Management of Patients With Oral and Esophageal Disorders

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Chapter 35: (prep)(me)

Cardiac complications, which may occur following resection of an esophageal tumor, are associated with irritation of which nerve at the time of surgery?

a) Vagus
b) Hypoglossal
c) Vestibulocochlear
d) Trigeminal

Vagus

Explanation: Cardiac complications include atrial fibrillation, which occurs due to irritation of the vagus nerve at the time of surgery. The hypoglossal nerve controls muscles of the tongue. The vestibulocochlear nerve functions in hearing and balance. The trigeminal nerve functions in chewing of food.

When caring for a client with the nursing diagnosis Impaired swallowing related to neuromuscular impairment, the nurse should:

a) encourage thin liquids for dietary intake.
b) encourage the client to remove dentures.
c) place the client in a supine position.
d) elevate the head of the bed 90 degrees during meals.

elevate the head of the bed 90 degrees during meals.

Explanation: The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent position — not a supine position — when lying down to reduce the risk of aspiration. The nurse should encourage the client to wear properly fitted dentures to enhance his chewing ability. Thick liquids — not thin — decrease the risk of aspiration.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

a) The client has normal gastric structures.
b) The client is free from esophagitis and achalasia.
c) The client reports diminished duodenal inflammation.
d) The client doesn't exhibit rectal tenesmus

The client is free from esophagitis and achalasia.

Explanation: Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

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:

a) maintaining a patent airway.
b) preventing injury.
c) helping the client cope with body image changes.
d) ensuring adequate nutrition.

Maintaining a patent airway.

Explanation: Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.

Cancer of the esophagus is most often diagnosed by which of the following?

a) Barium swallow
b) Fluoroscopy
c) X-ray
d) Esophagogastroduodenoscopy (EGD) with biopsy and brushings

Esophagogastroduodenoscopy (EGD) with biopsy and brushings

Explanation: Currently, diagnosis is confirmed most often by EGD with biopsy and brushings. The biopsy can be used to determine the presence of disease and cell differentiation. X-ray, barium swallow, and fluoroscopy are used in the diagnosis of hiatal hernia.

Which of the following is the primary symptom of achalasia?

a) Difficulty swallowing
b) Heartburn
c) Chest pain
d) Pulmonary symptoms

Difficulty swallowing

Explanation: The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

Which of the following is the most common symptom of gastrointestinal (GI) problems in general?

a) Dysphagia
b) Odynophagia
c) Vomiting
d) Nausea

Nausea

Explanation: Nausea is the most common symptoms of GI problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing. Odynophagia refers to acute pain on swallowing.

A group of students is reviewing the medications that may be used to treat esophageal reflux. The students demonstrate understanding of the information when they identify which of the following as an example of a proton-pump inhibitor?

a) Ranitidine (Zantac)
b) Sucralfate (Carafate)
c) Cisapride (Propulsid)
d) Omeprazole (Prilosec)

Omeprazole (Prilosec)

Explanation: Proton-pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid). Ranitidine (Zantac) is a histamine-2 antagonist; sucralfate (Carafate) is a cytoprotective agent; cisapride (Propulsid) is a gastrointestinal motility agent.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

a) "I'll eat frequent, small, bland meals that are high in fiber."
b) "I'll lie down immediately after a meal."
c) "I'll gradually increase the amount of heavy lifting I do."
d) "I'll eat three large meals every day without any food restrictions."

"I'll eat frequent, small, bland meals that are high in fiber."

Explanation: In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

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?

a) Uncontrolled rhythmic movements of the face or limbs
b) Anxiety or irritability
c) Excessive drowsiness
d) Dry mouth not relieved by sugar-free hard candy

Uncontrolled rhythmic movements of the face or limbs

Explanation: Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

a) "Avoid coffee and alcoholic beverages."
b) "Limit fluid intake with meals."
c) "Lie down after meals to promote digestion."
d) "Take antacids with meals."

"Avoid coffee and alcoholic beverages."

Explanation: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying?

a) Nizatidine (Axid)
b) Famotidine (Pepcid)
c) Esomeprazole (Nexium)
d) Metoclopramide (Reglan)

Metoclopramide (Reglan)

Explanation: Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

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?

a) Take long, slow breaths
b) Pant like a dog
c) Bear down as if having a bowel movement
d) Hold his breath

Take long, slow breaths

Explanation: During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

Which of the following is an accurate statement regarding cancer of the esophagus?

a) It is three times more common in women in the U.S. than men.
b) Chronic irritation of the esophagus is a known risk factor.
c) It is seen more frequently in Caucasian Americans than in African Americans.
d) It usually occurs in the fourth decade of life.

Chronic irritation of the esophagus is a known risk factor.

Explanation: In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life.

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:

a) helping the client cope with body image changes.
b) preventing injury.
c) maintaining a patent airway.
d) ensuring adequate nutrition.

maintaining a patent airway.

Explanation: Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.

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