Exam 4 (Chapter 46) MGMT of Pt's with Oral and Esophageal Disorders

__________________ percent of adults 45 to 64 years of age have severe periodontal disease.

15

Digestion normally begins in the _______________.

Mouth

1. The nurse is performing an assessment for a patient who presents to the clinic with a lip lesion. The lesion is erythemic, is fissuring, and has white hyperkeratosis. What does the nurse suspect that these findings are characteristic of? a. Actinic cheilitis b. Human papillomavirus lesion c. Frey syndrome d. Sialadenitis

a. Actinic cheilitis

15. A patient has been taking a 10-day course of antibiotics for pneumonia. The patient has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the patient about? a. Nystatin (Mycostatin) b. Cephalexin (Rocephin) c. Fluocinolone acetonide oral base gel d. Acyclovir (Zovirax)

a. Nystatin (Mycostatin)

3. The nurse is caring for a patient after drainage of a dentoalveolar or periapical abscess. What should the care of the patient include in the postoperative phase? (select all that apply.) a. Soft diet after 24 hours b. Fluid restriction for the first 48 hours because the gums are swollen and painful c. External heat by pad or compress to hasten the resolution of the inflammatory swelling d. Warm saline mouthwashes every 2 hours while awake e. Gargle with peroxide and saline every 4 hours.

a. Soft diet after 24 hours c. External heat by pad or compress to hasten the resolution of the inflammatory swelling d. Warm saline mouthwashes every 2 hours while awake

9. A patient is brought to the emergency department by a family member, who states that the patient "drank drain cleaner". What intervention does the nurse anticipate providing to treat this patient? Select all that apply a. Administering an irritant that will stimulate b. Aspirating secretions from the pharynx if the respirations are affected c. Neutralizing the chemical d. Washing the esophagus with large volumes of water e. Administering activated charcoal

b. Aspirating secretions from the pharynx if the respirations are affected c. Neutralizing the chemical d. Washing the esophagus with large volumes of water

4. A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland? a. Buccal b. Parotid c. Sublingual d. Submandibular

b. Parotid

17.) The nurse is planning care for a patient with painful oral lesions. Which of the following should be included in the patient's diet? a. Chili b. Jello c. Pretzels d. Hot tea

• Jello- The nurse should include Jello in the patient's diet; spicy, hot, and/or hard foods or beverages (pretzels, hot tea, chili) should be avoided to reduce pain and discomfort in the patient with painful oral lesions.

10.) For a patient with salivary calculi, which of the following procedures uses shock waves to disintegrate the stone? a. Biopsy b. Lithotripsy c. Radiation d. Chemotherapy

• Lithotripsy- Lithotripsy uses shock waves to disintegrate the stone. 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.

If detected early, prior to lymph node involvement, the 5l-year survival rate for oral cancer is about ______________ percent.

60

Preventative orthodontics for malocclusion can start as early as age _________________.

5 years

14.) The nurse is caring for a patient receiving chemotherapy. For which of the following mouth conditions associated with HIV infection should the nurse assess? Select all that apply. a. Stomatitis b. Candidiasis c. Kaposi's sarcoma d. Krythoplakia

• Stomatitis; Kaposi's sarcoma- Kaposi's sarcoma appears first on the oral mucosa as a red, purple, or blue lesion that is associated with HIV infection. Stomatitis is associated with chemotherapy and radiation therapy, as well as HIV infection. Krythoplakia is caused by a nonspecific inflammation. And candidiasis is caused by fungus.

8. 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? a. Achalasia b. Diffuse spasm c. Gastroesophageal reflux disease d. Hiatal hernia

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

6. A nurse inspects the stensen duct of the parotid gland to determine inflammation and possible obstruction. What area in the oral cavity with the nurse examine? a. Buccal mucosal next to the upper molars b. Dorsum of the tongue c. Roof of the mouth next to the incisors d. Posterior segment of the tongue near the uvula

A. Buccal mucosa next to the upper molars

The most common site for cancer of the oral cavity is the _______________.

mouth

Mumps, a viral infection affecting children, is usually an inflammation of the ______________________ gland.

parotid

The incidence of most dental caries is directly related to an increase in the dietary intake of _______________.

sugar

2.) The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they say which of the following? a. "Many oral cancers produce no symptoms in the early stages." b. "Blood testing is used to diagnose oral cancer." c. "A typical lesion is soft and craterlike." d. "Most oral cancers are painful at the outset."

• "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.

13. 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? a. Aphthous stomatitis b. Nicotine stomatitis c. Erythroplakia d. Hair leukoplakia

d. Hairy leukoplakia

16.) The nurse is creating a plan of care for a patient who is not able to tolerate brushing his teeth. The nurse includes in the plan of care which of the following mouth irrigations? a. Mouthwash and water b. Full-strength peroxide c. Baking soda and water d. Dextrose and water

• Baking soda and water- When a patient is unable to tolerate teeth brushing, the following irrigating solutions are recommended: 1 tsp of baking soda to 8 oz of warm water, half-strength hydrogen peroxide, or normal saline solution.

1.) Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland? a. Sialadenitis b. Parotitis c. Stomatitis d. Sialolithiasis

• 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.

A common lesion of the mouth that is also referred to as a "canker sore" is _______________.

aphithous stomatitis

10. While caring for a patient who has radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first post-operative day. What does the nurse know is expected amount of drainage in the wound unit? a. Between 40 and 80 mL b. Approximately 80 to 120 mL c. Between 120 and 160 mL d. Greater than 160 mL

b. Approximately 80 to 120 mL

2. 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 the symptoms indicate? a. Candidiasis b. Gingivitis c. Herpes simplex d. Cancer of the oral mucosa

b. Gingivitis

14. A patient comes to the clinic complaining of a sore throat. When assessing the patient, the nurse observes a reddened ulcerated lesion on the lip. The patient 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 physician about testing for? a. HIV b. Syphilis c. Gonorrhea d. Herpes simplex

b. Syphilis

11. A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? a. Peptic ulcer disease b. Esophageal cancer c. Gastroesophageal reflux disease d. Diverticulitis

c. Gastroesophageal reflux disease

5. An older adult patient who has been living at a home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of parotitis? a. Methicillin-resistant streptococcus aureus (MRSA) b. Pneumococcus c. Staphylococcus aureus d. Streptococcus viridans

c. Staphylococcus aureus

12. A patient has been diagnosed with Zenker's diverticulum. What treatment does the nurse anticipate educating the patient about? a. a low-residue diet b. Chemotherapeutic agents c. Radiation therapy d. Surgical removal of the diverticulum

d. Surgical removal of the diverticulum

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

• Actinic cheilitis- Actinic cheilitis is a type of premalignant squamous cell skin cancer that presents as scaling, crusty fissures or a white overgrowth of horny layers of the epidermis. Herpes simplex 1 is an opportunistic infection frequently seen in immunosuppressed patients. Chancres are reddened circumscribed lesions that ulcerate and become crusted and are the primary lesions of syphilis. Krythoplakia is a red patch on the oral mucous membrane that is frequently seen in the elderly.

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

• Avoid eating or drinking 2 hours before bedtime- The patient should not recline with a full stomach. The patients 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.

5.) A patient with gastro esophageal reflux disease (GERD) comes to the physician's office with complaints of a burning sensation in the esophagus. The nurse documents that the patient is experiencing which of the following? a. Odynophagia b. Dysphagia c. Dyspepsia d. Pyrosis

• Pyrosis- 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.

8.) The nurse is documenting that a patient has an inflammation of the salivary glands. The nurse documents which of the following findings? a. Stomatitis b. Pyosis c. Sialadenitis d. Parotits

• Sialadenitis- Sialadenitis is the inflammation of the salivary glands. Parotitis is inflammation of the parotid glands. Stomatitis is inflammation of the oral mucosa. Pyrosis is pus.

15.) Which of the following is the term for a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis? a. Chancre b. Actinic cheilitis c. Lichen planus d. Leukoplakia

• Chancre- 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 in the buccal mucosa.

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

• Chronic irritation of the esophagus is a known risk factor- 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.

9.) Which of the following is the primary symptom of achalasia? a. Chest pain b. Pulmonary symptoms c. Heartburn d. Difficulty swallowing

• Difficulty swallowing- The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient 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.

22.) The nurse is caring for a patient during the postoperative period following radical neck dissection. Which of the following should be reported to the physician? a. Serous drainage on the dressing b. High epigastric pain and/or discomfort c. Temperature of 99.0˚F d. Crackles that clear after coughing

• High epigastric pain and/or discomfort- 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 require reporting to the physician.

21.) The nurse working in the recovery room is caring for a patient who had a radical neck dissection. The nurse notices that the patient has a coarse, high-pitched sound on inspiration. Which of the following is the appropriate intervention by the nurse? a. Administering a breathing treatment b. Documenting the presence of stridor c. Lowering the head of the bed d. Notifying the physician

• Notifying the physician- The presence of stridor, a coarse, high-pitched sound on inspiration, in the immediate postoperative period following radical neck dissection indicates obstruction of the airway and requires that the nurse report it immediately to the physician.

7. The nurse is obtaining a history on a patient who comes into the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease? a. Dysphagia b. Malnutrition c. Pain d. Regurgitation of food

A. Dysphagia

25.) The nurse is caring for a patient with a history of bulimia. The patient complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which of the following conditions? a. Zenker's diverticulum b. Boerhaave syndrome c. Halitosis d. Periapical abscess

• Boerhaave syndrome- 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's diverticulum. A periapical abscess (an abscessed tooth) is characterized by dull, gnawing continuous pain, cellulitis, and edema and mobility of the involved tooth.

13.) Which of the following is an inaccurate clinical manifestation associated with hemorrhage? a. Bradycardia b. Tachypnea c. Hypotension d. Tachycardia

• Bradycardia- 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.

23.) The nurse is caring for an older adult who complains of xerostomia. The nurse evaluates for use of which of the following medications? a. Antiemetics b. Diuretics c. Antibodies d. Steroids

• 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.

3.) The most common symptom of esophageal disease is which of the following? a. Nausea b. Odynophagia c. Vomiting d. Dysphagia

• Dysphagia- Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing. Nausea is the most common symptom of GI problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain on swallowing.

18.) The nurse is creating a discharge teaching plan for a patient post surgery for oral cancer. Which of the following should be included in the teaching plan? Select all that apply. a. Follow-up medical appointment b. Follow-up dental appointment c. Use of humidification d. Oral hygiene

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

11.) The nurse is assessing the skin graft site of a patient who has undergone a radical neck dissection. The skin graft site is pink. The nurse documents which of the following? a. Venous congestion of graft b. Healthy graft c. Infection of graft d. Possible necrosis of graft

• Healthy graft- 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.

4.) A patient with an esophageal disorder comes into the hospital with symptoms that include halitosis and a sour taste in the mouth. These symptoms are associated most directly with which of the following? a. Gastoesophageal reflux b. Achalasia c. Esophageal diverticula d. Hiatal hernia

• Esophageal diverticula- Because the diverticula may retain decomposed food, halitosis and a sour taste in the mouth are frequent complaints. Achalasia presents as difficulty in swallowing both liquids and solids. Gastroesophageal reflux presents as burning in the esophagus, indigestion, and difficulty in, or pain upon, swallowing. Hiatal hernia presents as heartburn, regurgitation, and dysphagia in many patients, whereas at least 50% of patients are asymptomatic.

12.) Postoperatively, a patient with a radical neck dissection should be placed in which position? a. Prone b. Fowler's c. Supine d. Side-lying

• Fowler's- The patient should be placed in the Fowler's position to facilitate expansion of 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.

20.) The nurse is preparing to assess the donor site of a patient who underwent a myocutaneous flap after a radical neck dissection. The nurse prepares to assess the most commonly used muscle for this surgery. Which of the following muscles should the nurse assess? a. Bicep b. Sternomastoid c. Trapezius d. 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 patient's chart.

19.) The nurse is caring for a patient scheduled to undergo radical neck dissection. During preoperative teaching, the nurse includes that which of the following as associated complications? a. Venous engorgement b. Neck distention c. Shoulder drop d. Clavicle fracture

• Shoulder drop- The nurse should include shoulder drop as an associated complication of radical neck dissection. Another associated complication includes 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.