Chapter 20: Caring for Clients with Upper Respiratory Disorders

A 76-year-old client presents to the ED reporting "laryngitis." The triage nurse should ask whether the client has a medical history that includes a. Gastroesophageal reflux disease (GERD) b. Chronic obstructive pulmonary disease (COPD) c. Congestive heart failure (CHF) d. Respiratory failure (RF)

a The nurse should ask whether the client has a medical history of GERD. Laryngitis is common in older adults and may be secondary to GERD. Older adults are more likely to have impaired esophageal peristalsis and a weaker esophageal sphincter. COPD, CHF, and RF are not associated with laryngitis in the older adult.

A client has had a laryngectomy as treatment for laryngeal cancer. Which postoperative instruction is of utmost importance to the client's health and safety? a. avoid swimming b. avoid sponge baths c. avoid covering the stoma d. avoid coughing

a Water should not enter the stoma because it will flow from the trachea to the lungs.

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? a. more than 100 b. 50 c. 25 d. 12

a Rhinitis is inflammation of the nasal mucous membranes. It also is referred to as the common cold or coryza. Rhinitis may be acute, chronic, or allergic, depending on the cause. The most common cause is the rhinovirus, of which more than 100 strains exist.

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: a. 4 seconds with 2 episodes/hour. b. 6 seconds with 3 episodes/hour. c. 8 seconds with 4 episodes/hour. d. 10 seconds with 5 episodes/hour.

d OSA is characterized by frequent and loud snoring, with breathing cessation for 10 seconds or longer, for at least five episodes per hour, followed by abrupt awakening with a loud snort as the blood oxygen level drops. Symptoms typically progress with weight gain, aging, and during the transition to menopause for women.

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? a. Administer nasal spray and apply an occlusive dressing to the client's face. b. Position the client's head in a dependent position. c. Irrigate the client's nose with warm tap water. d. Apply ice and keep the client's head elevated.

d Immediately after the 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. Dependent positioning would exacerbate bleeding and the nose is not irrigated. Occlusive dressings are not used.

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? a. Esophageal speech b. Electric larynx c. Tracheoesophageal puncture d. American sign language (ASL)

c Tracheoesophageal puncture is simple and has few complications. It is associated with high phonation success, good phonation quality, and steady long-term results. As a result, it is preferred over esophageal speech, an electric larynx or ASL.

A client is being discharged from an outpatient surgery center following a tonsillectomy. What instruction should the nurse give to the client? a. "Gargle with a warm salt solution." b. "You may have a sore throat for 1 week." c. "You are allowed to have hot tea or coffee." d. "Decrease oral intake if increased swallowing occurs."

a A warm saline solution will help with removal of thick mucus and halitosis. It will be a gentle gargle, because a vigorous gargle may cause bleeding. A sore throat may be present for 3 to 5 days. Hot foods should be avoided.

Cuff pressure on the endotracheal or tracheostomy tube should be monitored by the nurse at least every: a. 8 hours. b. 2 hours. c. 4 hours. d. 6 hours.

a Cuff pressure must be monitored at least every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique.

A client comes to the ED and is admitted with epistaxis. Pressure has been applied to the client's midline septum for 10 minutes, but the bleeding continues. The nurse should anticipate using what treatment to control the bleeding? a. Irrigation with a hypertonic solution b. Nasopharyngeal suction c. Normal saline application d. Silver nitrate application

d If pressure to the midline septum does not stop the bleeding for epistaxis, additional treatment of silver nitrate application, Gelfoam, electrocautery, or vasoconstrictors may be used. Suction may be used to visualize the nasal septum, but it does not alleviate the bleeding. Irrigation with a hypertonic solution is not used to treat epistaxis.

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. a feeling of swelling at the back of the throat b. weight loss c. discomfort when drinking cold liquids d. headaches in the morning

a After an initial hoarseness lasting longer than a month, clients with laryngeal cancer will feel a sensation of swelling or a lump in the throat or in the neck. Weight loss often occurs later in the progression of laryngeal cancer due to reduced calorie intake as a result of impaired swallowing and pain. Clients with laryngeal cancer may report burning in the throat when swallowing hot or citrus liquids. Clients with obstructive sleep apnea may experience a morning headache.

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

a 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.

A client has had four major nosebleeds in one day. The physician performs a physical exam and orders blood tests. The client has no history of hypertension, trauma, or cocaine use. What could be the cause of nosebleeds that are so difficult to control? a. blood dyscrasias b. low blood pressure c. high humidity d. None of the options is correct.

a Causes of nosebleed include trauma, rheumatic fever, infection, hypertension, nasal tumors, and blood dyscrasias. Epistaxis that results from hypertension or blood dyscrasias is likely to be severe and difficult to control.

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. A client who is a habitual user of alcohol and tobacco b. A client who is a habitual user of caffeine and other stimulants c. A client who eats a diet high in spicy foods d. A client who has gastrointestinal reflux disease (GERD)

a Chronic pharyngitis is common in adults who live and work in dusty surroundings, use the voice to excess, suffer from chronic chough, and habitually use alcohol and tobacco. Caffeine and spicy foods have not been linked to chronic pharyngitis. GERD is not a noted risk factor.

The nurse is caring for a client who needs education on his medication therapy for allergic rhinitis. The client is to take cromolyn daily. In providing education for this client, how should the nurse describe the action of the medication? a. It inhibits the release of histamine and other chemicals. b. It inhibits the action of proton pumps. c. It inhibits the action of the sodium-potassium pump in the nasal epithelium. d. It causes bronchodilation and relaxes smooth muscle in the bronchi.

a Cromolyn inhibits the release of histamine and other chemicals. It is prescribed to treat allergic rhinitis. Beta-adrenergic agents lead to bronchodilation and stimulate beta-2 adrenergic receptors in the smooth muscle of the bronchi and bronchioles. It does not affect proton pump action or the sodium-potassium pump in the nasal cells.

A client has had a laryngectomy as treatment for laryngeal cancer. Which nutritional interventions should be implemented for the client? a. Use enteral feedings after the procedure. b. Offer plenty of thin liquids when intake resumes. c. Season food to suit increased sense of taste and smell. d. Recommend a long-term use of zinc lozenges.

a Enteral feedings are used for 10 to 14 days after a laryngectomy to avoid irritation to the sutures and reduce the risk of aspiration.

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? a. Apply an ice pack. b. Restrict fluid intake. c. Position the patient in the side-lying position. d. Apply pressure to the convex of the nose.

a 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 is scheduled for vocal cord stripping to treat a vocal cord lesion. Which statement indicates that the client has realistic postoperative expectations for this surgery? a. "I know my voice will sound hoarse." b. "I will have trouble swallowing." c. "I'm afraid of losing my voice." d. "Why do they need to remove my vocal cords?"

a Following vocal cord stripping, the client's voice will be hoarse. The affected cord is stripped of mucosa but otherwise left intact following vocal cord stripping.

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? a. An antiviral agent such as acyclovir b. An antibiotic such as amoxicillin c. An antihistamine such as Benadryl d. An ointment such as bacitracin

a Herpes labialis is an infection that is caused by herpes simplex virus type 1 (HSV-1). It is characterized by an eruption of small, painful blisters on the skin of the lips, mouth, gums, tongue, or the skin around the mouth. The blisters are commonly referred to as cold sores or fever blisters. Medications used in the management of herpes labialis include acyclovir (Zovirax) and valacyclovir (Valtrex), which help to minimize the symptoms and the duration or length of flare-up.

The nurse is caring for a client whose recent unexplained weight loss and history of smoking have prompted diagnostic testing for cancer. What symptom is most closely associated with the early stages of laryngeal cancer? a. Hoarseness b. Dyspnea c. Dysphagia d. Frequent nosebleeds

a Hoarseness is an early symptom of laryngeal cancer. Dyspnea, dysphagia, and lumps are later signs of laryngeal cancer. Alopecia is not associated with a diagnosis of laryngeal cancer.

The nurse is caring for a patient in the outpatient clinic with suspicion of cancer due to recent weight loss for unidentifiable reasons. The patient has a 25-year history of smoking. The nurse performs an assessment and asks the patient about symptoms related to laryngeal cancer. What is an early symptom associated with laryngeal cancer? a. Hoarseness b. Dyspnea c. Dysphagia d. Alopecia

a Hoarseness is an early symptom of laryngeal cancer. Dyspnea, dysphagia, and lumps are later signs of laryngeal cancer. Alopecia is not associated with a diagnosis of laryngeal cancer.

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. a. Hoarseness of more than 2 week's duration b. Dysphasia c. Persistent ulceration d. Cervical lymph adenopathy

a 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. Later symptoms include dysphasia, dyspnea (difficulty breathing), unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath. Cervical lymph adenopathy, unintentional weight loss, a general debilitated state, and pain radiating to the ear may occur with metastasis.

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

a 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.

Two months prior to a scheduled tonsillectomy, a client has a peritonsillar abscess related to a severe strep infection. After culturing the area and before receiving the results, the physician immediately prescribes a potent antibiotic. The physician is quick to prescribe a strong antibiotic to prevent: a. the spread of microorganisms into the bloodstream. b. hemoptysis. c. the need for a tonsillectomy. d. hypertrophied turbinates.

a Immediate treatment of a peritonsillar abscess is recommended to prevent the spread of the causative microorganism to the bloodstream or adjacent structures. Hemoptysis is the expectoration of bloody sputum and not a specific concern with a peritonsillar abscess. This client has already been scheduled for a tonsillectomy. Hypertrophied turbinates are enlargements of the nasal conchae, which results from chronic rhinitis and eventually leads to sinusitis.

A 13-year-old boy has been brought to the emergency department by his mother after he took a powerful blow to his nose during a volleyball game. Preliminary examination suggests a nasal fracture, which should prompt the nurse to: a. Apply ice and tell the patient to keep his head elevated b. Administer saline lavage and tell the patient not to swallow the solution c. Apply warm compresses to the bridge of the patient's nose d. Administer analgesia and a nebulized bronchodilator

a Immediately after the fracture, the nurse applies ice and encourages the patient to keep the head elevated. Saline lavage, warm compresses, and nebulizers are not common treatment modalities for nasal fractures.

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? a. Partial laryngectomy b. Supraglottic laryngectomy c. Hemilaryngectomy d. Total laryngectomy

a In a partial laryngectomy, 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. During a supraglottic laryngectomy, a tracheostomy is left in place until the glottic airway is established. Hemilaryngectomy is done by splitting the thyroid cartilage of the larynx in the midline of the neck, and the portion of the vocal cord is removed with the tumor. During a total laryngectomy, a complete removal of the larynx is performed, including the hyoid bone, epiglottis, cricoids cartilage, and two or three rings of the trachea.

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? a. "If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated." b. "I promise I won't blow my nose." c. "I'll sleep on two to three pillows." d. "I'll gargle with weak salt water three to four times a day."

a Instruct the client to avoid carbonated fluids and fluids high in citrus content. Such fluids are caustic to the surgical site and may traumatize tissue, disrupting the suture line. Instruct the client not to cough, clear throat, blow nose, or use a straw in the first few postoperative days. These actions increase pressure on the suture line and may cause disruption and bleeding. Keeping the head elevated may help prevent bleeding. Gently gargling with warm saline or an alkaline mouthwash assists in removing thick mucus.

Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? a. impaired verbal communication b. deficient knowledge c. risk for infection d. risk for chronic low self-esteem

a Loss of the ability to speak normally is a devastating consequence of laryngeal surgery and is certain with a total laryngectomy. Issues with self-esteem and deficient knowledge are possible, but less certain. Infection is a risk, but not a certainty.

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

a 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 client is being assessed for acute laryngitis. The nurse knows that clinical manifestations of acute laryngitis include a. hoarseness. b. a moist cough. c. a sore throat that feels worse in the evening. d. a nonedematous uvula.

a Signs of acute laryngitis include hoarseness or aphonia and severe cough. Other signs of acute laryngitis include a dry cough, and a sore throat that feels worse in the morning. If allergies are present, the uvula will be visibly edematous.

A has entered the postanesthesia care unit following sinus surgery. What will the nurse monitor closely during the postoperative period? a. repeated swallowing b. septal hematoma c. cerebrospinal fluid drainage d. periorbital edema

a Standards of postoperative care for clients who have undergone a sinus surgery include frequent assessment to make an early detection of repeated swallowing because this could indicate a possible hemorrhage. Septal hematoma may occur with a nasal fracture. cerebrospinal fluid drainage is generally a concern related a nasal fracture but not to sinus surgery. Periorbital edema is a possible complication of surgery to repair a nasal fracture.

A client stops breathing during sleep as a result of repetitive upper airway obstruction. To help decrease the frequency of the apneic episodes, the nurse intervenes by informing the client to: a. Eliminate alcohol ingestion. b. Sleep on the back. c. Take a hypnotic medication at hours of sleep. d. Use nasal oxygen at night.

a The client's symptoms are consistent with obstructive sleep apnea. Initial treatment includes avoidance of alcohol and hypnotic medications. Clients are told to not sleep on their backs. Administration of nasal oxygen may help with hypoxemia but has little effect on the frequency of apnea.

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

a 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 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? a. The nasal mucosa b. The buccal mucosa c. The frontal sinuses d. The tracheal mucosa

a The nurse inspects the nasal mucosa for abnormal findings such as increased redness, swelling, exudate, and nasal polyps, which may develop in chronic rhinitis. The mucosa of the nasal turbinates may also be swollen (boggy) and pale bluish-gray. The nurse palpates the frontal and maxillary sinuses for tenderness, which suggests inflammation, and then inspects the throat by having the patient open the mouth wide and take a deep breath.

The nurse is caring for a client with allergic rhinitis. The c;ient asks the nurse about measures to help decrease allergic symptoms. Which is the best response by the nurse? a. "You should try to reduce exposure to irritants and allergens." b. "Be sure to receive your influenza vaccination each year." c. "You need to see your ear, nose, and throat specialist monthly." d. "Take over-the-counter nasal decongestants when you experience symptoms."

a The nurse instructs the client with allergic rhinitis to avoid or reduce exposure to allergens and irritants, such as dusts, molds, animals, fumes, odors, powders, sprays, and tobacco smoke. Receiving an influenza vaccination each year is recommended for clients with infectious rhinitis. To prevent possible drug interactions, the client is cautioned to read drug labels before taking any over-the-counter medication. Clients with nasal septal deformities or nasal polyps may be referred to an ear, nose, and throat specialist.

A nurse is suctioning the tracheostomy of a hospitalized client with laryngeal cancer. Which nursing action should be included in this client's plan of care? a. Use intermittent suctioning while slowly withdrawing and rotating the catheter. b. Provide suctioning in 30-second intervals. c. Offer the client suctioning once per day. d. Instruct the client to use shallow breaths between suctioning.

a The nurse suctions the client to remove secretions that can obstruct the airway. Begin intermittent suctioning while slowly withdrawing and rotating the catheter. Do not suction for more than 10 seconds at a time. It is important to avoid unnecessary suctioning to decrease trauma to the airway. Allow the client to rest and breathe deeply before repeating if more suctioning is necessary.

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: a. Fever b. Headache c. Myalgias d. Nausea

a The signs and symptoms described are consistent with acute pharynigitis. 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.

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? a. Amoxicillin-clavulanic acid b. Cephalexin c. Cefuroxime d. Clarithromycin

a 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.

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? a. Group A, beta-hemolytic streptococci b. Gram-negative Klebsiella c. Pseudomonas aeruginosa d. Staphylococcus aureus

a Viral infection causes most cases of acute pharyngitis. Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus. Bacterial infection accounts for the remainder of cases. Ten percent of adults with pharyngitis have group A beta-hemolytic streptococcus (GABHS), which is commonly referred to as group A streptococcus (GAS) or streptococcal pharyngitis.

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? a. When the patient has less than 30 mL for 2 consecutive days b. When the patient states that there is discomfort and requests removal c. When the drainage tube comes out d. In 1 week when the patient no longer has serous drainage

a Wound drains, inserted during surgery, may be in place to assist in removal of fluid and air from the surgical site. Suction also may be used, but cautiously, to avoid trauma to the surgical site and incision. The nurse observes, measures, and records drainage. When drainage is less than 30 mL/day for 2 consecutive days, the physician usually removes the drains.

Which of the following interventions would be helpful for a client reporting nasal congestion, sneezing, sore throat, and muscle aches? Select all that apply. a. Provide warm salt-water gargles. b. Administer oral ibuprofen. c. Teach the client about handwashing. d. Refer the client to a physician for antibiotic therapy. e. Recommend guaifenesin.

a, b, c, d Described signs and symptoms are consistent with viral rhinitis (the common cold). Management consists of symptomatic therapy, such as gargling with warm salt-water gargles, taking nonsteroidal anti-inflammatory medications (e.g., ibuprofen [Motrin]), and using guaifenesin (Mucinex), which promotes removal of secretions. Handwashing is the most effective measure to prevent transmission of organisms. Antibiotics should not be used, because they are not effective against viruses and misuse of antibiotics have contributed to the development of antibiotic-resistant organisms.

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.) a. Apply an ice collar. b. Stay on bed rest during the febrile stage of the illness. c. Gargle with an alcohol-based mouthwash. d. Try a liquid or soft diet during the acute stage of the disease. e. Drink warm or hot liquids during the acute stage of the disease.

a, b, d 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 with a severe nosebleed. The physician inserts a nasal sponge. What should the nurse teach the client about this intervention? a. The sponge creates a risk for viral sinusitis b. The sponge can stay in place for 3 to 4 days if needed c. The client should remain supine while the sponge is in place d. NSAIDs are contraindicated while the sponge is in place

b A compressed nasal sponge may be used. Once the sponge becomes saturated with blood or is moistened with a small amount of saline, it will expand and produce tamponade to halt the bleeding. The packing may remain in place for 48 hours or up to 3 or 4 days if necessary to control bleeding. This does not require the client to be supine or to avoid all NSAIDs. Packing does not increase the risk for sinusitis.

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? a. Preparing the patient for a septoplasty b. Applying nasal packing c. Administering nasal lavage d. Applying steroidal nasal spray

b A nasal fracture very often produces bleeding from the nasal passage. As a rule, bleeding is controlled with the use of packing.

The health care provider has ordered continuous positive airway pressure (CPAP) with the delivery of oxygenation. The patient asks the nurse what the benefit of CPAP is. What would be the nurse's best response? a. CPAP allows a higher percentage of oxygen to be used b. CPAP prevents the collapse of the patient's airway c. CPAP eliminates the need for oxygen supplementation during the day d. CPAP alters alveolar perfusion

b CPAP provides positive pressure to the airways throughout the respiratory cycle preventing collapse. It does not eliminate the need for supplementary oxygen or alter perfusion.

The nurse is conducting a presurgical interview for a client with laryngeal cancer. The client states that he drinks approximately 20 oz (600 mL) of vodka per day. It is imperative that the nurse inform the surgical team so the client can be assessed for what? a. Increased risk for infection b. Delirium tremens c. Depression d. Nonadherence to postoperative care

b Considering the known risk factors for cancer of the larynx, it is essential to assess the client's history of alcohol intake. Infection is a risk in the postoperative period, but not an appropriate answer based on the client's history. Depression and nonadherence are risks in the postoperative phase, but would not be critical short-term assessments.

The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk? a. Facilitate total parenteral nutrition (TPN). b. Keep a complete suction setup at the bedside. c. Feed the client several small meals daily. d. Refer the client for occupational therapy.

b Due to the risk for aspiration, the nurse keeps a suction setup available in the hospital and instructs the family to do so at home for use if needed. TPN is not indicated and small meals do not necessarily reduce the risk of aspiration. Physical therapists do not address swallowing ability.

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? a. Difficulty ambulating b. Hemorrhage c. Infrequent swallowing d. Bradycardia

b Hemorrhage is a potential complication of a tonsillectomy. Increased pulse, fever, and restlessness may indicate a postoperative hemorrhage. Difficulty ambulating and bradycardia are not common complications in a client after a tonsillectomy. Infrequent swallowing does not indicate hemorrhage; frequent swallowing does.

The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include? a. "After surgery you will have a sore throat, but you will be able to speak." b. "You can use writing or a communication board to communicate." c. "After surgery you will have to use an electric larynx to communicate." d. "A speech therapist will evaluate you and recommend a system of communication after surgery."

b If a total laryngectomy is scheduled, the client must understand that the natural voice will be lost but special training can provide a means for communicating. The client needs to know that until training is started, communication will be possible using the call light, through writing, or using a special communication board. The use of an electronic device is a long-term postoperative goal. The speech therapist will evaluate the client before surgery and establish a method of immediate postoperative communication.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: a. lie supine with his neck extended. b. sit upright, leaning slightly forward. c. blow his nose and then put lateral pressure on his nose. d. hold his nose while bending forward at the waist.

b Sitting upright and leaning slightly forward avoids increasing vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine won't prevent aspiration of the blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure in the nose and promotes bleeding rather than halting it.

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? a. The client's swallowing ability b. The client's airway patency c. The client's carotid pulses d. Signs and symptoms of infection

b The client with a laryngectomy is a risk for airway occlusion and respiratory distress. As in all nursing situations, assessment of the airway is a priority over other potential complications and assessment parameters.

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? a. Encouraging the patient to adopt a later bedtime and earlier rising hour b. Encouraging the patient to avoid alcohol and hypnotic medications c. Teaching the patient deep breathing and coughing exercises to perform before going to bed d. Teaching the patient strategies for waking himself up when he experiences an apneic spell

b Treatments for OSA are varied but include weight loss and avoidance of alcohol and hypnotic medications initially. Patients are not normally able to awaken themselves during apneic periods. Deep breathing exercises and changes to sleeping times are not known to improve the signs and symptoms of OSA.

The nurse is performing a nutritional assessment on a client who has been diagnosed with cancer of the larynx. Which laboratory values would be assessed when determining the nutritional status of the client? Select all that apply. a. White blood cell count b. Protein level c. Albumin level d. Platelet count e. Glucose level

b, c, e The nurse also assesses the client's general state of nutrition, including height and weight and body mass index, and reviews laboratory values that assist in determining the client's nutritional status (albumin, protein, glucose, and electrolyte levels). The white blood cell count and the platelet count would not normally assist in determining the client's nutritional status.

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? Select all that apply. a. Apply ice or cold compresses for 20 minutes every hour for the first 24 hours. b. Check for any unusual changes in breathing during the first 48 hours. c. Observe for any clear drainage from either nostril. d. Keep the nasal packing in place for 72 hours to help reshape the form of the nose. e. Elevate the head of the bed for sleeping during the first week. f. Restrict from sports activities for 6 weeks.

b, c, e, f Ice or cold compresses are applied four to six times a day, for several days, until the swelling is decreased. Packing is inserted to control bleeding. It would not be used to reshape the nose.

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. A 1.5 L/day fluid restriction b. A high-potassium, low-sodium diet c. A liquid or soft diet d. A high-protein diet

c A liquid or soft diet is provided during the acute stage of the disease, depending on the client's appetite and the degree of discomfort that occurs with swallowing. The client is encouraged to drink as much fluid as possible (at least 2 to 3 L/day). There is no need for increased potassium or protein intake.

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

c 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.

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? a. Prescription medications can be safely supplemented with OTC medications. b. Use only one pharmacy so the pharmacist can check drug interactions. c. Read drug labels carefully before taking OTC medications. d. Consult the internet before selecting an OTC medication.

c Client education is essential when assisting the client in the use of all medications. To prevent possible drug interactions, the client is cautioned to read drug labels before taking any OTC medications. Some websites are reliable and valid information sources, but this is not always the case. Clients do not necessarily need to limit themselves to one pharmacy, though checking for potential interactions is important. Not all OTC medications are safe additions to prescription medication regimens.

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? a. Pharyngitis is more common in children whose immunizations are not up to date. b. There are no effective, evidence-based treatments for pharyngitis. c. Use of warm saline gargles or throat irrigations can relieve symptoms. d. Heat may increase the spasms in pharyngeal muscles.

c Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. The benefits of this treatment depend on the degree of heat that is applied. The nurse teaches about these procedures and about the recommended temperature of the solution: high enough to be effective and as warm as the client can tolerate, usually 105ºF to 110ºF (40.6ºC to 43.3ºC). Irrigating the throat may reduce spasm in the pharyngeal muscles and relieve soreness of the throat. You would not tell the parent teacher organization that there is no real treatment of pharyngitis.

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? a. Keep nasal passages clear. b. Use decongestants regularly. c. Humidify the indoor environment. d. Use a tissue when blowing the nose.

c Discharge teaching for prevention of epistaxis should include the following: avoid forceful nose bleeding, straining, high altitudes, and nasal trauma (nose picking). Adequate humidification may prevent drying of the nasal passages. Keeping nasal passages clear and using a tissue when blowing the nose are not included in discharge teaching for the prevention of epistaxis. Decongestants are not indicated.

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? a. Anxiety related to diagnosis of cancer b. Altered nutrition related to swallowing difficulties c. Ineffective airway clearance related to airway alterations d. Impaired verbal communication related to removal of the larynx

c Each of the listed diagnoses is valid, but ineffective airway clearance is the priority nursing diagnosis for all conditions.

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? a. Give the client his or her cell phone number. b. Refer the client to a social worker or psychologist. c. Provide the client with audiovisual materials about the surgery. d. Reassure the client and family that outcomes are nearly always positive.

c Informational materials (written and audiovisual) about the surgery are given to the client and family for review and reinforcement. The nurse never gives personal contact information to the client. Nothing in the scenario indicates that a referral to a social worker or psychologist is necessary. False reassurance must always be avoided.

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? a. Place warm washcloths on the client's throat, as needed. b. Have the client inhale warm steam three times daily. c. Encourage the client to limit speech whenever possible. d. Limit the client's fluid intake to 1.5 L/day.

c Management of acute laryngitis includes resting the voice, avoiding irritants (including smoking), resting, and inhaling cool steam or an aerosol. Fluid intake should be increased. Warm washcloths on the throat will not help relieve the symptoms of acute laryngitis.

Stiffness of the neck or inability to bend the neck is referred to as a. aphonia. b. xerostomia. c. nuchal rigidity. d. dysphagia.

c Nuchal rigidity is stiffness of the neck or inability to bend the neck. Aphonia is impaired ability to use one's voice due to distress or injury to the larynx. Xerostomia is dryness of the mouth from a variety of causes. Dysphagia is difficulty swallowing.

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? a. Teaching focuses on safe and effective use of antibiotics. b. The client should be preliminarily screened for surgery. c. Symptom management is the main focus of medical and nursing care. d. The focus of care is resting the voice to prevent chronic hoarseness.

c Nursing care for clients with viral pharyngitis focuses on symptomatic management. Antibiotics are not prescribed for viral etiologies. Surgery is not indicated in the treatment of viral pharyngitis. Chronic hoarseness is not a common sequela of viral pharyngitis, so teaching ways to prevent it would be of no use in this instance.

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

c 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 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? a. "I never normally get headaches, but I've had a splitting headache for days." b. "My eyes and ears are so itchy that it's driving me crazy." c. "I've been burning up with a fever at night and then getting terrible chills too." d. "My nose is raw because of my runny nose and sneezing."

c Rhinitis, headache, pruritus, and sneezing are all characteristic signs and symptoms of the viral rhinitis. However, fever is less common and is usually low-grade when it exists.

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

c 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.

Which is the priority nursing diagnosis for a client undergoing a laryngectomy? a. Imbalanced nutrition: Less than body requirements b. Impaired verbal communication c. Ineffective airway clearance d. Anxiety and depression

c The priority nursing diagnosis is Ineffective airway clearance, utilizing the ABCs. Imbalanced nutrition: Less than body requirement, impaired verbal communication, and anxiety and depression are all potential nursing diagnoses, but the question is asking for the priority nursing diagnosis for this patient. The priority is to identify any issues related to impaired airway.

The nurse is caring for a client admitted with a diagnosis of bacterial pharyngitis. The nurse anticipates the client will be ordered which medication? a. Robitussin DM b. Tylenol c. Penicillin d. Tylenol with codeine

c The treatment of choice for bacterial pharyngitis is penicillin. Penicillin V potassium taken for 5 days is the regimen of choice. Traditionally, penicillin was administered as a single injection; however, oral forms are now used more often and are as effective as and less painful than injections. Penicillin injections are recommended only if there is a concern that the client will not comply with therapy. Robitussin DM may be used as an antitussive. Aspirin or Tylenol, or Tylenol with codeine, may be given for severe sore throats.

The nurse is explaining the safe and effective administration of nasal spray to a client with seasonal allergies. What information is most important to include in this teaching? a. Finish the bottle of nasal spray to clear the infection effectively. b. Nasal spray can only be shared between immediate family members. c. Nasal spray should be given in a prone position. d. Overuse of nasal spray may cause rebound congestion.

d The use of topical decongestants is controversial because of the potential for a rebound effect. The client should hold his or her head back for maximal distribution of the spray. Only the client should use the bottle.

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? a. Total laryngectomy b. Cordectomy c. Vocal cord stripping d. Partial laryngectomy

d 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 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: a. The need to use inhaled corticosteroids and bronchodilators each night prior to applying CPAP b. The importance of participating in daily physical exercise when using CPAP on a regular basis c. The need to have continuous pulse oximetry in place while the CPAP machine is in use d. The importance of complying with CPAP despite the inconvenience associated with its use

d Although CPAP is effective in management of OSA, patient compliance with the treatment continues to be a major concern. Nursing interventions aimed at increasing compliance are consequently a priority. Steroids, bronchodilators, and pulse oximetry are not normally necessary. Daily exercise is beneficial but the promotion of compliance is a priority for patients using CPAP.

The nurse is assessing a patient who smokes 2 packs of cigarettes per day and has a strong family history of cancer. What early sign of cancer of the larynx does the nurse look for in this patient? a. Burning of the throat when hot liquids are ingested b. Enlarged cervical nodes c. Dysphagia d. Affected voice sounds

d 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. Affected voice sounds are not always early signs of subglottic or supraglottic cancer, however. The patient may complain of a persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices. A lump may be felt in the neck. Later symptoms include dysphagia, dyspnea (difficulty breathing), unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath.

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? a. Training on how to perform controlled belching b. Use of an electronically enhanced artificial pharynx c. Insertion of a specialized nasogastric tube d. Fitting for a voice prosthesis

d In clients receiving tracheoesophageal puncture, a valve is placed in the tracheal stoma to divert air into the esophagus and out the mouth. Once the puncture is surgically created and has healed, a voice prosthesis (Blom-Singer®) is fitted over the puncture site. A nasogastric tube and belching are not required. An artificial pharynx is not used.

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 a. Apply an ice pack to the nose. b. Reassure the client that the nose is not fractured. c. Administer prescribed oral ibuprofen (Motrin). d. Check the clear fluid for glucose.

d The client's signs and symptoms are consistent with a fracture of the nose. Clear fluid draining from either nostril suggests leakage of cerebrospinal fluid. This can be checked by assessing for glucose, which is in cerebrospinal fluid. This finding is important to identify, because infection can be transmitted through the opening in the cribiform plate. Other options, such as applying an ice pack to the nose and administering ibuprofen, are appropriate interventions but not most important for this client. Reassuring the client that the nose is not fractured is premature until all assessments are completed.