Question 1

The nurse should anticipate that a client with mechanical obstruction of the esophagus would initially have difficulty swallowing

Accepted Answer

When an obstruction narrows the esophageal lumen, clients first experience dysphagia only with solid foods. Later, dysphagia becomes associated with semi-solid foods and liquids and finally their own saliva.

Question 2

A nurse is preparing a client for surgical resection of esophageal cancer to be followed by chemotherapy and radiation. The nurse plans teaching carefully for this client because

Accepted Answer

Clients often report a diminished quality of life after treatment for esophageal cancer. They also report not receiving enough information to make informed decisions about their treatment choices, and some say that they would have refused treatment if they knew what the recovery period would entail.

Question 3

The nurse planning a teaching program for a client about postoperative care after a thoracotomy approach to an esophagomyotomy would include information about

Accepted Answer

After an esophagomyotomy, the client may have a thoracotomy incision and chest tubes in place. The client may also have a nasogastric (NG) tube, gastrostomy tube, or PEG tube.

Question 4

A client admitted for evaluation of gastroesophageal reflux disease (GERD) begins to complain of severe "heartburn" in the chest that radiates to the jaw. The client asks for the nitroglycerin (NTG) tablets brought in from home. The nurse realizes that the clinical manifestations demonstrated by the client are

Accepted Answer

Responses to pain-relieving measures (e.g., NTG) help to differentiate between esophagitis and problems of cardiac origin (e.g., angina pectoris). If the nitroglycerin does relieve the pain, the physician should be notified because the patient indeed may be having a cardiac event.

Question 5

Priority nursing interventions for a client immediately after glossectomy include measures to

Accepted Answer

The most critical postoperative intervention in the client with any oral surgery, including glossectomy, is to maintain a patent airway. Airway can be threatened by edema and potential massive hemorrhage.

Question 6

The nurse encourages the client to obtain routine dental care because plaque formation can lead to

Accepted Answer

Periodontal disease is caused by plaque formation and bacterial colonization and results in gingival inflammation if not removed. Oral cancer, herpes infections, and stomatitis are not caused by lack of dental hygiene.

Question 7

The nurse caring for a client receiving diuretics who develops parotitis would

Accepted Answer

Interventions for clients receiving diuretics include (a) administering frequent oral hygiene to keep the bacterial count of the mouth low, (b) keeping the client well hydrated, and (c) suggesting that the client use sugarless hard candy or chew sugarless gum to stimulate secretions of the glands.

Question 8

A client who had extensive oral surgery 5 days earlier has the nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements related to altered oral mucosa and surgical procedure. The most appropriate caution by the nurse when the client resumes oral feedings is

Accepted Answer

The client should be cautioned about a decrease in sensation in the oral cavity after surgery. Postoperative pain should diminish, and sense of taste and mouth capacity are unchanged.

Question 9

A client has returned from an extensive excision of a malignant oral tumor. On assessment, the nurse finds the client sitting in a high-Fowler position and complaining of jaw pain. The patient is dusky in color, but vital signs are within normal limits. The priority action by the nurse at this time is to

Accepted Answer

After surgical excision of an oral tumor, clients may appear dusky because of venous congestion. The nurse needs to quickly ascertain if the dusky color is related to insufficient oxygenation by assessing lung sounds and pulse oximetry. Once normal oxygenation status is confirmed, the nurse can do a more detailed pain assessment and give pain medication.

Question 10

When developing the care plan for a client with leukoplakia, the nurse would focus interventions on the primary problem leukoplakia poses to the client, which is

Accepted Answer

Leukoplakia, a potentially precancerous, yellow-white or gray-white lesion, may occur in any region of the mouth. While leukoplakia may be caused from irritation to the oral mucous membranes, cancer risk is a higher-priority problem.

Question 11

The nurse would assess the client with an early mechanical obstruction of the esophagus for

Accepted Answer

The most common manifestation of esophageal disease is dysphagia (difficulty swallowing). First it begins with solid foods and then progresses to semi-solids and liquids, and finally the client is unable to swallow saliva. Aspiration, coughing, and vomiting can be associated with dysphagia, but dysphagia is the major manifestation of early mechanical obstruction.

Question 12

A client with oral Candidiasis has the nursing diagnosis Acute Pain related to altered oral mucous membrane and ulcerations. To rinse the mouth and provide comfort, the nurse should instruct the client to use

Accepted Answer

Rinsing the mouth with saline promotes comfort. Commercial mouthwashes often contain alcohol, which is drying. Dakin's solution is not used in the mouth. Peroxide at even half strength, might be uncomfortable to the client.

Question 13

The nurse caring for a client who has recently undergone oral surgery has made a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements related to oral pain and difficulty eating. The nursing intervention that would best assist the client to achieve the goal of maintaining weight is

Accepted Answer

Instruct the client to avoid putting food directly on the suture line. After meals the client should perform oral hygiene to remove particles that may cause problems with the incision.

Question 14

Reviewing a client's chart, the nurse finds that the client has odynophagia. The nurse questions the client about experience with

Accepted Answer

Pain that affects the esophageal mucosa and occurs with swallowing is called odynophagia. The client usually describes the pain as sharp, constricting, sticking, crushing, stabbing, or knife-like.

Question 15

The nurse should be aware that the dental problem most likely to cause a person with periodontitis to seek treatment is

Accepted Answer

In periodontitis the inflammation extends from the gums into the alveolar bone and periodontal ligament, destroying the supporting structures of the teeth. As a result, the teeth loosen and may require extraction.

Question 16

Recently a client has been diagnosed with achalasia and is bothered greatly by the substernal pain. The nurse should encourage the client to

Accepted Answer

To prevent nocturnal reflux of food, the client should sleep with the head of the bed elevated.

Question 17

A nurse is teaching a client about oral care. Which action should the nurse recommend that will most likely result in a reduction of dental caries?

Accepted Answer

Nurses should encourage clients to brush and floss regularly, eat a diet low in simple carbohydrates, use fluoride, and schedule regular (biannual) dentist visits.

Question 18

The statement made by a postoperative client after esophagomyotomy that indicates that the client has a misunderstanding about the discharge plan is

Accepted Answer

Clients who have undergone an esophagomyotomy should be instructed to sleep with the head of the bed elevated and to recognize manifestations of respiratory complications. The nurse should explain the manifestations of infection and esophageal perforation and instruct the client to notify the physician if any of these problems occur.

Question 19

The nurse should be mindful that the factor in a client's history most likely to result in esophageal reflux is

Accepted Answer

Risk factors for gastroesophageal reflux disease include obesity and weight gain, pregnancy, smoking, chewing tobacco, high-fat foods, theophylline, caffeine, chocolate, and high levels of estrogen and progesterone.

Question 20

A client is being dismissed after extensive surgery for oral cancer. Teaching goals have been met and the client seems to be coping well with the diagnosis and physical changes from the operation. Which intervention by the nurse would best meet anticipated client needs at home?

Accepted Answer

Clients recuperating at home from such extensive surgery usually need further support and home health care services because of their complex care requirements. One main role of the nurse is to coordinate care and arrange consultations with the appropriate personnel.

Quiz 30: Management of Clients with Ingestive Disorders