway clearance is the highest priority nursing diagnosis.

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

Instruct the client to swish prescribed nystatin solution for 1 minute. A cheesy white plaque in the mouth that looks like milk curds and can be rubbed off is candidiasis. The most effective treatment is anitfungal medication such as nystatin (Mycostatin). When used as a suspension, the client is to swish vigorously for at least 1 minute and then swallow. Other measures such as providing saline rinses or ingesting a soft or bland diet are comfort measures. The nurse does not remove the plaques; doing so will cause erythema and potential bleeding.

The nurse is planning care for a client with painful oral lesions. Which food should be included in the client's diet? Chili Hot tea Jello Pretzels

Jell-O

Which mouth condition is most associated with HIV infection? Kaposi sarcoma Krythoplakia Candidiasis Stomatitis

Kaposi sarcoma Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1267 Kaposi sarcoma appears first on the oral mucosa as a red, purple, or blue lesion. Of the conditions listed, it is the most associated with HIV infection. Stomatitis is associated with chemotherapy and radiation therapy. Krythoplakia is caused by a nonspecific inflammation. Candidiasis is caused by fungus.

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

Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium) Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284

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? Nystatin Fluocinolone acetonide oral base gel Acyclovir Cephalexin

Nystatin Explanation: Candidiasis is a fungal infection that results in a cheesy white plaque in the mouth that looks like milk curds. It commonly occurs in antibiotic therapy. Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed.

A nurse practitioner, who is treating a patient with GERD, knows that this type of drug helps treat the symptoms of the disease. The drug classification is: H2-receptor antagonists. Antispasmodics Antacids Proton pump inhibitors.

Proton pump inhibitors. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284 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 a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an): Extension of the esophagus through an opening in the diaphragm. Involution of the esophagus, which causes a severe stricture. Twisting of the duodenum through an opening in the diaphragm. Protrusion of the upper stomach into the lower portion of the thorax.

Protrusion of the upper stomach into the lower portion of the thorax. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1280 It is important for the patient and his family to understand the altered association between the esophagus and the stomach. The diaphragm opening, through which the esophagus passes, becomes enlarged and part of the upper stomach moves up into the lower portion of the thorax. The abnormality is not an involuntary, protruding, or twisted segment.

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

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

Staphylococcus aureus Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1270 People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for parotitis. The infecting organisms travel from the mouth through the salivary duct. The organism is usually Staphylococcus aureus (except in mumps).

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? HIV Syphilis Gonorrhea Herpes simplex

Syphilis The primary lesion of syphilis is a chancre, which is a reddened circumscribed lesion that ulcerates and becomes crusted.

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

Take long, slow breaths Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1283 During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

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 nurse is providing discharge instructions for a client who fell from a bicycle, resulting in a fractured jaw. The client underwent surgical intervention with rigid fixation. What teaching should the nurse include with client education? Ways to obtain nutritional supplementation Solid foods client can ingest Rinse with alcohol based solution Foods low in calories

Ways to obtain nutritional supplementation The client who had rigid fixation of the jaw should be instructed not to chew food for the first 1 to 4 weeks. The client needs to obtain optimal caloric and protein intake, so the nurse should include ways to obtain supplemental nutrition. Solid foods require chewing, so a liquid diet is recommended. Rinsing with an alcohol-based solution is drying to the mucous membranes. Foods need to be high in calories to support adequate nutrition.

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

Weakness, diaphoresis, diarrhea 90 minutes after eating Explanation: Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome.

Which of the following is the most common type of diverticulum?

Zenker's diverticulum Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1281 The most common type of diverticulum, which is found three times more frequently in men than women, is Zenker's diverticulum (also known as pharyngoesophageal pulsion diverticulum or a pharyngeal pouch).

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

dysphagia. Explanation: This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

The nurse provides health teaching to inform the client with oral cancer that most oral cancers are painful at onset many oral cancers produce no symptoms in the early stages blood testing is used to diagnose oral cancer a typical lesion is soft and crater like

many oral cancers produce no symptoms in the early stages. The most frequent symptom of oral cancer is a painless sore that does not heal. The patient may complain of tenderness, and difficulty with 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

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? orogastric intubation nasogastric intubation gastrostomy nasoenteric intubation

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

The nurse is caring for client scheduled to undergo radical neck dissection. During preoperative teaching, the nurse states that an associated complication is shoulder drop. neck distension. venous engorgement clavicle fracture.

shoulder drop. Explanation: The nurse should include shoulder drop as an associated complication of radical neck dissection. Another associated complication is 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.

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

A canker sore of the oral soft tissues Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1266 Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

A nurse is performing an assessment for a client who presents to the clinic with an erythemic, fissuring lip lesion with white hyperkeratosis. What does the nurse suspect that these findings are characteristic of? Actinic cheilitis Human papillomavirus lesion Frey syndrome Sialadenitis

Actinic cheilitis Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1266 Actinic cheilitis is an irritation of the lips associated with scaling, crusting, fissure, and overgrowth of a white, horny layer of epidermis (hyperkeratosis). Human papillomavirus lesions appear as flat lesions, small cauliflower-like bumps, or tiny stem-like protrusions. Frey syndrome is damage to the parotid glands after surgery resulting in saliva disturbances. Sialadenitis is an infection associated with pain, tenderness, redness, and gradual, localized swelling affecting the salivary gland.

While stripping wax from surfboards, a client accidentally ingested a refrigerated strong base cleaning solution, thinking it was water. What interventions would the nurse anticipate including in this client's care plan? Select all that apply. Administer medication for report of pain. Insert an intravenous (IV) catheter for administration of IV fluids. Maintain nothing by mouth status. Induce vomiting to remove the base solution from the stomach. Assess respiratory status every 4 hours and prn.

Administer medication for report of pain. Insert an intravenous (IV) catheter for administration of IV fluids. Maintain nothing by mouth status. Assess respiratory status every 4 hours and prn. The client who has a chemical burn of the oral mucosa and esophagus will experience pain and may experience respiratory distress. The nurse will administer medication for pain and assess respiratory status. The client will be NPO, and IV fluids will be administered. Vomiting is avoided to prevent additional trauma from the caustic agent.

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? Hairy leukoplakia Nicotine stomatitis Erythroplakia Aphthous stomatitis

Hairy leukoplakia Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1266 Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough, hairlike projections form, typically on lateral border of the tongue. Aphthous stomatitis is typically a recurrent round or oval sore or ulcer on the inside of the lips and cheeks or underneath the tongue and is not associated with HIV. Erythroplakia describes a red area or red spots on the lining of the mouth and is not associated with HIV. Nicotine stomatitis is a white patch in the mouth caused by extreme heat from smoking.

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

Lithotripsy Lithotripsy uses shock waves to disintegrate stones. It may be used instead of surgical extraction for parotid stones and smaller submandibular stones. Radiation, chemotherapy, and biopsy do not use shock waves to disintegrate a stone.

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

Lubrication Protection against harmful bacteria Digestion Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1270 The three main functions of saliva are lubrication, protection against harmful bacteria, and digestion. Elimination and metabolism are not functions of saliva.

Immediate medical and nursing management is necessary for a patient who has ingested a corrosive substance and experienced a chemical burn. Select the first response. Rinse the mouth with water to dilute the corrosive agent. Administer pain medication. Maintain a patent airway. Treat the patient for shock.

Maintain a patent airway. Explanation: The first priority is to maintain an open airway. The second priority is to treat for shock. The patient should receive nothing by mouth.

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? Metoclopramide (Reglan) Nizatidine (Axid) Famotidine (Pepcid) Esomeprazole (Nexium)

Metoclopramide (Reglan) Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284 Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid) or nizatidine (Axid). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

Which term refers to the symptom of gastroesophageal reflux disease (GERD), which is characterized by a burning sensation in the esophagus? Pyrosis Dysphagia Dyspepsia Odynophagia

Pyrosis Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1283 Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain on swallowing is termed odynophagia.

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland? Sialolithiasis Parotitis Sialadenitis Stomatitis

Sialolithiasis Salivary stones are formed mainly from calcium phosphate. Parotitis refers to inflammation of the parotid gland. Sialadenitis refers to inflammation of the salivary glands. Stomatitis refers to inflammation of the oral mucosa.

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

Stridor Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 Stridor is the presence of coarse, high-pitched sounds on inspiration. The nurse would auscultate frequently over the trachea. This finding must be immediately reported because it indicates airway obstruction.

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

Surgical removal of the diverticulum Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1282 Because Zenker's diverticulum is progressive, the only means of cure is surgical removal of the diverticulum. A low-residue diet will not stop the progression of the disease. Chemotherapy and radiation therapy will not target the specific site of the Zenker's diverticulum.

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

The client lying in a lateral position, with the head of bed flat A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease: symptoms include oral bleeding. symptoms include oral numbness. symptoms include mouth pain. there are usually no symptoms.

there are usually no symptoms. Explanation: The early stage of oral cancer is characteristically asymptomatic.

The nurse fills a tube feeding bag with two 8-oz cans of commercially prepared formula. The client is to receive the formula at 80 mL/hour via continuous gastrostomy feeding tube and pump. How many hours will this bag of formula run before becoming empty? Record your answer using a whole number.

6

The nurse is caring for a client recovering from open reduction, internal fixation (ORIF) of the mandible. Which teachings will the nurse provide to the client after the surgery? Select all that apply. Abstain from smoking Follow a liquid or soft diet for 4 to 6 weeks Use medicated oral rinses as prescribed Refrain from ingesting alcohol Clear fluids only for the first three days

Abstain from smoking Refrain from ingesting alcohol Use medicated oral rinses as prescribed Follow a liquid or soft diet for 4 to 6 weeks Explanation: Open reduction, internal fixation (ORIF) with plate fixation (insertion of one or more metal plates and screws or arch bars into the bone to approximate and stabilize the bone) is the surgery of choice for a mandibular fracture. After the surgery, the client should be instructed to abstain from smoking and refrain from ingesting alcohol. The client should use medicated oral rinses as prescribed and follow a liquid or soft diet for 4 to 6 weeks. Oral intake is restricted to a soft diet for 7 to 10 days for maxillomandibular fixation.

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? Aphthous stomatitis Kaposi's sarcoma Chancre Hairy leukoplakia

Aphthous stomatitis Aphthous stomatitis is characterized by a shallow ulcer with a white or yellow center and red border, often on the inner lip and cheek or on the tongue. It begins with a burning or tingling sensation and slight swelling, and is painful, usually lasting 7 to 10 days. Aphthous ulcers are associated with HIV infection. Kaposi's sarcoma and hairy leukoplakia also are found in clients who are HIV positive. Kaposi's sarcoma is marked by red, purple, or blue lesions on the oral mucosa; hairy leukoplakia is characterized by white patches with rough hair-like projections typically on the lateral border of the tongue. A chancre is a reddened, circumscribed lesion that ulcerates and becomes crusted--it is a primary lesion of syphilis.

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?Between 40 and 80 mL Approximately 80 to 120 mL Between 120 and 160 mL Greater than 160 mL

Approximately 80 to 120 mL Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 Wound drainage tubes are usually inserted during surgery to prevent the collection of fluid subcutaneously. The drainage tubes are connected to a portable suction device (e.g., Jackson-Pratt), and the container is emptied periodically. Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours.

A client has undergone a radical neck dissection. His skin graft site is pale. This indicates which condition? Possible necrosis Arterial thrombosis Venous congestion Infection

Arterial thrombosis A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion.

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

Avoid beer, especially in the evening. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1283 Milk should be avoided, as should eating before bed. Advise the patient not to eat or drink 2 hours before bedtime.

Which clinical manifestation is not associated with hemorrhage? Bradycardia Tachypnea Tachycardia Hypotension

Bradycardia Explanation: Hemorrhage may occur from carotid artery rupture as a result of necrosis of the graft or damage to the artery itself from tumor or infection. Tachycardia, tachypnea, and hypotension may indicate hemorrhage and impending hypovolemic shock.

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

Chancre Explanation: A chancre is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis. Lichen planus is a white papule at the intersection of a network of interlacing lesions. Actinic cheilitis is an irritation of the lips associated with a scaling, crusting fissure. Leukoplakias are white patches usually found in the buccal mucosa.

Cancer of the esophagus is most often diagnosed by which of the following? Esophagogastroduodenoscopy (EGD) with biopsy and brushings X-ray Barium swallow Fluoroscopy

Esophagogastroduodenoscopy (EGD) with biopsy and brushings Currently, diagnosis is confirmed most often by EGD with biopsy and brushings. The biopsy can be used to determine the presence of disease and cell differentiation. X-ray, barium swallow, and fluoroscopy are used in the diagnosis of hiatal hernia.

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

Fowler Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 The client should be placed in the Fowler position to facilitate breathing and promote comfort. This position expands the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs. The other positions are not the position of choice postoperatively.

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. Ensuring intake of food and fluids 2 to 3 hours before bedtime Sleeping in a supine position Avoiding foods that intensify symptoms Maintaining an upright position following meals

Maintaining an upright position following meals Avoiding foods that intensify symptoms 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 cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is: Teach the client exercises for the neck and shoulder area to perform 1 day after surgery. Provide oxygen without humidity through the tracheostomy tube. Make a notation on the call light system that the client cannot speak. Encourage the client to position himself on his side.

Make a notation on the call light system that the client cannot speak. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1276 The client who has a laryngectomy cannot speak. Other personnel need to know this when answering the call light system. Exercises for the neck and shoulder are usually started after the drains have been removed and the neck incision is sufficiently healed. Humidified oxygen is provided through the tracheostomy to keep secretions thin. To prevent pneumonia, the client should be placed in a sitting position.

The nurse is creating a discharge teaching plan for a client after surgery for oral cancer. Which should be included in the teaching plan? Select all that apply. Follow-up medical appointment Follow-up dental appointment Use of humidificationd Oral hygiene

Oral hygiene Follow-up dental appointment Follow-up medical appointment Use of humidification Discharge teaching for a client after oral surgery includes oral hygiene, follow-up dental and medical appointments, and the use of humidification to keep secretions moist.

An elderly client comes into the emergency department reporting an earache. The client and has an oral temperature of 37.9° (100.2ºF) and 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?

Palpate the client's parotid glands to detect swelling and tenderness.

A patient reports an inflamed salivary gland below the right ear. The nurse documents probable inflammation of which gland? Sublingual Buccal Parotid Submandibular

Parotid Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1269 The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. What is the nurse's priority action? Administer morphine for report of pain. Empty the Jackson-Pratt device (portable drainage device). Provide feeding through the gastrostomy tube. Place the client in the Fowler's position.

Place the client in the Fowler's position. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 All the options are activities the nurse may do; however, the nurse has to prioritize according to Maslow's hierarchy of needs. Physiological needs are addressed first. Under physiological needs, ABCs (airway, breathing, circulation) take priority. Placing the client in the Fowler's position facilitates breathing and promotes comfort.

A client with oral cancer reports dryness of the mouth. What is the nurse's best response? State, "This is a normal consequence of oral cancer." Provide a humidifier for the client to use while sleeping. Ensure that the client maintains a fluid intake of 2000 mL per day. Allow the client to continue with his or her usual diet.

Provide a humidifier for the client to use while sleeping. Explanation: 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.

Which term describes an inflammation of the salivary glands? Parotitis Stomatitis Sialadenitis Pyosis

Sialadenitis Explanation: Sialadenitis is inflammation of the salivary glands. Parotitis is inflammation of the parotid glands. Stomatitis is inflammation of the oral mucosa. Pyosis is pus.

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

Vagus Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1288 Cardiac complications include atrial fibrillation, which occurs due to irritation of the vagus nerve at the time of surgery. The hypoglossal nerve controls muscles of the tongue. The vestibulocochlear nerve functions in hearing and balance. The trigeminal nerve functions in chewing of food.

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: altered oral mucous membranes. physical injury ineffective social interaction confusion.

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

A client is in the initial stages of oral cancer diagnosis and is frightened about the side effects of treatment and subsequent prognosis. The client has many questions regarding this type of cancer and asks where oral cancer typically occurs. What is the nurse's response?

floor of the mouth Malignant growths can be found anywhere in the oral cavity, but cancers usually occur on the lips, sides of the tongue, or floor of the mouth.

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

Chronic irritation of the esophagus is a known risk factor. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1286 In the 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.

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? Administer a breathing treatment Lower the head of the bed Document the presence of stridor Notify the physician

Notify the physician Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1275 The presence of stridor, a coarse, high-pitched sound upon inspiration, in the immediate postoperative period following radical neck dissection, indicates obstruction of the airway, and the nurse must report it immediately to the physician.

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? Use a hard-bristled toothbrush. Rinse with an alcohol-based solution. Brush and floss daily. Continue with the usual diet.

Brush and floss daily. The description of erythema, edema, and pain of the mouth following radiation treatment describes stomatitis. Nursing considerations include prophylactic mouth care such as brushing and flossing daily. A soft-bristled toothbrush is recommended. The client is to avoid alcohol-based mouth rinses and hot or spicy foods that may be part of the client's usual diet.

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 Ensuring adequate nutrition Maintaining a patent airway Preventing injury

Maintaining a patent airway Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.

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. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1279 Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up? The client complains of pain in his knees upon rising. The client states he feels like he always has a lump in his throat. The client has a blood pressure of 135/80 mm Hg and a pulse rate of 70 beats/minute. The client has gained 10 lb (4.5 kg) over the past year.

The client states he feels like he always has a lump in his throat. Explanation The sensation of a lump in throat is one of the warning signs of esophageal cancer and requires immediate follow-up. Other symptoms of esophageal cancer include dysphagia, substernal pain, regurgitation of undigested food, foul breath, and hiccups. A weight gain of 10 lb in a year, a blood pressure of 135/70 mm Hg, and a pulse rate of 70 beats/minute are normal findings. Although the nurse should ultimately investigate the complaint of pain in the knees upon rising, this finding isn't the priority at this time.

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? having a courageous attitude time to mourn, accept, and adjust to the loss knowing that everything will work out just fine not giving in to anger

time to mourn, accept, and adjust to the loss Explanation: The first time family members or clients see the effects of surgery, the experience usually is traumatic. The nurse needs to promote effective coping and therapeutic grieving at this time. Responses may range from crying or extreme sadness and avoiding contact with others to refusing to talk about the surgery or changes in appearance. Allowing the client time to mourn, accept, and adjust to losses is essential.

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? Bicep Sternomastoid Trapezius Pectoralis major

Pectoralis major The most common donor site for a myocutaneous flap after radical neck dissection is the pectoralis major muscle, so the nurse should prepare to assess this site unless a different donor site is documented on the client's chart.

The nurse reviews data collected during a client assessment. Which lifestyle modifications will the nurse discuss with the client to prevent the development of gastroesophageal reflux disease (GERD)? Select all that apply. Avoid eating before bedtime Limit the intake of alcohol Achieve a BMI of 22 Smoking cessation Engage in intermittent fasting

Smoking cessation Limit the intake of alcohol Avoid eating before bedtime Achieve a BMI of 22 Explanation: For clients with GERD, management begins with teaching the client to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation. Lifestyle modifications include smoking cessation, limiting the intake of alcohol, avoid eating before bedtime, and weight loss. Intermittent fasting is not identified as a lifestyle modification to prevent the development of GERD.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? "I'll eat three large meals every day without any food restrictions." "I'll lie down immediately after a meal." "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 eat frequent, small, bland meals that are high in fiber." In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

A client is recovering from a neck dissection. What volume of serosanguineous secretions would the nurse expect to drain over the first 24 hours? Greater than 160 mL Approximately 80 to 120 mL Between 120 and 160 mL Between 40 and 80 mL

Approximately 80 to 120 mL Explanation: Between 80 to 120 mL may drain over the first 24 hours. Drainage of greater than 120 mL may be indicative of a chyle fistula or hemorrhage.

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? Keeping the head of the bed elevated. Positioning the client flat on the abdomen or side. Providing a tracheostomy tray near the bed. Turning the client's head to the side.

Keeping the head of the bed elevated. 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 with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which strategy should the nurse use to assist the client? Provide the client with an irrigating solution of baking soda and warm water. Urge the client to regularly rinse the mouth with tap water. 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. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1272 If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended. Using tap water is not enough to promote oral hygiene. Drinking a small glass of alcohol will not provide oral hygiene. Wiping the outside of the mouth will not promote oral hygiene.

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. Monitor drainage in the closed chest drainage system. Replace the nasogastric tube if the tube becomes dislodged. Maintain the client in a side-lying position. Verify rhythm on the cardiac monitoring system. Assess lung sounds every 4 hours and prn.

Assess lung sounds every 4 hours and prn. Monitor drainage in the closed chest drainage system. Verify rhythm on the cardiac monitoring system. Explanation: 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 in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. What would be the first activity performed by the nurse? Administer prescribed morphine intravenously. Obtain consent for the esophagogastroscopy. Suction the oral cavity of the client. Assess lung sounds bilaterally.

Assess lung sounds bilaterally. Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1282 All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment.

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

Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease 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 has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client? Hyperactivity Uncontrolled rhythmic movements of the face or limbs Dry mouth not relieved by sugar-free hard candy Anxiety or irritability

Uncontrolled rhythmic movements of the face or limbs Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284 Metoclopramide 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 for uncontrolled rhythmic movements of the face or limbs. Metoclopramide side effects are headache, confusion, and drowsiness. Anxiety, hyperactivity, and a dry mouth are not common side effects.

TABLE Instructions for GERD: Eat a low-fat diet Avoid the following items: Caffeine, Tobacco, Beer, Milk, Peppermint, Spearmint, Carbonated beverages Eat at least 2 hours before bedtime. Maintain normal body weight. Avoid tight-fitting clothes. Elevate HOB on 6- to 8- inch blocks. Elevate the upper body on pillows during sleep. Take pantoprazole (Protonix) 40 mg every morning. Take metoclopramide (Reglan) 10 mg before each meal and at bedtime every day. The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). The nurse notes in the client's record that the client is taking carbidopa/levodopa. Which order for the client by the health care provider should the nurse question? metoclopramide a low-fat diet pantoprazole elevation of upper body on pillows

metoclopramide Chapter 45: Management of Patients With Oral and Esophageal Disorders - Page 1284 The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa (Sinemet), which is used for Parkinson's disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson's disease.