Chapter 49: Concepts Of Care For Patients With Oral Cavity And Esophageal Problems Flashcards
When providing discharge teaching about mouth care, which substance will the nurse teach the client with oral cancer to avoid? Select all that apply.
A. Mouthwash
B. Lip lubricant
C. Warm saline rinses
D. Ultra-soft toothbrush
E. Disposable foam brushes
F. Bicarbonate mouth rinse
Correct Answers: A, E
Rationale: The nurse will teach the client with oral cancer to avoid mouthwash (alcohol can irritate mucous membranes), and disposable foam brushes (which do not control plaque, and dry the mouth). Lip lubricant, warm saline or bicarbonate rinses, and use of an ultra-soft toothbrush can be encourage.
A community health nurse is screening clients for esophageal cancer. Which client is identified at highest risk?
A. 22-year-old who drinks a glass of beer weekly.
B. 44-year-old who smokes a pack of cigarettes daily.
C. 50-year-old who takes over-the-counter omeprazole.
D. 63-year old who uses protein supplements regularly.
Correct Answer: B
Rationale: The nurse identifies the 44-year-old patient who smokes a pack of cigarettes daily as at the highest risk for developing esophageal cancer. Drinking a glass of beer weekly is not high consumption; taking over-the-counter omeprazole reflects treatment of GERD; and using protein supplements daily demonstrates addressing the possibility of malnutrition.
The nurse is caring for a client with esophageal cancer who is scheduled for surgery. When the client asks, “Is this treatment going to cure me?”, which is the appropriate nursing response? Select all that apply.
A. “The surgery has been useful for many patients so it should work for you.”
B. “You can beat this disease if you just put your mind to it and do not give up.”
C. “Yes, and you have the best surgeon around who specializes in cancer treatment.”
D. “Your surgeon can give more information about the effectiveness of this treatment.”
E. “It sounds like you are concerned about surgical outcomes; let’s talk about your feelings.”
Correct Answers: D, E
Rationale: The nurse will respond by addressing the client’s question, as well as the possible fear that accompanies it. The surgeon obtains informed consent and will share information about the evidence-based outcomes of the surgery (including whether a surgery is curative or palliative in nature); the nurse can witness the informed consent. The nurse will address the client’s emotions by verbalizing the implied (stating that it sounds like the client is concerned out the outcome) and asking if the client would like to talk. The nurse should not indicate that the surgery should work for the client since it worked for others, nor should the nurse give false hope by telling the client that they can beat the disease if they will themselves to do it. Although the client may be treated by a surgeon with a favorable reputation, it is not appropriate to answer “yes”, because this implies that the surgery will be curative in nature.
While undergoing radiation treatment for oral cancer, a client develops xerostomia. What collaborative resource does the nurse suggest for this client’s care?
A. Dentist
B. Occupational therapist
C. Speech therapist
D. Psychiatrist
CORRECT: A
Dentist
Xerostomia is the subjective feeling of oral dryness. It is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits.
A client with oral cancer who is to have a radical neck dissection reports being depressed. What is the nurse’s priority response?
A. Suggest seeking support from a community group.
B. Listen to the client’s concerns.
C. Explain the grieving process.
D. Reassure that it is normal to feel depressed about the diagnosis.
CORRECT: B
Listen to the client’s concerns.
The nurse’s priority response is to listen to the client and allow him or her to process feelings. After the client has processed feelings, he or she is more open to learning about the normalcy of feeling depressed about this diagnosis, understanding the grieving process, and considering referral to a community group of clients undergoing a similar experience.
Which practice does the nurse include when teaching a client about proper oral hygiene?
A. Perform self-examination of the mouth every week, and report any unusual findings.
B. Brush the teeth daily and floss as needed.
C. Wear dentures that fit a bit loosely for movement when chewing.
D. Use mouthwash with alcohol unless lesions are present.
CORRECT: A
Perform self-examination of the mouth every week, and report any unusual findings.
The nurse will teach the client that proper oral care involves self-examination of the mouth every week and to report any unusual findings to the Health Care Provider.
When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the assistive personnel (AP)?
A. Instruct how to use nystatin oral rinses.
B. Assist with making appropriate dietary choices that do not irritate tissues.
C. Provide oral care using a soft toothbrush.
D. Inspect the oral mucosa for evidence of oral candidiasis.
CORRECT: C
Provide oral care using a soft toothbrush.
Providing oral care using a soft toothbrush for a client with oral lesions is an appropriate assignment for an AP. Assessments, client teaching, and assisting clients with oral problems in making appropriate dietary choices are the responsibilities of licensed nursing staff.
The community nurse is discussing risk factors for esophageal cancer with a group of clients. Which client behavior requires further teaching?
A. Eats a small snack each night before bedtime.
B. Walks at the shopping mall three times weekly.
C. Smokes 1/3 of a pack of cigarettes daily.
D. Elevates pillows at night.
CORRECT: C
Smokes 1/3 of a pack of cigarettes daily.
Tobacco use is one of the primary risk factors for esophageal cancer. This client behavior requires teaching about lifestyle risks that could increase the risk for esophageal cancer.
The nurse is teaching a client how to maintain effective oral health. Which measure does the nurse include in the teaching plan? (Select all that apply.)
A. Regular dental checkups.
B. Eating a balanced diet.
C. Use of mouthwashes containing alcohol.
D. Managing stress as much as possible.
E. Ensuring that dentures are slightly loose-fitting.
CORRECT: A, B, D
Regular dental checkups.
Regular dental checkups are important, so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the client’s risk for infections such as Candida albicans. Eating a balanced diet can reduce the risk for dental caries and infections such as C. albicans or stomatitis. Mouthwashes that contain alcohol may irritate tissues and cause inflammation, and should be avoided. Dentures must be in good repair and need to fit properly, not loosely.
Eating a balanced diet.
Regular dental checkups are important, so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the client’s risk for infections such as Candida albicans. Eating a balanced diet can reduce the risk for dental caries and infections such as C. albicans or stomatitis. Mouthwashes that contain alcohol may irritate tissues and cause inflammation, and should be avoided. Dentures must be in good repair and need to fit properly, not loosely.
Managing stress as much as possible.
Regular dental checkups are important, so potential problems can be prevented or attended to promptly. Stress suppresses the immune system, which can increase the client’s risk for infections such as Candida albicans.
The nurse is caring for a client who has been diagnosed with esophageal cancer. The client appears anxious, and asks the nurse, “Does this mean I am going to die?”. Which nursing response is appropriate? (Select all that apply.)
A. “Let me sit with you for awhile and we can discuss how you are feeling about this.”
B. “You can beat this disease if you just put your mind to it.”
C. “No, surgery can cure you.”
D. “It sounds like death frightens you.”
E. “Let me call the hospital chaplain to talk with you.”
CORRECT: A, D
“Let me sit with you for awhile and we can discuss how you are feeling about this.”
Acknowledging that death may frighten the client, and offering to talk about how the client is feeling, are therapeutic nursing interventions.
Telling the client that surgery is curative, and promising the client can beat the disease, are nontherapeutic responses that provide false hope. Although talking with the chaplain at a later time may be requested by the client, the immediate need is to allow the client to express feelings to the nurse.
“It sounds like death frightens you.”
Acknowledging that death may frighten the client, and offering to talk about how the client is feeling, are therapeutic nursing interventions. Telling the client that surgery is curative, and promising the client can beat the disease, are nontherapeutic responses that provide false hope. Although talking with the chaplain at a later time may be requested by the client, the immediate need is to allow the client to express feelings to the nurse.
Which food does the nurse teach a client undergoing chemotherapy with secondary stomatitis to avoid?
A. Broiled fish
B. Ice cream
C. Salted pretzels
D. Scrambled eggs
CORRECT: C
Salted pretzels
Salty foods like pretzels can further irritate ulcers in the client’s mouth, causing pain.
A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom?
A. This condition is common but is temporary.
B. Use saliva substitutes, especially when eating dry foods.
C. This indicates a complication of therapy.
D. Use lozenges and hard candies to prevent dry mouth.
CORRECT: B
