PrepU – Chapter 46: Management of Patients With Oral and Esophageal Disorders

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A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:
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Maintaining a patent airway.
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Which of the following is an accurate statement regarding cancer of the esophagus?
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Chronic irritation of the esophagus is a known risk factor.
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A client with esophageal cancer has difficulty in swallowing. Which of the following would be appropriate to help the client achieve improved nutrition?
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Give high-protein, semi-liquid foods.
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A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication can be safely administered for which condition?
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Gastroesophageal reflux disease (GERD)
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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?
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There are usually no symptoms.
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A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
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The client is free from esophagitis and achalasia.
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A client has a radical neck dissection to treat cancer of the neck. The nurse develops the care plan and includes all the following diagnoses. The nurse identifies the highest priority diagnosis as:
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Ineffective airway clearance related to obstruction by mucus.
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A patient is experiencing painful, inflamed, and swollen gums, and when brushing the teeth, the gums bleed. What common disease of the oral tissue does the nurse understand these symptoms indicate?
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Gingivitis
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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?
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Gastroesophageal reflux disease
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The most common symptom of esophageal disease is:
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Dysphagia
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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:
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A canker sore of the oral soft tissues.
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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?
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Take long, slow breaths
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To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?
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“Avoid coffee and alcoholic beverages.”
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Which of the following is the primary symptom of achalasia?
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Difficulty swallowing
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Immediate medical and nursing management is necessary for a patient who has ingested a corrosive substance and experienced a chemical burn. Select the first response.
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Maintain a patent airway.
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Cancer of the esophagus is most often diagnosed by which of the following?
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Esophagogastroduodenoscopy (EGD) with biopsy and brushings
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Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?
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Vagus
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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?
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Floor of the mouth
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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:
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Approximately 80 to 120 mL.
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The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a:
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Chancre
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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?
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Uncontrolled rhythmic movements of the face or limbs
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A patient has had a nasogastric tube decompression for 3 days and is scheduled for intestinal surgery in the morning. The nurse determines that this patient is at the greatest risk for
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Altered oral mucous membranes.
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An elderly patient is diagnosed with parotitis. The nurse is aware that this bacterial infection is most likely caused by:
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Staphylococcus aureus.
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A client with peptic ulcer disease is scheduled for a partial gastrectomy and vagotomy. The nurse understands the surgery will accomplish which of the following physiologic effects?
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Remove source of acid secretion.
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Regarding oral cancer, the nurse provides health teaching to inform the patient that:
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Many oral cancers produce no symptoms in the early stages.
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A patient with an esophageal disorder comes into the hospital with symptoms that include halitosis and a sour taste in the mouth. These symptoms are associated most directly with which of the following?
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Esophageal diverticula
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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):
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Protrusion of the upper stomach into the lower portion of the thorax.
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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:
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6
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Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland?
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Sialolithiasis
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A nurse is performing discharge teaching with a client who has been diagnosed with a temporomandibular joint disorder following reports of headaches and frequent dizziness. Which of the following would the nurse include in the discharge instructions? Select all that apply.
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– Ways to reduce stress – How to perform range-of-motion exercises – Directions for taking ibuprofen (Motrin) – Reminders to wear an intra-oral orthotic device
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Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?
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Weakness, diaphoresis, diarrhea 90 minutes after eating
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Postoperatively, a patient with a radical neck dissection should be placed in which position?
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Fowler’s
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Which of the following is one of the first clinical manifestations of esophageal cancer?
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Increasing difficulty is swallowing
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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?
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Notifying the physician
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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:
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Proton pump inhibitors.

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