Chapter 30: Management of Clients with Ingestive Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 30: Management of Clients with Ingestive Disorders

MULTIPLE CHOICE

1. 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.

ANS: B

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

DIF: Comprehension/Understanding REF: p. 596 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

2. 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.

ANS: C

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.

DIF: Comprehension/Understanding REF: p. 596 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

3. 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.

ANS: C

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.

DIF: Comprehension/Understanding REF: p. 596 OBJ: Assessment

MSC: Physiologic Integrity Reduction of Risk Potential

4. 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.

Dakins solution.

c.

half-strength peroxide.

d.

saline mouth rinses.

ANS: D

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

DIF: Application/Applying REF: p. 598 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies

5. 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.

ANS: A

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.

DIF: Application/Applying REF: p. 598 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential

6. 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.

ANS: A

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.

DIF: Application/Applying REF: p. 602 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Referrals

7. 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.

ANS: D

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.

DIF: Application/Applying REF: p. 602 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

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.

ANS: D

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.

DIF: Analysis/Analyzing REF: p. 602 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

9. 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.

ANS: C

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.

DIF: Application/Applying REF: pp. 602-603 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation

10. 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.

ANS: B

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.

DIF: Analysis/Analyzing REF: p. 601 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

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

a.

aspiration.

b.

coughing.

c.

dysphagia.

d.

vomiting.

ANS: C

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.

DIF: Application/Applying REF: p. 603 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation

12. 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.

ANS: A

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.

DIF: Comprehension/Understanding REF: p. 603 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation

13. Reviewing a clients 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.

ANS: C

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.

DIF: Knowledge/Remembering REF: p. 604 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation

14. 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.

ANS: C

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

DIF: Application/Applying REF: p. 604 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation

15. 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.

ANS: A

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.

DIF: Analysis/Analyzing REF: p. 601 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

16. 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 clients 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.

ANS: B

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.

DIF: Synthesis/Creating REF: p. 617 OBJ: Intervention

MSC: Psychosocial Integrity Quality of Life

17. 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.

ANS: D

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.

DIF: Application/Applying REF: p. 607 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation

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.

Im going to sleep on several pillows.

d.

It is OK to fall asleep in a chair.

ANS: B

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.

DIF: Evaluation/Evaluating REF: p. 607 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation

19. The nurse should be mindful that the factor in a clients 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.

ANS: B

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.

DIF: Knowledge/Remembering REF: p. 609 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

20. 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.

ANS: C

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.

DIF: Analysis/Analyzing REF: p. 610 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapy-Expected Effects/Outcomes

21. 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.

ANS: B

Metoclopramide may be prescribed because it increases LES pressure by stimulating the smooth muscle of the gastrointestinal tract and increasing the rate of gastric emptying. It has no effect on gastric acidity, no anesthetic effects, and does not work in the esophagus.

DIF: Evaluation/Evaluating REF: p. 611 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

22. The nursing instruction that would be included in a clients 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.

ANS: B

Health promotion behaviors to prevent or at least delay a hiatal hernia include avoiding any activities that increase intra-abdominal pressure, such as heavy lifting and wearing constrictive clothing.

DIF: Application/Applying REF: p. 612 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

23. 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.

ANS: D

To prevent reflux of food, the client should have the head of the bed raised for 2 hours after meals. Nocturnal reflux can often be prevented by sleeping with the head of the bed elevated. The client should avoid constrictive clothes and vigorous exercise after eating.

DIF: Comprehension/Understanding REF: p. 614 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Health Alterations

24. 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.

ANS: C

Because high-dose radiation may cause stenosis of the esophagus, treatments are usually administered over 6 to 8 weeks.

DIF: Application/Applying REF: p. 616 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Health Alterations

25. A client has oral cancer and is scheduled for a radical neck dissection. The priority intervention to address this clients 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 clients call light promptly.

d.

provide an alternate means of communication like paper and pencil.

ANS: C

Clients who are rendered unable to speak by this surgical procedure are often fearful and anxious. Ensuring the client is able to signal for help and responding promptly will help diminish this anxiety. Once in the room with the client, use alternative means of communication to decrease frustration. Preferably, these methods were determined in advance of the operation. Visits from someone who has had this procedure and being aware of tendencies to treat people who cannot talk as if they are deaf are also good interventions, but not the priority.

DIF: Application/Applying REF: p. 602 OBJ: Intervention

MSC: Psychological Integrity Coping Mechanisms

26. 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.

ANS: D

Squamous cell carcinoma is the most common type of oral malignancy, accounting for about 95% of the cancers found on the tongue. Although common, hemangiomas and neurofibromas are benign. Smoking is the primary cause for all the lesions listed. Secondary prevention measures are those that provide screening and early diagnosis.

DIF: Application/Applying REF: p. 599 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Screening

27. 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).

ANS: D

Anticholinergic drugs, calcium-channel blockers, and theophylline should be avoided, if possible, because they delay gastric emptying and can initiate manifestations of GERD.

DIF: Comprehension/Understanding REF: p. 609 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies

28. 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.

ANS: B

A client with a rolling hiatal hernia will experience greater discomfort when lying down.

DIF: Application/Applying REF: p. 612 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

29. 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

ANS: A

Erythroplakias, which are frequently early squamous cell carcinomas, have a red, velvety appearance. These lesions are not well delineated and bleed easily. The yellow-white lesion is probably leukoplakia, a potentially precancerous lesion. Milk curd lesions are typical for candidiasis. The ulcer-like lesions is probably mucositis.

DIF: Analysis/Analyzing REF: p. 598 OBJ: Assessment

MSC: Health Promotion and Maintenance Health Screening

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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