Nokea
A nurse in an oral surgery practice is working with a patient scheduled for removal of an abscessed tooth. When providing discharge education, the nurse should recommend which of the following actions?
- A. Rinse the mouth with alcohol before bedtime for the next 7 days.
- B. Use warm saline to rinse the mouth as needed.
- C. Brush around the area with a firm toothbrush to prevent infection.
- D. Use a toothpick to dislodge any debris that gets lodged in the socket.
Correct Answer: B
Rationale: The patient should be assessed for bleeding after the tooth is extracted. The mouth can be rinsed with warm saline to keep the area clean. A firm toothbrush or toothpick could injure the tissues around the extracted area. Alcohol would injure tissues that are healing.
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A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patients plan of care. Why are patients who are ill at increased risk for developing 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
Correct Answer: D
Rationale: Many ill patients 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 patient is not significant in the development of dental caries in the ill patient.
An elderly patient comes into the emergency department complaining of an earache. The patient has an oral temperature of 100.2 F and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?
- A. Palpate the patients parotid glands to detect swelling and tenderness.
- B. Assess the temporomandibular joint for evidence of a malocclusion.
- C. Test the integrity of cranial nerve XII by asking the patient to protrude the tongue.
- D. Inspect the patients gums for bleeding and hyperpigmentation.
Correct Answer: A
Rationale: Older adults and debilitated patients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. The 12th cranial nerve is not associated with the auditory system. Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed.
A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease?
- A. Perforation into the mediastinum
- B. Development of an esophageal lesion
- C. Erosion into the great vessels
- D. Painful swallowing
- E. Obstruction of the esophagus
Correct Answer: A,C,E
Rationale: In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.
A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what?
- A. Presence of small blood clots in the drainage
- B. 60 mL of milky or cloudy drainage
- C. Spots of drainage on the dressings surrounding the drain
- D. 120 mL of serosanguinous drainage
Correct Answer: B
Rationale: Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Milky drainage is indicative of a chyle fistula, which requires prompt treatment.
A nurse is performing health education with a patient who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis?
- A. Ineffective Tissue Perfusion
- B. Impaired Skin Integrity
- C. Aspiration
- D. Imbalanced Nutrition: Less Than Body Requirements
Correct Answer: D
Rationale: Because digestion normally begins in the mouth, adequate nutrition is related to good dental health and the general condition of the mouth. Any discomfort or adverse condition in the oral cavity can affect a persons nutritional status. Dental caries do not typically affect the patients tissue perfusion or skin integrity. Aspiration is not a likely consequence of dental caries.