Deck 22: Management of Patients With Upper Respiratory Tract Disorders

Question 1

The nurse is providing patient teaching to a young mother who has brought her 3-month-old infant to the clinic for a well-baby checkup. What action should the nurse recommend to the woman to prevent the transmission of organisms to her infant during the cold season?

A) Take preventative antibiotics, as ordered.
B) Gargle with warm salt water regularly.
C) Dress herself and her infant warmly.
D) Wash her hands frequently.

Answer 1

Wash her hands frequently.

Question 2

A patient visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the patient to perform which of the following?

A) Apply a cold pack to the affected area.
B) Apply a mustard poultice to the forehead.
C) Perform postural drainage.
D) Increase fluid intake.

Answer 2

Increase fluid intake.

Question 3

The nurse is creating a plan of car for a patient diagnosed with acute laryngitis. What intervention should
Be included in the patients plan of care?

A) Place warm cloths on the patients throat, as needed.
B) Have the patient inhale warm steam three times daily.
C) Encourage the patient to limit speech whenever possible.
D) Limit the patients fluid intake to $1.5 \mathrm{~L} /$ day.

Answer 3

Encourage the patient to limit speech whenever possible.

Question 4

A patient comes to the ED and is admitted with epistaxis. Pressure has been applied to the patients midline septum for 10 minutes, but the bleeding continues. The nurse should anticipate using what treatment to control the bleeding?

A) Irrigation with a hypertonic solution
B) Nasopharyngeal suction
C) Normal saline application
D) Silver nitrate application

Question 5

The nurse is planning the care of a patient who is scheduled for a laryngectomy. The nurse should assign the highest priority to which postoperative nursing diagnosis?

A) Anxiety related to diagnosis of cancer
B) Altered nutrition related to swallowing difficulties
C) Ineffective airway clearance related to airway alterations
D) Impaired verbal communication related to removal of the larynx

Question 6

The home care nurse is assessing the home environment of a patient who will be discharged from the hospital shortly after his laryngectomy. The nurse should inform the patient that he may need to arrange for the installation of which system in his home?

A) A humidification system
B) An air conditioning system
C) A water purification system
D) A radiant heating system

Question 7

The nurse is caring for a patient whose recent unexplained weight loss and history of smoking have prompted diagnostic testing for cancer. What symptom is most closely associated with the early stages of laryngeal cancer?

A) Hoarseness
B) Dyspnea
C) Dysphagia
D) Frequent nosebleeds

Question 8

The nurse is caring for a patient who needs education on his medication therapy for allergic rhinitis. The patient is to take cromolyn (Nasalcrom) daily. In providing education for this patient, how should the nurse describe the action of the medication?

A) It inhibits the release of histamine and other chemicals.
B) It inhibits the action of proton pumps.
C) It inhibits the action of the sodium-potassium pump in the nasal epithelium.
D) It causes bronchodilation and relaxes smooth muscle in the bronchi.

Question 9

The campus nurse at a university is assessing a 21-year-old student who presents with a severe nosebleed. The site of bleeding appears to be the anterior portion of the nasal septum. The nurse instructs the student to tilt her head forward and the nurse applies pressure to the nose, but the students nose continues to bleed. Which intervention should the nurse next implement?

A) Apply ice to the bridge of her nose
B) Lay the patient down on a cot
C) Arrange for transfer to the local ED
D) Insert a tampon in the affected nare

Question 10

The ED nurse is assessing a young gymnast who fell from a balance beam. The gymnast presents with a clear fluid leaking from her nose. What should the ED nurse suspect?

A) Fracture of the cribriform plate
B) Rupture of an ethmoid sinus
C) Abrasion of the soft tissue
D) Fracture of the nasal septum

Question 11

A 42-year-old patient is admitted to the ED after an assault. The patient received blunt trauma to the face and has a suspected nasal fracture. Which of the following interventions should the nurse perform?

A) Administer nasal spray and apply an occlusive dressing to the patients face.
B) Position the patients head in a dependent position.
C) Irrigate the patients nose with warm tap water.
D) Apply ice and keep the patients head elevated.

Question 12

The occupational health nurse is obtaining a patient history during a pre-employment physical. During the history, the patient states that he has hereditary angioedema. The nurse should identify what implication of this health condition?

A) It will result in increased loss of work days.
B) It may cause episodes of weakness due to reduced cardiac output.
C) It can cause life-threatening airway obstruction.
D) It is unlikely to interfere with the individuals health.

Question 13

The nurse is conducting a presurgical interview for a patient with laryngeal cancer. The patient states that he drinks approximately six to eight shots of vodka per day. It is imperative that the nurse inform the surgical team so the patient can be assessed for what?

A) Increased risk for infection
B) Delirium tremens
C) Depression
D) Nonadherence to postoperative care

Question 14

The nurse is explaining the safe and effective administration of nasal spray to a patient with seasonal allergies. What information is most important to include in this teaching?

A) Finish the bottle of nasal spray to clear the infection effectively.
B) Nasal spray can only be shared between immediate family members.
C) Nasal spray should be administered in a prone position.
D) Overuse of nasal spray may cause rebound congestion.

Question 15

As a clinic nurse, you are caring for a patient who has been prescribed an antibiotic for tonsillitis and has been instructed to take the antibiotic for 10 days. When you do a follow-up call with this patient, you are informed that the patient is feeling better and is stopping the medication after taking it for 4 days. What information should you provide to this patient?

A) Keep the remaining tablets for an infection at a later time.
B) Discontinue the medications if the fever is gone.
C) Dispose of the remaining medication in a biohazard receptacle.
D) Finish all the antibiotics to eliminate the organism completely.

Question 16

A nurse practitioner has provided care for three different patients with chronic pharyngitis over the past several months. Which patients are at greatest risk for developing chronic pharyngitis?

A) Patients who are habitual users of alcohol and tobacco
B) Patients who are habitual users of caffeine and other stimulants
C) Patients who eat a diet high in spicy foods
D) Patients who have gastrointestinal reflux disease (GERD)

Question 17

The perioperative nurse has admitted a patient who has just underwent a tonsillectomy. The nurses postoperative assessment should prioritize which of the following potential complications of this surgery?

A) Difficulty ambulating
B) Hemorrhage
C) Infrequent swallowing
D) Bradycardia

Question 18

A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

A) Adenoiditis
B) Chronic tonsillitis
C) Obstructive sleep apnea
D) Laryngeal cancer

Question 19

The nurse is caring for a patient in the ED for epistaxis. What information should the nurse include in patient discharge teaching as a way to prevent epistaxis?

A) Keep nasal passages clear.
B) Use decongestants regularly.
C) Humidify the indoor environment.
D) Use a tissue when blowing the nose.

Question 20

The nurse is caring for a patient who is postoperative day 2 following a total laryngectomy for supraglottic cancer. The nurse should prioritize what assessment?

A) Assessment of body image
B) Assessment of jugular venous pressure
C) Assessment of carotid pulse
D) Assessment of swallowing ability

Question 21

The nurse is performing the health interview of a patient with chronic rhinosinusitis who experiences frequent nose bleeds. The nurse asks the patient about her current medication regimen. Which medication would put the patient at a higher risk for recurrent epistaxis?

A) Afrin
B) Beconase
C) Sinustop Pro
D) Singulair

Question 22

The nurse is performing an assessment on a patient who has been diagnosed with cancer of the larynx. Part of the nurses assessment addresses the patients general state of nutrition. Which laboratory values would be assessed when determining the nutritional status of the patient? Select all that apply.

A) White blood cell count
B) Protein level
C) Albumin level
D) Platelet count
E) Glucose level

Question 23

The nurse is teaching a patient with allergic rhinitis about the safe and effective use of his medications. What would be the most essential information to give this patient about preventing possible drug interactions?

A) Prescription medications can be safely supplemented with OTC medications.
B) Use only one pharmacy so the pharmacist can check drug interactions.
C) Read drug labels carefully before taking OTC medications.
D) Consult the Internet before selecting an OTC medication.

Question 24

The nurse is caring for a patient who has just been diagnosed with chronic rhinosinusitis. While being admitted to the clinic, the patient asks, Will this chronic infection hurt my new kidney? What should the nurse know about chronic rhinosinusitis in patients who have had a transplant?

A) The patient will have exaggerated symptoms of rhinosinusitis due to immunosuppression.
B) Taking immunosuppressive drugs can contribute to chronic rhinosinusitis.
C) Chronic rhinosinusitis can damage the transplanted organ.
D) Immunosuppressive drugs can cause organ rejection.

Question 25

The nurse is caring for a patient with a severe nosebleed. The physician inserts a nasal sponge and tells the patient it may have to remain in place up to 6 days before it is removed. The nurse should identify that this patient is at increased risk for what?

A) Viral sinusitis
B) Toxic shock syndrome
C) Pharyngitis
D) Adenoiditis

Question 26

A nursing student is discussing a patient with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for patients with viral pharyngitis?

A) Teaching focuses on safe and effective use of antibiotics.
B) The patient should be preliminarily screened for surgery.
C) Symptom management is the main focus of medical and nursing care.
D) The focus of care is resting the voice to prevent chronic hoarseness.

Question 27

The nurse is providing patient teaching to a patient diagnosed with acute rhinosinusitis. For what possible complication should the nurse teach the patient to seek immediate follow-up?

A) Periorbital edema
B) Headache unrelieved by OTC medications
C) Clear drainage from nose
D) Blood-tinged mucus when blowing the nose

Question 28

A patient states that her family has had several colds during this winter and spring despite their commitment to handwashing. The high communicability of the common cold is attributable to what factor?

A) Cold viruses are increasingly resistant to common antibiotics.
B) The virus is shed for 2 days prior to the emergence of symptoms.
C) A genetic predisposition to viral rhinitis has recently been identified.
D) Overuse of OTC cold remedies creates a rebound susceptibility to future colds.

Question 29

It is cold season and the school nurse been asked to provide an educational event for the parent teacher organization of the local elementary school. What should the nurse include in teaching about the treatment of pharyngitis?

A) Pharyngitis is more common in children whose immunizations are not up to date.
B) There are no effective, evidence-based treatments for pharyngitis.
C) Use of warm saline gargles or throat irrigations can relieve symptoms.
D) Heat may increase the spasms in pharyngeal muscles.

Question 30

The nurse is doing discharge teaching in the ED with a patient who had a nosebleed. What should the nurse include in the discharge teaching of this patient?

A) Avoid blowing the nose for the next 45 minutes.
B) In case of recurrence, apply direct pressure for 15 minutes.
C) Do not take aspirin for the next 2 weeks.
D) Seek immediate medical attention if the nosebleed recurs.

Question 31

The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk?

A) Facilitate total parenteral nutrition (TPN).
B) Keep a complete suction setup at the bedside.
C) Feed the patient several small meals daily.
D) Refer the patient for occupational therapy.

Question 32

A patient has had a nasogastric tube in place for 6 days due to the development of paralytic ileus after
Surgery. In light of the prolonged presence of the nasogastric tube, the nurse should prioritize assessments related to what complication?

A) Sinus infections
B) Esophageal strictures
C) Pharyngitis
D) Laryngitis

Question 33

A mother calls the clinic asking for a prescription for Amoxicillin for her 2-year-old son who has what the nurse suspects to be viral rhinitis. What should the nurse explain to this mother?

A) I will relay your request promptly to the doctor, but I suspect that she wont get back to you if its a cold.
B) Ill certainly inform the doctor, but if it is a cold, antibiotics wont be used because they do not affect the virus.
C) Ill phone in the prescription for you since it can be prescribed by the pharmacist.
D) Amoxicillin is not likely the best antibiotic, but Ill call in the right prescription for you.

Question 34

The nurse is providing care for a patient who has just been admitted to the postsurgical unit following a laryngectomy. What assessment should the nurse prioritize?

A) The patients swallowing ability
B) The patients airway patency
C) The patients carotid pulses
D) Signs and symptoms of infection

Question 35

The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a patient who is postoperative day 1 following total laryngectomy. How should the nurse respond to this development?

A) Remove the patients drain and apply pressure with a sterile gauze.
B) Assess the patient, reposition the patient supine, and apply wall suction to the drain.
C) Rapidly assess the patient and notify the surgeon about the patients bleeding.
D) Administer a STAT dose of vitamin $\mathrm{K}$ to aid coagulation.

Question 36

The nurse is creating a care plan for a patient who is status post-total laryngectomy. Much of the plan consists of a long-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen?

A) Esophageal speech
B) Electric larynx
C) Tracheoesophageal puncture
D) American sign language (ASL)

Question 37

A patient is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the patients nutrition during treatment?

A) A $1.5 \mathrm{~L} /$ day fluid restriction
B) A high-potassium, low-sodium diet
C) A liquid or soft diet
D) A high-protein diet

Question 38

A patient has just been diagnosed with squamous cell carcinoma of the neck. While the nurse is doing health education, the patient asks, Does this kind of cancer tend to spread to other parts of the body? What is the nurses best response?

A) In many cases, this type of cancer spreads to other parts of the body.
B) This cancer usually does not spread to distant sites in the body.
C) You will have to speak to your oncologist about that.
D) Squamous cell carcinoma is nothing to be concerned about, so try to focus on your health.

Question 39

The nurse is performing preoperative teaching with a patient who has cancer of the larynx. After completing patient teaching, what would be most important for the nurse to do?

A) Give the patient his or her cell phone number.
B) Refer the patient to a social worker or psychologist.
C) Provide the patient with audiovisual materials about the surgery.
D) Reassure the patient and family that everything will be alright.

Question 40

A patients total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the patient when teaching him about this process?

A) Training on how to perform controlled belching
B) Use of an electronically enhanced artificial pharynx
C) Insertion of a specialized nasogastric tube
D) Fitting for a voice prosthesis