Nursing textbooks medical-surgical practice questions set 26

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Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently, and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom.

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Anticoagulants alter normal clotting factors and thus increase risk of hemorrhaging. They should be discontinued for 48 hours before surgery. It is not necessary to discontinue analgesic agents unless they contain aspirin, which alters the clotting function. Antihypertensive medications lower the blood pressure and prevent heart attack and stroke. Consult with the surgeon and/or anesthesia provider regarding use of this medication. Antibiotic agents are not generally discontinued before surgery. If given orally, consult with the surgeon and/or anesthesia provider.

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A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

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A possible complication of dislocations during the healing process involves an insufficient deposit of collagen during the repair stage. The end result is that the ligaments may have reduced tensile strength and future instability, leading to recurrent dislocations of the same joint. Carpal tunnel syndrome results from compression of the median nerve. Compartment syndrome is not a recurrent problem but will affect innervation. Volkmann contracture is a result of obstructed arterial blood flow to the forearm and hand and does not result from a dislocated shoulder.

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Demonstration of techniques, procedures, exercises, and the use of special equipment is an effective patient-teaching strategy for a skill. Lecture can be used to deliver information to a large group of patients but is more effective when the session is interactive; it is rarely used for individual instruction, except in combination with other strategies. Discovery is a good method for teaching problem-solving techniques and independent thinking. Panel discussions can be used to impart factual material but are also effective for sharing experiences and emotions.

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The nurse should instruct the client to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the client and family. Reporting any symptoms of sore throat or fever immediately and notifying the primary health care provider if glucose appears in the urine should be included in the teaching plan for a client undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the client to measure the amount of fluids taken each day in the teaching plan for the client receiving vasopressin.

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The steps in testing for extraocular movement are: (1) Ask the patient to sit or stand about 2 ft away, facing the nurse, who is sitting or standing at eye level with the patient; (2) ask the patient to hold the head still and follow the movement of a forefinger or a penlight with the eyes; (3) keeping the finger or light about 1 foot from the patient's face, move it slowly through the cardinal positions of gaze-up and down, left and right, diagonally up and down to the left, diagonally up and down to the right. Option B most accurately describes this procedure.

Correct answer:

Tepid sponge baths and cool compresses lower temperature via conduction (B), transferring heat from the skin to the cooler objects through direct contact. Radiation (A) involves heat loss to the environment without contact, not the primary method here. Convection (C) requires air movement (e.g., fans), not used. Evaporation (D) occurs with moisture vaporizing, a minor effect with tepid water but not dominant. Choice B is correct as conduction is the main mechanism, aligning with nursing interventions to reduce fever by physically drawing heat away from the body.

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When instructing a client about the use of an antifungal cream preparation for the treatment of ringworm in the ambulatory care setting, the nurse should include the following: cleaning the involved area and applying the cream to the skin as directed by the physician, not increasing or decreasing the amount used or number of times the cream should be applied unless directed to do so by the physician, keeping the affected area clean and dry, and keeping towels and washcloths for bathing separate from those of other family members to avoid the spread of infection.

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Excessive, ill-timed, or unrelieved stress is called distress. It triggers the general adaptation syndrome, a nonspecific physiologic response. Eustress means the right amount of stress and maintains a healthy balance in life. It cannot trigger general adaptation syndrome. The placebo effect refers to healing or improvement that takes place because the person believes a treatment method will be more effective. Helplessness is a psychological factor that makes a client with stress disease prone. It is not a condition that triggers the general adaptation syndrome.