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Chapter 53: Care of Patients with Oral Cavity Problems

Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. A student nurse is providing care to an older client with stomatitis and dysphagia. What
action by the student nurse requires the registered nurse to intervene?
a. Assisting the client to perform oral care every 2 hours
b. Preparing to administer a viscous lidocaine gargle
c. Reminding the client not to swallow nystatin (Mycostatin)
d. Teaching the client to use a soft-bristled toothbrush
ANS: B
Viscous lidocaine gargles or mouthwashes are sometimes prescribed for clients with
stomatitis and pain. However, the numbing effect can lead to choking or mouth burns from
hot food. This client already has difficulty swallowing, so this medication is not appropriate.
Therefore, the nurse should intervene when the student prepares to administer this
preparation. The other options are correct actions.
DIF: Applying/Application REF: 1102
KEY: Oral disorders| topical anesthetics| fungal infections
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
2. A client has a large oral tumor. What assessment by the nurse takes priority?
a. Airway
b. Breathing
c. Circulation
d. Nutrition
ANS: A
Airway always takes priority. Airway must be assessed first and any problems resolved if
present.
DIF: Applying/Application REF: 1104
KEY: Oral disorders| cancer| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
3. A female client hospitalized for an unrelated problem has a large pearly-white lesion on
her lip, to which she continues to apply lipstick that she will not remove for inspection. The
client refuses to discuss the lesion with the nurse or health care provider. What action by
the nurse is best?
a. Ask the client why her appearance is so important.
b. Ignore the lesion since the client will not discuss it.
c. Inform the client that early-stage cancer is curable.
d. Work with the client to establish a trusting relationship.
ANS: D
Clients with oral cancers often have body image difficulties due to the location of the tumor
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or the results of surgical treatment. This client appears to be using denial to cope with this
problem. The nurse should work to establish a helping-trusting relationship in hopes that
the client will be amenable to future discussions about the lesion. Asking why questions
often puts people on the defensive and should be avoided. Ignoring the lesion is not being
an advocate for the client. Education is important, but right now the client is in denial, so
this information will not seem relevant to her.
DIF: Applying/Application REF: 1103
KEY: Oral disorders| psychosocial response| coping| communication
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
4. A nurse has conducted a community screening event for oral cancer. What client is the
highest priority for referral to a dentist?
a. Client who has poor oral hygiene practices
b. Client who smokes and drinks daily
c. Client who tans for an upcoming vacation
d. Client who occasionally uses illicit drugs
ANS: B
Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not
related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk
factor, but short-term exposure does not have the same risk as daily exposure to tobacco
and alcohol. Illicit drugs are not related to oral cancers.
DIF: Understanding/Comprehension REF: 1103
KEY: Oral disorders| health screening| primary prevention| nursing assessment
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Health Promotion and Maintenance
5. The nurse reads a clients chart and sees that the health care provider assessed mucosal
erythroplasia. What should the nurse understand that this means for the client?
a. Early sign of oral cancer
b. Fungal mouth infection
c. Inflammation of the gums
d. Obvious oral tumor
ANS: A
Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection,
inflammation of the gums, or an obvious tumor.
DIF: Remembering/Knowledge REF: 1102
KEY: Oral disorders| cancer| pathophysiology
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
6. A client is having a temporary tracheostomy placed during surgery for oral cancer. What
action by the nurse is best to relieve anxiety?
a. Agree on a postoperative communication method.
b. Explain that staff will answer the call light promptly.
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c. Give the client a Magic Slate to write on postoperatively.

d. Reassure the client that you will take care of all of his or her needs.
ANS: A
Before surgery that interrupts the clients ability to communicate, the nurse, client, and
family (if possible) agree upon a method of communication in the postoperative period. The
client may or may not prefer a slate and may not be able to communicate in writing.
Reassuring the client and telling him or her you will take care of all of his or her needs does
not help the client be an active participant in care. Ensuring that the staff will answer the
call light promptly will not guarantee this will occur.
DIF: Applying/Application REF: 1105
KEY: Oral disorders| communication MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
7. A nurse is caring for four clients. After receiving the hand-off report, which client should
the nurse see first?
a. Client having a radial neck dissection tomorrow who is asking questions
b. Client who had a tracheostomy 4 hours ago and needs frequent suctioning
c. Client who is 1 day postoperative for an oral tumor resection who is reporting pain
d. Client waiting for discharge instructions after a small tumor resection
ANS: B
The client who needs frequent suctioning should be seen first to ensure that his or her
airway is patent. The client waiting for pain medication should be seen next. The nurse may
need to call the surgeon to see the client who is asking questions. The client waiting for
discharge instructions can be seen last.
DIF: Applying/Application REF: 1104
KEY: Oral disorders| airway| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A client is prescribed cetuximab (Erbitux) for oral cancer and asks the nurse how it
works. What response by the nurse is best?
a. It blocks epidermal growth factor.
b. It cuts off the tumors blood supply.
c. It prevents tumor extension.
d. It targets rapidly dividing cells.
ANS: A
Cetuximab (Erbitux) targets and blocks the epidermal growth factor, which contributes to
the growth of oral cancers. The other explanations are not correct.
DIF: Understanding/Comprehension REF: 1105
KEY: Oral disorders| cancer| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
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9. A client had an oral tumor removed this morning and now has a tracheostomy. What
action by the nurse is the priority?
a. Delegate oral care every 4 hours.
b. Monitor and record the clients intake.
c. Place the client in a high-Fowlers position.
d. Remove the inner cannula for cleaning.
ANS: C
To promote airway clearance, this client should be placed in a semi- or high-Fowlers
position. Oral care can be delegated, but that is not the priority. Intake and output should
also be recorded but again is not the priority. The inner cannula may or may not need to be
cleaned, and the tracheostomy may or may not have a disposable cannula.
DIF: Applying/Application REF: 1104
KEY: Oral disorders| airway
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
10. A nurse assesses a clients oral cavity and observes the condition depicted in the photo
below:
What action by the nurse is best?
a. Ask about the clients human immunodeficiency virus (HIV) status.
b. Assess the client for dysphagia.
c. Listen to the clients lung sounds.
d. Refer the client to an oncologist.
ANS: B
This client has oral candidiasis. If the infection extends down the pharynx, the client could
have difficulty swallowing. Therefore, the nurse should assess the client for dysphagia. HIV
status may or may not be related but is not the priority. Listening to the lungs is unrelated.
Since oral candidiasis is an infectious condition, referral to an oncologist is not needed.
DIF: Applying/Application REF: 1100
KEY: Oral disorders| nursing assessment| dysphagia
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
1. The nurse is caring for a client with sialadenitis. What comfort measures may the nurse
delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
a. Applying warm compresses
b. Massaging salivary glands
c. Offering fluids every hour
d. Providing lemon-glycerin swabs
e. Reminding the client to avoid speaking
ANS: A, C
The UAP can apply warm compresses and offer fluids. Massaging salivary glands can be
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done, but not by the UAP. Lemon-glycerin swabs are drying and should not be used.
Speaking has no effect on this condition.
DIF: Applying/Application REF: 1108
KEY: Delegation| oral disorders| comfort measures| unlicensed assistive personnel (UAP)
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort
2. A nurse studying cancer knows that job-related risks for developing oral cancer include
which occupations? (Select all that apply.)
a. Coal miner
b. Electrician
c. Metal worker
d. Plumber
e. Textile worker
ANS: A, C, D, E
The occupations of coal mining, metal working, plumbing, and textile work produce
exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens.
Electricians do not have this risk.
DIF: Remembering/Knowledge REF: 1103
KEY: Oral disorders| nursing assessment| cancer
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation