Deck 30: Management of Clients with Ingestive Disorders

Question 1

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

A) bread.
B) carbonated beverages.
C) mashed potatoes.
D) saliva.

Answer 1

bread.

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

A) the client's educational needs are so extensive.
B) many esophageal cancer clients feel they do not receive adequate information.
C) postoperative recovery and rehabilitation take commitment from the client.
D) successful treatment for esophageal cancer takes multiple procedures.

Answer 2

many esophageal cancer clients feel they do not receive adequate information.

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

A) application of a Hemovac.
B) drainage from a T tube.
C) insertion of a Blakemore tube.
D) presence of closed-chest drainage.

Answer 3

presence of closed-chest drainage.

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

A) classic manifestations of a myocardial infarction, and the physician should be paged immediately.
B) greatly influenced by fear related to the location of the pain, and the use of NTG should be discouraged.
C) indications that a thorough pain assessment should be done to determine the etiology of the pain, and the NTG should be given at once.
D) specifically associated with GERD and not myocardial infarction, but the NTG should be allowed if the client wants to use it.

Question 5

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

A) assist with body image issues.
B) maintain a patent airway.
C) monitor for hemorrhage.
D) provide analgesia.

Question 6

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

A) herpes simplex infection.
B) oral cancer.
C) periodontal disease.
D) stomatitis.

Question 7

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

A) ask the physician to discontinue the diuretics.
B) discontinue the use of dental floss.
C) encourage the client to suck sugarless candy.
D) restrict oral fluids.

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

A) "It will be painful to eat for some time."
B) "Often clients lose their sense of taste following surgery."
C) "The capacity of your mouth will be smaller."
D) "You may have difficulty feeling the food in your mouth."

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

A) assess oxygenation status by checking pulse oximetry and lung sounds.
B) call the physician and anticipate an order for an electrocardiogram (ECG).
C) have the client rate the pain and then administer the ordered pain medication.
D) remove the oral packing to assess the surgical incision.

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

A) cancer risk.
B) discomfort.
C) infection.
D) purulent secretions.

Question 11

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

A) aspiration.
B) coughing.
C) dysphagia.
D) vomiting.

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

A) a commercial mouthwash.
B) Dakin's solution.
C) half-strength peroxide.
D) saline mouth rinses.

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

A) administering analgesics before meals.
B) increasing the time interval between oral care and mealtime.
C) regularly suctioning secretions from the mouth.
D) teaching the client to avoid putting food directly on the suture site.

Question 14

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

A) dulled taste.
B) intermittent difficulty with swallowing.
C) knife-like pain.
D) throbbing sensations in the throat.

Question 15

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

A) decay.
B) headaches.
C) loose teeth.
D) pain.

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

A) begin a reducing diet.
B) eat foods with a dry consistency.
C) sleep with the head of the bed elevated.
D) take aspirin before going to sleep.

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?

A) Avoid fluoride rinses.
B) Brush and floss regularly.
C) Eliminate carbonated beverages.
D) See the dentist once a year.

Question 18

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

A) "Any fever should be reported immediately."
B) "I will use a board under my mattress."
C) "I'm going to sleep on several pillows."
D) "It is OK to fall asleep in a chair."

Question 19

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

A) eating foods high in sodium.
B) heavy consumption of coffee daily.
C) long-term sedentary lifestyle.
D) very-high-fiber diet.

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?

A) Arrange a social worker and home health care consult.
B) Be sure to give the client written discharge instructions.
C) Make follow-up appointments for the client and provide physician phone numbers.
D) Review the teaching about caring for the tracheostomy.

Question 21

The nursing instruction that would be included in a client's teaching plan to prevent or delay the development of hiatal hernia is

A) avoid drinking carbonated beverages rapidly.
B) avoid heavy lifting and stooping.
C) consume a high-carbohydrate, low-fat diet.
D) sit in an upright position in a straight-backed chair.

Question 22

A client has undergone radiation therapy to reduce the size of an esophageal tumor. The nurse should be especially vigilant in assessing for

A) prolonged epistaxis.
B) sudden onset of diarrhea.
C) esophageal stenosis.
D) projectile vomiting.

Question 23

Metoclopramide (Reglan) is prescribed for a client with GERD. The nurse realizes that teaching about this drug has been effective when the client says "I understand metoclopramide

A) acts as an antacid to reduce gastric acidity."
B) decreases the time food and fluids are in my stomach."
C) has a local anesthetic effect on the esophagus and stomach."
D) helps to promote movement in the esophagus."

Question 24

For a client with diverticula of the esophagus, the nurse would tell the client to avoid

A) deep-breathing exercises after meals.
B) ingestion of carbonated drinks.
C) sleeping with the head of the bed elevated.
D) vigorous exercise after eating.

Question 25

A nurse is conducting smoking cessation clinics and educates the clients they should report which finding in their mouths to their physicians immediately?

A) A patch that is red and has a velvety appearance
B) Elevated yellow-white lesions with a roughened, leathery appearance
C) Lesions that look like milk curds and adhere firmly to tissue
D) Multiple, concave, ulcer-like lesions

Question 26

A client with a rolling hiatal hernia complains of a feeling of fullness after eating and difficulty breathing. When the client says, "I think I should lie down for awhile," the nurse should remind the client

A) that arching the back while lying down will reduce the discomfort.
B) that lying down may increase the distress.
C) to drink milk or eat a small snack before lying down.
D) to lie on the left side for at least 15 minutes.

Question 27

The nurse is conducting secondary prevention measures for a group of clients who smoke. Screening is aimed at early diagnosis of

A) basal cell carcinoma.
B) hemangioma.
C) neurofibroma.
D) squamous cell carcinoma.

Question 28

A client has oral cancer and is scheduled for a radical neck dissection. The priority intervention to address this client's psychosocial needs is to

A) arrange a visit from someone who has recovered from this kind of operation.
B) be aware of the tendency to treat people who cannot talk like they are deaf.
C) keep the call light within reach and respond to the client's call light promptly.
D) provide an alternate means of communication like paper and pencil.

Question 29

During a health interview, the nurse informs a client with GERD that of all the drugs the client is presently taking, the drug that will aggravate the clinical manifestations of GERD is

A) digoxin (Lanoxin).
B) furosemide (Lasix).
C) rofecoxib (Vioxx).
D) theophylline (Theo-Dur).