Chapter 46 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 46  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. A nurse is providing oral care to a patient who is comatose. What action best addresses the patient’s risk of tooth decay and plaque accumulation?

  1. A)  Irrigating the mouth using a syringe filled with a bacteriocidal mouthwash
  2. B)  Applying a water-soluble gel to the teeth and gums
  3. C)  Wiping the teeth and gums clean with a gauze pad
  4. D)  Brushing the patient’s teeth with a toothbrush and small amount of toothpaste

Ans: D

Feedback:

Application of mechanical friction is the most effective way to cleanse the patient’s mouth. If the patient is unable to brush 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.

2. An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2oF 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?

  1. A)  Palpate the patient’s parotid glands to detect swelling and tenderness.
  2. B)  Assess the temporomandibular joint for evidence of a malocclusion.
  3. C)  Test the integrity of cranial nerve XII by asking the patient to protrude the tongue.
  4. D)  Inspect the patient’s gums for bleeding and hyperpigmentation.

Ans: A

Feedback:

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.

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3. A patient who had a hemiglossectomy earlier in the day 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?

  1. A)  Emotional support from visitors and staff
  2. B)  An effective means of communicating with the nurse
  3. C)  Referral to a speech therapist
  4. D)  Dietary teaching focused on consistency of food and frequency of feedings

Ans: B

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. Emotional support and dietary teaching are critical aspects of the plan of care; however, the patient’s ability to communicate would be essential for both. Referral to a speech therapist will be required as part of the patient’s rehabilitation; however, it is not a priority at this particular time. Communication with the nurse is crucial for the delivery of safe and effective care.

4. The nurse notes that a patient 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 patient?

  1. A)  Avoid applying suction on or near the suture line.
  2. B)  Position patient on the non operative side with the head of the bed down.
  3. C)  Assess the patient’s ability to perform self-suctioning.
  4. D)  Evaluate the patient’s ability to swallow saliva and clear fluids.

Ans: A

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. Self-sectioning may be unsafe because the patient may damage the suture line. Following a modified radical neck dissection with graft, the patient 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 patient’s ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the patient’s need for suctioning.

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5. A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett’s esophagus with minor cell changes. Which of the following principles should be integrated into the patient’s subsequent care?

  1. A)  The patient will require an upper endoscopy every 6 months to detect malignant changes.
  2. B)  Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic

    damage.

  3. C)  Small amounts of blood are likely to be present in the stools and are not cause for

    concern.

  4. D)  Antacids may be discontinued when symptoms of heartburn subside.

Ans: A

Feedback:

In the patient 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 patients 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 patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

 

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