Ch 9 Disorders of the Upper Airway

Offer small amounts of preferred beverage

An older adult has fluid volume deficit and needs to consume more fluids. Which approach by the nurse demonstrates gerontologic considerations?

Viral Infection

Most cases of acute pharyngitis are caused by which of the following? 1-Bacterial infection 2-Viral infection 3-Fungal infection 4-Systemic infection

2 to 12 days

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of 1-1 to 3 months. 2-2 to 12 days. 3-3 to 6 months. 4-20 to 30 days.

*Report the symptoms of a secondary infection, the major complication of a cold. *Increase fluid intake and rest as much as possible. *Be aware that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase.

Which of the following health care teaching points would a nurse cover when talking to a patient with rhinosinusitis? Select all that apply.

Sleep apnea actually increases your risk of having a stroke or heart attack.

A 64-year-old patient and his wife have presented to their primary care provider. The patient's wife has prompted her husband to seek care because she is worried about his apneic episodes and loud snoring. The husband had earlier undergone a diagnostic workup for obstructive sleep apnea (OSA) and been diagnosed with the disease but is not motivated to treat his health problem. How can the nurse at the clinic best characterize the risks of OSA?

An antiviral agent such as acyclovir

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? 1-An antihistamine such as Benadryl 2-An antibiotic such as amoxicillin 3-An antiviral agent such as acyclovir 4-An ointment such as bacitracin

Ineffective airway clearance related to excess mucus production

A client reports nasal congestion, sneezing, sore throat, and coughing up of yellow mucus. The nurse assesses the client's temperature as 100.2°F. The client states this is the third episode this season. The highest priority nursing diagnosis is

cardiac irregularities

A client's most recent blood work indicates a K+ level of 7.2 mEq/L (7.2 mmol/L), a finding that constitutes hyperkalemia. For what signs and symptoms should the nurse vigilantly monitor?

sit upright, leaning slightly forward.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: 1-sit upright, leaning slightly forward. 2-lie supine with his neck extended. 3-hold his nose while bending forward at the waist. 4- blow his nose and then put lateral pressure on his nose.

a feeling of swelling at the back of the throat

A client finished a course of antibiotics for laryngitis but continues to experience persistent hoarseness. Which symptom would cause the nurse to suspect laryngeal cancer?

Check the clear fluid for glucose

A client is in the emergency department following a fall on the face. The client reports facial pain. The nurse assesses bleeding from nasal cuts and from the nares, a deformity to the nose, periorbital ecchymoses, and some clear fluid draining from the right nostril. The first action of the nurse is to

Noisy breathing

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids?

hyponatremia

Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. This electrolyte imbalance is known as:

Comatose clients

What client would be most in need of an endotracheal tube? 1-A client status post tonsillectomy 2-Ambulatory clients 3-Older adult clients 4-Comatose clients

Ensure mouth breathing

Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction?

Ineffective airway clearance

Which is the priority nursing diagnosis for a client undergoing a laryngectomy? 1-Anxiety and depression 2-Impaired verbal communication 3-Ineffective airway clearance 4-Imbalanced nutrition: Less than body requirements

Ineffective airway clearance

Which is the priority nursing diagnosis for a client undergoing a laryngectomy? 1-Imbalanced nutrition: Less than body requirements 2-Ineffective airway clearance 3-Impaired verbal communication 4-Anxiety and depression

Nuchal rigidity

A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for 1-Nausea 2-Hypertension 3-Mild headache 4-Nuchal rigidity

Amoxicillin-clavulanic acid

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? 1-Clarithromycin 2-Amoxicillin-clavulanic acid 3-Cefuroxime 4-Cephalexin

hoarseness

A client is being assessed for acute laryngitis. The nurse knows that clinical manifestations of acute laryngitis include 1-a sore throat that feels worse in the evening. 2-hoarseness. 3-a moist cough. 4-a nonedematous uvula.

decreased blood volume and intracellular dehydration

A client who is NPO prior to surgery reports feeling thirsty. What is the physiologic process that drives the thirst factor?

Group A, beta-hemolytic streptococcus

A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis?

The nasal mucosa

A patient comes to the clinic complaining of a possible upper respiratory infection. What should the nurse inspect that would indicate that an upper respiratory infection may be present?

Hypercapnia

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? 1-Systemic hypotension 2-Increased smooth muscle contractility 3-Hypercapnia 4-Pulmonary hypotension

Rhinosinusitis

During a period of significant workplace stress, a patient has been experiencing the recurrence of viral rhinitis for the past several weeks and claims that he has been unable to fully recover from this cold. The nurse should recognize that this patient is at risk of developing: 1-Allergic rhinitis 2-Rhinosinusitis 3-Epiglottitis 4-Epistaxis

Initiate enteral feedings

The nurse is caring for a client who underwent a laryngectomy. Which intervention will the nurse initially complete in an effort to meet the client's nutritional needs? 1-Liberally season foods. 2-Initiate enteral feedings. 3-Offer plenty of thin liquids. 4-Encourage sweet foods.