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Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

Chapter 49: Concepts of Care for Patients With Oral Cavity and Esophageal Problems Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse is teaching a client diagnosed with stomatitis about special mouth care. Which

statement by the client indicates a need for further teaching? a. “I need to take out my dentures until my mouth heals.” b. “I’ll try to eat soft foods that aren’t spicy and acidic.” c. “I will use a more firm toothbrush to keep my mouth clean.” d. “I’ll be sure to rinse my mouth often with warm salt water.” ANS: C

The client who has stomatitis has oral inflammation which causes discomfort. Therefore, all of these actions help to avoid irritation except for needing to use a soft toothbrush or gauze rather than a firm one. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Stomatitis, Oral care MSC: Client Needs Category: Health Promotion and Maintenance 2. A client is admitted with a large oral tumor. What assessment by the nurse takes priority? a. Airway b. Breathing c. Circulation d. Nutrition ANS: A

Airway always takes priority. Airway must be assessed first and any problems managed if present. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Oral cancer, Assessment MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. The nurse is teaching a client about the use of viscous lidocaine for oral pain. What health

teaching would the nurse include? a. “Use the drug before every meal to prevent aspiration.” b. “Increase your intake of citrus foods to help with healing.” c. “Use the drug only at bedtime because you won’t be eating.” d. “Be sure to check food temperatures before eating.” ANS: D

Viscous lidocaine has an anesthetic effect in the oral cavity. Therefore, to promote client safety, the nurse would want to teach the client to check food temperature before eating. 4. A nurse participates in a community screening event for oral cancer. What client is the

highest priority for referral to a primary health care provider? a. Client who has poor oral hygiene practices. b. Client who smokes and drinks daily. c. Client who tans for an upcoming vacation.

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) d. Client who occasionally uses illicit drugs. ANS: B

Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk factor, but short-term exposure does not have the same risk as daily exposure to tobacco and alcohol. DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment KEY: Oral cancer, Health screening MSC: Client Needs Category: Health Promotion and Maintenance 5. The nurse notes that the primary health care provider documented the presence of mucosal

erythroplasia in a client. What does the nurse understand that this most likely means for this client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor ANS: A

Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Oral cancer, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 6. The nurse is caring for a client diagnosed with oral cancer. What is the nurse’s priority for

client care? Encourage fluids to liquefy the client’s secretions. Place the client on Aspiration Precautions. Remind the client to use an incentive spirometer. Manage the client’s pain and inflammation.

a. b. c. d.

ANS: B

The client who has oral cancer often has difficulty swallowing and is at risk for aspiration and possibly aspiration pneumonia. Therefore, the most important nursing action is to place the client on precautions to prevent aspiration. The nurse would implement the other actions but they are not as vital to promote client safety. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Oral cancer, Plan of care MSC: Client Needs Category: Safe and Effective Care Environment 7. A client has an open traditional hiatal hernia repair this morning. What is the nurse’s priority

for client care at this time? a. Managing surgical pain b. Ambulating the client early c. Preventing respiratory complications d. Managing the nasogastric tube

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) ANS: C

The client who has traditional surgery (rather than minimally invasive surgery) is at risk for respiratory complications such as atelectasis and pneumonia because he or she has an incision that may prevent the client from taking deep breaths or using an incentive spirometer. Therefore, the nurse’s priority is to prevent these potentially life-threatening respiratory problems. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Hiatal hernia, Perioperative care MSC: Client Needs Category: Safe and Effective Care Environment 8. Which of these client assessment findings is typically associated with oral cancer? a. Dry sticky oral membranes b. Increased appetite c. Itchy rash in oral cavity d. Painless red or raised lesion ANS: D

A painless red or raised lesion often indicates a diagnosis of oral cancer. The client usually has a decreased appetite and thick secretions. Itchiness is not a common finding associated with oral cancer. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Oral cancer, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The nurse is caring for a client with sialadenitis. What comfort measures are appropriate for

this client? (Select all that apply.) Applying warm compresses Applying ice to salivary glands Offering fluids every hour Providing lemon-glycerin swabs Reminding the patient to avoid speaking

a. b. c. d. e.

ANS: A, C

Warm compresses and fluids can help promote comfort for this client. Application of ice or lemon-glycerin swabs would not be used. Speaking has no effect on this condition. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Oral disorders, Comfort measures MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort 2. A nurse knows that job-related risks for developing oral cancer include which occupations?

(Select all that apply.) a. Coal miner b. Electrician c. Metal worker d. Plumber e. Textile worker

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) ANS: A, C, D, E

The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens. Electricians do not have this risk. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Oral cancer, Risk factors MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. The nurse is caring for a client who had an open traditional esophagectomy. Which

assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.) a. Nausea b. Wound dehiscence c. Fever d. Tachycardia e. Moderate pain f. Fatigue ANS: B, C, D

Wound dehiscence is a serious, potentially life-threatening problem that needs immediate attention of the primary health care provider, typically the surgeon. Fever and tachycardia may indicate that the client has a postoperative infection, another serious, potentially life-threatening complication. Indications of both of these problems need to be documented and reported by the nurse. Nausea, fatigue, and moderate pain are expected postoperative assessment findings. DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment KEY: Esophagectomy, Perioperative care MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 4. The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease

(GERD). What assessment finding(s) would the nurse expect? (Select all that apply.) Dyspepsia Regurgitation Belching Coughing Chest discomfort Dysphagia

a. b. c. d. e. f.

ANS: A, B, C, D, E, F

All of these signs and symptoms are commonly seen in clients who have GERD. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: GERD, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 5. The nursing is teaching a client diagnosed with gastroesophageal reflux disease (GERD) who

is planning to have an endoscopic radiofrequency (Stretta) procedure. What preprocedure health teaching would the nurse include? (Select all that apply.) a. “You will need to be on a liquid diet for the first week after the procedure.”

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) b. “Avoid taking any NSAIDs like ibuprofen for 10 days before the procedure.” c. “Contact the primary health care provider after the procedure if you have increased

pain.” d. “You will need a nasogastric tube for a few days after the procedure.” e. “You will have a small incision in your stomach area that will have a wound

closure. ANS: B, C

The client having this procedure does not have an incision and will not require a nasogastric tube (NGT). The client should avoid an NGT placement for at least a month after the procedure. A liquid diet is required for only 24 hours after the procedure and then the client should progress to include soft floods like custard and applesauce. DIF: Analyzing TOP: Integrated Process: Teaching/Learning KEY: GERD, Management MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 6. The nurse is teaching a client about risk factors for esophageal cancer. Which risk factors

would the nurse include? (Select all that apply.) a. Alcohol intake b. Obesity c. Smoking d. Lack of fresh fruits and vegetables e. Untreated GERD f. Use of NSAIDs ANS: A, B, C, D, E

All of these factors increase the risk of esophageal cancer except for the use of NSAIDs. Untreated GERD causes damage to esophageal tissue which may develop into Barrett esophagus, or precancerous cells. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Esophageal cancer, Risk factors MSC: Client Needs Category: Health Promotion and Maintenance 7. The nurse is teaching a client about the risk of uncontrolled or untreated the client’s

gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.) a. Asthma b. Laryngitis c. Dental caries d. Cardiac disease e. Cancer ANS: A, B, C, D, E

Any of these complications may occur in clients who have uncontrolled or untreated GERD. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: GERD, Complications MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation...