Chapter 35 Management of Patients with Oral and Esophageal Disorders


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Chapter 35  Management of Patients with Oral and Esophageal Disorders



Complete Chapter Questions And Answers

Sample Questions


Multiple Choice

1. A comatose patient is receiving oral care. What oral care regimen would be most effective in decreasing the client’s risk of tooth decay and plaque accumulation?
A) Irrigating the mouth using a syringe filled with a bacteriocidal mouthwash
B) Applying a water-soluble gel to the teeth and gums

C) Wiping the teeth and gums with a gauze pad
D) Gently stroking the teeth and gums with a lemon and glycerine swab

Ans: C
Chapter: 35
Client Needs: D-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Caring
Objective: 1
Page and Header: 998, Dental Plaque and Caries

Feedback: Application of mechanical friction is the most effective way to cleanse the client’s mouth. If the client is unable to brush his teeth, the nurse may brush them, taking precautions to prevent aspiration; or as a substitute, the nurse can achieve mechanical friction by wiping the teeth with a gauze pad. Bacteriocidal mouthwash does reduce plaque-causing bacteria; however,

it is not as effective as application of mechanical friction. Water-soluble gel may be applied to lubricate dry lips, but it is not part of oral care. Lemon and glycerine swabs dry the oral mucosa and are ineffective in cleansing the client’s mouth.

2. An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2 degrees Fahrenheit. 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 client’s parotid glands to detect swelling and tenderness.
B) Assess the temperomandibular joint for evidence of a malocclusion.
C) Test the integrity of the12th cranial nerve by asking the client to protrude his tongue. D) Inspect the client’s gums for bleeding and hyperpigmentation.

Ans: A
Chapter: 35
Client Needs: D-4
Cognitive Level: Analysis Difficulty: Difficult
Integrated Process: Nursing Process Objective: 3
Page and Header: 1003, Parotitis

Feedback: Older adults and debilitated clients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness and swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temperomandibular 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.

3. A patient who had a hemiglossectomy earlier today is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patient’s priority need at this time?
A) Emotional support from visitors and staff

B) An effective means of communicating with the nurse.
C) Referral to a speech therapist
D) Dietary teaching focused on consistency of food and frequency of feedings

Ans: B

Chapter: 35
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation Objective: 4
Page and Header: 1004, Cancer of the Oral Cavity and Pharynx

Feedback: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patient’s ability to communicate in writing before surgery. Pen and paper are provided postoperatively to patients who can use them to communicate. A communication board with commonly used words or pictures is obtained preoperatively and given after surgery to patients who cannot write so that they may point to needed items. A speech therapist is also consulted postoperatively. Without a means of communication, the client is likely to experience anxiety and frustration. Referral to a speech therapist will be required as part of the client’s rehabilitation; however, it is not a priority at this time. Emotional support and dietary teaching are critical aspects of the plan of care; however, the client’s ability to communicate would be essential for both. Communication with the nurse is crucial for the delivery of safe and effective care.

4. The nurse notes that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this client?
A) Avoid applying suction on or near the graft site.

B) Position client on her nonoperative side with the head of the bed down. C) Assess viability of the graft before beginning suctioning.
D) Evaluate the client’s ability to swallow saliva and clear fluids.

Ans: A
Chapter: 35
Client Needs: D-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Caring
Objective: 6
Page and Header: 1004, Cancer of the Oral Cavity and Pharynx

Feedback: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Following a modified radical neck dissection with graft, the client is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the client’s ability to swallow is an important

assessment for the nurse to make; however, it is not directly linked to the client’s need for suctioning.

5. A patient with GERD has a diagnosis of Barrett’s esophagus has been admitted to your unit. You are writing a care plan for this patient. What information is essential to include?
A) He will need to undergo 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 his stools and should not cause concern. D) Antacids may be discontinued when symptoms of heartburn subside.

Ans: A
Chapter: 35
Client Needs: D-3
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 7
Page and Header: 1015, Barrett’s Esophagus

Feedback: In the client with Barrett’s esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for clients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for clients with GERD, they should be taken as ordered whether or not the client is symptomatic.

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