Ch 22 PrepU
The nurse advises a patient who sustained a fractured nose during an automobile accident that surgery will be necessary. Due to significant facial edema, surgery would be scheduled:
Within 1 week
A client is prescribed two sprays of a nasal medication twice a day. The nurse is teaching the client how to self-administer the medication and instructs the client to
Blow the nose before applying medication into the nares.
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?
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.
Late symptoms of laryngeal cancer include which of the following.
Dysphagia Dyspnea Persistent hoarseness
The nurse is caring for a client diagnosed with rhinosinusitis. The physician has ordered the client to receive four sprays of budesonide (Rhinocort) in each nostril every morning. The nurse informs the client that a common side effect of this medication is
Epistaxis
The nurse assesses a patient for possible acute pharyngitis. Which of the following clinical manifestations are consistent with this diagnosis?
Red pharyngeal membranes Swollen lymphoid follicles White-purple exudates on the back of the throat A temperature >100.4°F
A patient prescribed a medication for hypertension started taking it 3 days ago and arrives in the emergency department with an edematous face and tongue and having a difficult time speaking. What medication is the nurse aware of that may produce this type of side effect?
Enalapril (vasotec)
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
Which clinical manifestation of hemorrhage is related to carotid artery rupture?
Increased pulse rate
The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse
Obtains a light, mirror, gauze, and curved hemostats
A late complication of radiation therapy is
laryngeal necrosis
During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events?
Hypercapnia
Which diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis?
Sinus aspirates
The nurse in the ICU is caring for a client with a nasotracheal tube. Because of the tube placement, the nurse understands that the client is at risk for developing
Sinus infection
A nurse is responsible for monitoring indicators of potential complications after laryngectomy. Which indicators would be priority concerns?
Somnolence and hypotension Tachycardia and tachypnea Impaired swallowing Persistent high tracheostomy cuff pressure
A client has had laryngeal surgery. What are the expected client outcomes?
The client's suture line remains intact The client can manage his or her own secretions the client maintains an adequate caloric intake
A patient comes to the clinic complaining of a possible upper respiratory infection. What should the nurse inspect that would indicate that an upper respiratory infection may be present?
The nasal mucosa
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
Which of the following methods most resembles normal speech following a total laryngectomy?
Blom-Singer voice prosthesis
Which of the following are clinical manifestations associated with obstructive sleep apnea (OSA)?
Insomnia, arrhythmias, loud snoring, excessive daytime sleepiness, impotence
The nurse is instructing a client who is scheduled for a laryngectomy about methods of laryngeal speech. Which best describes tracheoesophageal puncture (TEP)?
It requires the insertion of a prosthesis into the trachea
Late complications of radiation therapy may include which of the following?
Laryngeal necrosis, edema, fibrosis
A client who has been diagnosed with an early glottis cancer would likely undergo which type of surgery?
Laser microsurgery
The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation?
SOB
A client is experiencing acute viral rhinosinusitis. The nurse is providing instructions about self-care activities and includes information about
Saline lavages to the nares
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
Check the clear fluid for glucose
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?
Chronic granular
An obese male is being evaluated for OSA. The nurse asks the patient's wife to document the number and frequency of incidences of apnea while her husband is asleep. The nurse tells the wife that a characteristic indicator of OSA is a breathing cycle characterized by periods of breathing cessation for:
10 seconds with 5 episodes/hour
A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:
A permanent tracheal stoma would be necessary
The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections?
Administer an over-the-counter decongestant
The nurse is mentoring a new graduate nurse. Today, the two of you are caring for a client with a new tracheostomy. The new graduate nurse asks what the complications of tracheostomy are. What would the nurse respond?
Aspiration, infection, injury to the laryngeal nerve
The nurse is an occupational health nurse who is presenting a workshop on laryngeal cancer. What risk factors would the nurse be sure to include in the workshop?
Alcohol Age Tobacco Industrial pollutants
What is the most commonly prescribed treatment for the common cold?
Antihistamines
The nurse should advise the patient who has nasal packing for epistaxis that the packing can be left in place:
Anywhere from 2-6 days
A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis?
Apply direct continuous pressure
The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information?
Apply ice collar Try a liquid or soft diet during the acute stage of the disease Stay on bed rest during the febrile stage of the illness
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
The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information?
Ensure an adequate fluid intake Increase the humidity in the home Apply local heat to promote drainage
A patient comes to the clinic with a cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold?
Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase. Suggest that the patient take adequate fluids and get plenty of rest. Inform the patient about the symptoms of secondary infection.
The nurse makes the observations shown in the accompanying notes about a client who will be discharged following a laryngectomy. The nurse makes a referral to the home health nurse for client reteaching based on which observation?
Initial washing of hands after cleaning inner cannula
Following thoracic surgery, what should the nurse include in the care plan for a client at risk for impaired gas exchange?
Monitor vital signs frequently Reinforce preoperative breathing exercises Elevated HOB 30-40 degrees as tolerated Administer pain medications
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?
Nasal flaring with abdominal retractions Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 Increased respiratory effort Lung sounds of wheezing
A client is postoperative for a partial laryngectomy following a diagnosed malignancy. The client is to start oral feedings. The nurse does the following interventions:
Obtains results of a swallow study Provides thick liquids
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?
Partial laryngectomy
A patient diagnosed 2 weeks ago with acute pharyngitis comes to the clinic stating that the sore throat got better for a couple of days and is now back along with an earache. What complications should the nurse be aware of related to acute pharyngitis?
Peritonsillar abscess, otitis media, mastoiditis
The nurse is assessing a client in the clinic, and upon physical assessment the client demonstrates displacement of the sternum. This would be documented as which condition?
Pigeon chest
The nurse is assessing a client for obstructive sleep apnea (OSA). Which are signs and symptoms of OSA?
Polycythemia Loud snoring Insomnia
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?
Rapid, deep respirations
Bacterial infection occurs in about 70% of those who have acute rhinosinusitis. The nurse is aware that the least common bacteria is:
Staphylococcus aureus
The nurse is caring for a client with an endotracheal tube. Which client data does the nurse interpret as a life-threatening situation?
Sudden restlessness
When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided?
Swimming
The nurse initiates the following intervention upon receiving a client back to the clinical unit after a throat-related procedure, "Elevate the head of the bed 45°." This assists in meeting which nursing goal?
The client will have decreased edema
Which intervention regarding nutrition is implemented for clients who have undergone laryngectomy?
Use enteral feedings after the procedure
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
Another term for clergyman's sore throat is
chronic granular pharyngitis
Late symptoms of laryngeal cancer include which of the following
dysphagia, dyspnea, persistent hoarseness
A nurse is teaching a client with recurrent rhinosinusitis. What medication will the nurse instruct the client to take at the first sign of symptoms?
guaifenesin
