Chapter 9: Nursing Management: Patients With Upper Respiratory Tract Disorders - ML5

A 64-year-old patient and his wife have presented to their primary care provider. The patient's wife has prompted her husband to seek care because she is worried about his apneic episodes and loud snoring. The husband had earlier undergone a diagnostic workup for obstructive sleep apnea (OSA) and been diagnosed with the disease but is not motivated to treat his health problem. How can the nurse at the clinic best characterize the risks of OSA? "Without treatment, your sleep apnea could progress to chronic obstructive lung disease." "Sleep apnea has actually been identified as a risk factor for throat cancer." "Sleep apnea actually increases your risk of having a stroke or heart attack." "People with sleep apnea are much more susceptible to infections in their sinuses and throat."

"Sleep apnea actually increases your risk of having a stroke or heart attack." OSA is associated with myocardial infarction and stroke, but it is not known to contribute to chronic obstructive lung disease, infections, or cancer.

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? Postoperative bleeding Edema of the upper airway Plugged tracheostomy tube Infection

Edema of the upper airway 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.

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

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

Stands behind the worker, who has hands across the neck 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.

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

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

Encouraging the patient to avoid alcohol and hypnotic medications 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 receiving shift report about a patient who has a tracheostomy. The nurse learns that the patient was suctioned seven times during the past shift and has questioned the necessity of such frequent suctioning. Why is it important not to perform unnecessary tracheal suctioning? Frequent suctioning is a risk factor for respiratory alkalosis. Excessive suctioning can result in bronchospasm. Excessive suctioning produces "rebound" production of secretions. Frequent suctioning inhibits the patient's existing cough reflex.

Excessive suctioning can result in bronchospasm. Unnecessary suctioning can initiate bronchospasm and cause mechanical trauma to the tracheal mucosa. It does not inhibit the cough reflex, produce rebound secretions, or contribute to acid-base imbalances.

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? Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy Partial laryngectomy

Partial laryngectomy 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 nurse is developing the plan of care for a client who has just received a tracheostomy. The nurse would include interventions to prevent which early postoperative complication? Select all that apply. innominate artery rupture pneumothorax bleeding air embolism tracheoesophageal fistula

bleeding pneumothorax air embolism Postoperative complications may occur early or late in the course of tracheostomy tube management. Early complications include bleeding, pneumothorax, air embolism, aspiration, subcutaneous or mediastinal emphysema, recurrent laryngeal nerve damage, and posterior tracheal wall penetration. Long-term complications include airway obstruction from accumulation of secretions or protrusion of the cuff over the opening of the tube; infection; rupture of the innominate artery; dysphagia; tracheoesophageal fistula, tracheal dilation; and tracheal ischemia and necrosis. Tracheal stenosis may develop after the tube is removed.

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? Clarithromycin Amoxicillin-clavulanic acid Cephalexin Cefuroxime SUBMIT ANSWER

Amoxicillin-clavulanic acid 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.

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

Bleeding 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.

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

"I've been burning up with a fever at night and then getting terrible chills too." 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 client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? "Family members should continue to talk to the client." "Clean the tracheostomy tube with alcohol and water." "Oral intake of fluids should be limited for 1 week only." "Limit the amount of protein in the diet."

"Family members should continue to talk to the client." 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.

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." "I need to keep my inhaler at the bedside." "I should sleep on my side all night long." "I should eat a high-protein diet."

"I should become involved in a weight loss program."

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

2 to 12 days 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 surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: A permanent tracheal stoma would be necessary. A portion of the vocal cord was removed. One vocal cord was removed along with a portion of the larynx. The voice was spared and a tracheostomy would be in place until the airway was established.

A permanent tracheal stoma would be necessary. 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 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. Gently blow the nose to eliminate nasal secretions. Use an anti-allergy medication to decrease rhinitis. Place a warm cloth over the sinus area of the forehead.

Administer an over-the-counter decongestant. 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.

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? Select all that apply. Alcohol Age Tobacco Region of country lived in Industrial pollutants

Alcohol Age Tobacco Industrial pollutants Carcinogens, such as tobacco, alcohol, and industrial pollutants, are associated with laryngeal cancer. The age of the client is also a factor, with a higher incidence among those 65 years of age or older. Region of country lived in is not associated with laryngeal cancer as a specific risk factor.

medication does the nurse anticipate will be administered for this infection? An antihistamine such as Benadryl An antibiotic such as amoxicillin An ointment such as bacitracin An antiviral agent such as acyclovir

An antiviral agent such as acyclovir 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.

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

Apply direct continuous pressure. 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 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 Administering nasal lavage Applying steroidal nasal spray Preparing the patient for a septoplasty

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

Which assessment finding puts a client at increased risk for epistaxis? Use of a humidifier at night Cocaine use Hypotension History of nasal surgery

Cocaine use Using nasally inhaled illicit drugs, such as cocaine, increases the risk of epistaxis (nosebleed) because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) increases the risk of epistaxis. Hypertension, not hypotension, increases the risk of epistaxis. A history of nasal surgery doesn't increase the risk of epistaxis.

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

Continuous positive airway pressure (CPAP) 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.

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

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

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? Infection Postoperative bleeding Plugged tracheostomy tube Edema of the upper airway

Edema of the upper airway 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.

You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis? Caution against frequent coughing. Encourage deep breathing every 2 hours. Monitor for signs of dysphagia. Provide meticulous mouth care every 4 hours.

Encourage deep breathing every 2 hours. The nurse should encourage a client undergoing laryngeal surgery to practice deep breathing and coughing every 2 hours while the client is awake. These measures prevent atelectasis and promote effective gas exchange. Monitoring for signs of dysphagia and providing meticulous mouth care every 4 hours are the interventions related to the client's caloric intake.

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: Nausea Fever Myalgias Headache

Fever 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? Hoarseness for 2 weeks Epistaxis, twice last week Aphonia following a football game Laryngitis following a cold

Hoarseness for 2 weeks 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.

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? Pulmonary hypotension Increased smooth muscle contractility Hypercapnia Systemic hypotension

Hypercapnia Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

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

Ineffective airway clearance 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.

A client reports nasal congestion, sneezing, sore throat, and coughing up of yellow mucus. The nurse assesses the client's temperature as 100.2°F. The client states this is the third episode this season. The highest priority nursing diagnosis is Deficient knowledge related to prevention of upper respiratory infections Deficient fluid volume related to increased fluid needs Acute pain related to upper airway irritation Ineffective airway clearance related to excess mucus production

Ineffective airway clearance related to excess mucus production All the listed nursing diagnoses are appropriate for this client. Following Maslow's hierarchy of needs, physiological needs are addressed first and, within physiological needs, airway, breathing, and circulation are the most immediate. Thus, ineffective airway clearance is the priority nursing diagnosis.

The nurse is preparing the care plan for a patient who is scheduled for a laryngectomy. Which nursing diagnosis should receive the highest priority? Anxiety related to diagnosis of cancer Ineffective airway clearance related to surgical alterations in the airway Altered nutrition related to swallowing difficulties Impaired verbal communication related to removal of the larynx

Ineffective airway clearance related to surgical alterations in the airway Each of the listed diagnoses is a valid nursing diagnosis, but ineffective airway clearance is the priority nursing diagnosis for all conditions.

The nurse is caring for a client who underwent a laryngectomy. Which intervention will the nurse initially complete in an effort to meet the client's nutritional needs? Initiate enteral feedings. Liberally season foods. Offer plenty of thin liquids. Encourage sweet foods.

Initiate enteral feedings. Postoperatively, the client may not be permitted to eat or drink for at least 7 days. Alternative sources of nutrition and hydration include IV fluids, enteral feedings through a nasogastric or gastrostomy tube, and parenteral nutrition. Once the client is permitted to resume oral feedings, thick liquids are offered; sweet foods are avoided because they cause increased salivation and decrease the client's appetite. The client's taste sensations are altered for a while after surgery because inhaled air passes directly into the trachea, bypassing the nose and the olfactory end organs. In time, however, the client usually accommodates to this change and olfactory sensation adapts; thus, seasoning is based on personal preferences.

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

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

Seek medical help if he experiences inability to swallow 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.

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

Swimming 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.

The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice? Partial laryngectomy Total laryngectomy Radiation therapy Laser surgery

Total laryngectomy In more advanced cases, total laryngectomy may be the treatment of choice. Partial laryngectomy, laser surgery, and radiation therapy are not the treatment of choice for advanced cases of laryngeal cancer.

The nurse in a long-term-care facility is aware of the importance of preventing upper respiratory infections (URIs) among the residents of the facility. How is this best accomplished? Vigilant handwashing by staff and residents Encouraging residents' fluid intake Providing a high-calorie diet for residents Providing topical decongestants to residents

Vigilant handwashing by staff and residents Thorough handwashing is the mainstay of URI prevention. Nutritious diet, high fluid intake, and the use of decongestants may be necessary treatments for residents who have URIs, but none of these measures appreciably protects against the development of URIs.

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

impaired verbal communication 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.

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

nuchal rigidity. 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 the dryness of the mouth from a variety of causes. Dysphagia is difficulty swallowing.

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

sit upright, leaning slightly forward. 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 discharge instructions for a client following laryngeal surgery. The nurse instructs the client to avoid wearing a scarf over the stoma. wearing a plastic bib while showering. coughing. swimming.

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

"The ET tube will maintain your airway while you're under anesthesia." 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 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? Provide emphatic oral instructions for the client. Provide the client with oral penicillin that will last for 5 days. Administer one intramuscular injection of penicillin. Ask an accompanying homeless friend to monitor the client's follow-up.

Administer one intramuscular injection of penicillin. 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.

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? Take aspirin for nasal discomfort. Avoid sports activities for 6 weeks. Decrease the amount of daily fluids. Administer normal saline nasal drops as ordered.

Avoid sports activities for 6 weeks. 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.

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? Staphylococcus aureus Pseudomonas aeruginosa Gram-negative Klebsiella Group A, beta-hemolytic streptococci

Group A, beta-hemolytic streptococci 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.

While caring for a patient with an endotracheal tube the nurse recognizes that suctioning is required: To prevent the patient from coughing When adventitious breath sounds are auscultated To stimulate the cough reflex Every 2 hours

When adventitious breath sounds are auscultated It is usually necessary to suction the patient's secretions because of the decreased effectiveness of the cough mechanism. Tracheal suctioning is performed when adventitious breath sounds are detected or whenever secretions are present. Unnecessary suctioning, such as scheduling every 2 hours, can initiate bronchospasm and cause trauma to the tracheal mucosa.