Chapter 20: Caring for Clients with Upper Respiratory Disorders
It is cold season and the school nurse been asked to provide an educational event for the parent teacher organization of the local elementary school. What should the nurse include in teaching about the treatment of pharyngitis?
Use of warm saline gargles or throat irrigations can relieve symptoms.
A client is being discharged from an outpatient surgery center following a tonsillectomy. What instruction should the nurse give to the client?
"Gargle with a warm salt solution."
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."
A college student has sought care at the campus medical clinical after a 5-day history of malaise that he believes is due to a bad cold. Which of the student's following statements should cause the nurse to suspect an alternative diagnosis?
"I've been burning up with a fever at night and then getting terrible chills too."
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?
20 mL or less
A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis?
: Group A, beta-hemolytic streptococci
A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:
A permanent tracheal stoma would be necessary.
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?
Administer one intramuscular injection of penicillin.
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?
Apply an ice pack.
After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?
Bleeding
Which assessment finding puts a client at increased risk for epistaxis?
Cocaine use
A nurse is caring for a client who has just had a total laryngectomy. What is part of the client's plan of care related to the surgery?
Develop an alternative communication method.
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 smoke cigarettes, cigars, or a pipe?"
The nurse is creating a plan of care for a client diagnosed with acute laryngitis. What intervention should be included in the client's plan of care?
Encourage the client to limit speech whenever possible.
A 60-year-old man has been diagnosed with obstructive sleep apnea (OSA) based on his clinical symptoms and polysomnographic findings. What intervention should the nurse perform to assist this patient in the management of his health problem?
Encouraging the patient to avoid alcohol and hypnotic medications
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? (Select all that apply.)
Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.
The nurse expects that emergency medical treatment for epistaxis may include insertion of a cotton pledget moistened with:
Epinephrine
The nurse assesses a client who is bleeding profusely from the nose. The nurse documents this finding as which condition?
Epistaxis
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:
Fever
A client's total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the client when teaching him about this process?
Fitting for a voice prosthesis
The perioperative nurse has admitted a client who has just underwent a tonsillectomy. The nurse's postoperative assessment should prioritize which of the following potential complications of this surgery?
Hemorrhage
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
The nurse is caring for a client in the ED for epistaxis. What information should the nurse include in client discharge teaching as a way to prevent epistaxis?
Humidify the indoor environment.
Which is the priority nursing diagnosis for a client undergoing a laryngectomy?
Ineffective airway clearance
The nurse is planning the care of a client who is scheduled for a laryngectomy. The nurse should assign the highest priority to which postoperative nursing diagnosis?
Ineffective airway clearance related to airway alterations
The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk?
Keep a complete suction setup at the bedside.
The nurse is assessing a client for obstructive sleep apnea (OSA). Which are signs and symptoms of OSA? Select all that apply.
Loud snoring Polycythemia Insomnia
A critical care nurse is caring for a patient with an endotracheal tube who is on a ventilator. The nurse knows that meticulous management of this patient's needs is necessary. What is the rationale for this?
Maintaining a patent airway
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
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
The nurse is performing preoperative teaching with a client who has cancer of the larynx. After explaining the most important information, what is the nurse's best action?
Provide the client with audiovisual materials about the surgery.
The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a client who is postoperative day 1 following total laryngectomy. What is the nurse's best action?
Rapidly assess the client and notify the surgeon about the client's bleeding.
The nurse is teaching a client with allergic rhinitis about the safe and effective use of his medications. What would be the most essential information to give this client about preventing possible drug interactions?
Read drug labels carefully before taking OTC medications.
A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to
Seek medical help if he experiences inability to swallow
A client who has an altered level of consciousness is receiving tube feedings. Clients receiving tube feeding should be placed in which position?
Semi-Fowler's or higher
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
When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided?
Swimming
A nursing student is discussing a client with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for clients with viral pharyngitis?
Symptom management is the main focus of medical and nursing care.
The nurse is providing care for a client who has just been admitted to the postsurgical unit following a laryngectomy. What assessment should the nurse prioritize?
The client's airway patency
The nurse is creating a care plan for a client who is status post-total laryngectomy. Much of the plan consists of a long-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen?
Tracheoesophageal puncture
A client has had a laryngectomy as treatment for laryngeal cancer. Which nutritional interventions should be implemented for the client?
Use enteral feedings after the procedure.
The nurse is performing patient teaching with a young mother who has brought her 3-month-old to the clinic for a well-baby check. Knowing that it is cold season, what information should the nurse provide to the mother to best prevent transmission of organisms?
Wash hands frequently
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 young client presents with symptoms of sniffling, nasal discharge, coughing, and sneezing. The symptoms which are keeping the client awake at night, and interrupting feedings. The client is diagnosed with rhinovirus. How many strains of this virus cause coryza?
more than 100
Stiffness of the neck or inability to bend the neck is referred to as
nuchal rigidity.
A client is recovering from a tonsillectomy in the postanesthesia care unit. After an overnight stay in the hospital due to increased secretions and vomiting, the nurse delivers client education and accompanying paperwork. Which comment indicates that the client requires additional education?
"If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated."
A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, "If I am going to have radiation, I won't need surgery." What is the best response by the nurse?
"Radiation is used to shrink the tumor size and is an adjunct to surgery."
The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include?
"You can use writing or a communication board to communicate."
A nurse practitioner has provided care for three different clients with chronic pharyngitis over the past several months. Which clients are at greatest risk for developing chronic pharyngitis?
A client who is a habitual user of alcohol and tobacco
A client is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the client's nutrition during treatment?
A liquid or soft diet
A 42-year-old client is admitted to the ED after an assault. The client received blunt trauma to the face and has a suspected nasal fracture. What intervention should the nurse perform?
Apply ice and keep the client's head elevated.
A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks?
Applying nasal packing
A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse's priority for patient education should be:
The importance of complying with CPAP despite the inconvenience associated with its use
A first-line antibiotic used to treat acute bacterial rhinosinusitis (ABRS) is
amoxicillin-clavulanic acid.
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?
interference with sinus drainage
