ch 22 PrepU upper airway

You are a nurse caring for a client who has just had a tracheostomy. What should you monitor frequently? a) Level of consciousness b) Pain level c) Airway patency d) Psychologic status

c. Airway patency Explanation: The nurse monitors for potential complications and checks airway patency frequently. Secretions can rapidly clog the inner lumen of the tracheostomy tube, resulting in severe respiratory difficulty or death by asphyxiation.

Which of the following is the most effective treatment for obstructive sleep apnea (OSA)? a) Mechanical ventilation b) Bilevel positive airway pressure (BiPAP) c) Continuous positive airway pressure (CPAP) d) Oxygen by nasal cannula

c. Continuous positive airway pressure (CPAP) Explanation: CPAP is the most effective treatment for OSA because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. To use CPAP, the patient must be breathing independently. BiPAP ventilation offers independent control of inspiratory and expiratory pressure while providing pressure support ventilation. Mechanical ventilation is not the most effective treatment for OSA. Administration of low-flow nasal oxygen at night can help relieve hypoxemia in some patients but has little effect on the frequency or severity of apnea.

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? a) Vocal cord stripping b) Total laryngectomy c) Partial laryngectomy d) Cordectomy

c. Partial laryngectomy Explanation: A partial laryngectomy (laryngofissure-thyrotomy) is often used for patients in the early stages of cancer in the glottis area when only one vocal cord is involved.

The nurse is providing discharge instructions for a patient following laryngeal surgery. The nurse instructs the patient to avoid which of the following? a) Coughing b) Wearing a scarf over the stoma c) Swimming d) Wearing a plastic bib while showering

c. Swimming Explanation: Swimming is not recommended because a person with a laryngectomy can drown without submerging his or her face. Special precautions are needed in the shower to prevent water from entering the stoma. Wearing a loose-fitting plastic bib over the tracheostomy or simply holding a hand over the opening is effective. The nurse also suggests that the patient wear a scarf over the stoma to make the opening less obvious. The nurse encourages the patient to cough every 2 hours to promote effective gas exchange.

A late complication of radiation therapy includes a) pain. b) dysphasia. c) laryngeal necrosis. d) xerostomia.

c. laryngeal necrosis. Correct Explanation: Late complications of radiation therapy include laryngeal necrosis, edema, and fibrosis. Pain, xerostomia, and dysphasia are not late complications of radiation therapy.

A nurse takes the initial history of a patient who is being examined for cancer of the larynx. Select the sign that is considered an early clinical indicator. a) Cervical lymph adenopathy b) Dysphasia c) Persistent ulceration d) Hoarseness of more than 2 week's duration

d. Hoarseness of more than 2 week's duration Explanation: Hoarseness of more than 2 weeks' duration occurs in the patient with cancer in the glottic area, because the tumor impedes the action of the vocal cords during speech. The voice may sound harsh, raspy, and lower in pitch. Later symptoms include dysphasia, dyspnea (difficulty breathing), unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath. Cervical lymph adenopathy, unintentional weight loss, a general debilitated state, and pain radiating to the ear may occur with metastasis.

The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised? a) Obtain vital signs. b) Monitor heart rhythm. c) Assess capillary refill. d) Auscultate lung sounds.

d. Auscultate lung sounds. Explanation: Major goals of intubation are to improve respirations and maintain a patent airway for gas exchange. Regular auscultation of the lung fields is essential in confirming that air is reaching the lung fields for gas exchange. All other options are important to provide assessment data.

The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice? a) Radiation therapy b) Total laryngectomy c) Laser surgery d) Partial laryngectomy

b. Total laryngectomy Explanation: In more advanced cases, total laryngectomy may be the treatment of choice. Partial laryngectomy, laser surgery, and radiation therapy are not the treatment of choice for advanced cases of laryngeal cancer.

An obese male is being evaluated for OSA. The nurse asks the patient's wife to document the number and frequency of incidences of apnea while her husband is asleep. The nurse tells the wife that a characteristic indicator of OSA is a breathing cycle characterized by periods of breathing cessation for: a) 8 seconds with 4 episodes/hour. b) 6 seconds with 3 episodes/hour. c) 4 seconds with 2 episodes/hour. d) 10 seconds with 5 episodes/hour.

d. 10 seconds with 5 episodes/hour. Explanation: OSA is characterized by frequent and loud snoring, with breathing cessation for 10 seconds or longer, for at least five episodes per hour, followed by abrupt awakening with a loud snort as the blood oxygen level drops. Symptoms typically progress with weight gain, aging, and during the transition to menopause for women.

A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, "If I am going to have radiation, I won't need surgery." What is the best response by the nurse? a) "All patients have to have radiation before they have surgery. It is protocol." b) "Radiation is used to shrink the tumor size and is an adjunct to surgery." c) "That is correct. The radiation will eradicate the tumor and you won't have to have further treatment." d) "You really don't have to have radiation but you won't have to have such invasive surgery if you have the radiation first."

b. "Radiation is used to shrink the tumor size and is an adjunct to surgery." Explanation: Radiation therapy may also be used preoperatively to reduce the tumor size. Radiation therapy is combined with surgery in advanced laryngeal cancer as adjunctive therapy to surgery or chemotherapy and as a palliative measure.

When caring for a client who has just had a total laryngectomy, the nurse should plan to: a) keep the client flat in bed. b) develop an alternative communication method. c) keep the tracheostomy cuff fully inflated. d) encourage oral feedings as soon as possible.

b. develop an alternative communication method. Explanation: A client with a laryngectomy can't speak, but still needs to communicate. Therefore, the nurse should plan to develop an alternative communication method. After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. To prevent injury to the tracheal mucosa, the nurse should deflate the tracheostomy cuff or use the minimal leak technique. To decrease edema, the nurse should place the client in semi-Fowler's position.

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

c. "I should become involved in a weight loss program." Explanation: Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

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

c. A permanent tracheal stoma would be necessary. Explanation: A total laryngectomy will result in a permanent stoma and total loss of voice. A partial laryngectomy involves the removal of one vocal cord. The voice is spared with the supraglottic laryngectomy. Removal of a portion of the vocal cord occurs with a hemilaryngectomy.