32-2
Test Bank
Clayton: Basic Pharmacology for Nurses, 15th Edition
Chapter 32: Drugs Used to Treat Oral Disorders
Test Bank
MULTIPLE CHOICE
1. A patient with COPD uses a corticosteroid inhaler bid. Which adverse effect is associated with this medication?
A. / MucositisB. / Plaque
C. / Xerostomia
D. / Candidiasis
ANS: D
FeedbackA / Mucositis is not associated with steroid inhaler use.
B / Plaque is not associated with steroid inhaler use.
C / Xerostomia is not associated with steroid inhaler use.
D / Medications that predispose a patient to candidiasis are those that suppress the immune system, including immunosuppressants, corticosteroids, cytotoxics, and broad-spectrum antibiotics. Educating patients on the importance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication.
DIF: Cognitive Level: Application REF: 517
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
2. The nurse is assessing a patient’s mouth and notes white, milk curd–appearing plaques attached to the oral mucosa. Which condition is present?
A. / ThrushB. / Canker sores
C. / Cold sores
D. / Mucositis
ANS: A
FeedbackA / Thrush is characterized by white, milk curd–appearing plaques that are attached to the oral mucosa.
B / Canker sores can appear as ulcers 0.5 to 2 cm in diameter on surfaces that are not attached to bone, such as the tongue, gums, or inner lining of the cheeks and lips.
C / Cold sores (“fever blisters”) are most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils, although they can occur inside the mouth, especially affecting the gums and roof of the mouth.
D / Mucositis is a general term used to describe a painful inflammation of the mucous membranes of the mouth.
DIF: Cognitive Level: Knowledge REF: 517
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
3. What is the primary pharmacologic therapy for Candida albicans?
A. / SteroidsB. / Antifungal agents
C. / Topical anesthetics
D. / Topical anti-inflammatory agents
ANS: B
FeedbackA / Steroids are not used to treat C. albicans.
B / Candida albicans is the most common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress the immune system and those that cause xerostomia. C. albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin).
C / Topical anesthetics are not used to treat C. albicans.
D / Topical anti-inflammatory agents are not used to treat C. albicans.
DIF: Cognitive Level: Knowledge REF: 517
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
4. Which condition is treated by saliva substitutes?
A. / CariesB. / Mucositis
C. / Xerostomia
D. / Halitosis
ANS: C
FeedbackA / Dentifrices are used to treat caries.
B / Saliva substitutes are not used to treat mucositis.
C / Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry the mucous membranes or by artificial saliva products.
D / Mouthwash is used to treat halitosis, along with dentifrices.
DIF: Cognitive Level: Knowledge REF: 519
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
5. Which information will the nurse include when teaching a patient about cold sores?
A. / Use of drying agents prevents the spread 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
FeedbackA / Drying agents are not used to treat cold sores.
B / Cold sores are contagious.
C / Eruptions are not necessarily related to poor personal hygiene.
D / Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over the following 10 to 14 days, a crust develops as the vesicles that burst coalesce into larger lesions. The liquid from the vesicles contains the live virus that can be transferred to other people by direct contact. The base of the lesions is erythematous. If pus develops in the vesicles or under the crust of a cold sore, a secondary bacterial infection may be present and the patient should seek medical attention.
DIF: Cognitive Level: Application REF: 516
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
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
FeedbackA / Chlorhexidine is not a local anesthetic.
B / Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that the patient does not accidentally burn himself or herself because the drug anesthetizes the entire mouth and throat.
C / Nystatin is not a local anesthetic.
D / Hydrogen peroxide is not a local anesthetic.
DIF: Cognitive Level: Knowledge REF: 518
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
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
FeedbackA / Amlexanox paste is used to treat canker sores.
B / Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating the mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation.
C / Docosanol is used to treat cold sores.
D / Nystatin is used to treat thrush.
DIF: Cognitive Level: Knowledge REF: 519
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
8. What infection is often called the “disease of the diseased” because it appears in debilitated patients?
A. / AspergillosisB. / Candidiasis
C. / Trichomoniasis
D. / Brucellosis
ANS: B
FeedbackA / Aspergillosis is caused by the fungus 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.
B / Candidiasis is a fungal infection caused by Candida albicans, the most common organism associated with oral infections. It is often called the disease of the diseased because it appears in debilitated patients and patients taking a variety of medicines.
C / Trichomoniasis is a common parasitic sexually transmitted disease.
D / Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols.
DIF: Cognitive Level: Comprehension REF: 517
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
9. What is the most common cause of most tooth, gum, and periodontal disease?
A. / SugarB. / Halitosis
C. / Plaque
D. / Smoking
ANS: C
FeedbackA / Sugar is not a cause of dental disease as such, but becomes a problem when poor oral hygiene allows it to collect in the oral cavity.
B / Halitosis is a symptom of poor oral hygiene, but is not a cause of dental disease.
C / Plaque is the primary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, the whitish 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.
D / Although smoking can contribute to periodontal disease through vasoconstriction, it is not a cause of dental disease.
DIF: Cognitive Level: Comprehension REF: 517
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
10. Which instruction by the nurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis?
A. / “Cleanse the oral 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
FeedbackA / The oral cavity is cleansed before administration.
B / The medication can be used as a gargle, but this is not the most important instruction.
C / Caution the patient not to take food or drink for approximately 30 minutes after the medication because of the risk of aspiration from the absence of the gag reflex.
D / The sense of taste is diminished, but this is not the most important instruction.
DIF: Cognitive Level: Application REF: 522
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
MULTIPLE RESPONSE
1. The nurse is completing education for a patient who will be undergoing chemotherapy next week. In anticipation of adverse effects associated with oral mucositis secondary to chemotherapy, which information will the nurse include in the teaching plan? (Select all that apply.)
A. / Avoid acidic and spicy foods.B. / Using docosanol (Abreva) will decrease the pain.
C. / Milk of Magnesia can be used to rinse the mouth and coat mucous membranes.
D. / Nystatin liquid can be taken orally to eliminate fungal infections.
E. / Cleanse the oral cavity before applying topical agents.
F. / Rinse the mouth with an OTC mouthwash.
ANS: A, C, D, E
FeedbackCorrect / 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 the medication in the oral 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 the oral cavity before application.
Incorrect / This medication is not used in the treatment of oral mucositis.
Over-the-counter mouthwashes are usually not recommended for treatment of mucositis.
DIF: Cognitive Level: Application REF: 520
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
2. Which will the nurse include when educating a 12-year-old patient about care of a cold sore? (Select all that apply.)
A. / “Keep the cold sore clean with mild soap.”B. / “Use of an astringent will assist in drying the cold sore and promote rapid healing.”
C. / “Keep the cold sore moist to prevent cracking.”
D. / “Note signs of infection, including the presence of pus. Contact the health care provider if this occurs.”
E. / “Oral analgesics may help alleviate pain.”
ANS: A, C, D, E
FeedbackCorrect / To reduce the possibility of further infection with bacteria, the area should be kept clean.
Cold sores should be kept moist to prevent cracking and the development 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.
Incorrect / Astringents should be avoided to prevent drying, delayed healing, and increased discomfort.
DIF: Cognitive Level: Application REF: 520
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
3. Which assessment information is pertinent to oral health? (Select all that apply.)
A. / Medication historyB. / Dental history, visit frequency
C. / Presence of halitosis
D. / Amount of saliva present
E. / Bowel sounds
ANS: A, B, C, D
FeedbackCorrect / Pertinent history for oral health includes current drug therapy.
Pertinent history for oral health includes dental history and frequency.
Halitosis may indicate poor oral hygiene or the presence of infection in the oral cavity.
Reduced amount of saliva is a risk factor for injury and infection in the oral cavity.
Incorrect / Bowel sounds are not pertinent information to oral health.
DIF: Cognitive Level: Application REF: 519
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
4. A patient who is undergoing bone marrow transplantation has developed severe mucositis. Which treatment options may promote comfort? (Select all that apply.)
A. / 2% viscous lidocaine (Xylocaine) before mealsB. / Acetylcysteine (Mucomyst) therapy as needed
C. / Commercially prepared mouthwashes
D. / Docosanol (Abreva) therapy
E. / Milk of Magnesia mouth rinses
ANS: A, E
FeedbackCorrect / The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes the entire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that the patient does not burn himself or herself because sensation is diminished.
Milk of Magnesia can also be used as a mouth rinse to coat the mucous membranes.
Incorrect / Acetylcysteine does not treat mucositis.
Commercial mouthwashes contain alcohol, which is detrimental to the healing of mucositis.
Docosanol is used to treat topical herpes infections, not mucositis.
DIF: Cognitive Level: Application REF: 520
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
5. In addition to discomfort, which are adverse effects of xerostomia? (Select all that apply.)
A. / Reduced taste and appetiteB. / 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
FeedbackCorrect / Xerostomia causes loss of taste.
Xerostomia causes difficulty in chewing and swallowing food.
Xerostomia increases tooth decay.
Xerostomia causes difficulty in talking
Incorrect / Xerostomia does not cause excessive salivation.
Xerostomia does not cause food to taste better.
DIF: Cognitive Level: Comprehension REF: 517
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
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