Pharm Chapter 31 PDF

Pharm chp 31 1. Which adverse effect is associated with theuse of a corticosteroid inhaler? a. Mucositis b. Plaque c. Xerostomia d. Candidiasis ANS: D Medications that predispose a patient to candidiasis are those that suppress theimmune system, including immunosuppressants, corticosteroids, cytoto...

Pharm chp 31 1. Which adverse effect is associated with theuse of a corticosteroid inhaler? a. Mucositis b. Plaque c. Xerostomia d. Candidiasis ANS: D Medications that predispose a patient to candidiasis are those that suppress theimmune system, including immunosuppressants, corticosteroids, cytotoxics, and broad spectrum antibiotics. Educating patients on theimportance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication. Mucositis, plaque, and xerostomia are not associated with steroid inhaler use 2. Which condition is present when white, milk curd-appearing plaques are observed attached to theoral mucosa? a. Thrush b. Canker sores c. Cold sores d. Mucositis ANS: A Thrush is characterized by white, milk curd-appearing plaques that are attached to theoral mucosa. Canker sores can appear as ulcers 0.5 to 2 cm in diameter on surfaces that are not attached to bone, such as thetongue, gums, or inner lining of thecheeks and lips. Cold sores (―fever blisters‖) are most commonly found at thejunction of themucous membrane and theskin of thelips or nostrils, although they can occur inside themouth, especially affecting thegums and roof of themouth. Mucositis is a general term used to describe a painful inflammation of themucous membranes of themouth. 3. Which primary pharmacologic therapy is used to treat Candida albicans? a. Steroids b. Antifungal agents c. Topical anesthetics d. Topical anti-inflammatory agents ANS: B Candida albicans is themost common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress theimmune system and those that cause xerostomia. Candida albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin). Steroids, topical anesthetics, and topical anti-inflammatory agents are not used to treat C. albicans. 4. Which condition is treated by saliva substitutes? a. Caries b. Mucositis c. Xerostomia d. Halitosis ANS: C Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry themucous membranes or by artificial saliva products. Dentifrices are used to treat caries. Saliva substitutes are not used to treat mucositis. Mouthwash is used to treat halitosis, along with dentifrices. 5. Which information will thenurse include when teaching a patient about cold sores? a. Use of drying agents prevents thespread of secretions. b. Erupted lesions are not contagious. c. Eruptions are related to breaks in personal hygiene. d. Pus-filled lesions indicate a secondary bacterial infection. ANS: D Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over thefollowing 10 to 14 days, a crust develops as thevesicles that burst coalesce into larger lesions. theliquid from thevesicles contains thelive virus that can be transferred to other people by direct contact. thebase of thelesions is erythematous. If pus develops in thevesicles or under thecrust of a cold sore, a secondary bacterial infection may be present and thepatient should seek medical attention. Drying agents are not used to treat cold sores. Cold sores are contagious. Eruptions are not necessarily related to poor personal hygiene. 6. Which local anesthetic is used for inflammation of oral mucous membranes? a. Chlorhexidine (Peridex) b. 2% viscous lidocaine c. Nystatin (Mycostatin) d. Hydrogen peroxide ANS: B Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that thepatient does not accidentally burn himself or herself because thedrug anesthetizes theentire mouth and throat. Chlorhexidine, nystatin, and hydrogen peroxide are not local anesthetics. 7. Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or radiation treatment? a. Amlexanox paste (Aphthasol) b. Palifermin (Kepivance) c. Docosanol (Abreva) d. Nystatin (Mycostatin) ANS: B Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating themucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. Amlexanox paste is used to treat canker sores. Docosanol is used to treat cold sores. Nystatin is used to treat thrush. 8. Which infection is often called the―disease of thediseased‖ because it appears in debilitated Patients? a. Aspergillosis b. Candidiasis c. Trichomoniasis d. Brucellosis ANS: B Candidiasis is a fungal infection caused by C. albicans, themost common organism associated with oral infections. It is often called the―disease of thediseased‖ because it appears in debilitated patients and patients taking a variety of medicines. Aspergillosis is caused by thefungus Aspergillus, which is commonly found growing on dead leaves, stored grain, or compost piles, or in other decaying vegetation. Although it is similar to candidiasis in its occurrence in debilitated patients, it is not as common. Trichomoniasis is a common parasitic sexually transmitted disease. Brucellosis is a zoonotic infection transmitted from animals to humans by theingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols. 9. Which cause is themost common associated to tooth, gum, and periodontal disease? a. Sugar b. Halitosis c. Plaque d. Smoking ANS: C Plaque is theprimary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, thewhitish yellow substance that builds up on teeth and gum lines, is thought to originate from saliva. Plaque forms a sticky meshwork that traps bacteria and food particles. If not removed regularly, it thickens, and bacteria proliferate. Sugar is not a cause of dental disease as such but becomes a problem when poor oral hygiene allows it to collect in theoral cavity. Halitosis is a symptom of poor oral hygiene but is not a cause of dental disease. Although smoking can contribute to periodontal disease through vasoconstriction, it is not a cause of dental disease. 10. Which instruction by thenurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis? a. ―Cleanse theoral cavity after using.‖ b. ―This medication can be used as a gargle.‖ c. ―After using, wait for 30 minutes before eating.‖ d. ―Your sense of taste will be diminished.‖ ANS: C Caution thepatient not to take food or drink for approximately 30 minutes after themedication because of therisk of aspiration from theabsence of thegag reflex. theoral cavity is cleansed before administration. themedication can be used as a gargle and thesense of taste is diminished, but these are not themost important instructions. 11. A patient is being treated with topical amlexanox paste 5% (Zilactin). Which statement by thepatient indicates a knowledge deficit? a. ―This medicine will help control discomfort.‖ b. ―I will apply thepaste before meals.‖ c. ―The paste will be applied to each lesion.‖ d. ―Healing will be promoted.‖ ANS: B It is best to apply amlexanox paste 5% (Zilactin) after meals. Discomfort is controlled with this medication; it is applied to each lesion and promotes healing. 12. Which treatment will thenurse encourage when a patient using carbamide peroxide (Gly-Oxide) to treat multiple canker sores develops tissue irritation, a black hairy tongue and asks what can be done to soothe thepain? a. Milk of Magnesia b. Viscous lidocaine 2% c. Salivart d. Saline rinses ANS: D Saline rinses may be soothing and can be used before topical application of carbamide peroxide (Gly- Oxide). They would be encouraged prior to other measures. Milk of Magnesia, viscous lidocaine 2%, and Salivart are not used to soothe this side effect. 13. The nurse is assisting with care of a patient on chemotherapy with severe mucositis. thepatient reports mucous membrane pain level to be ―8‖ on thepain scale. Which priority nursing problem exists for this patient? a. Decreased nutrition b. Potential aspiration risk c. Dehydration d. Pain. ANS: D Pain is thenursing priority. A score of ―8‖ indicates severe pain and comfort measures would take priority. Altered nutrition: less than body requirements, risk for aspiration, and fluid volume deficit are not thepriorities at this time. MULTIPLE RESPONSE 1. The nurse is completing education for a patient who will be undergoing chemotherapy next week. Which information will thenurse include in theteaching plan in anticipation of adverse effects associated with oral mucositis resulting from chemotherapy? (Select all that apply.) a. Avoid acidic and spicy foods. b. Using docosanol (Abreva) will decrease thepain. c. Milk of Magnesia can be used to rinse themouth and coat mucous membranes. d. Nystatin liquid can be taken orally to eliminate fungal infections. e. Cleanse theoral cavity before applying topical agents. f. Rinse themouth with an over-the-counter (OTC) mouthwash. ANS: A, C, D, E Spicy and acidic foods should be avoided to prevent irritation to mucous membranes. Viscous lidocaine 2%, Milk of Magnesia, diluted bismuth subsalicylate (Kaopectate), and sucralfate suspensions may be used for topical application. Oral candidal infections are often adverse effects of chemotherapy, and nystatin liquid, an antifungal agent, may be prescribed. Directions for using this agent include swishing themedication in theoral cavity for approximately 1 minute before swallowing or sucking on lozenges (troches) to reduce candidal oral infections. Pain medication applied topically must come into contact with mucous membranes to be effective. Therefore, it is advisable to clean theoral cavity before application. This medication is not used in thetreatment of oral mucositis. OTC mouthwashes are usually not recommended for treatment of mucositis. 2. Which information will thenurse include when educating a 12-year-old patient about care of a cold sore? (Select all that apply.) a. ―Keep thecold sore clean with mild soap.‖ b. ―Use an astringent to assist in drying thecold sore and promote rapid healing.‖ c. ―Keep thecold sore moist to prevent cracking.‖ d. ―Note signs of infection, including thepresence of pus. Contact thehealthcare provider if this occurs.‖ e. ―Oralanalgesicsmayhelpalleviatepain.‖ ANS: A, C, D, E To reduce thepossibility of further infection with bacteria, thearea should be kept clean. Cold sores should be kept moist to prevent cracking and thedevelopment of secondary bacterial infection. With secondary infection, application of antibiotic ointment would be indicated. Application of docosanol, local anesthetics, and UV blockers or oral analgesics may be prescribed. Astringents should be avoided to prevent drying, delayed healing, and increased discomfort. 3. Which assessment information is pertinent to oral health? (Select all that apply.) a. Medication history b. Dental history, visit frequency c. Presence of halitosis d. Amount of saliva present e. Bowel sounds ANS: A, B, C, D Pertinent history for oral health includes current drug therapy and dental history and frequency. Halitosis may indicate poor oral hygiene or thepresence of infection in theoral cavity. Reduced amount of saliva is a risk factor for injury and infection in theoral cavity. Bowel sounds are not pertinent information to oral health. 4. Which treatment option(s) may promote comfort for a patient who is undergoing bone marrow transplantation has developed severe mucositis? (Select all that apply.) a. 2% viscous lidocaine (Xylocaine) before meals b. Acetylcysteine (Mucomyst) therapy as needed c. Commercially prepared mouthwashes d. Docosanol (Abreva) therapy e. Milk of Magnesia mouth rinses ANS: A, E The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes theentire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that thepatient does not burn himself or herself because sensation is diminished. Milk of Magnesia can also be used as a mouth rinse to coat themucous membranes. Acetylcysteine does not treat mucositis. Commercial mouthwashes contain alcohol, which is detrimental to thehealing of mucositis. Docosanol is used to treat topical herpes infections, not mucositis. 5. Which are adverse effects of xerostomia? (Select all that apply.) a. Reduced taste and appetite b. Excessive salivation c. Difficulty chewing and swallowing food d. Increase in dental caries e. Difficulty with speech f. Improved taste and enjoyment of food ANS: A, C, D, E Xerostomia increases tooth decay and causes loss of taste, difficulty in chewing and swallowing food, and difficulty talking. Xerostomia does not cause excessive salivation or food to taste better.