Management of Patients with Upper Respiratory Tract Disorders

A client exhibits a sudden and complete loss of voice and is coughing. The nurse states 1. "Do not use a humidifier; it will make your problem worse." 2. "Do not smoke and avoid being around others who are smoking." 3. "It is fine to speak in a whisper. This does not strain your voice." 4. "The 'tickle' in your throat will improve with cold liquids."

Correct response: "Do not smoke and avoid being around others who are smoking." Explanation: A sudden and complete loss of voice and cough are symptoms of laryngitis. The nurse instructs the client to avoid irritants, such as smoking. Voice rest is indicated. Whispering places stress on the larynx. Inhaling cool steam or aerosol aids in the treatment. Dry air may make the symptoms worse. A "tickle" in the throat that many clients report is actually worsened with cold liquids.

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 eat spicy foods?" "Do you eat a lot of red meat?" "Do you smoke cigarettes, cigars, or a pipe?" "Have you strained your voice recently?"

Correct response: "Do you smoke cigarettes, cigars, or a pipe?" Explanation: Persistent hoarseness may signal throat cancer, which commonly is associated with tobacco use. To assess the client's risk for throat cancer, the nurse should ask about smoking habits. Although straining the voice may cause hoarseness, it wouldn't cause hoarseness lasting for 1 month. Consuming red meat or spicy foods isn't associated with persistent hoarseness.

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: 1. "I should eat a high-protein diet." 2. "I should become involved in a weight loss program." 3. "I should sleep on my side all night long." 4. "I need to keep my inhaler at the bedside."

Correct response: "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 client is scheduled for endotracheal intubation prior to surgery. What can the nurse tell this client about an endotracheal tube? 1. "The ET tube will maintain your airway while you're under anesthesia." 2. "The ET tube will be inserted through an opening in your trachea." 3. "The ET tube will be connected to a negative-pressure ventilator." 4. "The ET tube will remain in place for at least a day postsurgery."

Correct response: "The ET tube will maintain your airway while you're under anesthesia." Explanation: An endotracheal tube provides a patent airway for clients who cannot maintain an adequate airway on their own. Tracheostomy tubes are inserted into a surgical opening in the trachea, called a tracheotomy. Clients receiving endotracheal intubation for the purpose of general anesthesia should not require long-term placement of the ET tube. Positive-pressure ventilators require intubation and are used for clients who are under general anesthesia. They are also used for clients with acute respiratory failure, primary lung disease, or who are comatose.

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

Correct response: 2 to 12 days Explanation: HSV-1 is transmitted primarily by direct contact with infected secretions. The incubation period is about 2 to 12 days. The time periods of 20 to 30 days, 1 to 3 months, and 3 to 6 months exceed the incubation period.

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? 1. No fluid is normally present 2. 20 mL or less 3. 20-40 mL 4. More than 40 mL

Correct response: 20 mL or less Explanation: The pleural space, located between the visceral and parietal pleura, normally contains 20 mL of fluid or less. The fluid helps lubricate the visceral and parietal pleura.

The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client's room? 1. A rigid shell 2. A ventilator 3. A face mask 4. A nasal cannula

Correct response: A face mask Explanation: A face mask or other nasal devices are found in the client's room as this type of ventilation does not require intubation or a ventilator. A rigid shell is used with a negative pressure chamber and is not frequently used today. A nasal cannula is not used with the positive pressure device.

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: 1. One vocal cord was removed along with a portion of the larynx. 2. The voice was spared and a tracheostomy would be in place until the airway was established. 3. A portion of the vocal cord was removed. 4. A permanent tracheal stoma would be necessary.

Correct response: 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.

A client recently diagnosed with laryngeal cancer and awaiting a laryngectomy was encouraged to attend a support group prior to surgery. The client asked the nurse about the name of the laryngeal speech method where the client speaks with the assistance of a surgically implanted device. The nurse is correct to provide teaching on which method? 1. A tracheoesophageal puncture 2. An artificial larynx 3. An electronic voice box 4. Esophageal speech

Correct response: A tracheoesophageal puncture Explanation: A tracheoesophageal puncture is the method where a client speaks with the assistance of a surgically implanted valve that diverts air through the esophagus through a surgical opening in the posterior wall of the trachea with the assistance of a voice prosthesis. Esophageal speech occurs from swallowing air and forming words with the lips. An artificial larynx is a throat vibrator or an apparatus that projects sound into the oral cavity. There is no electronic voice box on the market

The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections? 1. Administer an over-the-counter decongestant. 2. Gently blow the nose to eliminate nasal secretions. 3. Place a warm cloth over the sinus area of the forehead. 4. Use an anti-allergy medication to decrease rhinitis.

Correct response: Administer an over-the-counter decongestant. Explanation: The principle causes of sinusitis are the spread of infection from the nasal passages to the sinus and the blockage of normal sinus drainage. Interference with sinus drainage predisposes a client to sinusitis. Administering a decongestant opens the nasal passages for drainage. The other options can be helpful for a sinus infection, but opening the passages is best.

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? 1. Administer one intramuscular injection of penicillin. 2. Provide emphatic oral instructions for the client. 3. Ask an accompanying homeless friend to monitor the client's follow-up. 4. Provide the client with oral penicillin that will last for 5 days.

Correct response: Administer one intramuscular injection of penicillin. Explanation: If a nurse is concerned that a client may not perform follow-up treatment for streptococcal pharyngitis, the highest priority is to administer penicillin as a one-time injection dose. Oral penicillin is as effective and less painful, but the client needs to take the full course of treatment to prevent antibiotic-resistant germs from developing. The nurse should provide oral and written instructions for the client, but this is not as high a priority as administering the penicillin. Having a homeless friend monitor the client's care does not ensure that the client will follow therapy.

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? 1. Keflex 2. Levofloxacin 3. Ceftin 4. Amoxicillin

Correct response: Amoxicillin Explanation: Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid is the antibiotic of choice. For clients who are allergic to penicillin, doxycycline or respiratory quinolones, such as levofloxacin or moxifloxacin, can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin and cefuroxime, are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? 1. Levofloxacin 2. Ceftin 3. Keflex 4. Amoxicillin

Correct response: Amoxicillin Explanation: Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid is the antibiotic of choice. For clients who are allergic to penicillin, doxycycline or respiratory quinolones, such as levofloxacin or moxifloxacin, can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin and cefuroxime, are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

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. Amoxicillin-clavulanic acid 2. Cephalexin 3. Cefuroxime 4. Clarithromycin

Correct response: Amoxicillin-clavulanic acid Explanation: Treatment of acute rhinosinusitis depends on the cause; a 5- to 7-day course of antibiotics is prescribed for bacterial cases. Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid ( Augmentin) is the antibiotic of choice. Other antibiotics prescribed previously to treat ABRS, including cephalosporins such as cephalexin (Keflex), cefuroxime (Ceftin), cefaclor (Ceclor), and cefixime (Suprax), trimethoprim-sulfamethoxazole (Bactrim, Septra), and macrolides such as clarithromycin (Biaxin) and azithromycin (Zithromax), are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information? (Select all that apply.) 1. Stay on bed rest during the febrile stage of the illness. 2. Apply an ice collar. 3. Drink warm or hot liquids during the acute stage of the disease. 4. Gargle with an alcohol-based mouthwash. 5. Try a liquid or soft diet during the acute stage of the disease.

Correct response: Apply an ice collar. Stay on bed rest during the febrile stage of the illness. Try a liquid or soft diet during the acute stage of the disease. Explanation: A liquid or soft diet is provided during the acute stage of the disease, depending on the patient's appetite and the degree of discomfort that occurs with swallowing. Cool beverages, warm liquids, and flavored frozen desserts such as ice pops are often soothing. The nurse instructs the patient to stay in bed during the febrile stage of illness and to rest frequently once up and about. Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. An ice collar also can relieve severe sore throats.

The nurse is caring for a client admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been put in place. Which intervention should the nurse include in the client's care? 1. Apply pressure to the convex of the nose. 2. Restrict fluid intake. 3. Position the patient in the side-lying position. 4. Apply an ice pack.

Correct response: Apply an ice pack. Explanation: Following a nasal fracture, the nurse applies ice and encourages the client to keep the head elevated. The nurse instructs the client to apply ice packs to the nose to decrease swelling. The packing inserted to stop the bleeding may be uncomfortable and unpleasant, and obstruction of the nasal passages by the packing forces the client to breathe through the mouth. This, in turn, causes the oral mucous membranes to become dry. Mouth rinses help to moisten the mucous membranes and to reduce the odor and taste of dried blood in the oropharynx and nasopharynx. Applying direct pressure is not indicated in this situation.

A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis? 1. Apply a moustache dressing. 2. Apply direct continuous pressure. 3. Provide a nasal splint. 4. Place the client in a semi-Fowler's position.

Correct response: Apply direct continuous pressure. Explanation: The severity and location of bleeding determine the treatment of a client with epistaxis. To manage this condition, the nurse should apply direct continuous pressure to the nares for 5 to 10 minutes with the client's head tilted slightly forward. Application of a moustache dressing or a drip pad to absorb drainage, application of a nasal splint, and placement of the client in a semi-Fowler's position are interventions related to the management of a client with a nasal obstruction

A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis? 1. Apply direct continuous pressure. 2. Provide a nasal splint. 3. Apply a moustache dressing. 4. Place the client in a semi-Fowler's position

Correct response: Apply direct continuous pressure. Explanation: The severity and location of bleeding determine the treatment of a client with epistaxis. To manage this condition, the nurse should apply direct continuous pressure to the nares for 5 to 10 minutes with the client's head tilted slightly forward. Application of a moustache dressing or a drip pad to absorb drainage, application of a nasal splint, and placement of the client in a semi-Fowler's position are interventions related to the management of a client with a nasal obstruction.

A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis? 1. Place the client in a semi-Fowler's position. 2. Provide a nasal splint. 3. Apply a moustache dressing. 4. Apply direct continuous pressure.

Correct response: Apply direct continuous pressure. Explanation: The severity and location of bleeding determine the treatment of a client with epistaxis. To manage this condition, the nurse should apply direct continuous pressure to the nares for 5 to 10 minutes with the client's head tilted slightly forward. Application of a moustache dressing or a drip pad to absorb drainage, application of a nasal splint, and placement of the client in a semi-Fowler's position are interventions related to the management of a client with a nasal obstruction.

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? 1. Obtain vital signs. 2. Auscultate lung sounds. 3. Monitor heart rhythm. 4. Assess capillary refill.

Correct response: 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 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? 1. Take aspirin for nasal discomfort. 2. Administer normal saline nasal drops as ordered. 3. Avoid sports activities for 6 weeks. 4. Decrease the amount of daily fluids.

Correct response: Avoid sports activities for 6 weeks. Explanation: The nurse instructs the client to avoid sports activities for 6 weeks. There is no indication for the client to refrain from taking oral fluids. Mouth rinses help to moisten the mucous membranes and to reduce the odor and taste of dried blood in the oropharynx and nasopharynx. The client should take analgesic agents, such as acetaminophen or NSAIDs (i.e., ibuprofen or naproxen), to decrease nasal discomfort, not aspirin. The client does not need to use nasal drops when nasal packing is in place.

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? 1. Bleeding 2. Difficulty swallowing 3. Difficulty talking 4. Throat pain

Correct response: Bleeding Explanation: The nurse should instruct the client to report bleeding immediately. Delayed bleeding may occur when the healing membrane separates from the underlying tissue — usually 7 to 10 days postoperatively. Difficulty swallowing and throat pain are expected after a tonsillectomy and typically are present even before the client is discharged. Sudden difficulty talking wouldn't occur after discharge if the client could talk normally at the time of discharge, because swelling doesn't take that long to develop.

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? 1. Throat pain 2. Difficulty talking 3. Bleeding 4. Difficulty swallowing

Correct response: Bleeding Explanation: The nurse should instruct the client to report bleeding immediately. Delayed bleeding may occur when the healing membrane separates from the underlying tissue — usually 7 to 10 days postoperatively. Difficulty swallowing and throat pain are expected after a tonsillectomy and typically are present even before the client is discharged. Sudden difficulty talking wouldn't occur after discharge if the client could talk normally at the time of discharge, because swelling doesn't take that long to develop.

Which of the following is the most effective treatment for obstructive sleep apnea (OSA)? 1. Continuous positive airway pressure (CPAP) 2. Oxygen by nasal cannula 3. Bilevel positive airway pressure (BiPAP) 4. Mechanical ventilation

Correct response: 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.

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care? 1. Assess the tracheostomy cuff for leaks. 2. Develop an alternate method of communication. 3. Encourage oral nutrition on the second postoperative day. 4. Maintain the client in a low-Fowler's position.

Correct response: Develop an alternate method of communication. Explanation: The client with a total laryngectomy is not able to speak. Communication needs to be established using an alternate method. The client typically has difficulty with swallowing due to edema in the immediate postoperative period. Alternate forms of nutrition are used. The tracheostomy cuff is often deflated for periods of time. The head of the bed is maintained in a semi-Fowler's position to decrease edema.

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met? 1. The patient is able to assist with his own suctioning. 2. The stoma is healed, about 6 weeks after surgery. 3. The surgical site is dry with encrustations. 4. Drainage is <30 mL/day for 2 consecutive days.

Correct response: Drainage is <30 mL/day for 2 consecutive days. Explanation: Drains are removed when secretions are minimal, which usually is less than 30 mL for 48 straight hours.

You are caring for a client who is 42-years-old and status post adenoidectomy. You find the client in respiratory distress when you enter their room. You ask another nurse to call the physician and bring an endotracheal tube into the room. What do you suspect? 1. Edema of the upper airway 2. Infection 3. Post operative bleeding 4. Plugged tracheostomy tube

Correct response: Edema of the upper airway Explanation: An endotracheal tube is inserted through the mouth or nose into the trachea to provide a patent airway for clients who cannot maintain an adequate airway on their own. The scenario does not indicate infection, post operative bleeding, or a plugged tracheostomy tube.

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? 1. Plugged tracheostomy tube 2. Infection 3. Edema of the upper airway 4. Postoperative bleeding

Correct response: Edema of the upper airway Explanation: With severe respiratory distress in a status post adenoidectomy client, the nurse would suspect an airway issue related to edema of the upper airway. The scenario does not indicate infection, postoperative bleeding, or a plugged tracheostomy tube.

Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction? 1. Ensure mouth breathing 2. Apply a warm pack postoperatively 3. Provide a splint postoperatively 4. Apply pressure to the convex portion of the nose

Correct response: Ensure mouth breathing Explanation: For a patient who has undergone surgery for a nasal obstruction, it is important for the nurse to emphasize that nasal packing will be in place postoperatively, necessitating mouth breathing. The nurse applies an ice pack to reduce pain and swelling and not a warm pack. The nurse recommends the use of a splint and the application of pressure to the convex portion of the nose in case of a nasal fracture.

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: 1. Myalgias 2. Fever 3. Nausea 4. Headache

Correct response: Fever Explanation: The signs and symptoms described are consistent with acute pharyngitis. The nurse needs to assess for a fever higher than 39.3°C. Findings will help to determine if the client requires antibiotic therapy. The client may also experience headache, myalgias, and nausea. The nurse needs to assess for these symptoms also, and symptomatic treatment would then be provided.

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention? 1. Aphonia following a football game 2. Laryngitis following a cold 3. Hoarseness for 2 weeks 4. Epistaxis, twice last week

Correct response: Hoarseness for 2 weeks Explanation: Persistent hoarseness, especially of unknown cause, can be a sign of laryngeal cancer and merits prompt investigation. Epistaxis can be from several causes and has occurred infrequently. Aphonia and laryngitis are common following the noted activity.

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? 1. Erosion of the trachea 2. Incrusted mucous membranes 3. Hardened secretions 4. Noisy breathing

Correct response: Noisy breathing Explanation: Enlarged adenoids may produce nasal obstruction, noisy breathing, snoring, and a nasal quality to the voice. Incrustation of the mucous membranes in the trachea and the main bronchus occurs during the postoperative period following a tracheostomy. The long-term and short-term complications of tracheostomy include airway obstruction. These are caused by hardened secretions and erosion of the trachea.

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? 1. Partial laryngectomy 2. Cordectomy 3. Vocal cord stripping 4. Total laryngectomy

Correct response: 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.

A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to 1. Stay in bed when experiencing a fever 2. Properly dispose of used tissues 3. Place an ice collar on the throat to relieve soreness 4. Seek medical help if he experiences inability to swallow

Correct response: Seek medical help if he experiences inability to swallow Explanation: The client should seek medical assistance if swallowing is impaired to prevent aspiration. Following Maslow's hierarchy of needs, airway clearance is the highest priority.

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 1. Places both arms around the worker's waist 2. Makes a fist with one hand with the thumb outside the fist 3. Stands behind the worker, who has hands across the neck 4. Exerts pressure against the worker's abdomen

Correct response: Stands behind the worker, who has hands across the neck Explanation: The description of the fellow worker is a person who is choking. Following guidelines set by the American Heart Association, the nurse first stands behind the person who is choking.

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 1. Makes a fist with one hand with the thumb outside the fist 2. Exerts pressure against the worker's abdomen 3. Places both arms around the worker's waist 4. Stands behind the worker, who has hands across the neck

Correct response: Stands behind the worker, who has hands across the neck Explanation: The description of the fellow worker is a person who is choking. Following guidelines set by the American Heart Association, the nurse first stands behind the person who is choking.

When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided? 1. Swimming 2. Wearing a scarf over the stoma 3. Coughing 4. Hand-held showers

Correct response: Swimming Explanation: The nurse provides the client and family with the following postoperative instructions: water should not enter the stoma because it will flow from the trachea to the lungs. Therefore, the nurse instructs the client to avoid swimming and to use a handheld shower device when bathing. The nurse also suggests that the client wear a scarf over the stoma to make the opening less obvious. The nurse encourages the client to cough every 2 hours to promote effective gas exchange.

A first-line antibiotic used to treat acute bacterial rhinosinusitis (ABRS) is 1. cefprozil. 2. ampicillin. 3. cefuroxime. 4. amoxicillin-clavulanic acid.

Correct response: amoxicillin-clavulanic acid. Explanation: Amoxicillin-clavulanic acid (Augmentin) is the antibiotic of choice to treat ABRS. For patients who are allergic to penicillin, doxycycline (Vibramycin) or respiratory quinolones such as levofloxacin (Levaquin) or moxifloxacin (Avelox) can be used. Other antibiotics prescribed previously to treat ABRS, including cephalosporins such as cephalexin (Keflex), cefuroxime (Ceftin), cefaclor (Ceclor), and cefixime (Suprax), trimethoprim-sulfamethoxazole (Bactrim, Septra), and macrolides such as clarithromycin (Biaxin) and azithromycin (Zithromax), are no longer recommended because they are not effective in treating antibiotic-resistant organism

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? 1. more than 8 hours of sleep per night 2. excessive protein intake 3. increased exposure to the health care environment 4. interference with sinus drainage

Correct response: interference with sinus drainage Explanation: The principal causes are the spread of an infection from the nasal passages to the sinuses and the blockage of normal sinus drainage. Interference with sinus drainage predisposes a client to sinusitis because trapped secretions readily become infected. Client with persistent sinus infections may have allergies, nasal polyps, or a deviated septum. Eating a well-balanced diet that includes but does not rely exclusively on protein is a measure that may help reduce incidences of sinusitis. Getting plenty of rest is a measure that may help reduce incidences of sinusitis. Increased exposure to the health care environment is not a specific cause of sinusitis, which is more commonly caused by allergies or blockage of the nasal passages.

The nurse is providing discharge instructions for a client following laryngeal surgery. The nurse instructs the client to avoid 1. wearing a scarf over the stoma. 2. coughing. 3. swimming. 4. wearing a plastic bib while showering.

Correct response: swimming. Explanation: Swimming is not recommended because a client 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 client wear a scarf over the stoma to make the opening less obvious. The nurse encourages the client to cough every 2 hours to promote effective gas exchange.

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? 1. "Limit the amount of protein in the diet." 2. "Oral intake of fluids should be limited for 1 week only." 3. "Family members should continue to talk to the client." 4. "Clean the tracheostomy tube with alcohol and water."

Correct response:" Family members should continue to talk to the client." Explanation: Commonly, family members are reluctant to talk to the client who has had a total laryngectomy and can no longer speak. To promote a supportive environment, the nurse should encourage family members to continue normal communication. The nurse should teach the client to clean the tracheostomy tube with hydrogen peroxide and rinse it with sterile saline solution, to consume oral fluids as desired, and to eat protein-rich foods to promote healing.