Chapter 53: Care of Patients with Oral Cavity Problems

The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? (Select all that apply.) A. Apples B. Bananas C. Cheese Correct D. Nuts Correct E. Potatoes Correct

Certain foods such as cheese, nuts, and potatoes may trigger allergic responses that cause aphthous ulcers. Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers.

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? A. Acyclovir (Zovirax) Correct B. Diphenhydramine (Benadryl) C. Nystatin (Mycostatin) Incorrect D. Tetracycline syrup (Sumycin syrup)

Acyclovir (Zovirax) is an antiviral agent that is prescribed for immunocompromised clients who contract herpes simplex stomatitis. Diphenhydramine is an antihistamine that is not indicated for treating this condition. Nystatin is indicated for treatment of fungal infection. Tetracycline syrup is indicated for treatment of recurrent aphthous ulcers.

A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? A. Suction the client's oral secretions to clear the airway. Incorrect B. Place the client on humidified oxygen per nasal cannula. C. Assist the client to an upright position to facilitate breathing. D. Assess the respiratory effort and quantities and types of oral secretions. Correct

Assessment is the first step of the nursing process; the nurse should assess the client's respiratory effort and quantities and types of oral secretions first. Suctioning the client, placing the client on humidified oxygen, and assisting the client to an upright position are not the first steps in the nursing process. These interventions may or may not be necessary if the nurse follows the nursing process.

Which practice does the nurse include when teaching a client about proper oral care? A. Perform self-examination of the mouth every week, and report any unusual findings. Correct B. Brush the teeth daily and floss as needed. C. Use drugs that reduce the flow of saliva unless lesions are present. D. Getting daily sun exposure is essential to maintain good health.

Clients must be taught to perform self-examination of the mouth every week and to report any unusual findings. Clients should brush teeth and floss every day. Clients should be instructed to avoid, if possible, drugs that can cause inflammation of the mouth or that can reduce the flow of saliva. Clients must be instructed to avoid or limit sun exposure, which is a risk factor for skin cancer.

The nurse is caring for a postoperative client who had a radical neck dissection, and the client is describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? A. Diphenhydramine (Benadryl) B. Midazolam (Versed) intravenously C. Morphine sulfate intravenously Correct D. Oxycodone plus acetaminophen (Percocet, Tylox) Incorrect

Clients undergoing surgery for oral cancer describe their pain as throbbing or pounding. Intravenous morphine sulfate is indicated for severe pain and is given initially. Diphenhydramine is an anti-inflammatory agent and is not indicated for treatment of pain. Midazolam is used for conscious sedation and is not indicated for pain. Oxycodone/acetaminophen is given for systematic relief of moderate pain.

A client has undergone a radical neck dissection for cancer and is being discharged home while undergoing radiation therapy. Which is likely to be the most important aspect of this client's outpatient care? A. Dental care Correct B. Infection prevention C. Nutrition services Incorrect D. Support group for cancer survivors

If radiation therapy is part of the treatment plan, dental care is an important aspect of home care management for these clients. Acute problems include stomatitis and mucositis, and long-term effects include dental decay and xerostomia. Infection prevention, nutrition services, and support groups are part of the overall treatment plan as well, but are not as important.

After change-of-shift report, which client does the nurse plan to assess first? A. Young adult who had a tracheostomy tube removed at the end of the last shift Correct B. Adult who has severe xerostomia associated with radiation therapy C. Middle-aged adult who is describing oral pain after a partial glossectomy D. Older adult who has lost 10 pounds (4.5 kg) secondary to stomatitis

It is essential to assess the patency of the airway after a tracheostomy tube is removed. The airway could be obstructed by bleeding or swelling at the site or by mechanical objects such as bedding. Severe xerostomia, oral pain after a partial glossectomy, and losing 10 pounds secondary to stomatitis are not life-threatening and do not require immediate assessment or intervention by the nurse.

A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? A. Oral Cancer Foundation Incorrect B. American Cancer Society (ACS) Correct C. Client Advocate Foundation D. American Medical Supply Foundation

The ACS supplies dressings and transportation to and from follow-up visits or medical treatments for clients with cancer. The Oral Cancer Foundation is an organization for local support groups and resources. The Client Advocate Foundation provides education, legal counseling, and referrals to clients with cancer and survivors concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters. The American Medical Supply Foundation does not exist.

A client who has undergone surgery and radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? A. Use saliva substitutes, especially when eating dry foods. Correct B. This condition is common but is temporary. C. Use lozenges and hard candies to prevent dry mouth. D. This indicates a complication of therapy.

Xerostomia is a common effect of oral irradiation and may be permanent. Clients should be advised to use saliva substitutes. The condition is common, but often permanent. Lozenges and hard candies are not as effective as saliva substitutes. Dry mouth is a side effect of therapy, not a symptom of complications.

A client has had a radical neck dissection with a permanent tracheostomy for treatment of oral cancer. In what order should the following orders for postoperative nutritional care be implemented? A. Monitor weight, teach swallowing exercises, assess aspiration risk, provide nasogastric nutrition. B. Teach swallowing exercises, assess aspiration risk, monitor weight, provide nasogastric nutrition. C. Assess aspiration risk, teach swallowing exercises, provide nasogastric nutrition, monitor weight. D. Provide nasogastric nutrition, assess aspiration risk, monitor weight, teach swallowing exercises. Correct

Clients who have undergone radical neck dissection with a permanent tracheostomy are nothing by mouth (NPO) for several days. Nasogastric and total parental nutrition will be needed until oral nutrition can begin. Next, the nurse should assess the client's ability to swallow or should note signs of aspiration when oral intake is started. Third, weights and hydration should be monitored daily, because the client may need additional nutritional supplements. Last, the client should perform swallowing exercises and work with a speech-language pathologist to learn swallowing techniques.

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the home health aide? A. Provide oral care using disposable foam swabs. Correct B. Inspect the oral mucosa for evidence of oral candidiasis. C. Instruct the client on how to use nystatin (Mycostatin) oral rinses. D. Assist the client in making appropriate dietary choices.

Providing oral care for a client with oral lesions is an appropriate assignment for a home health aide. Assessments, client teaching, and assisting clients with oral problems in making appropriate dietary choices are the responsibilities of licensed nursing staff.

The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? (Select all that apply.) A. Regular dental checkups Correct B. Use of mouthwashes containing alcohol C. Ensuring that dentures are slightly loose-fitting D. Managing stress as much as possible Correct E. Eating a balanced diet Correct

Regular dental checkups are important so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the client's risk for infections such as Candida albicans. Eating a balanced diet can reduce the risk for dental caries and infections such as C. albicans or stomatitis. Mouthwashes that contain alcohol may cause inflammation and should be avoided. Dentures should be in good repair and should fit properly.

The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? A. Encourage the client to eat acidic foods to decrease bacteria. B. Mouth care should be performed twice daily. C. Rinse the mouth with warm saline or sodium bicarbonate. Correct D. Use a medium-bristled toothbrush for oral care.

Rinsing the mouth with warm saline or sodium bicarbonate or a combination of the two decreases inflammation and pain. Acidic foods increase inflammation and should be avoided. Mouth care should be done after each meal and as often as needed. If stomatitis is not controlled, mouth care may have to be done every 2 hours or more frequently. A soft toothbrush should be used for oral care.

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? A. Broiled fish B. Ice cream C. Salted pretzels Correct D. Scrambled eggs

Salty foods like pretzels can further irritate ulcers in the client's mouth, causing pain. Foods high in protein, such as fish, eggs, and ice cream, may be included in the diet of the client with stomatitis.

A client is newly diagnosed with tongue and esophageal cancer. Which response to the diagnosis does the nurse expect the client to have? A. Anxiety from knowing that, as a result of cancer and surgery, ingestion of food by mouth might become impossible B. Concern about getting an infection caused by invasive procedures C. Fear about the chance of aspiration after surgery D. Depression about changes in the face and neck after surgery Correct

The client will likely be depressed because of expected alterations to the body caused by cancer and probable surgery. Anxiety about nutritional intake, concern about infection, and fear of aspiration are not the client's likely initial responses to a new diagnosis of tongue and esophageal cancer.

A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? A. Listen to the client and then explain that it is normal to feel depressed about the diagnosis. Incorrect B. Explain the grieving process and listen to what the client has to say. C. Suggest that the client talk with friends and family and seek their support. D. Listen to the client's concerns and feelings, and then suggest that the client join a community group of cancer survivors. Correct

The nurse should listen to the client and suggest a community support group of those with similar diagnoses who can offer support to the client. Telling the client that his or her feelings are normal or explaining the grieving process to the client are not helpful or therapeutic; the client needs more guidance. The nurse should not assume that the client's family and friends are an appropriate support group, because this may not be the case.

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? A. Applying cold compresses B. Avoiding the use of fruit or citrus-flavored candy C. Massaging the salivary gland Correct D. Keeping the head of the bed at 10 degrees when the client is lying down

The salivary gland is massaged to stimulate the flow of saliva. This is done by milking the edematous gland with the fingertips toward the ductal opening. To promote the flow of saliva, warm compresses are applied to the affected salivary gland. Sialagogues such as lemon slices and fruit- or citrus-flavored candy are used to stimulate the flow of saliva. Elevation of the head of the bed promotes gravity drainage of the edematous gland.

As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What community resource does the nurse suggest for this client's care? A. Dentist Correct B. Occupational therapist C. Psychiatrist D. Speech therapist

Xerostomia is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits. Occupational therapists, psychiatrists, and speech therapists are not the appropriate resource for a client with xerostomia.