Chapter 35- Management of Patients With Oral and Esophageal Disorders

1. The nurse is providing oral hygiene care to a comatose patient. Which of the following regimens would be most effective in decreasing the patient's risk of tooth decay and plaque accumulation? A) Irrigating the mouth using a syringe filled with a bactericidal 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 glycerin swab Ans: C Difficulty: Moderate 2. An elderly patient complains of an earache and has an oral temperature of 100.2 F. Otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the nurse take next? A) Palpate the patient's parotid glands to detect swelling and tenderness. B) Assess the temperomandibular joint for evidence of a malocclusion. C) Test the integrity of cranial nerve XII by asking the patient to protrude his tongue. D) Inspect the patient's gums for bleeding and hyperpigmentation. Ans: A Difficulty: Difficult 3. The nurse is caring for a patient who had a hemiglossectomy earlier that day. Postoperative assessment reveals a patent airway, stable vital signs, and no bleeding or drainage from the operative site. 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 Difficulty: Moderate 4. 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? A) Avoid applying suction on or near the graft site B) Position the patient on his non-operative side with the head of the bed down C) Assess viability of the graft before beginning suctioning D) Evaluate the patient's ability to swallow saliva and clear fluids Ans: A Difficulty: Moderate 5. The nurse is caring for a patient who had a radical neck dissection for treatment of a malignant tumor. Which of the following nursing assessments would be a priority for this patient? A) Presence of acute pain and anxiety
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B) C) D)

Tissue integrity and color of the operative site Respiratory status and airway clearance Self-esteem and body image Ans: C Difficulty: Moderate

6. A patient who had a radical neck dissection has a Jackson-Pratt drain in place. The nurse observes the output from the drain over a 24-hour period. Which of the following findings should be reported to the physician immediately? A) 80 cc of serosanguinous drainage B) 400 cc of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) Several small clots noted in the drainage Ans: B Difficulty: Easy 7. The nurse is developing a teaching plan for a patient with GERD who has a diagnosis of Barrett's esophagus. Which of the following information is essential to include? A) He will need to undergo an upper endoscopy every 6 to 12 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 Difficulty: Moderate 8. A 6-year-old child is brought to the emergency room after swallowing a piece from a wooden puzzle. Which of the following medications is the nurse likely to administer intramuscularly in order to relax the esophagus to facilitate removal of the foreign body? A) Haloperidol B) Prostigmin C) Epinephrine D) Glucagon Ans: D Difficulty: Moderate 9. The nurse is planning a dental health promotion class for a group of 5th-graders. Which of the following would most likely increase the risk of tooth decay? A) Diet cola B) Raw carrots C) Shelled peanuts D) Cheddar cheese Ans: A Difficulty: Moderate 10. The nurse is assessing a patient's mouth for signs of oral cancer. Which of the following 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

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C) D)

Areas of tenderness that make chewing difficult Diffuse inflammation of the buccal mucosa Ans: B Difficulty: Easy

11. The nurse is caring for a patient who has a perforated esophagus as a result of a bullet wound to the neck. Which of the following interventions is the nurse most likely to implement in order to meet this patient's needs for nutrition and hydration? A) Administering fluids and nutrients parenterally until the wound is closed. B) Providing enteral nutrition via a nasogastric tube for a minimum of 30 days. C) Administering feedings via a percutaneous endoscopic gastrostomy tube. D) Maintaining the patient in Fowler's position when offering fluids to minimize reflux. Ans: A Difficulty: Difficult 12. Which of the following is the most significant risk factor for esophageal cancer? A) Delayed gastric emptying time B) Ingestion of 2 or more carbonated drinks daily C) Chronic gastroesophageal reflux disease (GERD) D) Persistent hiccups Ans: C Difficulty: Easy 13. Which of the following is a priority psychosocial outcome for a patient who has had a radical neck dissection? A) He indicates acceptance of altered appearance and demonstrates positive selfimage. B) He freely expresses needs and concerns related to postoperative pain management. C) He compensates effectively for alteration in ability to communicate related to dysarthria. D) He demonstrates effective stress management techniques to promote muscle relaxation. Ans: A Difficulty: Moderate 14. The nurse is preparing a patient who has had a radical neck dissection for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. The nurse recognizes that the goals of physical therapy for this patient include: A) Promoting circulation to the graft site on the affected side B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia, decreasing esophageal peristalsis Ans: C Difficulty: Moderate

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15. The nurse is caring for a 78-year-old patient who has an esophageal diverticulum. Which of the following assessment findings is characteristic of this disorder? A) Burning pain on swallowing C) Symptoms mimicking a heart attack B) Regurgitation of undigested food D) Chronic parotid abscesses Ans: B Difficulty: Easy 16. Performing oral and mouth care is an important nursing intervention because patients who are ill are at increased risk for developing dental caries due to: A) Their increased desire for sugar consumption B) Infections that may attack the enamel of the teeth C) A decreased fluid intake, so they are not getting adequate fluoride D) Inadequate nutrition and a decrease in the production of saliva Ans: D Difficulty: Moderate 17. The patient is scheduled for removal of an abscessed tooth. While providing discharge teaching, the nurse informs the patient to: A) Rinse the mouth with alcohol. B) Use warm saline to rinse the mouth. C) Brush around the area with a firm toothbrush. D) Use a toothpick to dislodge any debris that gets lodged in the socket. Ans: B Difficulty: Moderate 18. An adult patient with a fractured mandible has returned to the unit postoperatively. The patient's jaws are wired and will remain wired for the next 6 weeks. What should be kept at the patient's bedside for this patient? A) Thermometer B) Sterile gauze packing C) Wire cutters D) Ice water Ans: C Difficulty: Moderate 19. Which of the following patients is at the greatest risk for developing cancer of the tongue? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who smokes and has diabetes C) A 32-year-old man who uses smokeless tobacco and has hypertension D) A 57-year-old man with alcoholism and a history of dental caries Ans: A Difficulty: Easy 20. The patient has had a neck resection with a radial forearm free flap. The nurse assesses the graft and notes the color to be blue with mottling. What might this indicate? A) A viable graft C) Arterial occlusion B) Venous congestion D) A room that is too cool

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Ans: B Difficulty: Moderate 21. A nurse is obtaining a health history. How might the nurse best determine the integrity to cranial nerve XII during the examination of the patient's oral cavity? A) Have the patient smile. B) Ask the patient to pucker his or her lips. C) Have the patient stick out his or her tongue and move it laterally. D) Have the patient roll his or her tongue. Ans: C Difficulty: Difficult 22. The nurse is caring for a patient who is diagnosed with achalasia. The nurse determines that a common complaint of this disorder is: A) Sensation of food sticking in the lower portion of the esophagus B) Burning sensation in the esophagus C) Frequent burping after eating D) Recurring hiccups Ans: A Difficulty: Moderate 23. A nurse is caring for a patient diagnosed with esophageal reflux disorder. The patient should be advised to: A) Keep the head of the bed lowered. C) Avoid carbonated drinks. B) Drink a cup of hot tea before D) Drink a carbonated drink after bedtime. meals. Ans: C Difficulty: Moderate 24. A patient visiting the clinic tells the nurse that he has a diverticulum and is having surgery in 2 weeks. He asks why his breath is so foul. The nurse informs the patient that this is most likely due to: A) Diet choices B) Poor oral hygiene C) Decomposition of food retained in the diverticulum D) Breakdown of the oral mucosa Ans: C Difficulty: Moderate 25. The patient is complaining of dysphagia, substernal pain, and regurgitation of undigested food. Based upon these symptoms, the nurse anticipates that the physician will schedule the patient for: A) An esophagogastroduodenoscopy (EGD) B) A colonoscopy C) A CAT scan of the head and neck D) A barium swallow

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Ans: A Difficulty: Moderate 26. When caring for a patient with the nursing diagnosis of impaired swallowing related to neuromuscular impairment, the nurse should: A) Position the patient in a supine position. B) Elevate the head of the bed 90 degrees during meals. C) Encourage the patient to remove dentures. D) Encourage thin liquids for dietary intake. Ans: B Difficulty: Moderate

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