NUR212CH56

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Author:
TomWruble
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208437
Filename:
NUR212CH56
Updated:
2013-04-08 23:06:36
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nur212q1 Care Patients Oral Cavity Problems
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Care of Patients with Oral Cavity Problems
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  1. (56) Nystatin (Mycostatin) suspension is prescribed for a client who is diagnosed with oral candidiasis. What instructions does the nurse provide to the client when using this drug?

    A. “Take the drug when your mouth hurts or seems dry.”
    B. “Spit the drug out after you rinse your mouth with it.”
    C. “Use the drug once a day for 7 to 10 days.”
    D. “Swish the drug around in your mouth before swallowing it.”
    D. “Swish the drug around in your mouth before swallowing it.”

    (56) The nurse should instruct the client that the proper procedure for taking nystatin is to swish and swallow the medication to treat any fungal infection that may be in the throat. The client should take the drug four times daily for 7 to 10 days to ensure efficacy.
    (this multiple choice question has been scrambled)
  2. (56) Glossectomy
    tongue removal
  3. (56) Stomatitis
    inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, dietary protein deficiency, poorly fitted dentures, or from mouth burns from hot food or drinks, toxic plants, or by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, or infections.
  4. (56) A client who has completed radiation therapy for an oral tumor is being discharged to home. What health teaching should the nurse provide? Select all that apply.

    A. “Eat any foods that appeal to you.”
    B. “Rinse your mouth several times daily with Listerine.”
    C. “Use saliva substitutes as prescribed.”
    D. “Avoid exposure to the sun and tanning beds.”
    E. “Use a nondeodorant soap like Ivory.”
    F. “Use a firm-bristled toothbrush to remove plaque.”
    A, C, D, E

    Rationale: The nurse should instruct the client to consume any foods that are tolerated and comfortable to eat. Spicy and highly acidic foods may cause discomfort to the oral mucosa and should be avoided. The skin in the area of the radiation will be fragile, so exposure to sun and tanning beds should also be avoided, and gentle soaps like Ivory should be used. Saliva substitutes are recommended because saliva production can be greatly reduced as a result of radiation. Commercial mouthwashes contain alcohol and lemon-glycerin swabs are acidic, so these substances should be avoided because they can cause a burning sensation and contribute to dry oral mucous membranes. Oral care with a soft-bristled toothbrush is preferred to preserve the integrity of the oral mucous membranes.
  5. (56) Sialadenitis
    inflammation of a salivary gland. It may be subdivided temporally into acute, chronic and recurrent forms.
  6. (56) A 40-year-old homeless woman is admitted to the emergency department with difficulty breathing and swallowing. On assessment, the triage nurse finds that she has very poor dental hygiene and a large oral tumor. After a thorough evaluation, the patient is scheduled for oral surgery to remove as much of the tumor as possible.

    As the patient’s nurse, what is your priority for her care immediately after surgery?
    After extensive excision or resection, the most important nursing intervention is maintaining the patient’s airway. After awakening from anesthesia, the patient may not recall or may not realize that a tracheostomy tube is in place and may initially panic because of the inability to speak. The nurse should remind the patient why she cannot speak and provide reassurance that the vocal cords are intact (unless a total laryngectomy has been performed, in which case the loss of voice is permanent).
  7. (56) A 40-year-old homeless woman is admitted to the emergency department with difficulty breathing and swallowing. On assessment, the triage nurse finds that she has very poor dental hygiene and a large oral tumor. After a thorough evaluation, the patient is scheduled for oral surgery to remove as much of the tumor as possible.

    As you develop her plan of care, for what complications is this patient most at risk?
    The patient is at risk for an obstructed airway, inadequate oxygenation, altered skin integrity related to surgery, pain, and inadequate nutrition due to decreased oral intake, impaired swallowing, and an inability to chew during the healing process.
  8. (56) A 40-year-old homeless woman is admitted to the emergency department with difficulty breathing and swallowing. On assessment, the triage nurse finds that she has very poor dental hygiene and a large oral tumor. After a thorough evaluation, the patient is scheduled for oral surgery to remove as much of the tumor as possible.

    With what members of the health care team will you collaborate?
    The nurse will collaborate with the surgeon, anesthesiologist, speech therapist, and social worker or case manager.
  9. (56) A 40-year-old homeless woman is admitted to the emergency department with difficulty breathing and swallowing. On assessment, the triage nurse finds that she has very poor dental hygiene and a large oral tumor. After a thorough evaluation, the patient is scheduled for oral surgery to remove as much of the tumor as possible.

    What follow-up care is realistic for this patient?
    Follow-up care may take place in a local clinic or at the nursing facility secured for this patient. The follow-up may be conducted by a physician who did not perform the surgery, or the case worker may be able to secure a source of funding to assist with transportation to the outpatient office for follow-up care. The case worker or social worker can investigate community resources to assist in this patient’s care.
  10. (56) A 40-year-old homeless woman is admitted to the emergency department with difficulty breathing and swallowing. On assessment, the triage nurse finds that she has very poor dental hygiene and a large oral tumor. After a thorough evaluation, the patient is scheduled for oral surgery to remove as much of the tumor as possible.

    In view of her homelessness, what support systems might you seek?
    The nurse should work with the social worker or case manager to prepare this patient for discharge. The patient may need placement in a nursing facility/rehabilitation center that has funding for patients who do not have health insurance. The patient will also need a plan for follow-up care.
  11. (56) The client has undergone a radial neck dissection for cancer and is being discharged home. With which community resource will the nurse collaborate to maintain the client's care post-discharge?

    A. Chaplain
    B. Support group for cancer victims
    C. Home health nurse
    D. Social worker
    C. Home health nurse

    The home health nurse provides a comprehensive level of care for the client. The nurse can identify signs and symptoms of infection and the need for additional support services. The social worker is not responsible for maintaining the care of the client at home. The social worker makes referrals based on the needs of individual clients.
    (this multiple choice question has been scrambled)
  12. (56) The client has undergone a partial glossectomy for cancer. To what community resource will the nurse refer the client when dressing supplies will be needed at home?

    A. Oral Cancer Foundation
    B. American Cancer Society (ACS)
    C. Client Advocate Foundation
    D. American Medical Supply Foundation
    B. American Cancer Society (ACS)

    The ACS supplies dressings and transportation to and from follow-up visits or medical treatments for clients with cancer.

    The Oral Cancer Foundation is a resource for local support groups and resources.

    The Client Advocate Foundation provides education, legal counseling, and referrals to clients with cancer and survivors concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters.
    (this multiple choice question has been scrambled)
  13. (56) As a result of being treated with radiation for oral cancer, the client is experiencing xerostomia. What community resource will the nurse suggest for this client's care?

    A. Speech therapist
    B. Psychiatrist
    C. Occupational therapist
    D. Dentist
    D. Dentist

    Xerostomia 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.
    (this multiple choice question has been scrambled)
  14. (56) The client, who is an orthodox Catholic, is dying of oral cancer. Which resource will the nurse suggest to best meet this client's needs?

    A. Oral Cancer Foundation
    B. U.S. Food and Drug Administration (FDA)
    C. Local religious support group
    D. American Cancer Society
    C. Local religious support group

    Because this client is religious and is near the end of life, the religious organization of his or her choice is the most appropriate resource.
    (this multiple choice question has been scrambled)
  15. (56) The client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction?

    A. Listen to the client, and then explain that it is normal to feel depressed about the diagnosis.
    B. Explain the grieving process, and listen to what the client has to say.
    C. Suggest that the client talk with friends and family and seek their support.
    D. Listen to the client's concerns and feelings, and then suggest that the client join a community group of cancer survivors.
    D. Listen to the client's concerns and feelings, and then suggest that the client join a community group of cancer survivors.

    Telling the client that her or his feelings are normal is not helpful or therapeutic. The client needs more guidance.

    The nurse is assuming that the client's family and friends are an appropriate support group, but this may not be the case.

    The nurse should listen to the client and suggest a community support group of those with similar diagnoses who can offer support to the client.
    (this multiple choice question has been scrambled)
  16. (56) The client has recently developed acute sialadenitis. Which intervention will the nurse include in this client's care?

    A. Applying cold compresses
    B. Avoiding the use of fruit or citrus-flavored candy
    C. Keeping the head of the bed at 10 degrees when the client is lying down
    D. Massaging the salivary gland
    D. Massaging the salivary gland

    Applying cold compresses - Incorrect: To promote the flow of saliva, warm compresses are applied to the affected salivary gland.

    Avoiding the use of fruit or citrus-flavored candy - Incorrect: Sialogogues such as lemon slices and fruit- or citrus-flavored candy are used to stimulate the flow of saliva.

    Massaging the salivary gland - Correct: The salivary gland is massaged to stimulate the flow of saliva. This is done by milking the edematous gland with the fingertips toward the ductal opening.

    Keeping the head of the bed at 10 degrees when the client is lying down - Incorrect: Elevation of the head of the bed promotes gravity drainage of the edematous gland.
    (this multiple choice question has been scrambled)
  17. (56) T/F: Proper oral care: Clients must be taught to perform self-examination of the mouth every month and to report any unusual findings.
    True
  18. (56) The nurse is caring for a client postoperatively with a radical neck dissection, and the client is describing throbbing pain in the head. The nurse anticipates that the physician will request which medication for this client? Which is the preferred medication for clients who have undergone surgery for oral carcinoma?

    A. Morphine sulfate intravenously
    B. Diphenhydramine (Benadryl)
    C. Midazolam (Versed) intravenously
    D. Oxycodone plus acetaminophen (Percocet, Tylox)
    A. Morphine sulfate intravenously

    Diphenhydramine (Benadryl) - Incorrect: Diphenhydramine (Benadryl) is an anti-inflammatory agent and is not indicated for treatment of pain.

    Midazolam (Versed) intravenously - Incorrect: Midazolam (Versed) is used for conscious sedation and is not indicated for pain.

    Morphine sulfate intravenously - Correct: Clients undergoing surgery for oral cancer describe their pain as throbbing or pounding. Intravenous morphine sulfate is indicated for severe pain and is given initially.

    Oxycodone plus acetaminophen (Percocet, Tylox) - Incorrect: Oxycodone plus acetaminophen (Percocet, Tylox) is given for systematic relief of moderate pain.
    (this multiple choice question has been scrambled)
  19. (56) When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which nursing action will the nurse delegate to the home health aide?

    A. Provide oral care using disposable foam swabs.
    B. Inspect the oral mucosa for evidence of oral candidiasis.
    C. Assist the client in making appropriate dietary choices.
    D. Instruct the client on how to use nystatin (Mycostatin) oral rinses.
    A. Provide oral care using disposable foam swabs.

    Provide oral care using disposable foam swabs (but NOT a "disposable foam brush" or 'toothette') - Correct: Assessments, client teaching, and assisting clients with oral problems in making appropriate dietary choices are the responsibilities of licensed nursing staff. Providing oral care for a client with oral lesions is an appropriate assignment for a home health aide.

    Inspect the oral mucosa for evidence of oral candidiasis - Incorrect: Inspection is a nursing intervention that should be conducted by licensed nursing staff.

    Instruct the client on how to use nystatin (Mycostatin) oral rinses - Incorrect: Client teaching is a nursing function that should be conducted by licensed nursing staff.

    Assist the client in making appropriate dietary choices - Incorrect: Assisting the client in making dietary choices is a nursing function that should be conducted by licensed nursing staff.
    (this multiple choice question has been scrambled)
  20. (56) A client with an oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first?

    A. Assess the respiratory effort and quantities and types of oral secretions.
    B. Assist the client to an upright position to facilitate breathing.
    C. Suction the client's oral secretions to clear the airway.
    D. Place the client on humidified oxygen per nasal cannula.
    A. Assess the respiratory effort and quantities and types of oral secretions.

    Assessment is the first step of the nursing process. The other interventions may (or may not) be necessary based on the initial assessment.
    (this multiple choice question has been scrambled)
  21. (56) After change-of-shift report, which client will the nurse plan to assess first?

    A. Older adult who has lost 10 lbs (4.5 kg) secondary to stomatitis
    B. Middle-aged adult who is describing oral pain after a partial glossectomy
    C. Adult who has severe xerostomia associated with radiation therapy
    D. Young adult who had a tracheostomy tube removed at the end of the last shift
    D. Young adult who had a tracheostomy tube removed at the end of the last shift

    It is essential to assess the patency of the airway after a tracheostomy tube is removed. The airway could be obstructed by bleeding or swelling at the site or by mechanical objects such as bedding.
    (this multiple choice question has been scrambled)
  22. (56) The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? Select all that apply.

    A. Apples
    B. Bananas
    C. Cheese
    D. Nuts
    E. Potatoes
    C, D, and E

    Cheese, nuts and potatoes may trigger allergic responses that cause aphthous ulcers.

    Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers.
  23. (56) The nurse admits an immune compromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication?

    A. Tetracycline syrup (Sumycin syrup)
    B. Diphenhydramine (Benadryl)
    C. Nystatin (Mycostatin)
    D. Acyclovir (Zovirax)
    D. Acyclovir (Zovirax)

    Acyclovir (Zovirax) - Correct: Acyclovir (Zovirax) is an antiviral agent that is prescribed for immune compromised clients who contact herpes simplex stomatitis.

    Diphenhydramine (Benadryl) - Incorrect: Diphenhydramine (Benadryl) is an antihistamine that is not indicated for treating this condition.

    Nystatin (Mycostatin) - Incorrect: Nystatin (Mycostatin) is indicated for treatment of fungal infection.

    Tetracycline syrup (Sumycin syrup) - Incorrect: Tetracycline syrup (Sumycin syrup) is indicated for treatment of recurrent aphthous ulcers.
    (this multiple choice question has been scrambled)
  24. (56) Thrush is a AAA and it is a sign of BBB
    • A) yeast specifically candidasis (a fungus) infection of tongue
    • B) possible HIV

    Women with HIS/AIDS may have persistent vaginal candidasis.
  25. (56) A secondary type of stomatitis is called?
    A common stype results from fungal infection with candida and is called candidiasis.

    Secondary stomatitis generaly results from opportunistic infections opportunisitic viruses, fungi or bacteria.
  26. (56) Physical and Clinical Manifestation of Stomatitis:
    With oral candidiasis, a type of yeast infection, white plaque-like lesions may appear on the tongue, palate, pharynx and buccal mucossa.
  27. (56)  Nursing and Medical interventions for Stomatitis:
    • Oral hygiene
    • Food selection
    • Toothpastes w/o SLS (sodium lauryl sulfate)
    • Rinse q2-3hrs w/ sodium bicarbonarte or warm saline soln, possibly w/ H2O2.
    • Avoid high alcohol content mouthwashes
    • Tetracycline swish/swallow q6hr for 10 days
    • Fungal stomatitis: use Mycostatin oral susp q6hr for 7-10 days
  28. (56) Premalignant lesions are called?
    and are caused by?
    • Leukoplakia
    • Mechanical factors (irritation), including tobacco products
    • Though leukoplakia can be visually confused with candidiasis, lkeukoplakia cannot be scraped off.
  29. (56) Characteristics of Erythroplakia?
    • Red, velvety mucosal lesions
    • More malignant changes relative to leukoplakia, therefore often considered "precancerous" in presentation
    • Difficult to distinguish from inflammatory or immune reaction

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