MED SURG 2 EXAM 3 PRACTICE
QUESTIONS
The0nurse0is0planning0the0care0of0a0patient0who0is0scheduled0for0a0laryngectomy.0The
0nurse0should0assign0the0highest0priority0to0which0postoperative0nursing0diagnosis?
A)0Anxiety0related0to0diagnosis0of0cancer
B)0Altered0nutrition0related0to0swallowing0difficulties
C)0Ineffective0airway0clearance0related0to0airway0alterations
D)0Impaired0verbal0communication0related0to0removal0of0the0larynx0-0ans✔Ans:0C
Feedback:
Each0of0the0listed0diagnoses0is0valid,0but0ineffective0airway0clearance0is0the0priority0nu
rsing0diagnosis0for0all0conditions.
The0nurse0is0caring0for0a0patient0whose0recent0unexplained0weight0loss0and0history0of
0smoking0have0prompted0diagnostic0testing0for0cancer.0What0symptom0is0most0closely
0associated0with0the0early0stages0of0laryngeal0cancer?
A)0Hoarseness
B)0Dyspnea
C)0Dysphagia
D)0Frequent0nosebleeds0-0ans✔Ans:0A
Feedback:
Hoarseness0is0an0early0symptom0of0laryngeal0cancer.0Dyspnea,0dysphagia,0and0lump
s0are0later0signs0of0laryngeal0cancer.0Alopecia0is0not0associated0with0a0diagnosis0of0la
ryngeal0cancer.
A0nurse0practitioner0has0provided0care0for0three0different0patients0with0chronic0pharyn
gitis0over0the0past0several0months.0Which0patients0are0at0greatest0risk0for0developing0
chronic0pharyngitis?
A)0Patients0who0are0habitual0users0of0alcohol0and0tobacco
B)0Patients0who0are0habitual0users0of0caffeine0and0other0stimulants
C)0Patients0who0eat0a0diet0high0in0spicy0foods
D)0Patients0who0have0gastrointestinal0reflux0disease0(GERD)0-0ans✔Ans:0A
Feedback:
Chronic0pharyngitis0is0common0in0adults0who0live0and0work0in0dusty0surroundings,0us
e0the0voice0to0excess,0suffer0from0chronic0chough,0and0habitually0use0alcohol0and0tob
acco.0Caffeine0and0spicy0foods0have0not0been0linked0to0chronic0pharyngitis.0GERD0is0
not0a0noted0risk0factor.
,The0nurse0is0caring0for0a0patient0who0is0postoperative0day020following0a0total0laryngec
tomy0for0supraglottic0cancer.0The0nurse0should0prioritize0what0assessment?
A)0Assessment0of0body0image
B)0Assessment0of0jugular0venous0pressure
C)0Assessment0of0carotid0pulse
D)0Assessment0of0swallowing0ability0-0ans✔Ans:0D
Feedback:
A0common0postoperative0complication0from0this0type0of0surgery0is0difficulty0in0swallowi
ng,0which0creates0a0potential0for0aspiration.0Cardiovascular0complications0are0less0like
ly0at0this0stage0of0recovery.0The0patients0body0image0should0be0assessed,0but0dyspha
gia0has0the0potential0to0affect0the0patients0airway,0and0is0a0consequent0priority.
The0nurse0is0performing0an0assessment0on0a0patient0who0has0been0diagnosed0with0c
ancer0of0the0larynx.0Part0of0the0nurses0assessment0addresses0the0patients0general0st
ate0of0nutrition.0Which0laboratory0values0would0be0assessed0when0determining0the0nut
ritional0status0of0the0patient?0Select0all0that0apply.
A)0White0blood0cell0count
B)0Protein0level
C)0Albumin0level
D)0Platelet0count
E)0Glucose0level0-0ans✔Ans:0B,C,E
Feedback:
The0nurse0also0assesses0the0patients0general0state0of0nutrition,0including0height0and0
weight0and0body0mass0index,0and0reviews0laboratory0values0that0assist0in0determining
0the0patients0nutritional0status0(albumin,0protein,0glucose,0and0electrolyte0levels).0The0
white0blood0cell0count0and0the0platelet0count0would0not0normally0assist0in0determining0
the0patients0nutritional0status.
The0nurse0recognizes0that0aspiration0is0a0potential0complication0of0a0laryngectomy.0H
ow0should0the0nurse0best0manage0this0risk?
A)0Facilitate0total0parenteral0nutrition0(TPN).
B)0Keep0a0complete0suction0setup0at0the0bedside.
C)0Feed0the0patient0several0small0meals0daily.
D)0Refer0the0patient0for0occupational0therapy.0-0ans✔Ans:0B
Feedback:
Due0to0the0risk0for0aspiration,0the0nurse0keeps0a0suction0setup0available0in0the0hospit
al0and0instructs0the0family0to0do0so0at0home0for0use0if0needed.0TPN0is0not0indicated0a
nd0small0meals0do0not0necessarily0reduce0the0risk0of0aspiration.0Physical0therapists0d
o0not0address0swallowing0ability.
The0nurse0is0providing0care0for0a0patient0who0has0just0been0admitted0to0the0postsurgi
cal0unit0following0a0laryngectomy.0What0assessment0should0the0nurse0prioritize?
A)0The0patients0swallowing0ability
B)0The0patients0airway0potency
C)0The0patients0carotid0pulses
D)0Signs0and0symptoms0of0infection0-0ans✔Ans:0B
, Feedback:
The0patient0with0a0laryngectomy0is0a0risk0for0airway0occlusion0and0respiratory0distress
.0As0in0all0nursing0situations,0assessment0of0the0airway0is0a0priority0over0other0potenti
al0complications0and0assessment0parameters.
The0nurse0has0noted0the0emergence0of0a0significant0amount0of0fresh0blood0at0the0drai
n0site0of0a0patient0who0is0postoperative0day010following0total0laryngectomy.0How0shoul
d0the0nurse0respond0to0this0development?
A)Remove0the0patients0drain0and0apply0pressure0with0a0sterile0gauze.
B)0Assess0the0patient,0reposition0the0patient0supine,0and0apply0wall0suction0to0the0drai
n.0
C)0Rapidly0assess0the0patient0and0notify0the0surgeon0about0the0patients0bleeding.0
D)0Administer0a0STAT0dose0of0vitamin0K0to0aid0coagulation.0-0ans✔Ans:0C
Feedback:
The0nurse0promptly0notifies0the0surgeon0of0any0active0bleeding,0which0can0occur0at0a0
variety0of0sites,0including0the0surgical0site,0drains,0and0trachea.0The0drain0should0not0
be0removed0or0connected0to0suction.0Supine0positioning0would0exacerbate0the0bleedin
g.0Vitamin0K0would0not0be0administered0without0an0order.
The0nurse0is0creating0a0care0plan0for0a0patient0who0is0status0post-
total0laryngectomy.0Much0of0the0plan0consists0of0a0long-
term0postoperative0communication0plan0for0alaryngeal0communication.0What0form0of0a
laryngeal0communication0will0likely0be0chosen?
A)0Esophageal0speech
B)0Electric0larynx0
C)0Tracheoesophageal0puncture
D)0American0Sign0Language0(ASL)0-0ans✔Ans:0C0
Feedback:0
Tracheoesophageal0puncture0is0simple0and0has0few0complications.0It0is0associated0wit
h0high0phonation0success,0good0phonation0quality,0and0steady0long-
term0results.0As0a0result,0it0is0preferred0over0esophageal0speech,0and0electric0larynx0o
r0ASL.
A0patient0has0just0been0diagnosed0with0squamous0cell0carcinoma0of0the0neck.0While0t
he0nurse0is0doing0health0education,0the0patient0asks,0Does0this0kind0of0cancer0tend0to
0spread0to0other0parts0of0the0body?0What0is0the0nurses0best0response?
A)0In0many0cases,0this0type0of0cancer0spreads0to0other0parts0of0the0body.
B)0This0cancer0usually0does0not0spread0to0distant0sites0in0the0body.
C)0You0will0have0to0speak0to0your0oncologist0about0that.
D)0Squamous0cell0carcinoma0is0nothing0to0be0concerned0about,0so0try0to0focus0on0yo
ur0health.0-0ans✔Ans:0B0
Feedback:
The0incidence0of0distant0metastasis0with0squamous0cell0carcinoma0of0the0head0and0n
eck0(including0larynx0cancer)0is0relatively0low.0The0patients0prognosis0is0determined0b
y0the0oncologist,0but0the0patient0has0asked0a0general0question0and0it0would0be0inappr
opriate0to0refuse0a0response.0The0nurse0must0not0downplay0the0patients0concerns.
QUESTIONS
The0nurse0is0planning0the0care0of0a0patient0who0is0scheduled0for0a0laryngectomy.0The
0nurse0should0assign0the0highest0priority0to0which0postoperative0nursing0diagnosis?
A)0Anxiety0related0to0diagnosis0of0cancer
B)0Altered0nutrition0related0to0swallowing0difficulties
C)0Ineffective0airway0clearance0related0to0airway0alterations
D)0Impaired0verbal0communication0related0to0removal0of0the0larynx0-0ans✔Ans:0C
Feedback:
Each0of0the0listed0diagnoses0is0valid,0but0ineffective0airway0clearance0is0the0priority0nu
rsing0diagnosis0for0all0conditions.
The0nurse0is0caring0for0a0patient0whose0recent0unexplained0weight0loss0and0history0of
0smoking0have0prompted0diagnostic0testing0for0cancer.0What0symptom0is0most0closely
0associated0with0the0early0stages0of0laryngeal0cancer?
A)0Hoarseness
B)0Dyspnea
C)0Dysphagia
D)0Frequent0nosebleeds0-0ans✔Ans:0A
Feedback:
Hoarseness0is0an0early0symptom0of0laryngeal0cancer.0Dyspnea,0dysphagia,0and0lump
s0are0later0signs0of0laryngeal0cancer.0Alopecia0is0not0associated0with0a0diagnosis0of0la
ryngeal0cancer.
A0nurse0practitioner0has0provided0care0for0three0different0patients0with0chronic0pharyn
gitis0over0the0past0several0months.0Which0patients0are0at0greatest0risk0for0developing0
chronic0pharyngitis?
A)0Patients0who0are0habitual0users0of0alcohol0and0tobacco
B)0Patients0who0are0habitual0users0of0caffeine0and0other0stimulants
C)0Patients0who0eat0a0diet0high0in0spicy0foods
D)0Patients0who0have0gastrointestinal0reflux0disease0(GERD)0-0ans✔Ans:0A
Feedback:
Chronic0pharyngitis0is0common0in0adults0who0live0and0work0in0dusty0surroundings,0us
e0the0voice0to0excess,0suffer0from0chronic0chough,0and0habitually0use0alcohol0and0tob
acco.0Caffeine0and0spicy0foods0have0not0been0linked0to0chronic0pharyngitis.0GERD0is0
not0a0noted0risk0factor.
,The0nurse0is0caring0for0a0patient0who0is0postoperative0day020following0a0total0laryngec
tomy0for0supraglottic0cancer.0The0nurse0should0prioritize0what0assessment?
A)0Assessment0of0body0image
B)0Assessment0of0jugular0venous0pressure
C)0Assessment0of0carotid0pulse
D)0Assessment0of0swallowing0ability0-0ans✔Ans:0D
Feedback:
A0common0postoperative0complication0from0this0type0of0surgery0is0difficulty0in0swallowi
ng,0which0creates0a0potential0for0aspiration.0Cardiovascular0complications0are0less0like
ly0at0this0stage0of0recovery.0The0patients0body0image0should0be0assessed,0but0dyspha
gia0has0the0potential0to0affect0the0patients0airway,0and0is0a0consequent0priority.
The0nurse0is0performing0an0assessment0on0a0patient0who0has0been0diagnosed0with0c
ancer0of0the0larynx.0Part0of0the0nurses0assessment0addresses0the0patients0general0st
ate0of0nutrition.0Which0laboratory0values0would0be0assessed0when0determining0the0nut
ritional0status0of0the0patient?0Select0all0that0apply.
A)0White0blood0cell0count
B)0Protein0level
C)0Albumin0level
D)0Platelet0count
E)0Glucose0level0-0ans✔Ans:0B,C,E
Feedback:
The0nurse0also0assesses0the0patients0general0state0of0nutrition,0including0height0and0
weight0and0body0mass0index,0and0reviews0laboratory0values0that0assist0in0determining
0the0patients0nutritional0status0(albumin,0protein,0glucose,0and0electrolyte0levels).0The0
white0blood0cell0count0and0the0platelet0count0would0not0normally0assist0in0determining0
the0patients0nutritional0status.
The0nurse0recognizes0that0aspiration0is0a0potential0complication0of0a0laryngectomy.0H
ow0should0the0nurse0best0manage0this0risk?
A)0Facilitate0total0parenteral0nutrition0(TPN).
B)0Keep0a0complete0suction0setup0at0the0bedside.
C)0Feed0the0patient0several0small0meals0daily.
D)0Refer0the0patient0for0occupational0therapy.0-0ans✔Ans:0B
Feedback:
Due0to0the0risk0for0aspiration,0the0nurse0keeps0a0suction0setup0available0in0the0hospit
al0and0instructs0the0family0to0do0so0at0home0for0use0if0needed.0TPN0is0not0indicated0a
nd0small0meals0do0not0necessarily0reduce0the0risk0of0aspiration.0Physical0therapists0d
o0not0address0swallowing0ability.
The0nurse0is0providing0care0for0a0patient0who0has0just0been0admitted0to0the0postsurgi
cal0unit0following0a0laryngectomy.0What0assessment0should0the0nurse0prioritize?
A)0The0patients0swallowing0ability
B)0The0patients0airway0potency
C)0The0patients0carotid0pulses
D)0Signs0and0symptoms0of0infection0-0ans✔Ans:0B
, Feedback:
The0patient0with0a0laryngectomy0is0a0risk0for0airway0occlusion0and0respiratory0distress
.0As0in0all0nursing0situations,0assessment0of0the0airway0is0a0priority0over0other0potenti
al0complications0and0assessment0parameters.
The0nurse0has0noted0the0emergence0of0a0significant0amount0of0fresh0blood0at0the0drai
n0site0of0a0patient0who0is0postoperative0day010following0total0laryngectomy.0How0shoul
d0the0nurse0respond0to0this0development?
A)Remove0the0patients0drain0and0apply0pressure0with0a0sterile0gauze.
B)0Assess0the0patient,0reposition0the0patient0supine,0and0apply0wall0suction0to0the0drai
n.0
C)0Rapidly0assess0the0patient0and0notify0the0surgeon0about0the0patients0bleeding.0
D)0Administer0a0STAT0dose0of0vitamin0K0to0aid0coagulation.0-0ans✔Ans:0C
Feedback:
The0nurse0promptly0notifies0the0surgeon0of0any0active0bleeding,0which0can0occur0at0a0
variety0of0sites,0including0the0surgical0site,0drains,0and0trachea.0The0drain0should0not0
be0removed0or0connected0to0suction.0Supine0positioning0would0exacerbate0the0bleedin
g.0Vitamin0K0would0not0be0administered0without0an0order.
The0nurse0is0creating0a0care0plan0for0a0patient0who0is0status0post-
total0laryngectomy.0Much0of0the0plan0consists0of0a0long-
term0postoperative0communication0plan0for0alaryngeal0communication.0What0form0of0a
laryngeal0communication0will0likely0be0chosen?
A)0Esophageal0speech
B)0Electric0larynx0
C)0Tracheoesophageal0puncture
D)0American0Sign0Language0(ASL)0-0ans✔Ans:0C0
Feedback:0
Tracheoesophageal0puncture0is0simple0and0has0few0complications.0It0is0associated0wit
h0high0phonation0success,0good0phonation0quality,0and0steady0long-
term0results.0As0a0result,0it0is0preferred0over0esophageal0speech,0and0electric0larynx0o
r0ASL.
A0patient0has0just0been0diagnosed0with0squamous0cell0carcinoma0of0the0neck.0While0t
he0nurse0is0doing0health0education,0the0patient0asks,0Does0this0kind0of0cancer0tend0to
0spread0to0other0parts0of0the0body?0What0is0the0nurses0best0response?
A)0In0many0cases,0this0type0of0cancer0spreads0to0other0parts0of0the0body.
B)0This0cancer0usually0does0not0spread0to0distant0sites0in0the0body.
C)0You0will0have0to0speak0to0your0oncologist0about0that.
D)0Squamous0cell0carcinoma0is0nothing0to0be0concerned0about,0so0try0to0focus0on0yo
ur0health.0-0ans✔Ans:0B0
Feedback:
The0incidence0of0distant0metastasis0with0squamous0cell0carcinoma0of0the0head0and0n
eck0(including0larynx0cancer)0is0relatively0low.0The0patients0prognosis0is0determined0b
y0the0oncologist,0but0the0patient0has0asked0a0general0question0and0it0would0be0inappr
opriate0to0refuse0a0response.0The0nurse0must0not0downplay0the0patients0concerns.
