Chapter 56: Care of Patients with Oral Cavity Problems Nursing School Test Banks

Chapter 56: Care of Patients with Oral Cavity Problems

Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a client who is being discharged following surgery for oral cancer. Which sign is the client instructed to watch for that indicates possible metastasis of the cancer?

a.

Fragile gums that bleed easily

b.

White patches on the tongue and the back of the throat

c.

Painful ulcerated lesions on the gums or inside of the cheek

d.

Small hard lumps on the side of the neck or under the chin

ANS: D

Cervical lymph nodes that become hardened, enlarged, and fixed in position are indications of metastatic disease. An older adult or a client with a dry mouth may develop fragile gums that bleed easily. White patches on the tongue and the back of throat could be leukoplakiaprecancerous lesions that are normally benign. Stomatitis or inflammation of the oral cavity can lead to fragile gums, white patches (candidiasis), and painful open sores throughout the oral cavity, but these conditions are not cancerous.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Implementation)

2. The nurse is caring for a female client who has just undergone excision of a parotid gland tumor. The client tells the nurse that she is experiencing facial weakness on the operative side. Which is the nurses best response?

a.

You may be experiencing a slight stroke, and I will notify the doctor.

b.

This is a temporary condition that will resolve once radiation treatment is begun.

c.

You are experiencing weakness because the facial nerve was irritated during the surgery.

d.

You probably have a pinched nerve after lying on the operating room table for so long.

ANS: C

Cranial nerve V involvement is a possible outcome of this type of surgery. The client presents with facial weakness and possibly with loss of sensation to the affected side. The other choices regarding facial weakness following this type of surgery are not accurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

3. The nurse is caring for a client who is receiving radiation therapy for treatment of oral cancer. The client reports a constant dry mouth. Which is the nurses best response?

a.

Massage the area just over the lower jaw twice a day.

b.

Use lemon and glycerin swabs to clean your mouth and help keep it moist.

c.

Suck on lemon slices to help increase saliva production.

d.

Rinse your mouth out often with warm saline or sodium bicarbonate solution.

ANS: D

Clients should avoid agents that can irritate the oral mucosa and should keep their mouth moist with frequent rinses of warm saline or sodium bicarbonate solution. Massage is recommended only for acute sialadenitisinflammation of a salivary gland. Lemon slices and lemon and glycerin swabs are acidic and can further dry the mucosa, causing a burning sensation. The use of lemon slices after radiation therapy is discontinued may promote saliva production.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1197

TOP: Client Needs Category: Physiological Integrity (Basic Care and ComfortNon-Pharmacological Comfort Interventions)

MSC: Integrated Process: Nursing Process (Implementation)

4. The nurse is caring for a client who has just received a diagnosis of advanced oral cancer and has learned that a glossectomy with jaw resection will have to be scheduled. The client states to the nurse, I would rather die than have half of my face removed. My life is over. Which is the best description of the clients response to the diagnosis?

a.

Refusal of any more treatment

b.

Grief over the diagnosis

c.

Acceptance of the diagnosis

d.

Denial about the diagnosis

ANS: B

The client is grieving the loss of his health and present appearance. Because the client has just learned of the diagnosis and treatment, the client is reacting in a negative way. This behavior demonstrates grief, not necessarily refusal of treatment, nor denial or acceptance of the diagnosis.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1200

TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)

MSC: Integrated Process: Nursing Process (Assessment)

5. The nurse is caring for a client who has just received a diagnosis of advanced oral cancer that will require extensive surgery. Which statement by the client indicates that the diagnosis is accepted?

a.

The biopsy test results will be confirmed again next week.

b.

Of all the bad things to happen to me, now I have cancer on top of it all.

c.

If I can live long enough to see my son get married, everything will be alright.

d.

I dont like it, but I have cancer and thats the way it is.

ANS: D

The client has accepted the diagnosis. He is not happy about it but has acknowledged the reality of the situation. The other responses indicate denial, anger, or bargaining responses to the diagnosis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms)

MSC: Integrated Process: Nursing Process (Assessment)

6. The nurse is caring for a client who just had a radical jaw and neck resection. The nurse is developing a teaching plan for the client and spouse about care after discharge from the hospital. Which is an effective teaching objective for this client and spouse?

a.

The clients spouse will be able to change the clients tracheostomy ties correctly after three teaching sessions.

b.

The client and spouse will verbalize the signs of readiness for oral feedings following placement of the tracheostomy.

c.

The clients spouse will correctly administer the clients tube feedings twice daily.

d.

The client and spouse will understand incision care and the importance of infection prevention.

ANS: A

The objective is action oriented, specific, achievable, and measurable. The other responses are not as clear and measurable.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

7. The nurse is caring for a client who just had a radical jaw and neck resection for oral cancer. The nurse has just completed teaching for the spouse and client about tracheostomy care. Which notation in the clients chart is the most accurate documentation of the teaching that occurred?

a.

The client and spouse were instructed regarding management of mucous plugs and thick secretions.

b.

Information about home oxygen therapy and equipment was provided for the client and spouse.

c.

The client and spouse were shown how to suction the tracheostomy and change the ties.

d.

Correct suctioning procedure was demonstrated, and the clients spouse verbalized two instances when suctioning needs to occur.

ANS: D

The documentation should include teaching actions, as well as the spouses response to the instructions. The other choices do not indicate the response by the client and spouse to the teaching. A return demonstration would be beneficial.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Nursing Process (Evaluation)

8. The nurse is caring for a client who will be going home after a radical jaw and neck resection. The clients spouse will be the primary caregiver at home and will need to care for the clients feeding tube and tracheostomy. Which skill is the highest priority for the nurse to teach the clients spouse before discharge from the hospital?

a.

Monitoring the incision lines for infection or leakage of saliva

b.

Assessing the client for readiness to resume oral feedings

c.

Cleaning the tracheostomy and suctioning as needed

d.

Administering tube feedings and cleaning the feeding tube site

ANS: C

Maintaining a patent airway is the highest priority for this client and spouse. The other responses are next in importance because they reflect needed knowledge regarding infection control and knowledge of proper technique for nutritional support of the client.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

9. The spouse of a client has just completed tracheostomy care for the first time, with minimal assistance from the nurse. Which statement offers the most constructive feedback from the nurse?

a.

I see that you had a tough time, but you will do better with practice.

b.

You were able to clean the inner cannula well. Now, lets change the ties again.

c.

You seem to have had a tough time because it was your first attempt.

d.

You seem to understand what I said. Is there anything else I can help you with?

ANS: B

The statement that provides the most positive feedback concerns what the clients spouse did well and identifies a skill that needs more practice. The other responses by the nurse give negative overtones to the teaching environment and do not empower the spouse.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Nursing Process (Evaluation)

10. The nurse is caring for a client who has just completed treatment for basal cell carcinoma on the lower lip. The client says to the nurse, Cigarettes are ruining my life. Ill do anything to quit smoking. Which is the nurses best response?

a.

Here is some information about smoking cessation programs in the area. Lets discuss the options.

b.

Here are some pamphlets that show the financial benefits of quitting smoking.

c.

If you quit smoking, your risk for developing cancer again will decrease dramatically.

d.

Your chest x-ray is still clear, so you could prevent permanent lung damage if you quit smoking now.

ANS: A

The client has indicated a readiness to quit smoking; therefore, the nurse should help the client choose the best course of action by taking time to discuss the options. The other responses provide good rationales for why quitting smoking would be a positive outcome, but no help is being offered in preparing a plan to quit.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Behavioral Interventions)

MSC: Integrated Process: Nursing Process (Planning)

11. The nurse is leading a teaching session about methods to decrease the risk of mouth cancer. Which client statement indicates that the nurse was successful in teaching the information?

a.

I will chew tobacco rather than smoke it.

b.

I will use sugar rather than artificial sweeteners.

c.

I will regularly use a lip balm that contains sunscreen.

d.

I will use a tanning salon rather than sunbathing at the beach.

ANS: C

Lip balms that contain sunscreen can help prevent the development of oral cancer. The rest of the client choices can promote cancer, such as chewing tobacco and tanning. Using sugar rather than artificial sweeteners is not applicable to the risk of mouth cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Lifestyle Choices)

MSC: Integrated Process: Nursing Process (Evaluation)

12. The nurse is caring for a client who will be taking nystatin (Mycostatin) for treatment of oral candidiasis. Which instructions does the nurse provide for the client before administering the medication?

a.

Let the tablet dissolve slowly in your mouth.

b.

Take the medicine with a snack or a light meal.

c.

Swallow the pills whole, followed by a full glass of water.

d.

Swish the liquid around your mouth before swallowing it.

ANS: D

Mycostatin (nystatin) is a liquid medication that should be swished around the mouth for a minute before swallowing. The other responses do not reflect accurate administration of nystatin.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1195

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesMedication Administration) MSC: Integrated Process: Teaching/Learning

13. The nurse is caring for a client who has undergone a radical jaw and neck resection. The client tells the nurse that the area feels very swollen and painful. Which is the best intervention for the nurse to make this client more comfortable?

a.

Frequently suction the clients mouth and airway.

b.

Apply warm moist compresses to the area.

c.

Elevate the head of the clients bed to semi-Fowlers.

d.

Administer ibuprofen (Motrin) 600 mg every 6 hours around the clock.

ANS: C

Elevating the head of the bed will help to reduce edema by using gravity. Ibuprofen can affect blood clotting, leading to bleeding from the incisions. Intravenous morphine is a better choice than ibuprofen. Suctioning should be completed only when necessary because this will be uncomfortable. Moist compresses are used with salivary gland inflammation, not with postoperative radical jaw and neck resection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological IntegrityIllness Management)

MSC: Integrated Process: Nursing Process (Implementation)

14. The nurse is caring for a client who will be undergoing a radical jaw and throat resection for oral cancer. Which statement by the client indicates that further teaching is needed?

a.

I will have a temporary tracheostomy placed in my neck to help me breathe.

b.

I will not be able to get out of bed for 3 days after surgery.

c.

The doctor will put in a feeding tube for nutrition until I can swallow and eat.

d.

My speech may be slurred for a long time after the surgery.

ANS: B

Mobility should not be extensively limited. The client should not be on bedrest for 3 days. A temporary tracheostomy will be inserted to maintain a patent airway postoperatively. A nasogastric tube may be needed until oral nutrition can begin. Slurred speech is a common outcome if extensive resection has taken place and nerve damage has occurred.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Nursing Process (Evaluation)

15. The nurse is caring for a client who has just undergone surgery for oral cancer. What advice does the nurse give the client to assist in maintaining the airway?

a.

Limit your fluids to 3 cups of water a day.

b.

Take deep breaths, hold, then cough to mobilize any secretions.

c.

Lying flat in bed will be more comfortable for breathing.

d.

Usually suctioning is not needed after oral surgery.

ANS: B

Maintaining an airway after oral surgery is a priority. The client must be taught to deep breathe and mobilize the secretions by coughing effectively. The other responses are incorrect. Fluids should be increased, a semi-Fowlers or high Fowlers position should be maintained, and the client should be taught how to suction the oral cavity.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1197

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Implementation)

16. The nurse is caring for a client who has just undergone a partial glossectomy and partial mandibulectomy for oral cancer. Which is the highest priority for this client?

a.

Maintenance of the airway

b.

Ability to communicate

c.

Adequate body image

d.

Pain management

ANS: A

The priority problem for a client with oral cancer surgery is possible ineffective airway clearance. Airway obstruction can result from the presence of edema or secretions and could be life threatening. Communication is another problem postoperatively because of the tracheostomy tube, but a communication process should be established preoperatively. Emotional support should be given to help the client adjust to the new body image, and pain management should be maintained with IV medications.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention) MSC: Integrated Process: Nursing Process (Analysis)

17. The nurse is assessing a client during a routine physical examination. Which statement made by the client concerning the risk of oral cancer indicates that further teaching is needed?

a.

I will brush my teeth and floss regularly.

b.

I will begin a smoking cessation program.

c.

I can still use chewing tobacco since I stopped smoking.

d.

I will limit my intake of alcoholic beverages.

ANS: C

Tobacco in any form increases the risk of oral cancer. The client should be educated to eliminate all tobacco products. The other statements concerning brushing the teeth, flossing, smoking cessation, and decreasing alcohol intake are healthy choices to maintain good oral health.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Nursing Process (Evaluation)

18. The nurse is caring for a client with stomatitis. Which statement does the nurse include in teaching about oral care for this client?

a.

Rinse your mouth out twice a day with mouthwash.

b.

Clean your mouth frequently during the day with a gentle foam sponge.

c.

Use lemon-glycerin swabs to clean your mouth after meals and at bedtime.

d.

Suck on ice cubes to minimize the discomfort.

ANS: B

During painful, acute episodes of stomatitis, gentle mouth care using a gauze sponge dipped in warm normal saline or normal saline plus sodium bicarbonate is most appropriate. Commercial mouthwashes containing alcohol, acidic foods such as lemon-glycerin swabs, and techniques that may cause bleeding such as sucking on ice cubes should be avoided.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1194

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

MULTIPLE RESPONSE

1. The nurse is performing oral health screenings at a local community center. Which clients are at higher risk for developing oral cancer? (Select all that apply.)

a.

Female who has taken oral contraceptives for the last 4 years

b.

Adult client with a history of alcoholism

c.

Adult client who regularly eats spicy foods

d.

Middle-aged male who smokes a pipe

e.

Adult client who goes to a tanning salon weekly

f.

Client who frequently chews gum

ANS: B, D, E

Alcoholism (particularly with poor nutritional status), tobacco use, and exposure to the sun or tanning salons are all risk factors for the development of oral cancer. Oral contraceptives, spicy foods, and chewing gum are not high-risk activities for oral cancer.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1195

TOP: Client Needs Category: Health Promotion and Maintenance (High-Risk Behaviors)

MSC: Integrated Process: Nursing Process (Assessment)

2. The nurse is assessing a client with a salivary gland tumor for facial nerve involvement. Which movements does the nurse ask the client to perform? (Select all that apply.)

a.

Open the mouth wide.

b.

Raise the eyebrows.

c.

Smile or frown.

d.

Pucker the lips.

e.

Blow the nose.

f.

Puff out the cheeks.

ANS: B, C, D, F

With salivary gland tumors, close proximity to the facial nerve can cause damage to the nerve, which can be assessed by looking at the symmetric performance of certain movements such as raising the eyebrows, smiling, frowning, puckering the lips, and puffing out the cheeks. Opening the mouth widely or blowing the nose would not indicate any facial nerve involvement.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Nursing Process (Evaluation)

3. The nurse is caring for a client with stomatitis. Which items reported during the history of the client may contribute to the reoccurrence of this condition? (Select all that apply.)

a.

Drinking two glasses of wine nightly

b.

Smoking three cigarettes each day

c.

Vitamin A deficiency

d.

Drinking four cups of coffee daily

e.

Fruits and nuts as the mainstay of the diet

f.

Vitamin C deficiency

ANS: A, B, D, E

Stomatitis can result from irritants such as alcohol, smoking, caffeine, fruits, and nuts. Deficiencies in vitamin A or C do not seem to have any relationship to the development of stomatitis, but deficiency of vitamin B, folate, and iron has a relationship to stomatitis development.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Nursing Process (Assessment)

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