NCLEX Prep: Management of Patients with Oral and Esophageal Disorders
A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug? A) Metoclopramide (Reglan) B) Omeprazole (Prilosec) C) Lansoprazole (Prevacid) D) Famotidine (Pepcid)
A) Metoclopramide (Reglan) -Metoclopramide (Reglan) is useful in promoting gastric motility. -Omeprazole and lansoprazole are proton pump inhibitors that reduce gastric acid secretion. -Famotidine (Pepcid) is an H2 receptor antagonist, which has a similar effect.
An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2F 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? A) Palpate the patient's parotid glands to detect swelling and tenderness. B) Assess the temporomandibular joint for evidence of a malocclusion. C) Test the integrity of cranial nerve XII by asking the patient to protrude the tongue. D) Inspect the patient's gums for bleeding and hyperpigmentation.
A) Palpate the patient's parotid glands to detect swelling and tenderness -Older adults and debilitated patients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. -Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. -The 12th cranial nerve is not associated with the auditory system. -Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care? A) The patient will require an upper endoscopy every 6 months to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in the stools and are not cause for concern. D) Antacids may be discontinued when symptoms of heartburn subside.
A) The patient will require an upper endoscopy every 6 months to detect malignant changes.
A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply. A) Perforation into the mediastinum B) Development of an esophageal lesion C) Erosion into the great vessels D) Painful swallowing E) Obstruction of the esophagus
A, C and E are all late signs. -B and D are early signs.
A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD? A) Pyloric sphincter B) Lower esophageal sphincter C) Hypopharyngeal sphincter D) Upper esophageal sphincter
B) Lower esophageal sphincter (LES) -The lower esophageal sphincter, also called the gastroesophageal sphincter or cardiac sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric contents. -The upper esophageal sphincter and the hypopharyngeal sphincter are synonymous and are not responsible for the manifestations of GERD. -The pyloric sphincter exists between the stomach and the duodenum
A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what? A) Presence of small blood clots in the drainage B) 60 mL of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) 120 mL of serosanguinous drainage
B) Milky/cloudy drainage= CHYLE FISTULA!!! -Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Milky drainage is indicative of a chyle fistula, which requires prompt treatment.
The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages? A) Dull pain radiating to the ears and teeth B) Presence of a painless sore with raised edges C) Areas of tenderness that make chewing difficult D) Diffuse inflammation of the buccal mucosa
B) Presence of a painless sore with raised edges -Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently, and negatively affects prognosis. -Dull pain radiating to the ears and teeth is characteristic of malocclusion. -Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. -Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. -Pain related to oral cancer is a late symptom.
A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer? A) Promotion of a nutrient-dense, low-fat diet B) Annual screening endoscopy for patients over 50 with a family history of esophageal cancer C) Early diagnosis and treatment of gastroesophageal reflux disease D) Adequate fluid intake and avoidance of spicy foods
C) Early diagnosis and treatment of gastroesophageal reflux disease -There are numerous risk factors for esophageal cancer, but chronic esophageal irritation or GERD is among the most significant. This is a more significant risk factor than dietary habits. -Screening endoscopies are not recommended solely on the basis of family history.
A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include? A) Muscle training to relieve dysphagia B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia by decreasing esophageal peristalsis
C) Promoting maximum shoulder function -Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the patient's neck incision and graft, if present, were sufficiently healed. -Nerve paralysis in the cervical plexus and other variables affecting swallowing would be managed by a speech therapist rather than a physical therapist.
An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body? A) Haloperidol B) Prostigmine C) Epinephrine D) Glucagon
D) Glucagon -Haloperidol is an antipsychotic drug and is not indicated. -Prostigmine is prescribed for patients with myasthenia gravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. -Epinephrine is indicated in asthma attack and bronchospasm.
A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis? A) Ineffective Tissue Perfusion B) Impaired Skin Integrity C) Aspiration D) Imbalanced Nutrition: Less Than Body Requirements
D) Imbalanced Nutrition: Less Than Body Requirements -Because digestion normally begins in the mouth, adequate nutrition is related to good dental health and the general condition of the mouth. Any discomfort or adverse condition in the oral cavity can affect a persons nutritional status. -Dental caries do not typically affect the patients tissue perfusion or skin integrity. -Aspiration is not a likely consequence of dental caries.
A nurse is providing care for a patient whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis? A) Risk for Disuse Syndrome B) Unilateral Neglect C) Risk for Trauma D) Ineffective Tissue Perfusion
D) Ineffective Tissue Perfusion -Grafted skin is highly vulnerable to inadequate perfusion and subsequent ischemia and necrosis. This is a priority over chronic pain, which is unlikely to be a long-term challenge. -Neglect and disuse are not risks related to the graft site.
A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education? A) Drinking beverages after your meal, rather than with your meal, may bring some relief. B) Its best to avoid dry foods, such as rice and chicken, because they're harder to swallow. C) Many patients obtain relief by taking over-the-counter antacids 30 minutes before eating. D) Instead of eating three meals a day, try eating smaller amounts more often.
D) Instead of eating three meals a day, try eating smaller amounts more often. -Management for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. -Avoiding beverages and particular foods or taking OTC antacids are not noted to be beneficial.
Why would an older adult whose medication regimen includes an anticholinergic be at high risk for Parotitis?
Parotid glands contain saliva. Elderly, acutely ill, or debilitated people with decreased salivary flow from general dehydration or medications are at high risk for parotitis. Anticholinergic medications inhibit saliva production.
What is achalasia?
failure of LES (lower esophageal sphincter) to relax, making it difficult for food and liquid to pass into the stomach.
