Question 1

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?

Accepted Answer

Take long, slow breaths  During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

Question 2

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

Accepted Answer

The client lying in a lateral position, with the head of bed flat  A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration.

Question 3

The most common symptom of esophageal disease is

Accepted Answer

dysphagia.

Question 4

Which of the following terms refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus?

Accepted Answer

Pyrosis  Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain on swallowing is termed odynophagia.

Question 5

A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication can be safely administered for which conditon?

Accepted Answer

Gastroesophageal reflux disease

Question 6

Which of the following is one of the first clinical manifestations of esophageal cancer

Accepted Answer

Increasing difficulty is swallowing

Question 7

Paul Cavanagh, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. Although his surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to Mr. Cavanagh and his family?

Accepted Answer

Time to mourn, accept, and adjust to the loss  The first time family members or clients see the effects of surgery, the experience usually is traumatic. The nurse needs to promote effective coping and therapeutic grieving at this time. Responses may range from crying or extreme sadness and avoiding contact with others to refusing to talk about the surgery or changes in appearance. Allowing the client time to mourn, accept, and adjust to losses is essential.

Question 8

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Accepted Answer

Assist client to increase dietary fiber

Question 9

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

Accepted Answer

Gastroesophageal reflux disease

Question 10

A nurse caring for a patient who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. An expected normal amount of drainage is:

Accepted Answer

Approximately 80 to 120 mL.  Between 80 to 120 mL may drain over the first 24 hours. Drainage of greater than 120 mL may be indicative of a chyle fistula or hemorrhage.

Question 11

Postoperatively, a patient with a radical neck dissection should be placed in which position?

Accepted Answer

Fowler\'s

Question 12

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is

Accepted Answer

chancre

Question 13

Cancer of the esophagus is most often diagnosed by which of the following?

Accepted Answer

Esophagogastroduodenoscopy (EGD) with biopsy and brushings

Question 14

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?

Accepted Answer

Vagus

Question 15

James Jaeger, a 59-year-old carpenter, is being seen by a physician in your oncology group with a diagnosis of oral cancer. During your client education, Mr. Jaeger tells you that he is upset that he didn\'t recognize any early signs or symptoms of his disease. What do you tell Mr. Jaeger about the early stage of his cancer?

Accepted Answer

There are usually no symptoms

Question 16

A nurse is doing her initial assessment on a client who had gastric bypass surgery the previous day. Which of the following would she expect to see when observing the client\'s nasogastric tube drainage?

Accepted Answer

Yellow-green secretions

Question 17

The most common symptom of esophageal disease is which of the following?

Accepted Answer

Dysphagia

Question 18

Which of the following is the term for a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis?

Accepted Answer

Chancre

Question 19

The nurse is caring for a patient with a history of bulimia. The patient complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which of the following conditions?

Accepted Answer

Boerhaave syndrome  Boerhaave syndrome, a spontaneous rupture of the esophagus after forceful vomiting (may occur after eating a large meal), is characterized by retrosternal pain, dysphagia, infection, fever, and severe hypotension. Halitosis (bad breath) is a symptom of pharyngoesophageal pulsion diverticulum, also known as Zenker\'s diverticulum. A periapical abscess (an abscessed tooth) is characterized by dull, gnawing continuous pain, cellulitis, and edema and mobility of the involved tooth.

Question 20

One way for the nurse to confirm placement of a nasogastric tube is to test the pH of the tube aspirate. The nurse knows that tube placement in the lungs is indicated with a pH of:

Accepted Answer

6

Question 21

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as:

Accepted Answer

a canker sore of the oral soft tissues.

Question 22

Which of the following is one of the first clinical manifestations of esophageal cancer?

Accepted Answer

Increasing difficulty is swallowing

Question 23

Brock Nichols, a 4-year-old preschooler, is being seen in the ED where you practice nursing. His mother reports that Brock has been vomiting for 3 days and is unable to \"keep anything down.\" What poses the greatest danger to Brock?

Accepted Answer

Dehydration

Question 24

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?

Accepted Answer

Weakness, diaphoresis, diarrhea 90 minutes after eating  Dumping syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramping, and diarrhea from the rapid emptying of the chyme after eating. Elevated temperature and chills can be a significant finding for infection and should be reported. Constipation with rectal bleeding is not indicative of dumping syndrome.

Question 25

The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease?

Accepted Answer

Avoid eating or drinking 2 hours before bedtime.  The patient should not recline with a full stomach. The patient should be instructed to avoid the listed foods and food components. The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks. The patient is instructed to eat a low-fat diet.

Question 26

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis?

Accepted Answer

Staphylococcus aureus  People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for parotitis. The infecting organisms travel from the mouth through the salivary duct. The organism is usually Staphylococcus aureus (except in mumps).

Question 27

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

Accepted Answer

\"Avoid coffee and alcoholic beverages.\"

Question 28

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to

Accepted Answer

Assess the graft for color and temperature.  The nurse may do all these activities related to the neck wound and dressing. Airway, breathing, circulation (ABCs) take priority. Assessing the graft for color and temperature addresses circulation.

Question 29

A client has a new order for metoclorpramide (Reglan). The nurse knows that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following?

Accepted Answer

Uncontrolled rhythmic movements of the face or limbs  Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson\'s disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

Question 30

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client?

Accepted Answer

Provide the client with an irrigating solution of baking soda and warm water.  If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended.

Question 31

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are?

Accepted Answer

Hairy leukoplakia  Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough hairlike projections occur, typically found on lateral border of the tongue.

Question 32

Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland?

Accepted Answer

Sialolithiasis

Question 33

Regarding oral cancer, the nurse provides health teaching to inform the patient that

Accepted Answer

many oral cancers produce no symptoms in the early stages.

Question 34

Which of the following is the primary symptom of achalasia?

Accepted Answer

Difficulty swallowing

Question 35

An elderly client states, \"I don\'t understand why I have so many caries in my teeth.\" The nurse assesses the following as placing the client at risk:

Accepted Answer

Exhibiting hemoglobin A1C 8.2  Measures used to prevent and control dental caries include controlling diabetes. A hemoglobin A1C of 8.2 is not controlled. It is recommended for hemoglobin A1C to be less than 7 for people with diabetes. Other measures to prevent and control dental caries include drinking fluoridated water; eating foods that are less cariogenic, which include fruits, vegetables, nuts, cheese, or plain yogurt; and brushing teeth evenly with a soft-bristled toothbrush.

Question 36

A client in the emergency department reports that a piece of meat became stuck in the throat while eating. The nurse notes the client is anxious with respirations at 30 breaths/min, frequent swallowing, and little saliva in the mouth. An esophagogastroscopy with removal of foreign body is scheduled for today. The first activity of the nurse is to:

Accepted Answer

Assess lung sounds bilaterally.  All these activities are things the nurse may do for a client with a foreign body in the esophagus. This client is at risk for esophageal perforation, and thus pneumothorax. By auscultating lung sounds the nurse will be able to assess if a pneumothorax is present. The client has little saliva in the oral cavity and does not need to be suctioned. A client may also report pain with a foreign body. However, ABCs (airway, breathing, circulation) take priority. The consent for the esophagogastroscopy may be obtained after the nurse has completed the client assessment

Question 37

The nurse is creating a plan of care for a patient who is not able to tolerate brushing his teeth. The nurse includes in the plan of care which of the following mouth irrigations?

Accepted Answer

Baking soda and water  When a patient is unable to tolerate teeth brushing, the following irrigating solutions are recommended: 1 tsp of baking soda to 8 oz of warm water, half-strength hydrogen peroxide, or normal saline solution.

Question 38

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an):

Accepted Answer

Protrusion of the upper stomach into the lower portion of the thorax.

Question 39

Which of the following would be an intervention for a patient with a chemical burn to the esophagus?

Accepted Answer

Insertion of nasogastric (NG) tube  An NG tube may be inserted by the medical team. Vomiting and gastric lavage are avoided to prevent further exposure of the esophagus to the caustic agent. The patient is given nothing by mouth, and IV fluids are administered.

Question 40

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying?

Accepted Answer

Metoclopramide (Reglan)  Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

Question 41

Tyrone Freeman is a 49-year-old male being treated for GERD at the gastroenterology office where you work. During his visit, he states that his reflux is much improved, but now, he is having diarrhea. In addition to his prescribed treatment for GERD, he has been taking an antacid. Which of the following components of an antacid might be causing his diarrhea?

Accepted Answer

Magnesium  The magnesium component may tend to cause diarrhea in some clients. Magnesium can cause diarrhea in some clients.

Question 42

A client with a history of peptic ulcer disease is admitted for hematemesis associated with gastric bleeding. Which is the most appropriate action of the nurse?

Accepted Answer

Prepare for nasogastric irrigations.  Hemorrhage with peptic ulcer disease is initially handled through cold saline lavage via nasogastric tube. Increasing the IV rate is not a nursing measure. Administering oxygen is not indicated unless the client is experiencing respiratory difficulties. While having hematemesis, the head of the bed would remain elevated to avoid risk for aspiration.

Question 43

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom?

Accepted Answer

Esophageal tumor  Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer.

Question 44

The nurse is caring for an older adult who complains of xerostomia. The nurse evaluates for use of which of the following medications?

Accepted Answer

Diuretics  Diuretics, frequently taken by older adults, can cause xerostomia (dry mouth). This is uncomfortable, impairs communication, and increases the patient\'s risk for oral infection. Antibiotics, antiemetics, and steroids are not medications typically taken orally by adults that cause dry mouth.

Question 45

A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland?

Accepted Answer

Parotid  The salivary glands consist of the parotid glands, one on each side of the face below the ear; the submandibular and sublingual glands, both in the floor of the mouth; and the buccal gland, beneath the lips.

Question 46

The client has returned to the floor following a radical neck dissection. Anesthesia has worn off. It is most important for the nurse to

Accepted Answer

Place the client in the Fowler\'s position.

Question 47

A client with achalasia recently underwent pneumatic dilation. The nurse intervenes after the procedure by

Accepted Answer

Assessing lung sounds  Esophageal perforation is a risk following dilation of the esophagus. One way to assess is auscultating lung sounds. Airway and breathing are priorities according to Maslow\'s hierarchy of needs. The client is kept NPO until the gag reflex has returned. A barium swallow may be performed after as esophageal dilation if a perforation is suspected. Pain medication is administered for the procedure, but the client should have little pain after the procedure. Pain could indicate perforation.

Question 48

While stripping wax from surfboards, a client accidentally ingested a refrigerated strong base cleaning solution, thinking it was water. The nurse plans to include all the following in the care plan: (Select all that apply.)

Accepted Answer

Administer medication for report of pain. Insert an intravenous (IV) catheter for administration of IV fluids. Maintain nothing by mouth status. Assess respiratory status every 4 hours and prn.  The client who has a chemical burn of the oral mucosa and esophagus will experience pain and may experience respiratory distress. The nurse will administer medication for pain and assess respiratory status. The client will be NPO, and IV fluids will be administered. Vomiting is avoided to prevent additional trauma from the caustic agent.

Question 49

The nurse working in the recovery room is caring for a patient who had a radical neck dissection. The nurse notices that the patient has a coarse, high-pitched sound on inspiration. Which of the following is the appropriate intervention by the nurse?

Accepted Answer

Notifying the physician  The presence of stridor, a coarse, high-pitched sound on inspiration, in the immediate postoperative period following radical neck dissection indicates obstruction of the airway and requires that the nurse report it immediately to the physician

Question 50

A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:

Accepted Answer

Proton pump inhibitors.  Proton pump inhibitors are the strongest inhibitors of acid secretions. The H2-receptor antagonists are the next most powerful.

Question 51

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply.

Accepted Answer

Avoid beer, especially in the evening.  Elevate the head of the bed on 6- to 8-inch blocks.  Elevate the upper body on pillows.

Question 52

A client is preparing for discharge to home, following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?

Accepted Answer

Slows gastric emptying  Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.

Question 53

Which of the following is an inaccurate clinical manifestation associated with hemorrhage?

Accepted Answer

Bradycardia  Hemorrhage may occur from carotid artery rupture as a result of necrosis of the graft or damage to the artery itself from tumor or infection. Tachycardia, tachypnea, and hypotension may indicate hemorrhage and impending hypovolemic shock.

Question 54

A patient comes to the clinic complaining of a sore throat. When assessing the patient, the nurse observes a reddened ulcerated lesion on the lip. The patient tells the nurse that it has been there for a couple of weeks but it does not hurt. What should the nurse consult with the physician about testing for?

Accepted Answer

Syphilis  The primary lesion of syphilis is a chancre, which is a reddened circumscribed lesion that ulcerates and becomes crusted.

Question 55

A client has been receiving radiation therapy to the lungs and now has erythema, edema, and pain of the mouth. The nurse instructs the client to

Accepted Answer

Brush and floss daily.  The description of erythema, edema, and pain of the mouth following radiation treatment describes stomatitis. Nursing considerations include prophylactic mouth care such as brushing and flossing daily. A soft-bristled toothbrush is recommended. The client is to avoid alcohol-based mouth rinses and hot or spicy foods that may be part of the client\'s usual diet.

Question 56

A client with cancer has a neck dissection and laryngectomy. An intervention that the nurse will do is:

Accepted Answer

Make a notation on the call light system that the client cannot speak.

Question 57

Amanda Ford, a 53-year-old actress, is being seen by a physician in your oncology group for a diagnosis of oral cancer. She is in the initial stages of diagnosis and is frightened about the side effects of treatment and subsequent prognosis. She also has many questions regarding the type of cancer she has been diagnosed with and asks where oral cancer typically occurs. What is your response?

Accepted Answer

Floor of the mouth

Question 58

Which of the following is the most common symptom of gastrointestinal (GI) problems in general?

Accepted Answer

Nausea

Question 59

Which of the following are functions of saliva? Select all that apply.

Accepted Answer

Lubrication  Protection against harmful bacteria  Digestion

Question 60

A client with esophageal cancer has difficulty in swallowing. Which of the following would be appropriate to help the client achieve improved nutrition?

Accepted Answer

Give high-protein, semiliquid foods  A major goal for a client with esophageal cancer is adequate or improved nutrition and eventually stable weight. Because he has difficulty in swallowing, the nurse should ensure that the client receives soft foods or high-calorie, high-protein, semiliquid foods to get improved nutrition. Providing oral liquids alone will not provide improved nutrition. Using a straw leads to bloating and should be avoided. Providing liquid supplements are used in between meals, not as meals. Encouraging small, frequent meals will give improved nutrition to a client who does not have any difficulty in swallowing.

Question 61

A client with peptic ulcer disease complains of sharp mid-epigastric pain. Which assessment finding is most important to the care of this client?

Accepted Answer

Rigid abdomen  Sudden sharp mid-epigastric pain and abdominal rigidity are symptoms of perforation and needs immediate intervention. Pain relieved with food only to return an hour later is typical of peptic ulcer disease. Explosive diarrhea without further symptoms bears attention but not immediate.

Question 62

A patient has been taking a 10-day course of antibiotics for pneumonia. The patient has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the patient about?

Accepted Answer

Nystatin (Mycostatin)  Candidiasis is a fungal infection that results in a cheesy white plaque in the mouth that looks like milk curds. It commonly occurs in antibiotic therapy. Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed.

Question 63

A patient has undergone a radical neck dissection. His skin graft site is pale. This indicates which of the following conditions?

Accepted Answer

Arterial thrombosis  A pale graft indicates arterial thrombosis. A cyanotic, cool graft indicates possible necrosis. A purple graft indicates venous congestion.

Question 64

The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department for chest pain. The client was diagnosed as having gastroesophageal reflux disease. The nurse notes in the client\'s record that the client is taking carbidopa/levodopa (Sinemet). The nurse questions the physician\'s order for

Accepted Answer

metoclopramide  The instructions are appropriate for the client experiencing gastroesophageal reflux disease. The client is prescribed carbidopa/levodopa, which is used for Parkinson\'s disease. Metoclopramide can have extrapyramidal effects, and these effects can be increased in clients with Parkinson\'s disease.

CH 46 – ORAL/ESOPH DISORDERS – Flashcards

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