Chapter - 032 Intestitive Disorders

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Chapter 32: Management of Clients with Ingestive Disorders
Black & Hawks: Medical-Surgical Nursing: Clinical Management for

Positive Outcomes, 7th Edition
MULTIPLE CHOICE
1. The advice the nurse would give to a client that will most likely result in a reduction
of dental caries is
a. brush and floss regularly.
b. see the dentist once a year.
c. eliminate carbonated beverages.
d. avoid fluoride rinses.
ANS: a
Nurses should encourage clients to brush and floss regularly, eat a diet low in simple
carbohydrates, use fluoride, and schedule regular dentist visits.
DIF: Cognitive Level: Application REF: Text Reference: 717

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance
2. The nurse explains to a client asking about a “pulpectomy” that this procedure is also
commonly called a
a. dental filling.
b. scaling.
c. root canal.
d. tooth extraction.
ANS: c
In root canal therapy, the entire pulp of the tooth is removed. The canal space within the
roots is filled aseptically and sealed to prevent infection.
DIF: Cognitive Level: Knowledge REF: Text Reference: 718

3. The nurse encourages the client to obtain routine dental care because plaque
formation can lead to
a. periodontal disease.
b. oral cancer.
Elsevier items and derived items © 2005 by Elsevier Inc.

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c. herpes simplex infection.

d. stomatitis.
ANS: a
Periodontal disease is caused by plaque formation and bacterial colonization and results
in gingival inflammation if not removed.
DIF: Cognitive Level: Comprehension REF: Text Reference: 718

MSC: NCLEX: Physiological Integrity
4. The nurse should be aware that the dental problem most likely to cause a person with
periodontitis to seek treatment is
a. decay.
b. pain.
c. loose teeth.
d. headaches.
ANS: c
In periodontitis the inflammation extends from the gums into the alveolar bone and
periodontal ligament, destroying the supporting structures of the teeth. As a result, the
teeth loosen and may require extraction.
DIF: Cognitive Level: Analysis REF: Text Reference: 718

TOP: Nursing Process Step: Assessment
5. A client has undergone tooth extraction. The clients’s statement indicating that the
client did not fully understand discharge instructions is
a. “I can take analgesics for pain.”
b. “I plan to eat soft foods for several days.”
c. “ I can drink hot tea or coffee if I don’t feel like eating.”
d. “ I may use a normal-saline mouth rinse.”
ANS: c
After tooth extraction the client usually requires analgesics to control pain. The nurse
should instruct the client to eat soft foods and to avoid hot or cold foods for several days.
The client should gently rinse the mouth with normal saline but should avoid brushing
any remaining teeth for about 24 hours.

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TOP: Nursing Process Step: Evaluation

6. The nursing diagnosis is Acute Pain related to altered oral mucous membrane and
ulcerations for a client with Vincent’s angina. To wash the mouth, the client should be
instructed to use
a. a commercial mouthwash.
b. Dakin’s solution.
c. saline mouth rinses.
d. half-strength peroxide.
ANS: c
Rinsing the mouth with saline promotes comfort.

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
7. When developing the care plan for a client with leukoplakia, the nurse would consider
that the primary problem leukoplakia poses to the client is
a. cancer.
b. discomfort.
c. infection.
d. purulent secretions.
ANS: a
Leukoplakia, a potentially precancerous, yellow-white or gray-white lesion, may occur in
any region of the mouth.

8. A client is diagnosed as having carcinoma of the oral cavity. The finding that
indicates a high risk for this disease is
a. having had rheumatic fever as a child.
b. ingesting icy cold liquids.
c. working as a construction worker for 6 years.
d. having a history of alcohol abuse.
ANS: d

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Cancers of the oral cavity are most often associated with alcohol consumption and
tobacco use.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
9. The nurse caring for a client who has recently undergone oral surgery has made a
nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements related to
oral pain and difficulty eating. The nursing intervention that would best assist the
client to achieve the goal of maintaining weight is
a. administering analgesics before meals.
b. teaching the client to avoid putting food directly on the suture site.
c. increasing the time interval between oral care and mealtime.
d. suctioning secretions from the mouth.
ANS: b
Instruct the client to avoid putting food directly on the suture line. After meals the client
should perform oral hygiene to remove particles that may cause problems with the
incision.

10. A client who had extensive oral surgery 5 days earlier has the nursing diagnosis of
Imbalanced Nutrition: Less than Body Requirements related to altered oral mucosa
and surgical procedure. The most appropriate caution by the nurse when the client
resumes oral feedings is
a. “The capacity of your mouth will be smaller.”
b. “It will be painful to eat for some time.”
c. “You may have difficulty feeling the food in your mouth.”
d. “Often clients lose their sense of taste following surgery.”
ANS: c
The client should be cautioned about a decrease in sensation in the oral cavity after
surgery.

11. The nurse caring for a client receiving diuretics who develops parotitis would
a. ask the physician to discontinue the diuretics.

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b. discontinue the use of dental floss.

c. encourage the client to suck sugarless candy.
d. restrict oral fluids.
ANS: c
Interventions for clients receiving diuretics include (a) administering frequent oral
hygiene to keep bacterial count of the mouth low, (b) keeping the client well hydrated,
and (c) suggesting that the client use sugarless hard candy or chew sugarless gum to
stimulate secretions of the glands.

12. The immediate priority in postoperative nursing care for a client after glossectomy is
to
a. maintain a patent airway.
b. provide analgesia.
c. monitor for hemorrhage.
d. assist with body image issues.
ANS: a
The most critical postoperative intervention in the client with glossectomy is to maintain
a patent airway.

13. The nurse would assess the client with an early mechanical obstruction of the
esophagus for
a. aspiration.
b. dysphagia.
c. coughing.
d. vomiting.
ANS: b
The most common manifestation of esophageal disease is dysphagia (difficulty
swallowing).


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14. The nurse should anticipate that a client with mechanical obstruction of the esophagus
would initially have difficulty swallowing
a. carbonated beverages.
b. bread.
c. mashed potatoes.
d. saliva.
ANS: b
When an obstruction narrows the esophageal lumen, clients first experience dysphagia
only with solid foods. Later, dyspnea becomes associated with semi-solid foods and
liquids and finally their own saliva.

15. Reviewing a client’s chart notes, the nurse finds that the client has odynophagia. The
nurse questions the client about experience with
a. dulled taste.
b. knife-like pain.
c. intermittent difficulty with swallowing.
d. throbbing sensations in the throat.
ANS: b
Pain that affects the esophageal mucosa and occurs with swallowing is called
odynophagia. The client usually describes the pain as sharp, constricting, sticking,
crushing, stabbing, or knife-like.

16. Recently a client has been diagnosed with achalasia and is bothered greatly by the
substernal pain. The nurse should encourage the client to
a. begin a reducing diet.
b. eat foods with a dry consistency.
c. take aspirin before going to sleep.
d. sleep with the head of the bed elevated.

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ANS: d
To prevent nocturnal reflux of food, the client should sleep with the head of the bed
elevated.

17. The nurse explains to the client that bougienage is a procedure that will
a. increase esophageal peristalsis.
b. create a mechanical barrier to reflux.
c. dilate the lower esophagus.
d. alter the gastric pH.
ANS: c
Esophageal dilation, or bougienage, forcefully dilates the lower esophageal sphincter
(LES).

18. The nurse caring for a client who is to undergo the insertion of a PEG tube can best
explain how a PEG tube differs from a gastrostomy tube by describing
a. diameters of the tubes.
b. methods of insertion.
c. locations of the tubes.
d. procedures used for feedings.
ANS: b
There are two methods of inserting a gastrostomy tube. The first involves making an
incision in the wall of the abdomen and suturing the tube to the gastric wall. The second
method involves the percutaneous endoscopic gastrostomy (PEG) tube; with the client
under local anesthesia, the physician inserts a cannula into the stomach through an
abdominal incision.

19. The nurse planning a teaching program for a client about postoperative care after a
thoracotomy approach to an esophagomyotomy would include information about
a. insertion of a Blakemore tube.
b. prepartion for closed-chest drainage.

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c. drainage of a T tube.
d. application of a Hemovac.
ANS: b
After an esophagomyotomy, the client may have a thoracotomy incision and chest tubes
in place. The client may also have a nasogastric (NG) tube, gastrostomy tube, or PEG
tube.

20. The statement made by a postoperative client after esophagomyotomy that indicates
that the client has a misunderstanding about the discharge plan is
a. “I will use a board under my mattress.”
b. “I'm going to sleep on several pillows.”
c. “Any fever should be reported immediately.”
d. “It is OK to fall asleep in a chair.”
ANS: a
Clients who have undergone an esophagomyotomy should be instructed to sleep with the
head of the bed elevated and to recognize manifestations of respiratory complications.
The nurse should explain the manifestations of infection and esophageal perforation and
instruct the client to notify the physician if any of these problems occur.

TOP: Nursing Process Step: Evaluation
21. The nurse should be mindful that the factor in a client’s history most likely to result in
esophageal reflux is
a. very-high-fiber diet.
b. heavy consumption of coffee daily.
c. long-term sedentary lifestyle.
d. eating foods high in sodium.
ANS: b
Risk factors for gastroesophageal reflux disease include obesity and weight gain,
pregnancy, smoking, chewing tobacco, high-fat foods, theophylline, caffeine, chocolate,
and high levels of estrogen and progesterone.

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DIF: Cognitive Level: Knowledge REF: Text Reference: 731

22. During the assessment of a client admitted for evaluation of gastroesophageal reflux
disease (GERD), the client begins to complain of severe pain that radiates to the jaw.
The client is sitting upright in bed, her color is ruddy, and vital signs are within
normal limits, but she asks for the nitroglycerin (NTG) tablets in her purse. The nurse
realizes that the clinical manifestations demonstrated by the client are
a. classic manifestations of a myocardial infarction, and the physician should be
paged immediately.
b. specifically associated with GERD and not myocardial infarction, but the NTG
should be allowed if the client wants to use it.
c. greatly influenced by fear related to the location of the pain, and the use of NTG
should be discouraged.
d. indications that a thorough pain assessment should be done to determine the
etiology of the pain, and the NTG should be given at once.
ANS: d
Responses to pain-relieving measures (e.g., NTG) help to differentiate between
esophagitis and problems of cardiac origin (e.g., angina pectoris).

23. Metoclopramide (Reglan) is prescribed for a client with GERD. In explaining the
action of this drug, the nurse’s statement that most accurately describes the action of
metoclopramide is
a. “It decreases the time food and fluids are in the stomach.”
b. “It acts as an antacid to reduce gastric acidity.”
c. “It helps to promote movement in the esophagus.”
d. “It has a local anesthetic effect on the lower esophagus and stomach.”
ANS: a
Metoclopramide may be prescribed because it increases LES pressure by stimulating the
smooth muscle of the gastrointestinal tract and increasing the rate of gastric emptying.
DIF: Cognitive Level: Application

REF: Text Reference: 732, Integrating Pharmacology Box;

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24. The nursing instruction that would be included in a client’s teaching plan to prevent
or delay the development of hiatal hernia is
a. avoid drinking carbonated beverages rapidly.
b. sit in an upright position in a straight-backed chair.
c. avoid heavy lifting and stooping.
d. consume a high-carbohydrate, low-fat diet.
ANS: c
Health promotion behaviors to prevent or at least delay a hiatal hernia include avoiding
any activities that increase intra-abdominal pressure, such as heavy lifting and wearing
constrictive clothing.

25. For a client with diverticula of the esophagus, the nurse would tell the client to avoid
a. deep-breathing exercises after meals.
b. sleeping with the head of the bed elevated.
c. ingestion of carbonated drinks.
d. vigorous exercise after eating.
ANS: d
To prevent reflux of food, the client should have the head of the bed raised for 2 hours
after meals. Nocturnal reflux can often be prevented by sleeping with the head of the bed
elevated. The client should avoid constrictive clothes and vigorous exercise after eating.

26. A client has undergone radiation therapy to reduce the size of an esophageal tumor.
The nurse should be especially vigilant in assessing for
a. prolonged epistaxis.
b. sudden onset of diarrhea.
c. esophageal stenosis.
d. projectile vomiting.
ANS: c

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Because high-dose radiation may cause stenosis of the esophagus, treatments are usually
administered over 6 to 8 weeks.

27. The nurse assesses a knowledge deficit in a client who is scheduled for the placement
of an Angelchik prosthesis when the client says
a. “I am so glad that I won’t have to have surgery to get this thing applied.”
b. “My doctor said this procedure may not work.”
c. “I am going to have a poker chip–like thing tied to my esophagus.”
d. “This gadget is going to help keep my stomach contents where they belong.”
ANS: a
The application of the Angelchik prosthesis requires that a laparotomy be performed. The
appliance is a C-shaped disc that is tied around the distal esopagus to anchor the LES in
the abdomen and reinforce sphincter pressure. The appliance may not work, depending
on the severity of the problem.

28. The nurse instructs a group of clients who smoke that the leading type of malignant
oral cancer is
a. basal cell carcinoma.
b. neurofibroma.
c. hemangioma.
d. squamous cell carcinoma.
ANS: d
Squamous cell carcinoma is the most common type of oral malignancy, accounting for
about 95% of the cancers found on the tongue. Although common, hemangiomas and
neurofibromas are benign. Smoking is the prime cause for all the lesions listed.


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29. During a health interview, the nurse informs a client with GERD that of all the drugs
the client is presently taking, the drug that will aggravate the clinical manifestations
of GERD is
a. theophylline.
b. Vioxx.
c. Lanoxin.
d. Lasix.
ANS: a
Anticholinergic drugs, calcium channel blockers, and theophylline should be avoided, if
possible, because they delay gastic emptying and can initiate the manifestations of
GERD.

30. A client with a rolling hiatal hernia complains of a feeling of fullness after eating and
difficulty breathing. When the client says, “I think I should lie down for awhile,” the
nurse should remind the client
a. to lie on the left side for at least 15 minutes.
b. that lying down may increase the distress.
c. to drink milk or eat a small snack before lying down.
d. that arching the back while lying down will reduce the discomfort.
ANS: b
A client with a rolling hiatal hernia will experience greater discomfort when lying down.

31. A lesion of the mouth that often indicates an early squamous cell carcinoma is
erythroplakia, which can be identified by its
a. velvety appearance.
b. roughened, leathery appearance.
c. rigid delineated border that bleeds easily.
d. concave, ulcer-like lesion.
ANS: a

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Erythroplakias, which are frequenly early squamous cell carcinomas, have a red, velvety
appearance. These lesions are not well delineated and bleed easily.


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Chapter 32: Management of Clients with Ingestive Disorders

Black & Hawks: Medical-Surgical Nursing: Clinical Management for

Chapter 32: Management of Clients with Ingestive Disorders

DIF: Cognitive Level: Application REF: Text Reference: 717

DIF: Cognitive Level: Knowledge REF: Text Reference: 718

Elsevier items and derived items © 2005 by Elsevier Inc.

c. herpes simplex infection.

DIF: Cognitive Level: Comprehension REF: Text Reference: 718

DIF: Cognitive Level: Analysis REF: Text Reference: 718

DIF: Cognitive Level: Application REF: Text Reference: 718

Elsevier items and derived items © 2005 by Elsevier Inc.

TOP: Nursing Process Step: Evaluation

DIF: Cognitive Level: Application REF: Text Reference: 720

DIF: Cognitive Level: Application REF: Text Reference: 721

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 722

DIF: Cognitive Level: Application REF: Text Reference: 725

DIF: Cognitive Level: Analysis REF: Text Reference: 725

Elsevier items and derived items © 2005 by Elsevier Inc.

b. discontinue the use of dental floss.

DIF: Cognitive Level: Application REF: Text Reference: 726

DIF: Cognitive Level: Analysis REF: Text Reference: 724

DIF: Cognitive Level: Analysis REF: Text Reference: 726

Elsevier items and derived items © 2005 by Elsevier Inc.

MSC: NCLEX: Physiological Integrity

DIF: Cognitive Level: Application REF: Text Reference: 726

DIF: Cognitive Level: Comprehension REF: Text Reference: 726

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 728

DIF: Cognitive Level: Comprehension REF: Text Reference: 728

DIF: Cognitive Level: Application REF: Text Reference: 729

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 730

DIF: Cognitive Level: Analysis REF: Text Reference: 730

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 731

DIF: Cognitive Level: Analysis REF: Text Reference: 732

DIF: Cognitive Level: Application

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 734

DIF: Cognitive Level: Analysis REF: Text Reference: 735

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 737

DIF: Cognitive Level: Analysis REF: Text Reference: 734

DIF: Cognitive Level: Application REF: Text Reference: 722

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 732

DIF: Cognitive Level: Application REF: Text Reference: 734

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 722

Elsevier items and derived items © 2005 by Elsevier Inc.

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