CH. 18 Management of Patients with Upper Respiratory Tract Disorders

The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice? A. Total laryngectomy B. Laser surgery C. Partial laryngectomy D. Radiation therapy

A. Total laryngectomy

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. Hoarseness of more than 2 week's duration C. Dysphasia D. Persistent ulceration

B. Hoarseness of more than 2 week's duration

The nurse at an employee wellness clinic is meeting with a client who reports voice hoarseness for more than 2 weeks. To determine if the client may have symptoms of early laryngeal cancer, the next question the nurse should ask is, "Do you have A. difficulty swallowing foods" B. trouble with your breathing" C. a persistent cough or sore throat" D. a foul odor to your breath"

C. a persistent cough or sore throat"

Which diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis? A. Sinus x-rays B. MRI C. Sinus aspirates D. CT scan

D. CT scan

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? A. Incrusted mucous membranes B. Hardened secretions C. Erosion of the trachea D. Noisy breathing

D. Noisy breathing

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

D. Swimming

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

A. Amoxicillin

The nurse knows that there are three types of chronic pharyngitis. Which of the following is characterized by numerous swollen lymph follicles on the pharyngeal wall? A. Chronic granular B. Hypertrophic C. Aphonia D. Atrophic

A. Chronic granular

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

A. Laryngeal cancer

The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to laryngeal obstruction. The nurse is calling the physician to report on the client's condition. Which of the following will the nurse report? Select all that apply. A. Nasal flaring with abdominal retractions B. Lung sounds of wheezing C. Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 D. Administration of a corticosteroid inhaler for quick relief E. Increased respiratory effort F. A decreased respiratory rate

A. Nasal flaring with abdominal retractions B. Lung sounds of wheezing C. Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 E. Increased respiratory effort

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

A. Partial laryngectomy

Bleeding from the drains at the surgical site or with tracheal suctioning may signal the occurrence of hemorrhage. Which of the following is a clinical manifestations associated with hemorrhage? A. Rapid, deep respirations B. Warm, moist skin C. Decreased pulse rate D. Increased blood pressure

A. Rapid, deep respirations

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 A. Stands behind the worker, who has hands across the neck B. Exerts pressure against the worker's abdomen C. Places both arms around the worker's waist D. Makes a fist with one hand with the thumb outside the fist

A. Stands behind the worker, who has hands across the neck

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? A. No fluid is normally present B. 20 mL or less C. 20-40 mL D. More than 40 mL

B. 20 mL or less

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

B. Bleeding

The nurse is caring for a client status post adenoidectomy. The nurse finds the client in severe respiratory distress when entering the room. What does the nurse suspect? A. Infection B. Edema of the upper airway C. Plugged tracheostomy tube D. Postoperative bleeding

B. Edema of the upper airway

You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis? A. Monitor for signs of dysphagia. B. Encourage deep breathing every 2 hours. C. Provide meticulous mouth care every 4 hours. D. Caution against frequent coughing.

B. Encourage deep breathing every 2 hours.

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: A. Myalgias B. Fever C. Nausea D. Headache

B. Fever

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 sleep on my side all night long." C. "I should become involved in a weight loss program." D. "I should eat a high-protein diet."

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

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

C. 2 to 12 days

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? A. An ointment such as bacitracin B. An antihistamine such as Benadryl C. An antiviral agent such as acyclovir D. An antibiotic such as amoxicillin

C. An antiviral agent such as acyclovir

A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to A. Properly dispose of used tissues B. Stay in bed when experiencing a fever C. Seek medical help if he experiences inability to swallow D. Place an ice collar on the throat to relieve soreness

C. Seek medical help if he experiences inability to swallow

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

D. A permanent tracheal stoma would be necessary.

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

D. Apply direct continuous pressure.

The nurse is providing discharge instructions to a client who has nasal packing in place following nasal surgery. Which discharge instructions would be most appropriate for the client? A. Administer normal saline nasal drops as ordered. B. Decrease the amount of daily fluids. C. Take aspirin for nasal discomfort. D. Avoid sports activities for 6 weeks.

D. Avoid sports activities for 6 weeks.