Med-Surg: Lewis Ch 27

When initially teaching a patient the supraglottic swallow following a radical neck dissection, with which food or fluid should the nurse begin? A.Cola B.Applesauce C.French fries D.White grape juice

A.Cola When learning the supraglottic swallow, it may be helpful to start with carbonated beverages because the effervescence provides clues about the liquid's position. Thin, watery fluids should be avoided because they are difficult to swallow and increase the risk of aspiration. Nonpourable pureed foods, such as applesauce, would decrease the risk of aspiration, but carbonated beverages are the better choice with which to start.

The school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus (select all that apply)? A.Cover the nose when coughing. B.Obtain an influenza vaccination. C.Stay at home when symptomatic. D.Drink non-caffeinated fluids daily. E.Obtain antibiotic therapy promptly.

A.Cover the nose when coughing. B.Obtain an influenza vaccination. C.Stay at home when symptomatic. Covering the nose and mouth when coughing is an effective way to prevent the spread of the virus. Obtaining an influenza vaccination helps prevent the flu. Staying at home helps prevent direct exposure of others to the virus. Drinking fluids helps liquefy secretions but does not prevent influenza. Antibiotic therapy is not used unless the patient develops a secondary bacterial infection.

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? A.Hypersensitivity to eggs B.Age greater than 80 years C.History of upper respiratory infections D.Chronic obstructive pulmonary disease (COPD)

A.Hypersensitivity to eggs Although current vaccines are highly purified, and 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.

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

A.Test the drainage for the presence of glucose. 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.

The nurse is caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings 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's temperature is 100.1° F (37.8° C). d. The patient complains of level 7 (0 to 10 scale) pain.

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

The nurse is obtaining a health history from a 67-year-old patient with a 40 pack-year smoking history, complaints of hoarseness and tightness in the throat, and difficulty swallowing. Which question is most 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?"

ANS: 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. Streptococcal throat infections also may cause these clinical manifestations, but patients also will complain of pain and fever.

A patient with an uncuffed tracheostomy tube coughs violently during suctioning and dislodges the tracheostomy tube. Which action should the nurse take first? a. Insert the obturator and attempt to reinsert the tracheostomy tube. b. Position the patient in an upright position with the neck extended. c. Assess the patient's oxygen saturation and notify the health care provider. d. Ventilate the patient with a manual bag until the health care provider arrives.

ANS: A The first action should be to attempt to reinsert the tracheostomy tube to maintain the patient's airway. Assessing the patient's oxygenation is an important action, but it is not the most appropriate first action in this situation. 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. The patient should be placed in a semi-Fowler's position if reinsertion of the tracheostomy tube is not successful.

Which of these patients in the respiratory disease clinic should the nurse assess first? a. A 23-year-old, complaining of a sore throat, who has a "hot potato" voice b. A 34-year-old who has a "scratchy throat" and a positive rapid strep antigen test c. A 55-year-old who is receiving radiation for throat cancer and has severe fatigue d. A 72-year-old with a history of a total laryngectomy whose stoma is red and inflamed

ANS: A The patient's clinical manifestation of a "hot potato" 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.

After completing discharge instructions for a patient with a total laryngectomy, the nurse determines that additional instruction is needed when the patient says, a. "I must keep the stoma covered with a loose sterile dressing at all times." b. "I can participate in most of my prior fitness activities except swimming." c. "I should wear a Medic Alert bracelet that identifies me as a neck breather." d. "I need to be sure that I have smoke and carbon monoxide detectors installed."

ANS: A The stoma may be covered with clothing or a loose dressing, but this is not essential. The other patient comments are all accurate and indicate that the teaching has been effective.

A patient with laryngeal cancer has received teaching about radiation therapy. Which statement by the patient indicates that the teaching has been effective? 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 oral ulcers."

ANS: 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 irradiated skin, although they should not be used just before the radiation therapy.

The teaching plan for a patient with acute sinusitis will need to include which of the following interventions (select all that apply)? a. Taking a hot shower will increase sinus drainage and decrease pain. b. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. c. Saline nasal spray can be made at home and used to wash out secretions. d. Blowing the nose forcefully should be avoided to decrease nosebleed risk. e. You will be more comfortable if you keep your head in an upright position.

ANS: A, B, C, E The steam and heat from a shower will help thin secretions and improve drainage. Antihistamines can be used. Patients can use either OTC 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.

When inflating the cuff on a tracheostomy tube to the appropriate level, the best action by the nurse will be to a. check the pilot balloon after inflation to ensure that it is firm. b. use a manometer to ensure cuff pressure is at an appropriate level. c. check the amount of cuff pressure ordered by the health care provider. d. fill the balloon until minimal air leakage around the cuff is auscultated.

ANS: B Measurement of cuff pressure using a manometer to ensure that cuff pressure is 20 mm Hg or lower will avoid compression of the tracheal capillaries. A firm pilot balloon indicates that the cuff is inflated but does not assess for overinflation. A health care provider's order is not required to determine safe cuff pressure. A minimal leak technique is an alternate means for cuff inflation, but this technique does allow a small air leak around the cuff and increases the risk for aspiration.

An RN is observing a nursing student who is suctioning a hospitalized patient with a tracheostomy in place. Which action by the student requires the RN to intervene? a. The student preoxygenates the patient for 1 minute before suctioning. b. The student puts on clean gloves and uses a sterile catheter to suction. c. The student inserts the catheter about 5 inches into the tracheostomy tube. d. The student applies suction for 10 seconds while withdrawing the catheter.

ANS: B Sterile gloves and a sterile catheter are used when suctioning a tracheostomy. The other student actions do not require intervention by the RN. Although the patient may not need 1 minute of preoxygenation, this would not be unsafe. Suctioning for 10 seconds is appropriate. The length of catheter that should be inserted depends on the length of the tracheostomy tube, but 5 inches would be appropriate for most adult patients.

Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN/LVN who is caring for a patient with a permanent tracheostomy? a. Assessing the patient's risk for aspiration b. Suctioning the tracheostomy when needed c. Educating the patient about self-care of the tracheostomy d. Determining the need for replacement of the tracheostomy tube

ANS: B Suctioning of a stable patient can be delegated to LPN/LVNs. Assessments and patient teaching should be done by the RN.

The nurse obtains the following assessment data in a 76-year-old patient who has influenza. Which information will be most important 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

ANS: 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 symptoms of influenza and are treated with supportive care measures such as over-the-counter (OTC) pain relievers and increased fluid intake.

Which action should the nurse take first when a patient develops a nosebleed? a. Pack both nares tightly with 1/2-inch ribbon gauze. b. Pinch the lower portion of the nose for 10 minutes. c. Prepare supplies that will be needed for cauterization. d. Apply ice compresses over the patient's nose and cheeks.

ANS: 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 somewhat, but will not be sufficient to stop bleeding. Cauterization or nasal packing may be needed if pressure to the nares does not stop bleeding, but these are not the first actions to take for nosebleed.

When the 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 for bleeding. b. Assess breath sounds. c. Clean the inner cannula every 8 hours. d. Avoid changing the tracheostomy ties.

ANS: B The most important goals posttracheotomy are to maintain the airway and ensure adequate oxygenation. Assessment of the breath sounds is the priority action. Maintenance of the tracheostomy ties, cleaning the inner cannula, and checking for bleeding also are appropriate nursing actions but are not of as high a priority.

The nurse is reviewing the charts for five patients who are scheduled for their yearly physical examinations in October. Which of the following patients will require the inactivated influenza vaccination (select all that apply)? a. A 56-year-old patient who is allergic to eggs b. A 36-year-old female patient who is pregnant c. A 42-year-old patient who has a 15 pack-year smoking history d. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis e. A 24-year-old patient who has allergies to penicillin and the cephalosporins

ANS: B, D Current guidelines suggest that healthy individuals between 6 months and age 49 receive intranasal immunization with live, attenuated influenza vaccine. Individuals who are pregnant, have chronic medical conditions, or are immunocompromised should receive inactivated vaccine. The corticosteroid use by the 30-year-old increases the risk for infection. Individuals with egg allergies should not receive inactivated flu vaccine because it is made using eggs.

The nurse enters the room of a patient who has 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 space between each answer choice (a, b, c, d, etc.) ____________________ a. The nasogastric (NG) tube is disconnected from suction and clamped off. b. The patient is in a side-lying position with the head of the bed flat. c. The Hemovac in the neck incision contains 200 mL of bloody drainage. d. The patient is coughing blood-tinged secretions from the tracheostomy

ANS: B, D, C, A 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 Hemovac should be drained because the 200 mL of drainage will decrease the amount of suction in the Hemovac 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 nurse is caring for a spontaneously breathing patient who has a tracheostomy. To determine that the patient can protect the airway when eating without having the tracheostomy cuff inflated, the nurse will deflate the cuff and a. ask the patient to say a few sentences. b. monitor for signs of respiratory distress. c. have the patient drink a small amount of grape juice and observe for coughing. d. auscultate the lungs for crackles after having the patient take a few sips of water.

ANS: 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 is the best indicator that the problem identified in this nursing diagnosis is resolving? a. The patient lets the spouse provide tracheostomy care. b. The patient allows the nurse to suction the tracheostomy. c. The patient asks how to clean the tracheostomy stoma and tube. d. The patient uses a communication board to request "No Visitors."

ANS: 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 patient has undergone a rhinoplasty, which nursing intervention will be included in the plan of care? a. Educate the patient about how to safely remove and reapply nasal packing. b. Reassure the patient that the nose will look normal when the swelling subsides. c. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. d. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.

ANS: C Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not be taught to 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.

After discussing management of upper respiratory infections (URI) with a patient who has acute viral rhinitis, the nurse determines that additional teaching is needed when the patient says a. "I can take acetaminophen (Tylenol) to treat discomfort." b. "I will drink lots of juices and other fluids to stay hydrated." c. "I can use my nasal decongestant spray until the congestion is all gone." d. "I will watch for changes in nasal secretions or the sputum that I cough up."

ANS: C 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 the nurse is deflating the cuff of a tracheostomy tube to evaluate the patient's ability to swallow, it is important to a. clean the inner cannula of the tracheostomy tube before deflation. b. deflate the cuff during the inhalation phase of the respiratory cycle. c. suction the patient's mouth and trachea before deflation of the cuff. d. insert exactly the same volume of air into the cuff during reinflation.

ANS: C The patient's mouth and trachea should be suctioned before the cuff is deflated to prevent aspiration of oral secretions. The amount of air needed to inflate the cuff varies and is adjusted by measuring cuff pressure or using the minimal leak technique, not by measuring the volume of air removed from the cuff. The cuff is deflated during patient exhalation so that secretions will be forced into the mouth rather than aspirated. There is no need to clean the inner cannula before cuff deflation.

When teaching the patient with allergic rhinitis about management of the condition, the nurse explains that a. over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered. b. corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use. c. use of oral antihistamines for a few weeks before the allergy season may prevent reactions. d. identification and avoidance of environmental triggers are the best way to avoid symptoms.

ANS: D 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. Nonsedating antihistamines are available OTC.

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse, "How will I talk after the surgery?" The best response by the nurse is, 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 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." d. "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration."

ANS: D 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 appropriate to tell a patient that this ability would 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.

When caring for a patient who is 3 hours postoperative laryngectomy, what is the nurse's highest priority assessment? A.Patient comfort B.Airway patency C.Incisional drainage D.Blood pressure and heart rate

B.Airway patency Remember the ABCs with prioritization. Airway patency is always the highest priority and is essential for a patient undergoing surgery surrounding the upper respiratory system. Comfort, drainage, and vital signs follow the ABCs in priority.

A patient is being discharged from the emergency department after being treated for epistaxis. In teaching the family first aid measures in the event the epistaxis would recur, what measures should the nurse suggest (select all that apply)? A.Tilt patient's head backwards. B.Apply ice compresses to the nose. C.Tilt head forward while lying down. D.Pinch the entire soft lower portion of the nose. E.Partially insert a small gauze pad into the bleeding nostril

B.Apply ice compresses to the nose. D.Pinch the entire soft lower portion of the nose. First aid measures to control epistaxis include placing the patient in a sitting position, leaning forward. Pinching the soft lower portion of the nose or inserting a small gauze pad into the bleeding nostril should stop the bleeding within 15 minutes. Tilting the head back or forward does not stop the bleeding, but rather allows the blood to enter the nasopharynx, which could result in aspiration or nausea/vomiting from swallowing blood. Lying down also will not decrease the bleeding.

A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when he coughs and expels the tracheostomy tube. How should the nurse respond? A.Suction the tracheostomy opening. B.Maintain the airway with a sterile hemostat. C.Use an Ambu bag and mask to ventilate the patient. D.Insert the tracheostomy tube obturator into the stoma.

B.Maintain the airway with a sterile hemostat. As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube, the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse will use an Ambu bag and mask to ventilate the patient temporarily.

Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? A.Assessing the need for suctioning B.Suctioning the patient's oropharynx C.Assessing the patient's swallowing ability D.Maintaining appropriate cuff inflation pressure

B.Suctioning the patient's oropharynx Providing the individual has been trained in correct technique, UAP may suction the patient's oropharynx. Assessing the need for suctioning should be performed by an RN or licensed practical nurse, whereas swallowing assessment and the maintenance of cuff inflation pressure should be performed solely by the RN.

A patient with a history of tonsillitis complains of difficulty breathing. Which patient assessment data warrants emergency interventions by the nurse? A.Bilateral erythema of especially large tonsils B.Temperature 102.2° F, diaphoresis, and chills C.Contraction of neck muscles during inspiration D.β-hemolytic streptococcus in the throat culture

C.Contraction of neck muscles during inspiration Contraction of neck muscles during inspiration indicates that the patient is using accessory muscles for breathing and is in serious respiratory distress. The reddened and enlarged tonsils indicate pharyngitis. The increased temperature, diaphoresis, and chills indicate an infection, which could be β-hemolytic streptococcus or fungal infection, but not an emergency situation for the patient.

The patient has been diagnosed with head and neck cancer. Along with the treatment for the cancer, what other treatment should the nurse expect? A.Nasal packing B.Epistaxis balloon C.Gastrostomy tube D.Peripheral skin care

C.Gastrostomy tube Because 50% of patients with head and neck cancer are malnourished before treatment begins, many patients need enteral feeding via a gastrostomy tube because the effects of treatment make it difficult to take in enough nutrients orally, whether surgery, chemotherapy, or radiation is used. Nasal packing could be used with epistaxis or with nasal or sinus problems. Peripheral skin care would not be expected because it is not related to head and neck cancer.

What is the priority nursing assessment in the care of a patient who has a tracheostomy? A.Electrolyte levels and daily weights B.Assessment of speech and swallowing C.Respiratory rate and oxygen saturation D.Pain assessment and assessment of mobility

C.Respiratory rate and oxygen saturation 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 may also be necessary, such as nutritional status, speech, pain, and swallowing ability.

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? A.Apply an external splint to the nose. B.Insert plastic nasal implant surgically. C.Humidify the air for mouth breathing. D.Maintain surgical packing in the nose.

D.Maintain surgical packing in the nose 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.

The patient seeks relief from the symptoms of an upper respiratory infection (URI) that has lasted for 5 days. Which patient assessment should the nurse use to help determine if the URI has developed into acute sinusitis? A.Coughing B.Fever, chills C.Dust allergy D.Maxillary pain

D.Maxillary pain The nurse should assess the patient for sinus pain or pressure as a clinical indicator of acute sinusitis. Coughing and fever are nonspecific clinical indicators of a URI. A history of an allergy that is likely to affect the upper respiratory tract is supportive of the sinusitis diagnosis but is not specific for sinusitis.

The patient has decided to use the voice rehabilitation that offers the best speech quality even though it must be cleaned regularly. The nurse knows that this is what kind of voice rehabilitation? A.Electromyograph B.Intraoral electrolarynx C.Neck type electrolarynx D.Transesophageal puncture

D.Transesophageal puncture The transesophageal puncture provides a fistula between the esophagus and trachea with a one-way valved prosthesis to prevent aspiration from the esophagus to the trachea. Air moves from the lungs, vibrates against the esophagus, and words are formed with the tongue and lips as the air moves out the mouth. The electromyography and both electrolarynx methods produce low-pitched mechanical sounds

The best method for determining the risk of aspiration in a patient with a tracheostomy is to a. consult a speech therapist for swallowing assessment. b. have the patient drink plain water and assess for coughing c. assess for change of sputum color 48 hours after patient drinks small amount of blue dye. d. suction above the cuff after the patients eats or drinks to determine presence of food in trachea.

a. consult a speech therapist for swallowing assessment. Rationale: The ability to swallow secretions without aspiration has traditionally been evaluated with the use of blue dye. A teaspoon of water colored with blue dye is swallowed by the patient. Respiratory secretions are then monitored for 24 hours for appearance of the dye, which would indicate aspiration. Recent studies, however, do not support the sensitivity of this test. It is therefore no longer recommended. Instead, clinical assessment by a speech therapist, videofluoroscopy, or fiberoptic endoscopic evaluations of swallow are recommended. Patients should begin swallowing with thickened liquids, not plain water. Ability to swallow should be assessed with the cuff deflated, inasmuch as cuff inflation may interfere with swallowing ability.

When planning health care teaching to prevent or detect early head and neck cancer, which people would be the priority to target (select all that apply) a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 78-year-old woman who has been drinking hard liquor since her husband died 15 years ago d. 21-year-old college student who drinks beer on weekends with his fraternity brothers e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix a. 65-year-old man who has used chewing tobacco most of his life

b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 78-year-old woman who has been drinking hard liquor since her husband died 15 years ago e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix Rationale: Eighty-five percent of head and neck cancers are caused by tobacco use. Excessive alcohol consumption is also a major risk factor. Head and neck cancers in people younger than 50 years of age have been associated with human papilloma virus (HPV) infection. Sun exposure, especially to the oral cavity, is also a risk factor.

When using a prosthesis for transesophageal speech, the patient a. places a vibrating device in the mouth. b. blocks the stoma entrance with a finger. c. swallows air using a Valsalva maneuver. d. places a speaking valve next the stoma

b. blocks the stoma entrance with a finger. Rationale: To use a prosthesis for transesophageal speech, the patient manually blocks the stoma with a finger. Air moves from the lungs through the prosthesis, into the esophagus, and out the mouth. Speech is produced by the air vibrating against the esophagus and is formed into words by movement of the tongue and lips.

Which nursing action would e of highest priority when suctioning a patient with a tracheostomy? a. Auscultating lung sounds after suctioning is complete. b. Providing a means of communication for the patient during the procedure. c. Assessing the patient's oxygenation saturation before, during and after suctioning. d. Administering pain and/or antianxiety medication 30 minutes before suctioning.

c. Assessing the patient's oxygenation saturation before, during and after suctioning. Rationale: A patient with a tracheostomy is at risk for hypoxemia after suctioning. Therefore, it is imperative to monitor the patient's oxygen status before, during, and after suctioning. Remember the protocol for airway, breathing, and circulation (ABCs) when prioritizing.

A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudates, and headache. The nurse anticipates that the collaborative management will include (select all that apply) a. antiviral agents to treat influenza. b. treatment with antibiotics starting ASAP. c. a throat culture or rapid strep antigen test d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology.

c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology. Rationale: The goals of nursing management are infection control, symptom relief, and prevention of secondary complications. Medications are not prescribed until the etiology is known. Unnecessary use of antibiotics leads to the development of antibiotic-resistant organisms. A thorough history and a throat culture help identify the cause. The nurse should encourage the patient with pharyngitis to increase fluid intake. Cool, bland liquids and gelatin do not irritate the pharynx; citrus juices are often irritating.

While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? a. Notify the physician immediately. b. Place the patient in the prone position to facilitate drainage. c. Instill 3 mL of normal saline into the tracheostomy tube to loosen secretions. d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds.

d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds. Rationale: Immediately after surgery, the patient with a laryngectomy requires frequent suctioning by means of the laryngectomy tube. Secretions typically change in amount and consistency over time. Secretions may initially be copious and blood-tinged secretions and then diminish and thicken. Normal saline bolus through the tracheostomy tube is not recommended to assist with removal of thickened secretions because it causes hypoxia and damage to the epithelial cells.

A patient with allergic rhinitis reports sever nasal congestion; sneezing; and watery, itchy eyes and nose at various times of the year. To teach the patient to control these symptoms, the nurse advises the patients to a. avoid all intranasal sprays and oral antihistamines. b. limit the usage of nasal decongestant spray to 10 days. c. use oral decongestants at bedtime to prevent symptoms during the night. d. keep a diary of when the allergic reaction occurs and what precipitates it.

d. keep a diary of when the allergic reaction occurs and what precipitates it. Rationale: An important intervention involves identifying and avoiding triggers of allergic reactions. The nurse should instruct the patient to keep a diary of times when the allergic reaction occurs and of the activities that precipitate the reaction. To prevent rebound nasal congestion, decongestant sprays should not be used for more than 3 days.

1. A patient was seen in the clinic for an episode of epistaxis, which was controlled by placement of anterior nasal packing. During discharge teaching, the nurse instructs the patient to a. use aspirin for pain relief. b. remove the packing later that day. c. skip the next dose of antihypertensive medication d. avoid vigorous nose blowing and strenuous activity.

d.avoid vigorous nose blowing and strenuous activity. Rationale: The nurse should teach the patient about home care before discharge: to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 to 6 weeks; to sneeze with the mouth open; and to avoid the use of aspirin-containing products or nonsteroidal antiinflammatory drugs (NSAIDs).