Incorrect PrepU -Exam 3 -Ch 22 Management of Patients With Upper Respiratory Tract Disorders

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

10 seconds with 5 episodes/hour. Explanation: 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 76-year-old man presents to the ED complaining of "laryngitis." The triage nurse should ask if the patient has a past medical history that includes which of the following? a) Congestive heart failure (CHF) b) Gastroesophageal reflux disease (GERD) c) Chronic obstructive pulmonary disease (COPD) d) Respiratory failure (RF)

Gastroesophageal reflux disease (GERD) Explanation: The nurse should ask if the patient has a past medical history of GERD. Laryngitis in the older adults is common 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 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) Cervical lymph adenopathy b) Dysphasia c) Hoarseness of more than 2 week's duration d) Persistent ulceration

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

Which diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis? a) MRI b) CT scan c) Sinus aspirates d) Sinus x-rays

Sinus aspirates Explanation: To confirm the diagnosis of maxillary and frontal sinusitis and identify the pathogen, sinus aspirates may be obtained. Sinus x-rays and CT scans may be obtained for patients with frontal headaches, in refractory cases, and if complications are suspected.

The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis (ABRS) includes which of the following? a) Ceftin (Cefuroxime) b) Levofloxacin (Levaquin) c) Amoxicillin (Augmentin) d) Keflex (Cephalexin)

The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis (ABRS) includes which of the following? You selected: Amoxicillin (Augmentin) Correct Explanation: Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanate (Augmentin) is the antibiotic of choice. For patients who are allergic to penicillin, doxycycline (Vibramycin) or respiratory quinolones, such as levofloxacin (Levaquin) or moxifloxacin (Avelox), can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin (Keflex) and cefuroxime (Ceftin), are no longer recommended as they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

Most cases of acute pharyngitis are caused by which of the following? a) Bacterial infection b) Systemic infection c) Fungal infection d) Viral infection

Viral infection Explanation: Most cases of acute pharyngitis are caused by viral infection. Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus.

A client is being discharged from an outpatient surgery center following a tonsillectomy. The nurse gives the following instructions: a) "Gargle with a warm salt solution." b) "Gargle vigorously to clean your throat." c) "You are allowed to have hot tea or coffee." d) "You may have a sore throat for 1 week."

"Gargle with a warm salt solution." Explanation: 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.

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

Apply direct continuous pressure. Explanation: 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.

The nurse knows that there are three types of chronic pharyngitis. Which of the following is characterized by numerous swollen lymph follicles on the pharyngeal wall? a) Atrophic b) Hypertrophic c) Chronic granular d) Aphonia

Chronic granular Explanation: Chronic granular pharyngitis is characterized by numerous swollen lymph follicles on the pharyngeal wall. Aphonia refers to the inability to use one's voice. Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled. Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.

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

Administer one intramuscular injection of penicillin. Explanation: 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 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) Affected voice sounds c) Enlarged cervical nodes d) Dysphagia

Affected voice sounds Explanation: Hoarseness of more than 2 weeks' duration occurs in the patient with cancer in the glottic area because the tumor impedes the action of the vocal cords during speech. The voice may sound harsh, raspy, and lower in pitch. 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 first-line antibiotic utilized in the treatment of acute sinusitis includes a) Cefzil b) Augmentin c) Ceftin d) Ampicillin

Ampicillin Explanation: First-line antibiotics include amoxicillin, ampicillin, and erythromycin. Second-line therapy includes Ceftin, Cefzil, and Augmentin.

The nurse knows that there are three types of chronic pharyngitis. Which of the following is characterized by numerous swollen lymph follicles on the pharyngeal wall? a) Hypertrophic b) Aphonia c) Atrophic d) Chronic granular

Chronic granular Explanation: Chronic granular pharyngitis is characterized by numerous swollen lymph follicles on the pharyngeal wall. Aphonia refers to the inability to use one's voice. Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled. Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.

The nurse is caring for a client experiencing laryngeal trauma. Upon assessment, swelling and bruising is noted to the neck. Which breath sound is anticipated? a) Rhonchi in the bronchial region b) Audible stridor without using a stethoscope c) Diminished breath sounds throughout d) Crackles in the bases of the lungs

Audible stridor without using a stethoscope Explanation: The nurse anticipates hearing audible stridor without needing a stethoscope due to the neck swelling narrowing the airway. Rhonchi in the bronchial region is heard lower in the airways and crackles are heard in the bases of the lungs. Diminished breath sounds that occur throughout are indicative of airway obstruction and not indicative of laryngeal swelling.

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

Bleeding Explanation: 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.

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care? a) Assess the tracheostomy cuff for leaks. b) Encourage oral nutrition on the second postoperative day. c) Develop an alternate method of communication. d) Maintain the client in a low-Fowler's position.

Develop an alternate method of communication. Explanation: The client with a total laryngectomy is not able to speak. Communication needs to be established using an alternate method. The client typically has difficulty with swallowing due to edema in the immediate postoperative period. Alternate forms of nutrition are used. The tracheostomy cuff is often deflated for periods of time. The head of the bed is maintained in a semi-Fowler's position to decrease edema

Which of the following nursing diagnoses best encompasses the anticipated psychosocial concerns of a client who is scheduled for a laryngectomy? a) Risk for infection b) Risk for chronic low self-esteem c) Deficient knowledge d) Disturbed body image

Disturbed body image Explanation: Loss of the ability to speak normally is a devastating consequence of laryngeal surgery. Clients with a malignancy of the larynx require emotional support before and after surgery and help in understanding and choosing an alternative method of speech. Clients require information prior to their surgery to make appropriate decisions, but this is not considered a psychosocial concern. Clients are at high risk for infection following a laryngectomy, but this is not considered a psychosocial concern. Although chronic low self-esteem may develop following a laryngectomy, depending on the client's ability to cope, a more immediate concern would be related to disturbed body image.

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

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? You selected: Hypercapnia Correct Explanation: Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require? a) Emotional support b) Referral for counseling c) Family counseling d) Referral for vocational training

Emotional support Explanation: Clients with a malignancy of the larynx require emotional support before and after surgery and help in understanding and choosing an alternative method of speech. It does not require a referral for counseling or vocational training. It also does not require family counseling.

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 a) Deficient knowledge related to prevention of upper respiratory infections b) Deficient fluid volume related to increased fluid needs c) Acute pain related to upper airway irritation d) Ineffective airway clearance related to excess mucus production

Ineffective airway clearance related to excess mucus production Explanation: 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.

Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion? a) Central b) Obstructive c) Mixed d) Simple

Obstructive Correct Explanation: Obstructive sleep apnea occurs usually in men, and especially in men who are older and overweight. Types of sleep apnea do not include a simple characterization. Mixed sleep apnea is a combination of central and obstructive apnea with one apneic episode. In central sleep apnea, the patient demonstrates simultaneous cessation of both airflow and respiratory movements.

Most cases of acute pharyngitis are caused by which of the following? a) Viral infection b) Bacterial infection c) Fungal infection d) Systemic infection

Viral infection Explanation: Most cases of acute pharyngitis are caused by viral infection. Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus.

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

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met? You selected: Drainage is <30 mL/day for 2 consecutive days. Correct Explanation: Drains are removed when secretions are minimal, which usually is less than 30 mL for 48 straight hours.

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 portion of the vocal cord was removed. d) A permanent tracheal stoma would be necessary.

You selected: A permanent tracheal stoma would be necessary. Correct Explanation: 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.

You are caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? a) Incrusted mucous membranes b) Erosion of the trachea c) Noisy breathing d) Hardened secretions

You are caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? You selected: Noisy breathing Correct Explanation: 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.

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of which of the following? a) 0 to 3 months b) 2 to12 days c) 20 to 30 days d) 3 to 6 months

b) 2 to12 days

Late complications of radiation therapy may include which of the following? Select all that apply. a) Fibrosis b) Edema c) Xerostomia d) Laryngeal necrosis e) Loss of taste

• Laryngeal necrosis • Edema • Fibrosis Explanation: Complications occurring late may include laryngeal necrosis, edema, and fibrosis. Loss of taste and xerostomia are symptoms of radiation therapy that may occur earlier in treatment.

The nurse is assessing a patient for obstructive sleep apnea (OSA). Which of the following are signs and symptoms of OSA? Select all that apply. a) Pulmonary hypotension b) Evening headaches c) Polycythemia d) Insomnia e) Loud snoring

• Polycythemia • Loud snoring • Insomnia Explanation: Signs and symptoms include excessive daytime sleepiness, frequent nocturnal awakening, insomnia, loud snoring, morning headaches, intellectual deterioration, personality changes, irritability, impotence, systemic hypertension, dysrhythmias, pulmonary hypertension, corpulmonale, polycythemia, and enuresis.

The nurse is responsible for monitoring indicators of potential complications post laryngectomy. Which of the following indicators would be of concern? Select all that apply. a) Rapid capillary refill b) Impaired swallowing c) Tachycardia and tachypnea d) A tracheostomy cuff pressure >20 mmHg e) Somnolence and hypotension

• Somnolence and hypotension • Tachycardia and tachypnea • Impaired swallowing • A tracheostomy cuff pressure >20 mmHg Explanation: Delayed capillary refill and two or more residual volumes of 200 mL or more would be indicators of the potential complications of hypoxia and tracheostomal stenosis.