Chapter 18

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: One vocal cord was removed along with a portion of the larynx. The voice was spared and a tracheostomy would be in place until the airway was established. A permanent tracheal stoma would be necessary. A portion of the vocal cord was removed.

A permanent tracheal stoma would be necessary.

You are caring for a client who is 42-years-old and status post adenoidectomy. You find the client in respiratory distress when you enter their room. You ask another nurse to call the physician and bring an endotracheal tube into the room. What do you suspect? Infection Post operative bleeding Edema of the upper airway Plugged tracheostomy tube

Edema of the upper airway

A client who has an altered level of consciousness is receiving a tube feeding. Clients receiving tube feeding should be placed in which position? Side-lying Supine Trendelenburg Semi-Fowler's or higher

Semi-Fowler's or higher Clients receiving tube feedings are positioned with the head of the bed at 30 degrees or higher during feedings and left in that position for 30 to 45 minutes after the feeding.

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention? Epistaxis, twice last week Aphonia following a football game Hoarseness for 2 weeks Laryngitis following a cold

Hoarseness for 2 weeks Persistent hoarseness, especially of unknown cause, can be a sign of laryngeal cancer and merits prompt investigation. Epistaxis can be from several causes and has occurred infrequently. Aphonia and laryngitis are common following the noted activity.

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following? Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy

Partial laryngectomy In a partial laryngectomy, a portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing. During a supraglottic laryngectomy, a tracheostomy is left in place until the glottic airway is established. Hemilaryngectomy is done by splitting the thyroid cartilage of the larynx in the midline of the neck, and the portion of the vocal cord is removed with the tumor. During a total laryngectomy, a complete removal of the larynx is performed, including the hyoid bone, epiglottis, cricoids cartilage, and two or three rings of the trachea.

The nurse is performing preoperative teaching with a client who has cancer of the larynx. After explaining the most important information, what is the nurse's best action? Give the client his or her cell phone number. Refer the client to a social worker or psychologist. Provide the client with audiovisual materials about the surgery. Reassure the client and family that outcomes are nearly always positive.

Provide the client with audiovisual materials about the surgery. Informational materials (written and audiovisual) about the surgery are given to the client and family for review and reinforcement. The nurse never gives personal contact information to the client. Nothing in the scenario indicates that a referral to a social worker or psychologist is necessary. False reassurance must always be avoided.

The client is to receive cephalexin (Ancef) 500 mg in 50 mL of normal saline intravenous piggyback. The medication is to infuse over 30 minutes. How many mL/hr would the nurse set the intravenous pump? Enter the correct number ONLY.

100

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of 2 to 12 days 20 to 30 days 1 to 3 months 3 to 6 months

2 to 12 days

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? Clean the tracheostomy tube with alcohol and water." "Family members should continue to talk to the client." "Oral intake of fluids should be limited for 1 week only." "Limit the amount of protein in the diet."

"Family members should continue to talk to the client."

A client is being discharged from an outpatient surgery center following a tonsillectomy. What instruction should the nurse give to the client? "Gargle with a warm salt solution." "You may have a sore throat for 1 week." "You are allowed to have hot tea or coffee." "Decrease oral intake if increased swallowing occurs."

"Gargle with a warm salt solution."

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? Pulmonary hypotension Hypercapnia Systemic hypotension Increased smooth muscle contractility

Hypercapnia Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

A nurse is teaching a client with recurrent rhinosinusitis. What medication will the nurse instruct the client to take at the first sign of symptoms? guaifenesin acetaminophen oxymetazoline nasal spray naproxen

guaifenesin The client should take a decongestant (e.g., guaifenesin [Mucinex]) at the first sign of recurrence of rhinosinusitis to promote drainage of the sinus cavities and prevent bacterial infection. Medications that the client may take later in the illness for pain relief include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as naproxen (Aleve). Over-the-counter nasal oxymetazoline sprays (Afrin) may cause rebound congestion.

A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis? Apply a moustache dressing. Provide a nasal splint. Apply direct continuous pressure. Place the client in a semi-Fowler's position.

Apply direct continuous pressure.

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? Amoxicillin Levofloxacin Keflex Ceftin

Amoxicillin Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid is the antibiotic of choice. For clients who are allergic to penicillin, doxycycline or respiratory quinolones, such as levofloxacin or moxifloxacin, can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin and cefuroxime, are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

A client has been diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for treatment of this disorder does the nurse anticipate educating the client about? Amoxicillin-clavulanic acid Cephalexin Cefuroxime Clarithromycin

Amoxicillin-clavulanic acid

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? An antiviral agent such as acyclovir An antibiotic such as amoxicillin An antihistamine such as Benadryl An ointment such as bacitracin

An antiviral agent such as acyclovir

Your client has a history of hoarseness lasting longer than 2 weeks. The client is now complaining of feeling a lump in their throat. What would you suspect this client has? Cancer of the pharynx Laryngeal cancer Laryngeal polyps Cancer of the tonsils

Laryngeal cancer Later, the client notes a sensation of swelling or a lump in the throat, followed by dysphagia and pain when talking. Hoarseness is not indicative of pharyngeal cancer; laryngeal polyps; or cancer of the tonsils.

A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education? Total laryngectomy Cordectomy Vocal cord stripping Partial laryngectomy

Partial laryngectomy

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: "I need to keep my inhaler at the bedside." "I should eat a high-protein diet." "I should become involved in a weight loss program." "I should sleep on my side all night long."

"I should become involved in a weight loss program."