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A client presents with a non-healing ulcer on the lateral border of the tongue for over three weeks. What is the nurse's priority action?
Correct Answer: C. Notify the healthcare provider for biopsy evaluation
Rationale: Any oral ulcer lasting more than 2–3 weeks must be evaluated for malignancy. A biopsy is the gold standard for diagnosis.
Which of the following is the most significant risk factor for developing oral cancer?
Correct Answer: C. Long-term tobacco and alcohol use
Rationale: Tobacco (smoking or smokeless) and alcohol have a synergistic effect and are the leading causes of oral cancer.
The nurse is teaching a patient post-oral surgery for oral cancer. Which dietary recommendation is most appropriate?
Correct Answer: C. Bland, soft, high-calorie foods
Rationale: These foods minimize irritation while ensuring nutritional support in patients with oral discomfort or surgical wounds.
Which of the following findings is most concerning in a patient with oral cancer?
Correct Answer: B. A persistent sore on the lip
Rationale: A chronic, non-healing sore on the lip or mouth may be a sign of squamous cell carcinoma and needs evaluation.
The nurse is assessing a patient with advanced oral cancer. Which finding suggests metastasis?
Correct Answer: C. Enlarged, fixed cervical lymph nodes
Rationale: Firm, non-mobile cervical lymph nodes are a sign of regional metastasis, especially in oral cancers.
A nurse is preparing a patient with oral cancer for radiation therapy. What should the nurse teach first?
Correct Answer: C. Avoid smoking and alcohol before and after treatment
Rationale: Smoking and alcohol impair healing and worsen mucositis during radiation. Oral care and avoiding irritants are critical.
What is a common complication of chemotherapy for oral cancer?
Correct Answer: B. Oral mucositis
Rationale: Chemotherapy affects rapidly dividing cells, including oral mucosa, leading to painful ulcers, mucositis, and risk of infection.
Which nursing diagnosis is most appropriate for a client with oral cancer experiencing mouth pain and weight loss?
Correct Answer: C. Imbalanced nutrition: less than body requirements
Rationale: Oral pain often causes decreased intake, leading to weight loss and nutritional deficits.
The nurse evaluates that discharge teaching for a patient post-oral cancer surgery was effective when the client states:
Correct Answer: C. "I will avoid tobacco and alcohol to prevent recurrence."
Rationale: Continued tobacco or alcohol use increases recurrence risk. Patients must maintain abstinence for long-term outcomes.
Which of the following is the most important intervention to maintain airway patency in a post-op oral cancer patient?
Correct Answer: C. Place the patient in high Fowler's position
Rationale: Elevating the head helps maintain airway patency, reduces edema, and facilitates breathing post-operatively.
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