Chapter 20: Upper respiratory infections

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 Apply an ice pack to the nose. Reassure the client that the nose is not fractured. Administer prescribed oral ibuprofen (Motrin). Check the clear fluid for glucose.

Check the clear fluid for glucose.

Which assessment finding puts a client at increased risk for epistaxis? Use of a humidifier at night Hypotension Cocaine use History of nasal surgery

Cocaine use

The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk? Facilitate total parenteral nutrition (TPN). Keep a complete suction setup at the bedside. Feed the client several small meals daily. Refer the client for occupational therapy.

Keep a complete suction setup at the bedside.

A client has undergone a polysomnography and is diagnosed with sleep apnea. Which lifestyle changes are recommended for clients with sleep apnea? Select all that apply. Drink alcohol in moderation. Lose weight. Quit smoking. Sleep in a supine position. Use saline spray to reduce nasal dryness.

Lose weight. Quit smoking. Use saline spray to reduce nasal dryness.

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 58-year-old male patient with a 60 pack-year history of cigarette smoking and a history of heavy alcohol use has been diagnosed with laryngeal cancer following a physical examination and endoscopy. The patient has been scheduled for a partial laryngectomy and is highly anxious about the consequences of this surgery. What patient education should the nurse provide for this man? "Most people who have a partial laryngectomy find that their breathing, swallowing, and speech are unchanged." "After a partial laryngectomy, most patients work with a speech therapist and regain some of their ability to speak." "A partial laryngectomy has the advantage of having only a minimal effect on your speech." "Unfortunately, the nature of a partial laryngectomy means that you can no longer use your vocal cords."

"A partial laryngectomy has the advantage of having only a minimal effect on your speech."

A client exhibits a sudden and complete loss of voice and is coughing. The nurse states "Do not smoke and avoid being around others who are smoking." "It is fine to speak in a whisper. This does not strain your voice." "Do not use a humidifier; it will make your problem worse." "The 'tickle' in your throat will improve with cold liquids."

"Do not smoke and avoid being around others who are smoking."

A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? "Do you smoke cigarettes, cigars, or a pipe?" "Have you strained your voice recently?" "Do you eat a lot of red meat?" "Do you eat spicy foods?"

"Do you smoke cigarettes, cigars, or a pipe?"

A client is scheduled for vocal cord stripping to treat a vocal cord lesion. Which statement indicates that the client has realistic postoperative expectations for this surgery? "I know my voice will sound hoarse." "I will have trouble swallowing." "I'm afraid of losing my voice." "Why do they need to remove my vocal cords?"

"I know my voice will sound hoarse."

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."

The nurse instructs a patient to take diphenhydramine (Benadryl) after an allergic reaction. Which of the following statements by the patient indicates successful teaching concerning the administration of diphenhydramine (Benadryl)? "I will still be able to have my after-dinner drink with this medication." "I will eat a diet low in sodium while taking this medication." "I should not drive my car after taking this medication." "I can take this medication every 2 hours until I feel better."

"I should not drive my car after taking this medication.

A client is recovering from a tonsillectomy in the postanesthesia care unit. After an overnight stay in the hospital due to increased secretions and vomiting, the nurse delivers client education and accompanying paperwork. Which comment indicates that the client requires additional education? "If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated." "I promise I won't blow my nose." "I'll sleep on two to three pillows." "I'll gargle with weak salt water three to four times a day."

"If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated."

A client is scheduled for endotracheal intubation prior to surgery. What can the nurse tell this client about an endotracheal tube? "The ET tube will maintain your airway while you're under anesthesia." "The ET tube will be inserted through an opening in your trachea." "The ET tube will remain in place for at least a day postsurgery." "The ET tube will be connected to a negative-pressure ventilator."

"The ET tube will maintain your airway while you're under anesthesia."

The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include? "After surgery you will have a sore throat, but you will be able to speak." "You can use writing or a communication board to communicate." "After surgery you will have to use an electric larynx to communicate." "A speech therapist will evaluate you and recommend a system of communication after surgery."

"You can use writing or a communication board to communicate."

A nurse practitioner has provided care for three different clients with chronic pharyngitis over the past several months. Which clients are at greatest risk for developing chronic pharyngitis? A client who is a habitual user of alcohol and tobacco A client who is a habitual user of caffeine and other stimulants A client who eats a diet high in spicy foods A client who has gastrointestinal reflux disease (GERD)

A client who is a habitual user of alcohol and tobacco

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.

A homeless client with streptococcal pharyngitis is being seen in a clinic. The nurse is concerned that the client will not continue treatment after leaving the clinic. Which of the following measures is the highest priority? Administer one intramuscular injection of penicillin. Provide the client with oral penicillin that will last for 5 days. Provide emphatic oral instructions for the client. Ask an accompanying homeless friend to monitor the client's follow-up.

Administer one intramuscular injection of penicillin.

The nurse is assessing a patient who smokes 2 packs of cigarettes per day and has a strong family history of cancer. What early sign of cancer of the larynx does the nurse look for in this patient? Burning of the throat when hot liquids are ingested Enlarged cervical nodes Dysphagia Affected voice sounds

Affected voice sounds

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

A 42-year-old client is admitted to the ED after an assault. The client received blunt trauma to the face and has a suspected nasal fracture. What intervention should the nurse perform? Administer nasal spray and apply an occlusive dressing to the client's face. Position the client's head in a dependent position. Irrigate the client's nose with warm tap water. Apply ice and keep the client's head elevated.

Apply ice and keep the client's head elevated.

A 13-year-old boy has been brought to the emergency department by his mother after he took a powerful blow to his nose during a volleyball game. Preliminary examination suggests a nasal fracture, which should prompt the nurse to: Apply ice and tell the patient to keep his head elevated Administer saline lavage and tell the patient not to swallow the solution Apply warm compresses to the bridge of the patient's nose Administer analgesia and a nebulized bronchodilator

Apply ice and tell the patient to keep his head elevated

A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks? Preparing the patient for a septoplasty Applying nasal packing Administering nasal lavage Applying steroidal nasal spray

Applying nasal packing

A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is given which of the following post-discharge instructions? Select all that apply. Apply ice or cold compresses for 20 minutes every hour for the first 24 hours. Check for any unusual changes in breathing during the first 48 hours. Observe for any clear drainage from either nostril. Keep the nasal packing in place for 72 hours to help reshape the form of the nose. Elevate the head of the bed for sleeping during the first week. Restrict from sports activities for 6 weeks.

Check for any unusual changes in breathing during the first 48 hours. Observe for any clear drainage from either nostril. Elevate the head of the bed for sleeping during the first week. Restrict from sports activities for 6 weeks.

The nurse is creating a plan of care for a client diagnosed with acute laryngitis. What intervention should be included in the client's plan of care? Place warm washcloths on the client's throat, as needed. Have the client inhale warm steam three times daily. Encourage the client to limit speech whenever possible. Limit the client's fluid intake to 1.5 L/day.

Encourage the client to limit speech whenever possible.

A 60-year-old man has been diagnosed with obstructive sleep apnea (OSA) based on his clinical symptoms and polysomnographic findings. What intervention should the nurse perform to assist this patient in the management of his health problem? Encouraging the patient to adopt a later bedtime and earlier rising hour Encouraging the patient to avoid alcohol and hypnotic medications Teaching the patient deep breathing and coughing exercises to perform before going to bed Teaching the patient strategies for waking himself up when he experiences an apneic spell

Encouraging the patient to avoid alcohol and hypnotic medications

A client has a red pharyngeal membrane, reddened tonsils, and enlarged cervical lymph nodes. The client also reports malaise and sore throat. The nurse needs to assess first for: Fever Headache Myalgias Nausea

Fever

A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis? Group A, beta-hemolytic streptococci Gram-negative Klebsiella Pseudomonas aeruginosa Staphylococcus aureus

Group A, beta-hemolytic streptococci

The perioperative nurse has admitted a client who has just underwent a tonsillectomy. The nurse's postoperative assessment should prioritize which of the following potential complications of this surgery? Difficulty ambulating Hemorrhage Infrequent swallowing Bradycardia

Hemorrhage

The nurse is caring for a patient in the outpatient clinic with suspicion of cancer due to recent weight loss for unidentifiable reasons. The patient has a 25-year history of smoking. The nurse performs an assessment and asks the patient about symptoms related to laryngeal cancer. What is an early symptom associated with laryngeal cancer? Hoarseness Dyspnea Dysphagia Alopecia

Hoarseness

The nurse is caring for a client in the ED for epistaxis. What information should the nurse include in client discharge teaching as a way to prevent epistaxis? Keep nasal passages clear. Use decongestants regularly. Humidify the indoor environment. Use a tissue when blowing the nose.

Humidify the indoor environment.

Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion? Simple Mixed Obstructive Central

Obstructive

The nurse is performing a nutritional assessment on a client who has been diagnosed with cancer of the larynx. Which laboratory values would be assessed when determining the nutritional status of the client? Select all that apply. White blood cell count Protein level Albumin level Platelet count Glucose level

Protein level Albumin level Glucose level

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.

The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a client who is postoperative day 1 following total laryngectomy. What is the nurse's best action? Remove the client's drain and apply pressure with a sterile gauze. Assess the client, reposition the client supine, and apply wall suction to the drain. Rapidly assess the client and notify the surgeon about the client's bleeding. Administer a STAT dose of vitamin K to aid coagulation.

Rapidly assess the client and notify the surgeon about the client's bleeding.

x The nurse is teaching a client with allergic rhinitis about the safe and effective use of his medications. What would be the most essential information to give this client about preventing possible drug interactions? Prescription medications can be safely supplemented with OTC medications. Use only one pharmacy so the pharmacist can check drug interactions. Read drug labels carefully before taking OTC medications. Consult the internet before selecting an OTC medication.

Read drug labels carefully before taking OTC medications.

A nursing student is discussing a client with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for clients with viral pharyngitis? Teaching focuses on safe and effective use of antibiotics. The client should be preliminarily screened for surgery. Symptom management is the main focus of medical and nursing care. The focus of care is resting the voice to prevent chronic hoarseness.

Symptom management is the main focus of medical and nursing care.

The nurse is providing care for a client who has just been admitted to the postsurgical unit following a laryngectomy. What assessment should the nurse prioritize? The client's swallowing ability The client's airway patency The client's carotid pulses Signs and symptoms of infection

The client's airway patency

A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse's priority for patient education should be: The need to use inhaled corticosteroids and bronchodilators each night prior to applying CPAP The importance of participating in daily physical exercise when using CPAP on a regular basis The need to have continuous pulse oximetry in place while the CPAP machine is in use The importance of complying with CPAP despite the inconvenience associated with its use

The importance of complying with CPAP despite the inconvenience associated with its use

Which intervention regarding nutrition is implemented for clients who have undergone laryngectomy? Use enteral feedings after the procedure Offer plenty of thin liquids when intake resumes Season food to suit an increased sense of taste and smell Recommend the long-term use of zinc lozenges

Use enteral feedings after the procedure

The nurse in a long-term-care facility is aware of the importance of preventing upper respiratory infections (URIs) among the residents of the facility. How is this best accomplished? Vigilant handwashing by staff and residents Providing a high-calorie diet for residents Encouraging residents' fluid intake Providing topical decongestants to residents

Vigilant handwashing by staff and residents

A client is being seen by the physician because of an unrelenting headache, facial tenderness, low-grade fever, and dark yellow nasal discharge. The client reports seeming to develop sinus infections "all the time." Which factor may predispose the client to sinusitis? interference with sinus drainage excessive protein intake more than 8 hours of sleep per night increased exposure to the health care environment

interference with sinus drainage

A 73-year-old client is admitted to the pulmonology unit of the hospital. She was admitted with pleural effusion and was "tapped" to drain the fluid to reduce her mediastinal pressure. How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub? No fluid is normally present 20 mL or less 20-40 mL More than 40 mL

20 mL or less

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

The nurse is caring for a client who is postoperative day 2 following a total laryngectomy for supraglottic cancer. The nurse should prioritize what assessment? Assessment of body image Assessment of jugular venous pressure Assessment of carotid pulse Assessment of swallowing ability

Assessment of swallowing ability

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? Bleeding Difficulty swallowing Throat pain Difficulty talking

Bleeding

The health care provider has ordered continuous positive airway pressure (CPAP) with the delivery of oxygenation. The patient asks the nurse what the benefit of CPAP is. What would be the nurse's best response? CPAP allows a higher percentage of oxygen to be used CPAP prevents the collapse of the patient's airway CPAP eliminates the need for oxygen supplementation during the day CPAP alters alveolar perfusion

CPAP prevents the collapse of the patient's airway

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."

A client's 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 client when teaching him about this process? Training on how to perform controlled belching Use of an electronically enhanced artificial pharynx Insertion of a specialized nasogastric tube Fitting for a voice prosthesis

Fitting for a voice prosthesis

A client visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the client to perform what action? Apply a cold pack to the affected area. Apply heat to the forehead. Perform postural drainage. Increase fluid intake.

Increase fluid intake.

The nurse is planning the care of a client who is scheduled for a laryngectomy. The nurse should assign the highest priority to which postoperative nursing diagnosis? Anxiety related to diagnosis of cancer Altered nutrition related to swallowing difficulties Ineffective airway clearance related to airway alterations Impaired verbal communication related to removal of the larynx

Ineffective airway clearance related to airway alterations

The occupational health nurse is obtaining a client history during a pre-employment physical. During the history, the client states that he has hereditary angioedema. The nurse should identify what implication of this health condition? It will result in increased loss of work days. It may cause episodes of weakness due to reduced cardiac output. It can cause life-threatening airway obstruction. It is a risk factor for ischemic heart disease.

It can cause life-threatening airway obstruction.

The nurse is explaining the safe and effective administration of nasal spray to a client with seasonal allergies. What information is most important to include in this teaching? Finish the bottle of nasal spray to clear the infection effectively. Nasal spray can only be shared between immediate family members. Nasal spray should be given in a prone position. Overuse of nasal spray may cause rebound congestion.

Overuse of nasal spray may cause rebound congestion.

A nurse is in the cafeteria at work. A fellow worker at another table suddenly stands up, leans forward with hands crossed at the neck, and makes gasping noises. The nurse first Stands behind the worker, who has hands across the neck Places both arms around the worker's waist Makes a fist with one hand with the thumb outside the fist Exerts pressure against the worker's abdomen

Stands behind the worker, who has hands across the neck

When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided? Hand-held showers Wearing a scarf over the stoma Swimming Coughing

Swimming

A nurse is suctioning the tracheostomy of a hospitalized client with laryngeal cancer. Which nursing action should be included in this client's plan of care? Use intermittent suctioning while slowly withdrawing and rotating the catheter. Provide suctioning in 30-second intervals. Offer the client suctioning once per day. Instruct the client to use shallow breaths between suctioning.

Use intermittent suctioning while slowly withdrawing and rotating the catheter.

The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed? When the patient has less than 30 mL for 2 consecutive days When the patient states that there is discomfort and requests removal When the drainage tube comes out In 1 week when the patient no longer has serous drainage

When the patient has less than 30 mL for 2 consecutive days

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? a feeling of swelling at the back of the throat weight loss discomfort when drinking cold liquids headaches in the morning

a feeling of swelling at the back of the throat

A client has had a laryngectomy as treatment for laryngeal cancer. Which postoperative instruction is of utmost importance to the client's health and safety? avoid swimming avoid sponge baths avoid covering the stoma avoid coughing

avoid swimming

A client has had four major nosebleeds in one day. The physician performs a physical exam and orders blood tests. The client has no history of hypertension, trauma, or cocaine use. What could be the cause of nosebleeds that are so difficult to control? blood dyscrasias low blood pressure high humidity None of the options is correct.

blood dyscrasias

Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? impaired verbal communication deficient knowledge risk for infection risk for chronic low self-esteem

impaired verbal communication

A client who has been diagnosed with an early glottis cancer would likely undergo which type of surgery? laser microsurgery vocal cord stripping partial laryngectomy total laryngectomy

laser microsurgery

A young client presents with symptoms of sniffling, nasal discharge, coughing, and sneezing. The symptoms which are keeping the client awake at night, and interrupting feedings. The client is diagnosed with rhinovirus. How many strains of this virus cause coryza? more than 100 50 25 12

more than 100

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

sit upright, leaning slightly forward.

Two months prior to a scheduled tonsillectomy, a client has a peritonsillar abscess related to a severe strep infection. After culturing the area and before receiving the results, the physician immediately prescribes a potent antibiotic. The physician is quick to prescribe a strong antibiotic to prevent: the spread of microorganisms into the bloodstream. hemoptysis. the need for a tonsillectomy. hypertrophied turbinates.

the spread of microorganisms into the bloodstream.