Brunner and Suddarth's Textbook of
Medical-surgical Nursing- Chapter 39
Multiple Choice
Chapter 39: Management of Patients with Oral and Esophageal Disorders
1. The nurse determines that a client who has undergone skin, tissue, and muscle
grafting following a modified radical neck dissection requires suctioning. What is the
nurse's priority when suctioning this client?
A. Avoid applying suction on or near the suture line.
B. Position client on the non-operative side with the head of the bed down.
C. Assess the client's ability to perform self-suctioning.
D. Evaluate the client's ability to swallow saliva and clear fluids. - answerA
Rationale: The nurse should avoid positioning the suction catheter on or near the graft
suture lines. Application of suction in these areas could damage the graft. Self-
sectioning may be unsafe because the client may damage the suture line. Following a
modified radical neck dissection with graft, the client is usually positioned with the head
of the bed elevated to promote drainage and reduce edema. Assessing the viability of
the graft is important but is not part of the suctioning procedure and may delay initiating
suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the client's
ability to swallow is an important assessment for the nurse to make; however, it is not
directly linked to the client's need for suctioning.
PTS: 1 REF: p. 1240
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
2. A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett
esophagus with minor cell changes. What principle should be integrated into the client's
subsequent care?
A. The client will be monitored closely to detect malignant changes.
B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause
hepatic damage.
C. Small amounts of blood are likely to be present in the stools and are not cause for
concern.
D. Antacids may be discontinued when symptoms of heartburn subside. - answerA
,Rationale: In the client with Barrett esophagus, the cells lining the lower esophagus
have undergone change and are no longer squamous cells. The altered cells are
considered precancerous and are a precursor to esophageal cancer, necessitating
close monitoring. H2 receptor antagonists are commonly prescribed for clients with
GERD; however, monitoring of liver enzymes is not routine. Stools that contain
evidence of frank bleeding or that are tarry are not expected and should be reported
immediately. When antacids are prescribed for clients with GERD, they should be taken
as prescribed whether or not the client is symptomatic.
PTS: 1 REF: p. 1257 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
3. A medical nurse who is caring for a client being discharged home after a radical neck
dissection has collaborated with the home health nurse to develop a plan of care for this
client. What is a priority psychosocial outcome for this client?
A. Indicates acceptance of altered appearance and demonstrates positive self-image
B. Freely expresses needs and concerns related to postoperative pain management
C. Compensates effectively for alteration in ability to communicate related to dysarthria
D. Demonstrates effective stress management techniques to promote muscle relaxation
- answerA
Rationale: Since radical neck dissection involves removal of the sternocleidomastoid
muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck,
the client's appearance is visibly altered. The face generally appears asymmetric, with a
visible neck depression; shoulder drop also occurs frequently. These changes have the
potential to negatively affect self-concept and body image. Facilitating adaptation to
these changes is a crucial component of nursing intervention. Clients who have had
head and neck surgery generally report less pain as compared with other postoperative
clients; however, the nurse must assess each individual client's level of pain and
response to analgesics. Clients may experience transient hoarseness following a radical
neck dissection; however, their ability to communicate is not permanently altered.
Stress management is beneficial but would not be considered the priority in this clinical
situation.
PTS: 1 REF: p. 1241 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Caring BLM: Cognitive Level: Apply
Multiple Choice
4. A client has been diagnosed with an esophageal diverticulum after undergoing
diagnostic imaging. When taking the health history, the nurse should expect the client to
describe what sign or symptom?
A. Burning pain on swallowing
, B. Regurgitation of undigested food
C. Symptoms mimicking a myocardial infarction
D. Chronic parotid abscesses - answerB
Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa
that protrudes through the esophageal musculature. Food becomes trapped in the
pouch and is frequently regurgitated when the client assumes a recumbent position.
The client may experience difficulty swallowing; however, burning pain is not a typical
finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid
abscesses are not associated with a diagnosis of esophageal diverticulum.
PTS: 1 REF: p. 1255
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
5. A nurse is caring for a client who is acutely ill and has included vigilant oral care in
the client's plan of care. What factor increases this client's risk for dental caries?
A. Hormonal changes brought on by the stress response cause an acidic oral
environment
B. Systemic infections frequently migrate to the teeth
C. Hydration that is received intravenously lacks fluoride
D. Inadequate nutrition and decreased saliva production can cause cavities - answerD
Rationale: Many ill clients do not eat adequate amounts of food and therefore produce
less saliva, which in turn reduces the natural cleaning of the teeth. Stress response is
not a factor, infections generally do not attack the enamel of the teeth, and the fluoride
level of the client is not significant in the development of dental caries in the ill client.
PTS: 1 REF: p. 1232
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
Multiple Choice
6. A nurse who provides care in an ambulatory clinic integrates basic cancer screening
into admission assessments. What client most likely faces the highest immediate risk of
oral cancer?
A. A 65-year-old man with alcoholism who smokes
B. A 45-year-old woman who has type 1 diabetes and who wears dentures
C. A 32-year-old man who is obese and uses smokeless tobacco
D. A 57-year-old man with GERD and dental caries - answerA
Medical-surgical Nursing- Chapter 39
Multiple Choice
Chapter 39: Management of Patients with Oral and Esophageal Disorders
1. The nurse determines that a client who has undergone skin, tissue, and muscle
grafting following a modified radical neck dissection requires suctioning. What is the
nurse's priority when suctioning this client?
A. Avoid applying suction on or near the suture line.
B. Position client on the non-operative side with the head of the bed down.
C. Assess the client's ability to perform self-suctioning.
D. Evaluate the client's ability to swallow saliva and clear fluids. - answerA
Rationale: The nurse should avoid positioning the suction catheter on or near the graft
suture lines. Application of suction in these areas could damage the graft. Self-
sectioning may be unsafe because the client may damage the suture line. Following a
modified radical neck dissection with graft, the client is usually positioned with the head
of the bed elevated to promote drainage and reduce edema. Assessing the viability of
the graft is important but is not part of the suctioning procedure and may delay initiating
suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the client's
ability to swallow is an important assessment for the nurse to make; however, it is not
directly linked to the client's need for suctioning.
PTS: 1 REF: p. 1240
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
2. A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett
esophagus with minor cell changes. What principle should be integrated into the client's
subsequent care?
A. The client will be monitored closely to detect malignant changes.
B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause
hepatic damage.
C. Small amounts of blood are likely to be present in the stools and are not cause for
concern.
D. Antacids may be discontinued when symptoms of heartburn subside. - answerA
,Rationale: In the client with Barrett esophagus, the cells lining the lower esophagus
have undergone change and are no longer squamous cells. The altered cells are
considered precancerous and are a precursor to esophageal cancer, necessitating
close monitoring. H2 receptor antagonists are commonly prescribed for clients with
GERD; however, monitoring of liver enzymes is not routine. Stools that contain
evidence of frank bleeding or that are tarry are not expected and should be reported
immediately. When antacids are prescribed for clients with GERD, they should be taken
as prescribed whether or not the client is symptomatic.
PTS: 1 REF: p. 1257 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
3. A medical nurse who is caring for a client being discharged home after a radical neck
dissection has collaborated with the home health nurse to develop a plan of care for this
client. What is a priority psychosocial outcome for this client?
A. Indicates acceptance of altered appearance and demonstrates positive self-image
B. Freely expresses needs and concerns related to postoperative pain management
C. Compensates effectively for alteration in ability to communicate related to dysarthria
D. Demonstrates effective stress management techniques to promote muscle relaxation
- answerA
Rationale: Since radical neck dissection involves removal of the sternocleidomastoid
muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck,
the client's appearance is visibly altered. The face generally appears asymmetric, with a
visible neck depression; shoulder drop also occurs frequently. These changes have the
potential to negatively affect self-concept and body image. Facilitating adaptation to
these changes is a crucial component of nursing intervention. Clients who have had
head and neck surgery generally report less pain as compared with other postoperative
clients; however, the nurse must assess each individual client's level of pain and
response to analgesics. Clients may experience transient hoarseness following a radical
neck dissection; however, their ability to communicate is not permanently altered.
Stress management is beneficial but would not be considered the priority in this clinical
situation.
PTS: 1 REF: p. 1241 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Caring BLM: Cognitive Level: Apply
Multiple Choice
4. A client has been diagnosed with an esophageal diverticulum after undergoing
diagnostic imaging. When taking the health history, the nurse should expect the client to
describe what sign or symptom?
A. Burning pain on swallowing
, B. Regurgitation of undigested food
C. Symptoms mimicking a myocardial infarction
D. Chronic parotid abscesses - answerB
Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa
that protrudes through the esophageal musculature. Food becomes trapped in the
pouch and is frequently regurgitated when the client assumes a recumbent position.
The client may experience difficulty swallowing; however, burning pain is not a typical
finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid
abscesses are not associated with a diagnosis of esophageal diverticulum.
PTS: 1 REF: p. 1255
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
5. A nurse is caring for a client who is acutely ill and has included vigilant oral care in
the client's plan of care. What factor increases this client's risk for dental caries?
A. Hormonal changes brought on by the stress response cause an acidic oral
environment
B. Systemic infections frequently migrate to the teeth
C. Hydration that is received intravenously lacks fluoride
D. Inadequate nutrition and decreased saliva production can cause cavities - answerD
Rationale: Many ill clients do not eat adequate amounts of food and therefore produce
less saliva, which in turn reduces the natural cleaning of the teeth. Stress response is
not a factor, infections generally do not attack the enamel of the teeth, and the fluoride
level of the client is not significant in the development of dental caries in the ill client.
PTS: 1 REF: p. 1232
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
Multiple Choice
6. A nurse who provides care in an ambulatory clinic integrates basic cancer screening
into admission assessments. What client most likely faces the highest immediate risk of
oral cancer?
A. A 65-year-old man with alcoholism who smokes
B. A 45-year-old woman who has type 1 diabetes and who wears dentures
C. A 32-year-old man who is obese and uses smokeless tobacco
D. A 57-year-old man with GERD and dental caries - answerA
