Med Surg 40

A nurse is providing oral care to a patient who is comatose. What action best addresses the patient's risk of tooth decay and plaque accumulation?

Irrigating the mouth using a syringe filled with a bacteriocidal mouthwash

Applying a water-soluble gel to the teeth and gums

Wiping the teeth and gums clean with a gauze pad

Brushing the patient's teeth with a toothbrush and small amount of toothpaste

Brushing the patient's teeth with a toothbrush and small amount of toothpaste

An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2°F and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?

Palpate the patient's parotid glands to detect swelling and tenderness.

Assess the temporomandibular joint for evidence of a malocclusion.

Test the integrity of cranial nerve XII by asking the patient to protrude the tongue.

Inspect the patient's gums for bleeding and hyperpigmentation.

Palpate the patient's parotid glands to detect swelling and tenderness.

A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patient's priority need at this time?

Emotional support from visitors and staff

An effective means of communicating with the nurse

Referral to a speech therapist

Dietary teaching focused on consistency of food and frequency of feedings

An effective means of communicating with the nurse

The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?

Avoid applying suction on or near the suture line.

Position patient on the non operative side with the head of the bed down.

Assess the patient's ability to perform self-suctioning.

Evaluate the patient's ability to swallow saliva and clear fluids.

Avoid applying suction on or near the suture line.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care?

The patient will require an upper endoscopy every 6 months to detect malignant changes.

Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.

Small amounts of blood are likely to be present in the stools and are not cause for concern.

Antacids may be discontinued when symptoms of heartburn subside.

The patient will require an upper endoscopy every 6 months to detect malignant changes.

The school nurse is planning a health fair for a group of fifth graders and dental health is one topic that the nurse plans to address. What would be most likely to increase the risk of tooth decay?

Organic fruit juice

Roasted nuts

Red meat that is high in fat

Cheddar cheese

Organic fruit juice

The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?

Dull pain radiating to the ears and teeth

Presence of a painless sore with raised edges

Areas of tenderness that make chewing difficult

Diffuse inflammation of the buccal mucosa

Presence of a painless sore with raised edges

A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?

Indicates acceptance of altered appearance and demonstrates positive self-image

Freely expresses needs and concerns related to postoperative pain management

Compensates effectively for alteration in ability to communicate related to dysarthria

Demonstrates effective stress management techniques to promote muscle relaxation

Indicates acceptance of altered appearance and demonstrates positive self-image

A patient has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the patient to describe what sign or symptom?

Burning pain on swallowing

Regurgitation of undigested food

Symptoms mimicking a heart attack

Chronic parotid abscesses

Regurgitation of undigested food

A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patient's plan of care. Why are patients who are ill at increased risk for developing dental caries?

Hormonal changes brought on by the stress response cause an acidic oral environment

Systemic infections frequently migrate to the teeth

Hydration that is received intravenously lacks fluoride

Inadequate nutrition and decreased saliva production can cause cavities

Inadequate nutrition and decreased saliva production can cause cavities

A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer?

A 65-year-old man with alcoholism who smokes

A 45-year-old woman who has type 1 diabetes and who wears dentures

A 32-year-old man who is obese and uses smokeless tobacco

A 57-year-old man with GERD and dental caries

A 65-year-old man with alcoholism who smokes

A nurse is caring for a patient who has undergone neck resection with a radial forearm free flap. The nurse's most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse's most appropriate action?

Document the findings as being consistent with a viable graft.

Promptly report these indications of venous congestion.

Closely monitor the patient and reassess in 30 minutes.

Reposition the patient to promote peripheral circulation.

Promptly report these indications of venous congestion.

A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?

Assess ability to clear oral secretions.

Assess for signs of infection.

Assess for a patent airway.

Assess for ability to communicate.

Assess for a patent airway.

A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patient's care?

Risk for Aspiration Related to Inhalation of Gastric Contents

Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired Absorption

Risk for Decreased Cardiac Output Related to Vasovagal Response

Risk for Impaired Verbal Communication Related to Oral Trauma

Risk for Aspiration Related to Inhalation of Gastric Contents

A nurse is providing health promotion education to a patient diagnosed with an esophagus reflux disorder. What practice should the nurse encouraged patient to implement?

Keep the head of the bed lowered.

Drinka cup of hot tea before bedtime.

Avoid carbonated drinks.

Eat a low-protein diet.

Avoid carbonated drinks.

A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?

Pyloric sphincter

Lower esophageal sphincter

Hypopharyngeal sphincter

Upper esophageal sphincter

Lower esophageal sphincter

A patient who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this patient include?

Muscle training to relieve dysphagia

Relieving nerve paralysis in the cervical plexus

Promoting maximum shoulder function

Alleviating achalasia by decreasing esophageal peristalsis

Promoting maximum shoulder function

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?

Promotion of a nutrient-dense, low-fat diet

Annual screening endoscopy for patients over 50 with a family history of esophageal cancer

Early diagnosis and treatment of gastroesophageal reflux disease

Adequate fluid intake and avoidance of spicy foods

Early diagnosis and treatment of gastroesophageal reflux disease

An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?

Haloperidol

Prostigmine

Epinephrine

Glucagon

Glucagon

A nurse in an oral surgery practice is working with a patient scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend which of the following actions?

Rinse the mouth with alcohol before bedtime for the next 7 days.

Use warm saline to rinse the mouth as needed.

Brush around the area with a firm toothbrush to prevent infection.

Use a toothpick to dislodge any debris that gets lodged in the socket.

Use warm saline to rinse the mouth as needed.

A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?

Radiation therapy often results in secondary brain tumors.

Surgical complications are exceedingly common.

Diagnosis rarely occurs until the cancer is endstage.

Metastases are common and respond poorly to treatment.

Metastases are common and respond poorly to treatment.

A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient?

Placing the patient in a left lateral position

Administering opioids as ordered

Placing the patient in Fowler's position

Teaching the patient to use the patient-controlled analgesia (PCA) system

Placing the patient in Fowler's position

A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis?

Ineffective Tissue Perfusion

Impaired Skin Integrity

Aspiration

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements

A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patient's discharge education?

Resumption of activities of daily living

Pain control

Promotion of adequate nutrition

Strategies for promoting communication

Promotion of adequate nutrition

A radial graft is planned in the treatment of a patient's oropharyngeal cancer. In order to ensure that the surgery will be successful, the care team must perform what assessment prior to surgery?

Assessing function of cranial nerves V, VI, and IX

Assessing for a history of GERD

Assessing for signs or symptoms of atherosclerosis

Assessing the patency of the ulnar artery

Assessing the patency of the ulnar artery

A nurse is caring for a patient who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the patient and notes the presence of high-pitched adventitious sounds over the patient's trachea on auscultation. The patient's oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse's most appropriate action?

Encourage the patient to perform deep breathing and coughing exercises hourly.

Reposition the patient into a prone or semi-Fowler's position and apply supplementary oxygen by nasal cannula.

Activate the emergency response system.

Report this finding promptly to the physician and remain with the patient.

Report this finding promptly to the physician and remain with the patient.

A nurse is caring for a patient who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this patient, what would the nurse be sure to include?

Increasing calcium intake to promote bone healing

Avoiding chewing food for the specified number of weeks after surgery

Techniques for managing parenteral nutrition in the home setting

Techniques for managing a gastrostomy

Avoiding chewing food for the specified number of weeks after surgery

A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis?

A patient who is receiving intravenous antibiotic therapy in the home setting

A patient who has a chronic venous ulcer

An older adult whose medication regimen includes an anticholinergic

A patient with poorly controlled diabetes who receives weekly wound care

An older adult whose medication regimen includes an anticholinergic

A nurse is providing care for a patient whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis?

Risk for Disuse Syndrome

Unilateral Neglect

Risk for Trauma

Ineffective Tissue Perfusion

Ineffective Tissue Perfusion

A patient's neck dissection surgery resulted in damage to the patient's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize?

The patient's swallowing ability

The patient's ability to speak

The patient's management of secretions

The patient's airway patency

The patient's swallowing ability

A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. Which of the following should be included in the patient's immediate postoperative plan of care?

Teaching the patient to self-suction

Performing chest physiotherapy to promote oxygenation

Positioning the patient to prevent gastric reflux

Providing a regular diet as tolerated

Positioning the patient to prevent gastric reflux

A patient has received treatment for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status?

Ensure that none of the patient's visitors has an infection.

Arrange for a diet that is high in protein and low in fat.

Administer colony stimulating factors (CFs) as ordered.

Prepare to administer chemotherapeutics as ordered.

Ensure that none of the patient's visitors has an infection.

A nurse is caring for a patient who has had surgery for oral cancer. When addressing the patient's long-term needs, the nurse should prioritize interventions and referrals with What goal?

Enhancement of verbal communication

Enhancement of immune function

Maintenance of adequate social support

Maintenance of fluid balance

Enhancement of verbal communication

A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this patient?

Presence of acute pain and anxiety

Tissue integrity and color of the operative site

Respiratory status and airway clearance

Self-esteem and body image

Respiratory status and airway clearance

A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what?

Presence of small blood clots in the drainage

60 mL of milky or cloudy drainage

Spots of drainage on the dressings surrounding the drain

120 mL of serosanguinous drainage

60 mL of milky or cloudy drainage

A nurse is caring for a patient who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the patient's appetite?

Encourage the family to bring in the patient's favored foods.

Limit visitors at mealtimes so that the patient is not distracted.

Avoid offering food unless the patient initiates.

Provide thorough oral care immediately after the patient eats.

Encourage the family to bring in the patient's favored foods.

A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug?

Metoclopramide (Reglan)

Omeprazole (Prilosec)

Lansoprazole (Prevacid)

Famotidine (Pepcid)

Metoclopramide (Reglan)

Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patient's knowledge of this new diagnosis. Which of the following should the nurse encourage?

Eating several small meals daily rather than 3 larger meals

Keeping the head of the bed slightly elevated

Drinking carbonated mineral water rather than soft drinks

Avoiding food or fluid intake after 6:00 p.m.

Keeping the head of the bed slightly elevated

A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply.

Perforation into the mediastinum

Development of an esophageal lesion

Erosion into the great vessels

Painful swallowing

Obstruction of the esophagus

Perforation into the mediastinum

Erosion into the great vessels

Obstruction of the esophagus

A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?

" Drinking beverages after your meal, rather than with your meal, may bring some relief."

"It's best to avoid dry foods, such as rice and chicken, because they're harder to swallow."

"Many patients obtain relief by taking over-the-counter antacids 30 minutes before eating."

" Instead of eating three meals a day, try eating smaller amounts more often."

" Instead of eating three meals a day, try eating smaller amounts more often."