med surg I- Chapter 22: Management of Patients With Upper Respiratory Tract Disorders

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:

"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.

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

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation?

Tension pneumothorax

Which of the following is the most effective treatment for obstructive sleep apnea (OSA)?

CPAP ( continuous positive airway pressure) explanation- positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. To use CPAP, the patient must be breathing independently

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?

Drainage is <30 mL/day for 2 consecutive days.

What is the reason for chest tubes after thoracic surgery?

Draining secretions, air, and blood from the thoracic cavity is necessary.

A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient?

Dyspnea

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?

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. P. 551

what is a post complication after a tracheostomy

Incrustation of the mucous membranes in the trachea and the main bronchus occurs

apnea

cessation of breathing

xerostomia

dryness of the mouth

A client comes into the clinic complaining of hoarseness that has lasted for about a month. What would you suspect?

laryngeal cancer explanation: Persistent hoarseness (longer than 2 weeks) is usually the earliest symptom. P: 558

what is thrombocytopenia

low blood platelet count. Platelets (thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

Viral rhiniti

most frequent viral infection "common cold"

A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for

nuchal rigidity explanation: Potential complications of acute bacterial rhinosinusitis are nuchal rigidity and severe headache.

what is BIPAP ventilation

offers independent control of inspiratory and expiratory pressure while providing pressure support ventilation

Which of the following medications is the treatment of choice for bacterial pharyngitis?

penecillin

signs/ symptoms of rhinits

rhinorrhea (excessive nasal drainage, runny nose); nasal congestion; nasal discharge (purule

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:

sit upright, leaning slightly forward.

The client is to receive cephalexin (Ancef) 500 mg in 50 mL of normal saline intravenous piggyback. The medication is to infuse over 30 minutes. How many mL/hr would the nurse set the intravenous pump? Enter the correct number ONLY.

100 explanation: The volume of the IV medication is 50 mL. The time for infusion is 30 minutes or 0.5 hr. 50 mL/0.5 hr = 100 mL/1 hr.

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of which of the following?

2-12 days

most common treatment for rhinitis includes

Antihistamines and corticosteroid nasal sprays may be useful.

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

Group A, beta-hemolytic streptococcus

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.

Hoarseness of more than 2 week's duration explanation: Hoarseness of more than 2 weeks' duration occurs in the patient with cancer in the glottic area, because the tumor impedes the action of the vocal cords during speech. The voice may sound harsh, raspy, and lower in pitch

A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first?

Institute isolation precautions.

You are assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis?

Pain in the calf

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?

Partial laryngectomy Explanation: a portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing.

Once the patient has been cleared for oral feedings, post laryngectomy, the nurse knows to prepare: q

Thick liquids that are easy to swallow.

The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis (ABRS) includes which of the following?

amoxicillan

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?

auscultating lung sounds

Rhinitis

group of disorders characterized by inflammation and irritation of the mucous membranes of the nose -Rhinitis often coexists with other respiratory disorders, such as asthma

You are caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids?

noisy breathing explanation: Enlarged adenoids may produce nasal obstruction, noisy breathing, snoring, and a nasal quality to the voice.

Stiffness of the neck or inability to bend the neck is referred to as which of the following?

nuchal rigidity

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:

A permanent tracheal stoma would be necessary. explanation: A total laryngectomy will result in a permanent stoma and total loss of voice.

what is mechanical ventilation

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.

A client comes into the emergency department with epistaxis. What intervention should you perform when caring for a client with epistaxis?

Apply direct continuous pressure. explanation: 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

A patient who has an altered level of conscious is receiving a tube feeding. Patients receiving tube feeding should be placed into which of the following positions?

Semi-Fowler's or higher

The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice?

Total laryngectomy

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

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

what is a longterm/ shorterm complication of a tracheostomy

airway obstruction

alaryngeal communication

alternative modes of speaking that do not involve the normal larynx; used by patients whose larynx has been surgically removed

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require?

emotional support explanation: help in understanding and choosing an alternative method of speech. It does not require a referral for counseling or vocational training. It also does not require family counseling.

The nurse is caring for a client in the physician's office with a potential sinus infection. The physician orders a diagnostic test to identify if fluid is found in the sinus cavity. Which diagnostic test, written by the physician, is specifically ordered for this purpose?

transillumination of the sinus explanation: Transillumination and x-rays of the sinuses may show a change in the shape of or confirms that there is fluid in the sinus cavity.