Chapter 26. Nasal symptoms and sinus congestion
1. Epistaxis can be a symptom of:
A. Over-anticoagulation
B. Hematologic malignancy
C. Cocaine abuse
D. All of the above
ANS: D
Cocaine abuse, which is more common than might be expected, frequently causes epistaxis. Hematologic
disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary
coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums.
2. Nasal discharge of green-yellow mucus, pharyngitis, and otitis media commonly indicate: A.
Allergic rhinitis
B.
Viral infection
C.
Bacterial infection
D.
Nasal polyps
. ANS: C
Nasal discharge should be assessed for its amount and color as well as any associated symptoms. Clear,
profuse discharge is allergic in nature; yellow-green purulent discharge indicates bacterial infection.
3. The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement,
if made by the patient, indicates that the teaching was successful?
a. I can take 800 mg ibuprofen for pain control.
b. I will safely remove and reapply nasal packing daily.
c. My nose will look normal after 24 hours when the swelling goes away.
d. I will keep my head elevated for 48 hours to minimize swelling and pain. ANS: D
Maintaining the head in an elevated position will decrease the amount of nasal swelling.
NSAIDs, such as ibuprofen, increase the risk for postoperative bleeding and should not be used
postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually
removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of
the surgery, it is not always possible to achieve this result, especially in the first few weeks after surgery.
4. The nurse plans to teach a patient how to manage allergic rhinitis. Which information should
the nurse include in the teaching plan?
a. Hand washing is the primary way to prevent spreading the condition to others.
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, b. Use of oral antihistamines for 2 weeks before the allergy season may prevent reactions.
c. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.
d. Identification and avoidance of environmental triggers are the best way to avoid symptoms. ANS:
D
The most important intervention is to assist the patient in identifying and avoiding potential
allergens. Intranasal corticosteroids (not oral antihistamines) should be started several weeks
before the allergy season. Corticosteroid nasal sprays have minimal systemic absorption. Acute viral rhinitis
(the common cold) can be prevented by washing hands.
5. The nurse discusses management of upper respiratory infections (URI) with a patient who has
acute sinusitis. Which statement by the patient indicates that additional teaching is needed?
a. I can take acetaminophen (Tylenol) to treat my discomfort.
b. I will drink lots of juices and other fluids to stay well hydrated.
c. I can use my nasal decongestant spray until the congestion is all gone.
d. I will watch for changes in nasal secretions or the sputum that I cough up. ANS: C
The nurse should clarify that nasal decongestant sprays should be used for no more than 3 days
to prevent rebound vasodilation and congestion. The other responses indicate that the teaching
has been effective.
6. A nurse obtains a health history from a patient who has a 35 pack-year smoking history. The patient
complains of hoarseness and tightness in the throat and difficulty swallowing. Which question is most
important for the nurse to ask?
a. How much alcohol do you drink in an average week? b. Do you have a family history of head or
neck cancer? c. Have you had frequent streptococcal throat infections?
d. Do you use antihistamines for upper airway congestion? ANS: A
Prolonged alcohol use and smoking are associated with the development of laryngeal cancer,
which the patients symptoms and history suggest. Family history is not a risk factor for head or
neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the
patients symptoms are not suggestive of this diagnosis. Streptococcal throat infections also may cause these
clinical manifestations, but patients with this type of infection will also have pain and a fever.
7. Which action should the nurse take first when a patient develops a nosebleed?
a. Pinch the lower portion of the nose for 10 minutes.
b. Pack the affected nare tightly with an epistaxis balloon.
c. Obtain silver nitrate that will be needed for cauterization. d. Apply ice compresses over the
patients nose and cheeks.
ANS: A
1. Epistaxis can be a symptom of:
A. Over-anticoagulation
B. Hematologic malignancy
C. Cocaine abuse
D. All of the above
ANS: D
Cocaine abuse, which is more common than might be expected, frequently causes epistaxis. Hematologic
disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary
coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums.
2. Nasal discharge of green-yellow mucus, pharyngitis, and otitis media commonly indicate: A.
Allergic rhinitis
B.
Viral infection
C.
Bacterial infection
D.
Nasal polyps
. ANS: C
Nasal discharge should be assessed for its amount and color as well as any associated symptoms. Clear,
profuse discharge is allergic in nature; yellow-green purulent discharge indicates bacterial infection.
3. The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement,
if made by the patient, indicates that the teaching was successful?
a. I can take 800 mg ibuprofen for pain control.
b. I will safely remove and reapply nasal packing daily.
c. My nose will look normal after 24 hours when the swelling goes away.
d. I will keep my head elevated for 48 hours to minimize swelling and pain. ANS: D
Maintaining the head in an elevated position will decrease the amount of nasal swelling.
NSAIDs, such as ibuprofen, increase the risk for postoperative bleeding and should not be used
postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually
removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of
the surgery, it is not always possible to achieve this result, especially in the first few weeks after surgery.
4. The nurse plans to teach a patient how to manage allergic rhinitis. Which information should
the nurse include in the teaching plan?
a. Hand washing is the primary way to prevent spreading the condition to others.
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, b. Use of oral antihistamines for 2 weeks before the allergy season may prevent reactions.
c. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.
d. Identification and avoidance of environmental triggers are the best way to avoid symptoms. ANS:
D
The most important intervention is to assist the patient in identifying and avoiding potential
allergens. Intranasal corticosteroids (not oral antihistamines) should be started several weeks
before the allergy season. Corticosteroid nasal sprays have minimal systemic absorption. Acute viral rhinitis
(the common cold) can be prevented by washing hands.
5. The nurse discusses management of upper respiratory infections (URI) with a patient who has
acute sinusitis. Which statement by the patient indicates that additional teaching is needed?
a. I can take acetaminophen (Tylenol) to treat my discomfort.
b. I will drink lots of juices and other fluids to stay well hydrated.
c. I can use my nasal decongestant spray until the congestion is all gone.
d. I will watch for changes in nasal secretions or the sputum that I cough up. ANS: C
The nurse should clarify that nasal decongestant sprays should be used for no more than 3 days
to prevent rebound vasodilation and congestion. The other responses indicate that the teaching
has been effective.
6. A nurse obtains a health history from a patient who has a 35 pack-year smoking history. The patient
complains of hoarseness and tightness in the throat and difficulty swallowing. Which question is most
important for the nurse to ask?
a. How much alcohol do you drink in an average week? b. Do you have a family history of head or
neck cancer? c. Have you had frequent streptococcal throat infections?
d. Do you use antihistamines for upper airway congestion? ANS: A
Prolonged alcohol use and smoking are associated with the development of laryngeal cancer,
which the patients symptoms and history suggest. Family history is not a risk factor for head or
neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the
patients symptoms are not suggestive of this diagnosis. Streptococcal throat infections also may cause these
clinical manifestations, but patients with this type of infection will also have pain and a fever.
7. Which action should the nurse take first when a patient develops a nosebleed?
a. Pinch the lower portion of the nose for 10 minutes.
b. Pack the affected nare tightly with an epistaxis balloon.
c. Obtain silver nitrate that will be needed for cauterization. d. Apply ice compresses over the
patients nose and cheeks.
ANS: A
