Med Surg Upper GI system
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.
-verify rhythm on the cardiac monitoring system (EKG) -Monitor draining in the closed chest drainage system -assess lung sounds every 4 hours and PRN
A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage?
80-120 mL
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
Cancer of the esophagus is most often diagnosed by which of the following?
EGD with biopsy and brushings
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?
Exhibiting Hemoglobin A1C 8.2
Postoperatively, a client with a radical neck dissection should be placed in which position?
Fowler
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 (GERD)
A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition?
Gastroesophageal reflux disease (GERD) *contraindicated with hemorrhage or perforation*
A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:
Proton Pump inhibitors
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?
Staphylococcus aureus
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?
Take long, slow breaths
A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
The client is free from esophagitis and achalasia.
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?
The client lying in a lateral position with the head of the bed flat after surgery the patient is at risk for neck swelling, to prevent respiratory complications the head of the bed should be at least a 30 degrees angle
When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. How is aphthous stomatitis best described by the nurse?
a canker sore of the oral soft tissues
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?
achalasia
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
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?
actinic cheilitis
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
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?
assess the graft for color and temperature
The most common symptom of esophageal disease is
dysphagia
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
When caring for a client with the impaired swallowing related to neuromuscular impairment, what is the nurse's priority intervention?
elevate the head of the bed 90 degrees during meals
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 upper body on pillows elevate the head of the bed to 6 to 8 inch blocks avoid beer, especially in the evening
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
A client is being evaluated for esophageal cancer. What initial manifestation of esophageal cancer should the nurse assess?
increase difficulty in swallowing
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
ineffective airways clearance related to obstruction by mucus
Which of the following are functions of saliva? Select all that apply.
lubrication digestion protection against harmful bacteria
A client with cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is:
make a notation on the call light system that the client cannot speak
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?
nasogastric intubation
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?
notify the physician
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
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?
pectoralis major
The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. What is the nurse's priority action?
place the client in the fowlers position
Which term describes an inflammation of the salivary glands?
sialadenitis
Which term is used to describe stone formation in a salivary gland, usually the submandibular gland?
sialolithiasis
A client has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client?
uncontrolled rhythmic movements of the face or limbs (tardive dyskinesia)
Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?
vagus
Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?
weakness, diaphoresis, diarrhea 90 min after eating
Which of the following is the most common type of diverticulum?
zenker's diverticulum
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):
Protrusion of the upper stomach into the lower portion of the thorax
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
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?
assess lung sounds bilaterally
A client with achalasia recently underwent pneumatic dilation. The nurse intervenes after the procedure by
assessing lung sounds esophageal perforation is a risk following dilation of esophagus, assessing lung sounds is essential to ensure patency of esophagus
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?
avoid coffee and alcoholic beverages
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?
avoiding chocolate and coffee
which clinical manifestation is not associated with hemorrhage
bradycardia
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
Which of the following medications, used in the treatment of GERD, accelerate gastric emptying?
metoclopramide
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
A client with gastroesophageal reflux disease (GERD) comes to the physician's office reporting a burning sensation in the esophagus. The nurse documents that the client is experiencing
pyrosis
The client has a chancre on the lips. What instruction should the nurse provide?
take measures to prevent spreading the lesions to other people
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:
there are usually no symptoms
Which is the primary symptom of achalasia?
difficulty swallowing (dysphagia)
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?
buccal mucosa next to the upper molars
Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis?
chancre
Which is an accurate statement regarding cancer of the esophagus?
chronic irritation of the esophagus is a known risk factor
A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?
"I'll eat frequent, small, bland meals that are high in fiber." 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).
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?
esophageal tumor
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?
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.
The nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician?
epigastric pain and/or discomfort
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?
boerhaave syndrome
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?
brush and floss daily
