Med_Surg_Chapter_22

Med-Surg Chapter 22: Management of Patients With Upper respiratory Tract Disorders Question A 76-year-old client presents to the ED reporting “laryngitis.” The triage nurse should ask whether the client has a medical history that includes • Gastroesophageal reflux disease (GERD) Question A client comes into the clinic complaining of hoarseness that has lasted for about a month. What would you suspect? • Laryngeal cancer Question A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis? • Apply direct continuous pressure. Question A client exhibits a sudden and complete loss of voice and is coughing. The nurse states • "Do not smoke and avoid being around others who are smoking." Question A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for • Nuchal rigidity Question A client has undergone a laryngectomy. The nurse notes evidence of wound breakdown. The nurse understands that the client is at a high risk for developing • Carotid artery hemorrhage Question A client is being discharged from an outpatient surgery center following a tonsillectomy. The nurse gives the following instructions: • "Gargle with a warm salt solution." Question A client is experiencing acute viral rhinosinusitis. The nurse is providing instructions about self–care activities and includes information about • Saline lavages to the nares Question 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 maintain your airway while you're under anesthesia." Question A client finished a course of antibiotics for laryngitis but continues to experience persistent hoarseness. Which symptom would cause the nurse to suspect laryngeal cancer? • a feeling of swelling at the back of the throat Question A client has a nursing diagnosis of acute pain related to upper airway irritation. The best short-term goal for this client is for the client to • Report relief of pain to level 3 using a pain intensity scale of 1 to 10. Question A client is prescribed two sprays of a nasal medication twice a day. The nurse is teaching the client how to self- administer the medication and instructs the client to • Blow the nose before applying medication into the nares. Question A client is postoperative for a partial laryngectomy following a diagnosed malignancy. The client is to start oral feedings. The nurse does the following interventions: (Select all that apply.) • Obtains results of a swallow study • Provides thick liquids Question A client recently diagnosed with laryngeal cancer and awaiting a laryngectomy was encouraged to attend a support group prior to surgery. The client asked the nurse about the name of the laryngeal speech method where the client speaks with the assistance of a surgically implanted device. The nurse is correct to provide teaching on which method? • A tracheoesophageal puncture Question 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 • Ineffective airway clearance related to excess mucus production Question A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? • "Do you smoke cigarettes, cigars, or a pipe?" Question A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: • sit upright, leaning slightly forward. Question A client who has an altered level of consciousness is receiving a tube feeding. Clients receiving tube feeding should be placed in which position? • Semi-Fowler's or higher Question 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." Question A first-line antibiotic used to treat acute rhinosinusitis is • ampicillin. Question 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? • Administer one intramuscular injection of penicillin. Question A late complication of radiation therapy is • laryngeal necrosis. Question A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to • Seek medical help if he experiences inability to swallow Question 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." Question 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 • Stands behind the worker, who has hands across the neck Question A nurse is providing instructions for the client with chronic rhinosinusitis. The nurse accurately tells the client: • Sleep with the head of bed elevated. Question 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. • Hoarseness of more than 2 week's duration Question 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? • Group A, beta-hemolytic streptococci Question A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis? • Group A, beta-hemolytic streptococcus Question A patient 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 patient about? • Amoxicillin-clavulanic acid (Augmentin) Question 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? • Partial laryngectomy Question A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? • An antiviral agent such as acyclovir Question 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 Question A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: • A permanent tracheal stoma would be necessary. Question As part of a primary cancer prevention program, an oncology nurse answers questions from the public at a health fair. When someone asks about laryngeal cancer, the nurse should explain that: • laryngeal cancer is one of the most preventable types of cancer. Question During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? • Hypercapnia Question Late complications of radiation therapy may include which of the following? Select all that apply. • Laryngeal necrosis • Edema • Fibrosis Question Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require? • Emotional support Question Select the nursing diagnosis that would warrant immediate health care provider notification. • Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation Question Stiffness of the neck or inability to bend the neck is referred to as • nuchal rigidity. Question The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of • 2 to 12 days Question The nurse in the ICU is caring for a client with a nasotracheal tube. Because of the tube placement, the nurse understands that the client is at risk for developing • sinus infection. Question 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? • Affected voice sounds Question 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? • Apply an ice pack. Question The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? • Noisy breathing Question The nurse is caring for a client diagnosed with rhinosinusitis. The physician has ordered the client to receive four sprays of budesonide (Rhinocort) in each nostril every morning. The nurse informs the client that a common side effect of this medication is • Epistaxis Question 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? • Audible stridor without using a stethoscope Question The nurse is caring for a client in the physician’s office with a potential sinus infection. The physician orders a diagnostic test to identify if fluid is found in the sinus cavity. Which diagnostic test, written by the physician, is specifically ordered for this purpose? • Transillumination of the sinus Question 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? • Edema of the upper airway Question 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. Question The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client’s room? • A face mask Question The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include? • “You can use writing or a communication board to communicate.” Question 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 Question The nurse is providing discharge instructions for a client following laryngeal surgery. The nurse instructs the client to avoid • swimming. Question 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? • Avoid sports activities for 6 weeks. Question 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. • Somnolence and hypotension • Tachycardia and tachypnea • Impaired swallowing • A tracheostomy cuff pressure 20 mmHg Question When caring for a client with head trauma, a nurse notes a small amount of clear, watery fluid oozing from the client's nose. What should the nurse do first? • Test the nasal drainage for glucose. Question Which assessment finding puts a client at increased risk for epistaxis? • Cocaine use Question Which intervention regarding nutrition is implemented for clients who have undergone laryngectomy? • Use enteral feedings after the procedure Question Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction? • Ensure mouth breathing Question Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? • Amoxicillin Question Which is the priority nursing diagnosis for a client undergoing a laryngectomy? • Ineffective airway clearance Question Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? • impaired verbal communication Question Which of the following methods most resembles normal speech following a total laryngectomy? • Blom-Singer voice prosthesis Question Wound drains, inserted during the laryngectomy, stay in place until what criteria are met? • Drainage is 30 mL/day for 2 consecutive days. Question You are caring for a client who is 42-years-old and status post adenoidectomy. You find the client in respiratory distress when you enter their room. You ask another nurse to call the physician and bring an endotracheal tube into the room. What do you suspect? • Edema of the upper airway Question You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis? • Encourage deep breathing every 2 hours. Question Your client has just been diagnosed with laryngeal cancer. The client asks you what causes laryngeal cancer. What would be your best response? • “Research has shown that heredity contributes to having laryngeal cancer.”