LIPPINCOTT FINAL PAPER 2025/2026 QUESTIONS WITH
ANSWERS GRADED A+
✔✔A client who has undergone outpatient nasal
surgery is ready for discharge and has nasal packing
in place. Which of the following discharge instructions
would be appropriate for the client?
■ 1. Avoid activities that elicit the Valsalva
maneuver.
■ 2. Take aspirin to control nasal discomfort.
■ 3. Avoid brushing the teeth until the nasal packing
is removed.
■ 4. Apply heat to the nasal area to control swelling. - ✔✔1. The client should be
instructed to avoid any activities that cause Valsalva's maneuver (e.g., constipation,
vigorous coughing, exercise) in order to reduce bleeding and stress on suture lines. The
client should not take aspirin because of its antiplatelet
properties, which may cause bleeding. Oral hygiene is important to rid the mouth of old
dried blood and to enhance the client's appetite. Cool
compresses, not heat, should be applied to decrease swelling and control discoloration
of the area.
✔✔Which of the following statements should indicate
to the nurse that a client has understood the discharge
instructions provided after her nasal surgery?
■ 1. "I should not shower until my packing is
removed."
■ 2. "I will take stool softeners and modify my
diet to prevent constipation."
■ 3. "Coughing every 2 hours is important to prevent
respiratory complications."
■ 4. "It is important to blow my nose each day to
remove the dried secretions." - ✔✔2. Constipation can cause straining during
defecation, which can induce bleeding. Showering is not contraindicated. The client
should take measures to prevent coughing, which can cause bleeding. The client should
avoid blowing her nose for 48 hours after the packing is removed. Thereafter, she
should blow her nose gently, using the open mouth technique to minimize bleeding in
the surgical area.
✔✔The nurse is planning to give preoperative instructions to a client who will be
undergoing rhinoplasty. Which of the following instructions should be included?
■ 1. After surgery, nasal packing will be in place
for 7 to 10 days.
■ 2. Normal saline nose drops will need to be
administered preoperatively.
■ 3. The results of the surgery will be immediately
obvious postoperatively.
,■ 4. Aspirin-containing medications should not be
taken for 2 weeks before surgery. - ✔✔4. Aspirin-containing medications should be
discontinued for 2 weeks before surgery to decrease
the risk of bleeding. Nasal packing is usually removed the day after surgery. Normal
saline nose drops are not routinely administered preoperatively. The results of the
surgery will not be obvious immediately after surgery because of edema and
ecchymosis.
✔✔Which of the following assessments should
be a priority immediately after nasal surgery?
■ 1. Assessing the client's pain.
■ 2. Inspecting for periorbital ecchymosis.
■ 3. Assessing respiratory status.
■ 4. Measuring intake and output. - ✔✔3. Immediately after nasal surgery, ineffective
breathing patterns may develop as a result of
the nasal packing and nasal edema. Nasal packing
may dislodge, leading to obstruction. Assessing
for airway obstruction is a priority. Assessing for
pain is important, but it is not as high a priority as
assessment of the airways. It is too early to detect
ecchymosis. Measuring intake and output is not
typically a priority nursing assessment after nasal
surgery.
✔✔After nasal surgery, the client expresses concern
about how to decrease facial pain and swelling
while recovering at home. Which of the following
discharge instructions would be most effective for
decreasing pain and edema?
■ 1. Take analgesics every 4 hours around the clock.
■ 2. Use corticosteroid nasal spray as needed to control symptoms.
■ 3. Use a bedside humidifier while sleeping.
■ 4. Apply cold compresses to the area. - ✔✔4. Applying cold compresses helps to
decrease facial swelling and pain from edema. Analgesics may decrease pain, but they
do not decrease edema. A corticosteroid nasal spray would not be administered
postoperatively because it can impair healing. Use of a bedside humidifier promotes
comfort by providing moisture for nasal mucosa, but it does not decrease edema.
✔✔A client is being discharged with nasal packing in place. The nurse should instruct
the client to:
■ 1. Perform frequent mouth care.
■ 2. Use normal saline nose drops daily.
■ 3. Sneeze and cough with mouth closed.
,■ 4. Gargle every 4 hours with salt water. - ✔✔1. Frequent mouth care is important to
provide comfort and encourage eating. Mouth care promotes moist mucous
membranes. Nose drops
cannot be used with nasal packing in place. When
sneezing and coughing, the client should do so with the mouth open to decrease the
chance of dislodging the packing. Gargling should not be attempted with packing in
place.
✔✔Which of the following activities should the nurse teach the client to implement after
the
removal of nasal packing on the second postoperative
day?
■ 1. Avoid cleaning the nares until swelling has subsided.
■ 2. Apply water-soluble jelly to lubricate the nares.
■ 3. Keep a nasal drip pad in place to absorb secretions.
■ 4. Use a bulb syringe to gently irrigate nares. - ✔✔2. After removal of nasal packing,
the client
should be instructed to apply water-soluble jelly to the nares to lubricate the nares and
promote comfort.
Swelling gradually subsides over several weeks; the client can gently clean the nares as
soon as packing is removed. A nasal drip pad is not needed after removal of packing.
Irrigation with a bulb syringe
may interfere with healing and introduce infection.
✔✔The nurse is teaching a client how to manage a nosebleed. Which of the following
instructions would be appropriate to give the client?
■ 1. "Tilt your head backward and pinch your nose."
■ 2. "Lie down flat and place an ice compress over the bridge of the nose."
■ 3. "Blow your nose gently with your neck flexed."
■ 4. "Sit down, lean forward, and pinch the soft
portion of your nose." - ✔✔4. The client should assume a sitting position
and lean forward. Firm pressure should be applied
to the soft portion of the nose for approximately
10 minutes. Tilting the head backward can cause the client to swallow blood, which can
obscure the amount of bleeding and also can lead to nausea. Ice compresses may be
applied, but the client should not lie flat. Blowing the nose is to be avoided because it
can increase bleeding.
✔✔An elderly client had posterior packing inserted to control a severe nosebleed. After
insertion of the packing, the client should be closely
monitored for which of the following complications?
■ 1. Vertigo.
■ 2. Bell's palsy.
■ 3. Hypoventilation.
, ■ 4. Loss of gag reflex. - ✔✔3. Posterior packing may alter the respiratory status of the
client, especially in elderly clients, causing hypoventilation. Clients should be observed
carefully for changes in level of consciousness, respiratory rate, and heart rate and
rhythm after the insertion of the packing. Vertigo does not occur as a result of the
insertion of posterior packing. Bell's palsy, a disorder of the seventh cranial nerve, is not
associated with epistaxis or nasal packing. Loss of gag reflex does not occur as a result
of the insertionof posterior packing.
✔✔The Client with Cancer of the Larynx
Postoperative nursing management of the client following a radical neck dissection for
laryngeal cancer requires:
■ 1. Complete bed rest minimizing head
movement.
■ 2. Vital signs once a shift.
■ 3. Clear liquid diet started at 48 hours.
■ 4. Frequent suctioning of the laryngectomy tube. - ✔✔4. The nurse must maintain
patency of the
airway with frequent suctioning of the laryngectomy tube that can become occluded
from secretions, blood, and mucus plugs. Once the client is hemodynamically stable,
getting out of bed should be encouraged to prevent postoperative complications. Vital
signs should be monitored more frequently in a postoperative client. A swallow study is
done at approximately 5 to 7 days after surgery, prior to starting oral intake.
✔✔A client who has had a total laryngectomy
appears withdrawn and depressed. He keeps the
curtain drawn, refuses visitors, and indicates a
desire to be left alone. Which nursing intervention
would most likely be therapeutic for the client?
■ 1. Discussing his behavior with his wife to
determine the cause.
■ 2. Exploring his future plans.
■ 3. Respecting his need for privacy.
■ 4. Encouraging him to express his feelings nonverbally
and in writing. - ✔✔4. The client has undergone body changes
and permanent loss of verbal communication. He may feel isolated and insecure. The
nurse can encourage him to express his feelings and use this
information to develop an appropriate plan of care. Discussing the client's behavior with
his wife may not reveal his feelings. Exploring future plans is not appropriate at this time
because more information about the client's behavior is needed before proceeding to
this level. The nurse can respect the client's need for privacy while also encouraging
him to
express his feelings.
✔✔The nurse is suctioning a client who had a
laryngectomy. What is the maximum amount of time
the nurse should suction the client?
ANSWERS GRADED A+
✔✔A client who has undergone outpatient nasal
surgery is ready for discharge and has nasal packing
in place. Which of the following discharge instructions
would be appropriate for the client?
■ 1. Avoid activities that elicit the Valsalva
maneuver.
■ 2. Take aspirin to control nasal discomfort.
■ 3. Avoid brushing the teeth until the nasal packing
is removed.
■ 4. Apply heat to the nasal area to control swelling. - ✔✔1. The client should be
instructed to avoid any activities that cause Valsalva's maneuver (e.g., constipation,
vigorous coughing, exercise) in order to reduce bleeding and stress on suture lines. The
client should not take aspirin because of its antiplatelet
properties, which may cause bleeding. Oral hygiene is important to rid the mouth of old
dried blood and to enhance the client's appetite. Cool
compresses, not heat, should be applied to decrease swelling and control discoloration
of the area.
✔✔Which of the following statements should indicate
to the nurse that a client has understood the discharge
instructions provided after her nasal surgery?
■ 1. "I should not shower until my packing is
removed."
■ 2. "I will take stool softeners and modify my
diet to prevent constipation."
■ 3. "Coughing every 2 hours is important to prevent
respiratory complications."
■ 4. "It is important to blow my nose each day to
remove the dried secretions." - ✔✔2. Constipation can cause straining during
defecation, which can induce bleeding. Showering is not contraindicated. The client
should take measures to prevent coughing, which can cause bleeding. The client should
avoid blowing her nose for 48 hours after the packing is removed. Thereafter, she
should blow her nose gently, using the open mouth technique to minimize bleeding in
the surgical area.
✔✔The nurse is planning to give preoperative instructions to a client who will be
undergoing rhinoplasty. Which of the following instructions should be included?
■ 1. After surgery, nasal packing will be in place
for 7 to 10 days.
■ 2. Normal saline nose drops will need to be
administered preoperatively.
■ 3. The results of the surgery will be immediately
obvious postoperatively.
,■ 4. Aspirin-containing medications should not be
taken for 2 weeks before surgery. - ✔✔4. Aspirin-containing medications should be
discontinued for 2 weeks before surgery to decrease
the risk of bleeding. Nasal packing is usually removed the day after surgery. Normal
saline nose drops are not routinely administered preoperatively. The results of the
surgery will not be obvious immediately after surgery because of edema and
ecchymosis.
✔✔Which of the following assessments should
be a priority immediately after nasal surgery?
■ 1. Assessing the client's pain.
■ 2. Inspecting for periorbital ecchymosis.
■ 3. Assessing respiratory status.
■ 4. Measuring intake and output. - ✔✔3. Immediately after nasal surgery, ineffective
breathing patterns may develop as a result of
the nasal packing and nasal edema. Nasal packing
may dislodge, leading to obstruction. Assessing
for airway obstruction is a priority. Assessing for
pain is important, but it is not as high a priority as
assessment of the airways. It is too early to detect
ecchymosis. Measuring intake and output is not
typically a priority nursing assessment after nasal
surgery.
✔✔After nasal surgery, the client expresses concern
about how to decrease facial pain and swelling
while recovering at home. Which of the following
discharge instructions would be most effective for
decreasing pain and edema?
■ 1. Take analgesics every 4 hours around the clock.
■ 2. Use corticosteroid nasal spray as needed to control symptoms.
■ 3. Use a bedside humidifier while sleeping.
■ 4. Apply cold compresses to the area. - ✔✔4. Applying cold compresses helps to
decrease facial swelling and pain from edema. Analgesics may decrease pain, but they
do not decrease edema. A corticosteroid nasal spray would not be administered
postoperatively because it can impair healing. Use of a bedside humidifier promotes
comfort by providing moisture for nasal mucosa, but it does not decrease edema.
✔✔A client is being discharged with nasal packing in place. The nurse should instruct
the client to:
■ 1. Perform frequent mouth care.
■ 2. Use normal saline nose drops daily.
■ 3. Sneeze and cough with mouth closed.
,■ 4. Gargle every 4 hours with salt water. - ✔✔1. Frequent mouth care is important to
provide comfort and encourage eating. Mouth care promotes moist mucous
membranes. Nose drops
cannot be used with nasal packing in place. When
sneezing and coughing, the client should do so with the mouth open to decrease the
chance of dislodging the packing. Gargling should not be attempted with packing in
place.
✔✔Which of the following activities should the nurse teach the client to implement after
the
removal of nasal packing on the second postoperative
day?
■ 1. Avoid cleaning the nares until swelling has subsided.
■ 2. Apply water-soluble jelly to lubricate the nares.
■ 3. Keep a nasal drip pad in place to absorb secretions.
■ 4. Use a bulb syringe to gently irrigate nares. - ✔✔2. After removal of nasal packing,
the client
should be instructed to apply water-soluble jelly to the nares to lubricate the nares and
promote comfort.
Swelling gradually subsides over several weeks; the client can gently clean the nares as
soon as packing is removed. A nasal drip pad is not needed after removal of packing.
Irrigation with a bulb syringe
may interfere with healing and introduce infection.
✔✔The nurse is teaching a client how to manage a nosebleed. Which of the following
instructions would be appropriate to give the client?
■ 1. "Tilt your head backward and pinch your nose."
■ 2. "Lie down flat and place an ice compress over the bridge of the nose."
■ 3. "Blow your nose gently with your neck flexed."
■ 4. "Sit down, lean forward, and pinch the soft
portion of your nose." - ✔✔4. The client should assume a sitting position
and lean forward. Firm pressure should be applied
to the soft portion of the nose for approximately
10 minutes. Tilting the head backward can cause the client to swallow blood, which can
obscure the amount of bleeding and also can lead to nausea. Ice compresses may be
applied, but the client should not lie flat. Blowing the nose is to be avoided because it
can increase bleeding.
✔✔An elderly client had posterior packing inserted to control a severe nosebleed. After
insertion of the packing, the client should be closely
monitored for which of the following complications?
■ 1. Vertigo.
■ 2. Bell's palsy.
■ 3. Hypoventilation.
, ■ 4. Loss of gag reflex. - ✔✔3. Posterior packing may alter the respiratory status of the
client, especially in elderly clients, causing hypoventilation. Clients should be observed
carefully for changes in level of consciousness, respiratory rate, and heart rate and
rhythm after the insertion of the packing. Vertigo does not occur as a result of the
insertion of posterior packing. Bell's palsy, a disorder of the seventh cranial nerve, is not
associated with epistaxis or nasal packing. Loss of gag reflex does not occur as a result
of the insertionof posterior packing.
✔✔The Client with Cancer of the Larynx
Postoperative nursing management of the client following a radical neck dissection for
laryngeal cancer requires:
■ 1. Complete bed rest minimizing head
movement.
■ 2. Vital signs once a shift.
■ 3. Clear liquid diet started at 48 hours.
■ 4. Frequent suctioning of the laryngectomy tube. - ✔✔4. The nurse must maintain
patency of the
airway with frequent suctioning of the laryngectomy tube that can become occluded
from secretions, blood, and mucus plugs. Once the client is hemodynamically stable,
getting out of bed should be encouraged to prevent postoperative complications. Vital
signs should be monitored more frequently in a postoperative client. A swallow study is
done at approximately 5 to 7 days after surgery, prior to starting oral intake.
✔✔A client who has had a total laryngectomy
appears withdrawn and depressed. He keeps the
curtain drawn, refuses visitors, and indicates a
desire to be left alone. Which nursing intervention
would most likely be therapeutic for the client?
■ 1. Discussing his behavior with his wife to
determine the cause.
■ 2. Exploring his future plans.
■ 3. Respecting his need for privacy.
■ 4. Encouraging him to express his feelings nonverbally
and in writing. - ✔✔4. The client has undergone body changes
and permanent loss of verbal communication. He may feel isolated and insecure. The
nurse can encourage him to express his feelings and use this
information to develop an appropriate plan of care. Discussing the client's behavior with
his wife may not reveal his feelings. Exploring future plans is not appropriate at this time
because more information about the client's behavior is needed before proceeding to
this level. The nurse can respect the client's need for privacy while also encouraging
him to
express his feelings.
✔✔The nurse is suctioning a client who had a
laryngectomy. What is the maximum amount of time
the nurse should suction the client?
