26 ?'s MS

The nurse is providing discharge teaching for a patient who has a new laryngectomy. Which statement by the patient reflects an adequate understanding of care of the laryngectomy? 1 "I will cover my stoma if I cough." 2 "I can swim as long as I don't get my neck wet." 3 "I will remove the tube once a week for cleaning." 4 "I will clean the area around the stoma with alcohol."

1 The patient should cover the stoma when coughing (because mucus may be expectorated). Swimming is contraindicated when a laryngectomy is present. The laryngectomy tube should be removed daily for cleaning. The area around the stoma should be washed with a moist cloth, not alcohol. Text Reference - p. 512

What are the symptoms of laryngeal cancer? Select all that apply. 1 Leukoplakia 2 Hoarseness 3 Scratchy throat 4 Difficulty swallowing 5 Discolored nasal drainage

, 2, 4 Leukoplakia (white patches on the lining of the cheeks of the mouth), hoarseness and difficulty swallowing are symptoms of laryngeal cancer. A scratchy throat is a symptom of acute pharyngitis. Discolored nasal drainage is a symptom of sinusitis. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 512

The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. What would be a contraindication to the administration of the vaccine to a resident? 1 Hypersensitivity to eggs 2 Age greater than 80 years 3 History of upper respiratory infections 4 Chronic obstructive pulmonary disease (COPD)

1 Although current vaccines are highly purified, and hypersensitivity reactions are extremely uncommon, a hypersensitivity to eggs precludes vaccination, because the vaccine is produced in eggs. Advanced age and a history of respiratory illness are not contraindications for influenza vaccination. Text Reference - p. 503

The nurse notices clear nasal drainage in a patient newly admitted with facial trauma, including a nasal fracture. What should the nurse do first? 1 Test the drainage for the presence of glucose 2 Suction the nose to maintain airway clearance 3 Document the findings and continue monitoring 4 Apply a drip pad and reassure the patient that this is normal

1 Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be tested for the presence of glucose, which would indicate the presence of CSF. Suctioning should not be done. Documenting the findings and monitoring are important after notifying the health care provider. A drip pad may be applied, but the patient should not be reassured that this is normal. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. Text Reference - p. 498

Which surgery is associated with the partial removal of one vocal cord? 1 Cordectomy 2 Hemilaryngectomy 3 Supraglottic laryngectomy 4

1 Cordectomy is the partial removal of one vocal cord. Hemilaryngectomy involves the removal of one side of the larynx. Supraglottic laryngectomy is the removal of the epiglottis and false vocal cords. Supracricoid laryngectomy is the removal of the entire supraglottis, false and true vocal cords, and thyroid cartilage, including the paraglottic and preepiglottic spaces. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 513

The patient with a tracheostomy is using a speaking valve and begins having shortness of breath. What action by the nurse is most appropriate? 1 Remove the speaking valve immediately 2 Call the attending health care provider 3 Deflate the tracheostomy cuff 4 Page the speech therapis

1 Initially, a patient may be able to tolerate only short periods of use until he or she becomes acclimated to exhaling through the mouth. However, during or even after any period of acclimation if the patient demonstrates any signs of respiratory distress, the priority will be to remove the valve or cap immediately. Calling the attending health care provider will create a delay and should be done after the speaking valve is removed. The cuff would be deflated already and in the setting of respiratory distress; the cuff should be inflated after the speaking valve is removed. Removing the speaking valve because of respiratory distress should not be delayed. Communication of adverse events can be communicated to the appropriate care parties after the immediate life-threatening event has been addressed. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 535

A patient is having difficulty breathing through one side of the nose and there is obvious deformity occluding the nostril. For what surgery will the nurse prepare the patient? 1 Rhinoplasty 2 Cordectomy 3 Tracheostomy 4 Hemilaryngectomy

1 Rhinoplasty is a surgical procedure that reconstructs the nose in order to improve airway function or to repair nasal obstruction due to the effects of trauma. Cordectomy is the removal of one vocal cord and is performed in patients with a tumor in one cord. Tracheostomy is a surgically created stoma used to bypass an upper airway obstruction or for long-term mechanical ventilation. Hemilaryngectomy is a surgical procedure that involves the removal of one side of the larynx. Text Reference - p. 498

What is the most frequent and annoying side effect that typically begins a few weeks after initiating radiation therapy in a patient with head and neck cancer? 1 Xerostomia 2 Depression 3 Frozen shoulder 4 Copious blood-tinged secretion

1 Xerostomia is defined as dry mouth resulting from reduced or absent saliva flow. It is the most frequent and annoying side effect of radiation therapy and typically begins few weeks after initiating radiation therapy in a patient with head and neck cancer. Depression is not specifically associated with radiation therapy. Frozen shoulder is caused by removal of or damage to the spinal accessory nerve and sternocleidomastoid muscles. Copious blood-tinged secretions may be seen in a patient who has undergone surgical therapy. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 515

A patient reports a headache, nasal congestion, and fever for the past three days. A nurse examines the patient's nose and sinus areas thoroughly. What findings would suggest that the patient has sinusitis? Select all that apply. 1 Hyperemic and edematous mucosa and hyperemia 2 Tenderness over the sinuses 3 Clear nasal discharge 4 Nosebleed 5 Swollen turbinates

1 2 5

A patient reports sneezing, itchy eyes and nose, and watery nasal discharge to a nurse. The nurse finds pale, boggy, and swollen nasal turbinate. Which category of medication does the nurse expect to be included in the patient's prescription? Select all that apply. 1 Decongestants 2 Anticoagulants 3 H1-antihistamines 4 Neuraminidase inhibitors 5 Nonsteroidal antiinflammatory drugs`

1 3 Allergic rhinitis is the inflammation of nasal mucosa due to allergens such as pollens, animal dander, house molds, or dust mites. The patient with allergic rhinitis will have pale, boggy, and swollen nasal turbinates. Decongestants increase the vasoconstriction of the blood vessels and help to reduce nasal congestion. H1-antihistamines are used in the treatment of rhinitis, because these medications bind with H1 receptors to block histamine binding and reduce inflammation. Anticoagulants, when administered to a patient with allergic rhinitis, increase bleeding time and aggravate the risk of epistaxis. Neuraminidase inhibitors are used in the treatment of influenza but do not help in relieving allergic rhinitis. Nonsteroidal antiinflammatory drugs increase bleeding time and pose a risk for epistaxis when used in a patient with rhinitis. Test-Taking Tip: Reducing inflammation in the nasal mucosa is the primary objective. Identify the medications that help in reducing inflammation and in alleviating its symptoms. Text Reference - p. 500

A patient is suspected of having influenza. What assessment data obtained by the nurse would correlate with this diagnosis? Select all that apply. 1 Temperature of 102.4° F 2 Muscle aches 3 Sore throat 4 Difficulty breathing through the nose 5

1, 2, 3 Influenza is an infectious disease caused by a virus that attacks the respiratory system. Fever, myalgia, sore throat, chills, cough, and rhinorrhea are symptoms of influenza. Nasal obstruction and purulent nasal discharge are symptoms of sinusitis. Text Reference - p. 503

A patient presents with epistaxis. Which interventions are appropriate to control the bleeding? Select all that apply. 1 Reassure the patient and keep him or her quiet. 2 Place the patient in a sitting position with the head tilted forward. 3 Apply direct pressure by pinching the entire soft lower portion of the nose. 4 Administer saline nasal sprays to relieve congestion. 5 Ask the patient to blow the nose to remove all the collected blood.

1, 2, 3 To control epistaxis, the patient should be reassured and kept quiet. In epistaxis, approximately 90% of nosebleeds occur in the anterior portion of the nasal cavity and can be easily visualized. The patient should be made to sit, leaning slightly forward, with the head tilted forward. Direct pressure should be applied by pinching the entire soft lower portion of the nose against the nasal septum for 10 to 15 minutes. If bleeding does not stop within 15 to 20 minutes, consult the health care provider. Saline nasal sprays should not be used, because these can dislodge the clot that is needed to stop the bleeding. Nose blowing will also remove the clot, which could lead to further bleeding. Text Reference - p. 498

A patient is diagnosed with allergic rhinitis. Which instructions should the nurse include when teaching the patient about ways to avoid allergens? Select all that apply. 1 Wash your bedding in hot water weekly. 2 Remove pets from the interior of your home. 3 Ventilate closed rooms and open doors. 4 Wear a mask while vacuuming at home. 5 Maintain high humidity levels at home

1, 2, 3, 4 Washing bedding in hot water weekly, removing pets from the interior of the home, ventilating closed rooms and opening doors, and wearing a mask while vacuuming are necessary to avoid allergens and will help to prevent allergic rhinitis. Maintaining high humidity levels at home will increase the chance of exposure to allergens and is not recommended. Text Reference - p. 500

What are side effects associated with radiation therapy? Select all that apply. 1 Fatigue 2 Dry mouth 3 Constipation 4 Oral mucositis 5 Nasal irritation

1, 2, 4 Fatigue, dry mouth, and oral mucositis are side effects of radiation therapy. Constipation is a side effect associated with antihistamines. Nasal irritation is a side effect associated with the use of anticholinergics and antihistamines. Text Reference - p. 515

When educating a patient about managing sinusitis without pharmacologic interventions, which instructions should the nurse include? Select all that apply. 1 Use a steam inhaler. 2 Sleep with your head elevated. 3 Restrict fluid intake. 4 Avoid exposure to smoke. 5 Apply a cold compress on your cheek

1, 2, 4 In the case of sinusitis, steam inhalation helps to promote drainage of secretions. Sleeping with the head elevated helps to drain the sinuses and reduce congestion. Smoke is an irritant and will worsen the symptoms of sinusitis. Adequate fluid intake will decrease the symptoms of sinusitis. Applying a cold compress on the cheeks is not recommended, because this worsens the symptoms. A hot compress on the cheeks will help. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely. Text Reference - p. 506

Which clinical signs should the nurse monitor to ensure safety in a patient who has posterior nasal packing in the nose? Select all that apply. 1 Heart rate 2 Hypothermia 3 Heart rhythm 4 Respiratory rate 5 Red blood cell count

1, 3, 4 Posterior nasal packing is applied to a patient to reduce bleeding from the nose. Posterior nasal packing can increase the risk of cardiovascular complications such as tachycardia and heart rhythm. The nurse should monitor heart rate and heart rhythm to check for complications. Posterior nasal packing can cause hypoxemia. Therefore, the nurse should closely monitor the patient's respiratory rate. Posterior nasal packing does not alter thermoregulation. Therefore, it does not result in hypothermia. Posterior nasal packing does not alter the red blood cell count. Text Reference - p. 499

The nurse is suctioning a patient with a tracheostomy tube. Which physiologic parameters are assessed during suctioning? Select all that apply. 1 Heart rate 2 Temperature 3 Glucose level 4 Blood pressure 5 Oxygen saturation

1, 5 Heart rate and oxygen saturation level are considered when recording a baseline for detecting changes during suctioning. Temperature, glucose level, and blood pressure are not assessed while recording the baseline. Text Reference - p. 509

Which tube has openings on the surface of the cannula to permit airflow? 1 Speaking tracheostomy tube 2 Fenestrated tracheostomy tube 3 Tracheostomy tube with foam-filled cuff 4 Tracheostomy tube with cuff and pilot balloon

2 A fenestrated tube has openings on the surface of the outer cannula that permit air to flow over the vocal cords. Speaking tracheostomy tubes, tracheostomy tubes with foam-filled cuffs, and tracheostomy tubes with cuffs and pilot balloons do not have openings on the surface of the cannula. Text Reference - p. 511

The nurse is suctioning the patient's tracheostomy. Which occurrence is the first priority consideration by the nurse? 1 Heart rate increases from a baseline of 65 to 70 2 Heart rate decreases from a baseline of 65 to 44 3 SpO2 decreases from 100% to 92% 4 SpO2 decreases from 99% to 90%

2 A heart rate decrease by 20 or more beats from baseline is an indication to immediately discontinue suctioning through the tracheostomy. A heart rate increase from baseline by 40 or more beats is an indication to immediately discontinue suctioning through the tracheostomy. The heart rate only increases by 5 beats and is not a reason, by itself, to discontinue suctioning. A decrease in SpO2 less than 90% is an indication to discontinue suctioning through the tracheostomy. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it. Text Reference - p. 530

A patient diagnosed with acute viral sinusitis has experienced sneezing, congestion, sore throat, and fever for one week. The patient reports worsening of symptoms and severe ear pain. The nurse recognizes that the worsening of symptoms is caused by what? 1 Influenza 2 Bacterial infection 3 Fungal infection 4 Protozoal infection

2 Acute viral sinusitis may lead to secondary bacterial infection, which is manifested as high fever (more than 100.4o Fahrenheit), swelling of the tonsils, severe ear pain, severe sinus pain, and worsening of present symptoms. Influenza, fungal, and protozoal infections are not caused by viral sinusitis. Text Reference - p. 502

The nurse is providing tracheostomy care for a patient. What priority action should the nurse perform prior to deflating the cuff of the tube? 1 Explaining the procedure to the patient. 2 Encouraging the patient to cough up secretions. 3 Placing retention sutures in the tracheal cartilage. 4 Keeping the replacement tube near the patient's bed

2 Cuff deflation is performed to allow the patient to talk; therefore, before deflating the cuff, the nurse should encourage the patient to cough up secretions. Information regarding deflating the cuff is provided to the patient before performing tracheostomy, but not before deflating the cuff. Retention sutures are placed in the tracheal cartilage while performing tracheostomy, but not before deflating the cuff of a tracheostomy tube. A replacement tube is placed near the patient's bed for use in case of accidental tracheotomy tube dislodgment. Text Reference - p. 509

The nurse is working in the hospital during the flu season and knows that: 1 The onset is insidious. 2 Generalized myalgia occurs. 3 Vomiting and diarrhea result. 4 Nuchal rigidity starts before headache.

2 Generalized myalgia or body aches are common flu symptoms. The onset of flu is abrupt and not insidious. Anorexia occurs, but not vomiting and diarrhea. Nuchal rigidity is impaired neck flexion resulting from muscle spasms of the neck and is related to meningeal irritation. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success. Text Reference - p. 503

The patient has an acute nasal fracture. What action by the nurse is best to maintain the patient's airway? 1 Apply ice to the nasal bridge 2 Keep the patient sitting upright 3 Administer acetaminophen 4 Encourage the patient to take hot showers

2 The nursing management goal for a patient with a nasal fracture is to maintain the airway by keeping the patient sitting upright. Applying ice to face and nose will reduce edema and bleeding and therefore indirectly assist with maintaining the airway, but sitting upright is paramount. Acetaminophen will provide analgesia but will not maintain the airway in a patient with a nasal fracture. Taking a hot shower will lead to increased swelling and should be avoided in the first 48 hours after a nasal fracture. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process. Text Reference - p. 520

A patient is admitted to an emergency department with injuries of the face and nose. A nurse notices a clear, pink-tinged discharge from the nostrils of the patient, even after controlling the nasal bleed. What could be the cause of the discharge? 1 Skull fracture 2 Septal deviation 3 Cerebrospinal fluid (CSF) leak 4 Epistaxis

3 A clear and pink-tinged discharge from the nose even after control of nasal bleeding suggests a cerebrospinal fluid (CSF) leak. It is an emergency situation and can lead to life-threatening complications. Skull fracture is manifested as ecchymosis of the eyes. There is no clear discharge in the event of a septal deviation or epistaxis. Text Reference - p. 498

A nurse is suctioning the airway of a patient with a tracheostomy tube in place. While suctioning, the nurse notices that the heart rate of the patient drops from 80 to 60 beats/minute. What nursing intervention is most appropriate in this case? 1 Apply continuous suction. 2 Apply rapid intermittent suction. 3 Stop suction. 4 Start rotating the suction catheter.

3 A drop in the heart rate during suctioning indicates hypoxia. If the heart rate drops or increases by 20 beats per minute while suctioning the airway through a tracheostomy tube, suctioning should be stopped immediately. No intermittent or continuous suction should be applied, because it may lead to hypoxia. The suction catheter should be rotated while applying suction. Text Reference - p. 510

Which statement by the student nurse indicates a need for further instruction about airway obstruction? 1 "Airway obstruction can be either partial or complete." 2 "Endotracheal intubation may be performed to reestablish the airway." 3 "Ventilation should be provided after 10 minutes of complete airway obstruction." 4 "Airway obstruction may be caused by aspiration of food contents into the windpipe."

3 Complete airway obstruction should be corrected within three to five minutes, because delaying can lead to permanent brain damage or death. Airway obstruction can be either partial or complete. Establishing ventilation can be performed by endotracheal intubation, tracheostomy, or cricothyroidotomy. Airway obstruction can be caused by aspiration of food contents into the windpipe, allergic reactions, malignancies, and trauma. Text Reference - p. 507

A patient on radiation therapy for neck cancer reports of dry mouth. The primary health care provider prescribes amifostine to the patient. Which route does the nurse prefer to administer the medication? 1 Oral 2 Intravenous 3 Subcutaneous 4 Intramuscular

3 One of the side effects of radiation therapy is dry mouth and amifostine is a cytoprotective adjuvant therapy used to treat this issue. Administration of amifostine through a subcutaneous route has a greater effectiveness in reducing dry mouth when compared to an oral route. Administration of amifostine through intravenous and intramuscular routes leads to reversible hypotension in a patient. Text Reference - p. 515

A patient is receiving external radiation therapy to the lower jaw and neck for cancer of the larynx. The nurse recognizes the need to monitor the patient for: 1 Dyspnea and aphonia 2 Diarrhea and mucositis 3 Xerostomia and dysphagia 4 Constipation and dysphagia

3 Radiation therapy destroys and damages the cells in the healthy tissue of the salivary glands and oral pharynx, resulting in dysphagia (difficulty swallowing) and xerostomia (dry oral cavity). Aphonia (total loss of speech) is usually not seen with external radiation therapy. Diarrhea and constipation are not associated with radiation of the jaw and neck. Mucositis may be seen toward the end of the course of radiation therapy but will be localized to the upper oropharynx. Text Reference - p. 516

What is the priority nursing assessment in the care of a patient who has a tracheostomy? 1 Electrolyte levels and daily weights 2 Assessment of speech and swallowing 3 Respiratory rate and oxygen saturation 4 Pain assessment and assessment of mobility

3 The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurse's assessments that also may be necessary, such as nutritional status, speech, pain, and swallowing ability. Text Reference - p. 507

A student nurse is performing first aid measures in a patient who has had epistaxis for 15 minutes after being admitted to the hospital. Which step taken by the student nurse needs correction? 1 Applying anterior packing 2 Elevating the head of the patient 3 Laying the patient in a supine position 4 Pinching the lower soft part of the nose

3 While providing first aid measurement to a patient with epistaxis, the nurse should place the patient in a sitting position because it will reduce the blood pressure in the veins of the nose and reduce bleeding, thereby preventing the patient from swallowing blood. Anterior packing is used to prevent the flow of blood when the bleeding does not stop after 15 minutes. The nurse should elevate the head of the patient to prevent the flow of blood, and for the clear visualization of the nostrils. The nurse should pinch the lower soft part of the nose, because this intervention helps to send the pressure back to the bleeding point in the nasal septum and stops the flow of blood. Text Reference - p. 49

What is the clinical manifestation of oral cancer? 1 Sore throat, cough, and fever 2 Voice hoarseness for more than two weeks 3 White or red patches in the mouth 4 Recurrent need to clear the throat

3 White or red patches in the mouth are manifestations of oral cancer. Sore throat, cough, and fever are the symptoms of allergic rhinitis. Hoarseness of voice lasting for more than two weeks is a sign of early laryngeal cancer. A recurrent need to clear the throat is seen in patients with acute viral rhinitis. Text Reference - p. 512

Which indicates effective learning about measures to be followed while caring for a patient who has undergone a complete laryngectomy? 1 Giving lemon tea to the patient 2 Implementing fluid restriction in the patient 3 Continuously encouraging the patient to speak 4 Teaching the patient a keyboard-based communication program

4 A complete laryngectomy is the surgical removal of larynx. Patients who do not have a larynx cannot speak; therefore, a caregiver should teach the patient to use a keyboard-based communication program, which converts typed messages into an audio format, and they then are transmitted through handheld speakers. Lemon tea is beneficial for health, but it is not necessary to provide after a laryngectomy. Fluid restriction is not advised because it can result in dehydration and constipation. Insisting the patient speak when he or she cannot may lead to frustration, depression, and loss of hope. Text Reference - p. 512

A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to implement an intervention that focuses on both nursing and medical goals for this patient. Which intervention should the nurse implement? 1 Apply an external splint to the nose 2 Insert plastic nasal implant surgically 3 Humidify the air for mouth breathing 4 Maintain surgical packing in the nose

4 A goal that is common to nursing and medical management of a patient after rhinoplasty is to prevent the formation of a septal hematoma and potential infections resulting from a septal hematoma. Therefore, the nurse helps to keep the nasal packing in the nose. The packing applies direct pressure to oozing blood vessels to stop postoperative bleeding. A medical goal includes realigning the fracture with an external or internal splint. The nurse helps maintain the airway by humidifying inspired air because the nose is unable to do so following surgery because it is swollen and packed with gauze. Text Reference - p. 498

A patient has an infection caused by β-hemolytic streptococci. What condition does the nurse correlate with this bacterial infection? 1 Sinusitis 2 Fungal pharyngitis 3 Acute viral rhinitis 4 Peritonsillar abscess

4 A peritonsillar abscess is a complication of bacterial acute pharyngitis that is most often caused by β-hemolytic streptococci. Sinusitis is caused by rhinovirus and coronavirus and is characterized by inflammation of the sinuses. Fungal pharyngitis is a fungal infection caused by Candida albicans. Acute viral rhinitis is caused by a virus, but not by β-hemolytic streptococci. Text Reference - p. 507

Which disease is associated with scratchy throat, severe pain, and enlargement of the anterior cervical lymph node? 1 Sinusitis 2 Influenza 3 Allergic rhinitis 4 Acute pharyngitis

4 Acute pharyngitis is an inflammation of the pharynx and enlargement of the anterior cervical lymph node. Sore throat, scratchiness in the throat, and difficulty swallowing are clinical manifestations of acute pharyngitis. Sinusitis is inflammation of the sinuses. It develops when inflammation or hypertrophy of the mucosa blocks the openings in the sinuses through which mucus drains into the nose. This causes pain over the affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, and malaise. Influenza is an infectious disease caused by the influenza virus. The systemic symptoms of influenza include chills, fever, anorexia, malaise, and generalized myalgia. Allergic rhinitis is an allergic inflammation of the nasal airways. It includes sneezing; watery, itchy eyes; altered sense of smell; and thin, watery nasal discharge resulting in sustained mucus production and nasal congestion. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 506

A patient with head and neck cancer has undergone a cordectomy. Which complication is associated with this procedure? 1 Anxiety 2 Acute pain 3 Risk for aspiration 4 Impaired verbal communication

4 Cordectomy is surgical removal of the vocal cords, which causes impaired verbal communication. The patient may have anxiety due to lack of knowledge regarding a surgical procedure; anxiety is not specifically associated with cordectomy. Acute pain is related to tissue injury during surgery. The presence of an artificial airway and the accumulation of mucus in the airways increases risk of aspiration; these complications are not associated with cordectomy. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 515

Which condition is suspected in a patient who is exposed to sun and asbestos? 1 Rhinitis 2 Sinusitis 3 Influenza 4 Head and neck cancer

4 Exposure to sun and asbestos are risk factors for head and neck cancer. Rhinitis is suspected when the patient is exposed to animal dander and house molds. Sinusitis is suspected when the patient has inflammation of the mucosa that blocks the opening to the sinuses. Influenza is suspected when the patient is exposed to an influenza virus. Text Reference - p. 512

The nurse is teaching a patient stoma care after a tracheostomy. Discharge instructions should include: 1 No diving into water but swimming is okay. 2 Washing the area around the stoma at least three times a day. 3 No covering of the stoma while coughing so secretions can be excreted. 4 Wearing a Medic Alert bracelet or other form of emergency identification

4 It is important to wear a Medic Alert bracelet or other form of identification so that emergency personnel are able to identify that the patient breathes from the neck. Swimming and diving are contraindicated. At least once a day, the area around the stoma needs to be cleansed with a moist cloth. The stoma needs to be covered when coughing to prevent the spread of mucous and secretions to others. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 517

The nurse is caring for the patient with acute pharyngitis. Which action by the nurse is most appropriate? 1 Encourage the patient to drink orange juice. 2 Suggest that the patient sip hot tea. 3 Offer hydrogen peroxide for gargling. 4 Offer a drink of water.

4 Offering a drink of water is correct because cool, bland liquids, such as water, will not irritate the pharynx. Citrus juices often irritate the pharynx, making it painful. Drinking warm or cold liquid is recommended, but consuming hot tea will irritate the pharynx and cause pain. Gargling with warm salt water can alleviate the symptoms of acute pharyngitis, but there are no recommendations to use hydrogen peroxide to alleviate the symptoms. Text Reference - p. 506

A patient is taking phenylephrine nasal spray for nasal congestion. What should the nurse be sure to include when discussing side effects with the patient? 1 It can cause nasal dryness and irritation. 2 It can lead to occasional burning or nasal irritation. 3 It can cause mild transient nasal burning and stinging. 4 It can cause rebound nasal congestion if used for more than three days.

4 Phenylephrine is a nasal spray decongestant used in the treatment of rhinitis and sinusitis. Use of this nasal spray for more than three days can cause rebound nasal congestion. Ipratropium bromide is an anticholinergic nasal spray that can cause nasal dryness and irritation. Cromolyn spray can cause occasional burning or nasal irritation. Budesonide is a corticosteroid nasal spray that causes nasal burning and stinging. Text Reference - p. 502

A patient with a new laryngectomy is considering different methods of voice restoration. The nurse knows that which of these offers the best speech quality and patient satisfaction? 1 Esophageal speech 2 Intraoral electrolarynx 3 Neck type electrolarynx 4 Transesophageal puncture

4 Transesophageal puncture, the most common voice rehabilitation method, offers the best speech quality with the highest patient satisfaction. Esophageal speech is used, but very few develop fluent speech. Neck type electrolarynx and intraoral electrolarynx are easy to use and common, but have a mechanical-sounding speech. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely. Text Reference - p. 523

A nurse practitioner has provided care for three different patients with chronic pharyngitis over the past several months. Which patients are at greatest risk for developing chronic pharyngitis? A) Patients who are habitual users of alcohol and tobacco B) Patients who are habitual users of caffeine and other stimulants C) Patients who eat a diet high in spicy foods D) Patients who have gastrointestinal reflux disease (GERD)

A

The ED nurse is assessing a young gymnast who fell from a balance beam.The gymnast presents with a clear fluid leaking from her nose. What should the ED nurse suspect? A) Fracture of the cribriform plate B) Rupture of an ethmoid sinus C) Abrasion of the soft tissue D)Fracture of the nasal septum

A

After being hit by a baseball, a patient arrives in the emergency department with a possible nasal fracture. Which finding by the nurse is most important to report to the health care provider? a. Clear nasal drainage b. Complaint of nasal pain c. Bilateral nose swelling and bruising d. Inability to breathe through the nose

A (Clear nasal drainage may indicate a meningeal tear with leakage of cerebrospinal fluid. This would place the patient at risk for complications such as meningitis. The other findings are typical with a nasal fracture and do not indicate any complications.)

The nurse is caring for a mechanically ventilated patient with a cuffed tracheostomy tube. Which action by the nurse would determine if the cuff has been properly inflated? a. Use a hand-held manometer to measure cuff pressure. b. Review the health record for the prescribed cuff pressure. c. Suction the patient through a fenestrated inner cannula to clear secretions. d. Insert the decannulation plug before removing the nonfenestrated inner cannula.

A (Measurement of cuff pressure using a manometer to ensure that cuff pressure is 20 mm Hg or lower will avoid compression of the tracheal wall and capillaries. Never insert the decannulation plug in a tracheostomy tube until the cuff is deflated and the nonfenestrated inner cannula is removed. Otherwise, the patient's airway is occluded. A health care provider's order is not required to determine safe cuff pressure. A nonfenestrated inner cannula must be used to suction a patient to prevent tracheal damage occurring from the suction catheter passing through the fenestrated openings.)

The nurse is caring for a hospitalized older patient who has nasal packing in place after a nosebleed. Which assessment finding will require the most immediate action by the nurse? a. The oxygen saturation is 89%. b. The nose appears red and swollen. c. The patient reports level 8 (0 to 10 scale) pain. d. The patient's temperature is 100.1° F (37.8° C).

A (Older patients with nasal packing are at risk of aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to further assess for these complications. The other assessment data also indicate a need for nursing action but not as immediately as the low O2 saturation.)

A nurse obtains a health history from a patient who has a 35 pack-year smoking history. The patient complains of hoarseness and tightness in the throat and difficulty swallowing. Which question is important for the nurse to ask? a. "How much alcohol do you drink in an average week?" b. "Do you have a family history of head or neck cancer?" c. "Have you had frequent streptococcal throat infections?" d. "Do you use antihistamines for upper airway congestion?"

A (Prolonged alcohol use and smoking are associated with the development of laryngeal cancer, which the patient's symptoms and history suggest. Family history is not a risk factor for head or neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the patient's symptoms are not suggestive of this diagnosis. Patients with streptococcal throat infections will also have pain and a fever.)

Which patient in the ear, nose, and throat (ENT) clinic should the nurse assess first? a. A patient who is complaining of a sore throat and has a muffled voice b. A patient who has a "scratchy throat" and a positive rapid strep antigen test c. A patient who is receiving radiation for throat cancer and has severe fatigue d. A patient with a history of a total laryngectomy whose stoma is red and inflamed

A (The patient's clinical manifestation of a muffled voice suggests a possible peritonsillar abscess that could lead to an airway obstruction requiring rapid assessment and potential treatment. The other patients do not have diagnoses or symptoms that indicate any life-threatening problems.)

The nurse completes discharge instructions for a patient with a total laryngectomy. Which statement by the patient indicates that additional instruction is needed? a. "I must keep the stoma covered with an occlusive dressing." b. "I need to have smoke and carbon monoxide detectors installed." c. "I can participate in my prior fitness activities except swimming." d. "I should wear a Medic-Alert bracelet to identify me as a neck breather."

A (The stoma may be covered with clothing or a loose dressing, but this is not essential. An occlusive dressing will completely block the patient's airway. The other patient comments are all accurate and indicate that the teaching has been effective.)

Which statement by the patient indicates that teaching has been effective for a patient scheduled for radiation therapy of the larynx? a. "I will need to buy a water bottle to carry with me." b. "I should not use any lotions on my neck and throat." c. "Until the radiation is complete, I may have diarrhea." d. "Alcohol-based mouthwashes will help clean my mouth."

A (Xerostomia can be partially alleviated by drinking fluids at frequent intervals. Radiation will damage tissues at the site being radiated but should not affect the abdominal organs, so loose stools are not a usual complication of head and neck radiation therapy. Frequent oral rinsing with non-alcohol-based rinses is recommended. Prescribed lotions and sunscreen may be used on radiated skin, although they should not be used just before the radiation therapy.)

The nurse is reviewing the medical records for five patients who are scheduled for their yearly physical examinations in September. Which patients should receive the inactivated influenza vaccination (select all that apply)? a. A 76-yr-old nursing home resident b. A 36-yr-old female patient who is pregnant c. A 42-yr-old patient who has a 15 pack-year smoking history d. A 30-yr-old patient who takes corticosteroids for rheumatoid arthritis e. A 24-yr-old patient who has allergies to penicillin and cephalosporins

A, B, D (Current guidelines suggest that healthy individuals between 6 months and age 49 years receive intranasal immunization with live, attenuated influenza vaccine. Individuals who are pregnant, residents of nursing homes, or are immunocompromised or who have chronic medical conditions should receive inactivated vaccine by injection. The corticosteroid use by the 30-yr-old patient increases the risk for infection.)

The nurse assumes care of a patient who just returned from surgery for a total laryngectomy and radical neck dissection and notes the following problems. In which order should the nurse address the problems? (Put a comma and a space between each answer choice [A, B, C, D].) a. The patient is in a side-lying position with the head of the bed flat. b. The patient is coughing blood-tinged secretions from the tracheostomy. c. The nasogastric (NG) tube is disconnected from suction and clamped off. d. The wound drain in the neck incision contains 200 mL of bloody drainage.

A, B, D, C (The patient should first be placed in a semi-Fowler's position to maintain the airway and reduce incisional swelling. The blood-tinged secretions may obstruct the airway, so suctioning is the next appropriate action. Then the wound drain should be drained because the 200 mL of drainage will decrease the amount of suction in the wound drain and could lead to incisional swelling and poor healing. Finally, the NG tube should be reconnected to suction to prevent gastric dilation, nausea, and vomiting.)

The clinic nurse is teaching a patient with acute sinusitis. Which interventions should the nurse plan to include in the teaching session (select all that apply)? a. Decongestants can be used to relieve swelling. b. Blowing the nose should be avoided to decrease the nosebleed risk. c. Taking a hot shower will increase sinus drainage and decrease pain. d. Saline nasal spray can be made at home and used to wash out secretions. e. You will be more comfortable if you keep your head in an upright position.

A, C, D, E (The steam and heat from a shower will help thin secretions and improve drainage. Decongestants can be used to relieve swelling. Patients can use either over-the-counter sterile saline solutions or home-prepared saline solutions to thin and remove secretions. Maintaining an upright posture decreases sinus pressure and the resulting pain. Blowing the nose after a hot shower or using the saline spray is recommended to expel secretions.)

Which nursing action could the registered nurse (RN) working in a skilled care hospital unit delegate to an experienced licensed practical/vocational nurse (LPN/LVN) caring for a patient with a permanent tracheostomy? a. Assess the patient's risk for aspiration. b. Suction the tracheostomy when directed. c. Teach the patient to provide tracheostomy self-care. d. Determine the need for tracheostomy tube replacement.

B (Suctioning of a stable patient can be delegated to LPNs/LVNs. Patient assessment and patient teaching should be done by the RN.)

The nurse is doing discharge teaching in the ED with a patient who had a nosebleed. What should the nurse include in the discharge teaching of this patient? A) Avoid blowing the nose for the next 45 minutes. B) In case of recurrence, apply direct pressure for 15 minutes. C) Do not take aspirin for the next 2 weeks. D) Seek immediate medical attention if the nosebleed recurs.

B

The nurse obtains the following assessment data on an older patient who has influenza. Which information will be most important for the nurse to communicate to the health care provider? a. Fever of 100.4° F (38° C) b. Diffuse crackles in the lungs c. Sore throat and frequent cough d. Myalgia and persistent headache

B (The crackles indicate that the patient may be developing pneumonia, a common complication of influenza, which would require aggressive treatment. Myalgia, headache, mild temperature elevation, and sore throat with cough are typical manifestations of influenza and are treated with supportive care measures such as over-the-counter pain relievers and increased fluid intake.)

Which action should the nurse take first when a patient develops epistaxis? a. Pack the affected nare tightly with an epistaxis balloon. b. Apply squeezing pressure to the nostrils for 10 minutes. c. Obtain silver nitrate that may be needed for cauterization. d. Instill a vasoconstrictor medication into the affected nare.

B (The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils. Application of cold packs may decrease blood flow to the area but will not be sufficient to stop bleeding. Cauterization, nasal packing, and vasoconstrictors are medical interventions that may be needed if pressure to the nares does not stop the bleeding, but these are not the first actions to take for a nosebleed.)

The nurse plans to teach a patient how to manage allergic rhinitis. Which information should the nurse include in the teaching plan? a. Using oral antihistamines for 2 weeks before the allergy season may prevent reactions. b. Identifying and avoiding environmental triggers are the best way to prevent symptoms. c. Frequent hand washing is the primary way to prevent spreading the condition to others. d. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.

B (The most important intervention is to assist the patient in identifying and avoiding potential allergens. Intranasal corticosteroids (not oral antihistamines) should be started several weeks before the allergy season. Corticosteroid nasal sprays have minimal systemic absorption. Acute viral rhinitis (common cold) can be prevented by washing hands, but allergic rhinitis cannot.)

The nurse discusses management of upper respiratory infections (URIs) with a patient who has acute sinusitis. Which statement by the patient indicates that additional teaching is needed? a. "I will drink lots of juices and other fluids to stay well hydrated." b. "I can use nasal decongestant spray until the congestion is gone." c. "I can take acetaminophen (Tylenol) to treat my sinus discomfort." d. "I will watch for changes in nasal secretions or the sputum that I cough up."

B (The nurse should clarify that nasal decongestant sprays should be used for no more than 3 days to prevent rebound vasodilation and congestion. The other responses indicate that the teaching has been effective.)

When assessing a patient with a sore throat, the nurse notes anterior cervical lymph node swelling, a temperature of 101.6° F (38.7° C), and yellow patches on the tonsils. Which action will the nurse anticipate taking? a. Teach the patient about the use of expectorants. b. Use a swab to obtain a sample for a rapid strep antigen test. c. Discuss the need to rinse the mouth out after using any inhalers. d. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).

B (The patient's clinical manifestations are consistent with streptococcal pharyngitis, and the nurse will anticipate the need for a rapid strep antigen test or cultures (or both). Because patients with streptococcal pharyngitis usually do not have a cough, use of expectorants will not be anticipated. Rinsing out the mouth after inhaler use may prevent fungal oral infections, but the patient's assessment data are not consistent with a fungal infection. NSAIDs are frequently prescribed for pain and fever relief with pharyngitis.)

A patient is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the patients nutrition during treatment? A) A 1.5 L/day fluid restriction B) A high-potassium, low-sodium diet C) A liquid or soft diet D) A high-protein diet

C

The nurse is creating a plan of car for a patient diagnosed with acute laryngitis. What intervention shouldbe included in the patients plan of care? A) Place warm cloths on the patients throat, as needed. B) Have the patient inhale warm steam three times daily. C) Encourage the patient to limit speech whenever possible. D) Limit the patients fluid intake to 1.5 L/day.

C

A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist? a. Leave the tracheostomy inner cannula inserted at all times. b. Place the decannulation cap in the tube before cuff deflation. c. Assess the ability to swallow before using the fenestrated tube. d. Inflate the tracheostomy cuff during use of the fenestrated tube.

C (Because the cuff is deflated when using a fenestrated tube, the patient's risk for aspiration should be assessed before changing to a fenestrated tracheostomy tube. The decannulation cap is never inserted before cuff deflation because to do so would obstruct the patient's airway. The cuff is deflated and the inner cannula removed to allow air to flow across the patient's vocal cords when using a fenestrated tube.)

A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse indicates that this identified problem is resolving? a. The patient allows the nurse to suction the tracheostomy. b. The patient's spouse provides the daily tracheostomy care. c. The patient asks how to clean the tracheostomy stoma and tube. d. The patient uses a communication board to request "No Visitors."

C (Independently caring for the laryngectomy tube indicates that the patient has regained control of personal care and hopelessness is at least partially resolved. Letting the nurse and spouse provide care and requesting no visitors may indicate that the patient is still experiencing hopelessness.)

After a laryngectomy, a patient coughs violently during suctioning and dislodges the tracheostomy tube. Which action should the nurse take first? a. Arrange for arterial blood gases to be drawn immediately. b. Cover stoma with sterile gauze and ventilate through stoma. c. Attempt to reinsert the tracheostomy tube with the obturator in place. d. Assess the patient's oxygen saturation and notify the health care provider.

C (The first action should be to attempt to reinsert the tracheostomy tube to maintain the patient's airway. Covering the stoma with a dressing and manually ventilating the patient may be an appropriate action if the nurse is unable to reinsert the tracheostomy tube. Assessing the patient's oxygenation is an important action, but it is not as appropriate until there is an established airway.)

A nurse is caring for a patient who has had a total laryngectomy and radical neck dissection. During the first 24 hours after surgery what is the priority nursing action? a. Monitor the incision for bleeding. b. Maintain adequate IV fluid intake. c. Keep the patient in semi-Fowler's position. d. Teach the patient to suction the tracheostomy.

C (The most important goals after a laryngectomy and radical neck dissection are to maintain the airway and ensure adequate oxygenation. Keeping the patient in a semi-Fowler's position will decrease edema and limit tension on the suture lines to help ensure an open airway. Maintenance of IV fluids and monitoring for bleeding are important, but maintaining an open airway is the priority. During the immediate postoperative period, the patient with a laryngectomy requires frequent suctioning of the tracheostomy tube. The patient may be taught to suction after the tracheostomy is stable, if needed, but not during the immediate postoperative period.)

The nurse has just auscultated coarse crackles bilaterally on a patient with a tracheostomy tube in place. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. b. Encourage the patient to increase oral fluid intake. c. Put on sterile gloves and use a sterile catheter to suction. d. Preoxygenate the patient for 3 minutes before suctioning.

C (This patient needs suctioning now to secure a patent airway. Sterile gloves and a sterile catheter are used when suctioning a tracheostomy. Preoxygenation for 3 minutes is not necessary; 30 seconds is recommended. Incentive spirometer use opens alveoli and can induce coughing, which can mobilize secretions. However, the patient with a tracheostomy may not be able to use an incentive spirometer. Increasing oral fluid intake would not moisten and help mobilize secretions in a timely manner.)

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse, "Will I be able to talk normally after surgery?" What is the most accurate response by the nurse? a. "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally." b. "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed." c. "You will have a permanent opening into your neck, and you will need rehabilitation for some type of voice restoration." d. "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally."

C (Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible.)

A patients total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the patient when teaching him about this process? A) Training on how to perform controlled belching B) Use of an electronically enhanced artificial pharynx C) Insertion of a specialized nasogastric tube D) Fitting for a voice prosthesis

D

A patient arrives in the ear, nose, and throat clinic complaining of a piece of tissue being "stuck up my nose" and with foul-smelling nasal drainage from the right nare. Which action should the nurse take first? a. Notify the clinic health care provider. b. Obtain aerobic culture specimens of the drainage. c. Ask the patient about how the cotton got into the nose. d. Have the patient occlude the left nare and blow the nose.

D (Because the highest priority action is to remove the foreign object from the nare, the nurse's first action should be to assist the patient to remove the object. The other actions are also appropriate but should be done after attempting to clear the nose.)

The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement, if made by the patient, indicates that the teaching was successful? a. "My nose will look normal after 24 to 48 hours." b. "I can take 800 mg ibuprofen every 6 hours for pain." c. "I will remove and reapply the nasal packing every day." d. "I will elevate my head for 48 hours to minimize swelling."

D (Maintaining the head in an elevated position will decrease the amount of nasal swelling. Nonsteroidal antiinflammatory drugs, such as ibuprofen, increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not remove or reapply nasal packing, which is usually removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of the surgery, it is not always possible to achieve this result, especially in the first few weeks after surgery.)

The nurse is caring for a patient who has acute pharyngitis caused by Candida albicans. Which action is appropriate for the nurse to include in the plan of care? a. Assess patient for allergies to penicillin antibiotics. b. Teach the patient to sleep in a warm, dry environment. c. Avoid giving the patient warm food or warm liquids to drink. d. Teach patient to "swish and swallow" prescribed oral nystatin

D (Oral or pharyngeal fungal infections are treated with nystatin solution. The goal of the "swish and swallow" technique is to expose all of the oral mucosa to the antifungal agent. Warm liquids may be soothing to a sore throat. The patient should be taught to use a cool mist humidifier. There is no need to assess for penicillin and cephalosporin allergies because Candida albicans infection is treated with antifungals)