Deck 27: Nursing Management: Upper Respiratory Problems

Question 1

The nurse is obtaining a health history from a 67-year-old patient with a 40 pack-year smoking history, complaints 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 history of using chewing tobacco or snuff?
C) Do you use antihistamines for upper airway congestion?
D) Have you had frequent streptococcal throat infections?

Answer 1

How much alcohol do you drink in an average week?

Question 2

The nurse notes all of these findings in a 76-year-old patient who has influenza. Which information will be most important to communicate to the health care provider?

A) Fever of 100.4° F (38° C)
B) Myalgia and persistent headache
C) Diffuse crackles in the lungs
D) Sore throat and frequent cough

Answer 2

Diffuse crackles in the lungs

Question 3

A spontaneously breathing patient who has a cuffed tracheostomy tube in place has new orders for speech therapy and a soft diet. To evaluate whether the patient can safely have the cuff deflated to promote speaking and make swallowing easier, the nurse deflates the cuff and then

A) assesses whether the patient is able to talk.
B) monitors for symptoms of respiratory distress.
C) asks the patient to swallow a small amount of clear liquid and auscultates the lungs for the presence of crackles.
D) has the patient drink a small amount of grape juice and observes for coughing and the presence of colored sputum.

Answer 3

has the patient drink a small amount of grape juice and observes for coughing and the presence of colored sputum.

Question 4

A patient returns from surgery with a tracheostomy tube after a total laryngectomy and radical neck dissection. In caring for the patient during the first 24 hours after surgery, the priority nursing action is to

A) avoid changing the tracheostomy ties.
B) clean the inner cannula every 8 hours.
C) monitor for bleeding around the stoma.
D) assess the airway and breath sounds.

Question 5

A patient is discharged from the hospital with a tracheostomy tube for long-term airway management. The nurse determines that teaching related to care of the tracheostomy has been effective when the patient says,

A) "It will be several months before I will be able to change my tracheostomy tube at home."
B) "My medical insurance will cover the cost of sterile gloves and catheters for suctioning."
C) "I should maintain a liquid diet as long as I have the tracheostomy tube in place."
D) "If I have thick mucus, I can instill about a teaspoon of water into my tracheostomy tube."

Question 6

An RN is observing a nursing student who is suctioning a hospitalized patient with a tracheostomy in place. Which action by the student requires the RN to intervene?

A) The student preoxygenates the patient for 2 minutes before suctioning.
B) The student applies suction for 10 seconds while withdrawing the catheter.
C) The student puts on clean gloves and uses a sterile catheter to suction.
D) The student inserts the catheter about 5 inches into the tracheostomy tube.

Question 7

When the nurse removes a nasogastric (NG) tube that has been in place for 7 days, the patient develops a nosebleed. To control the bleeding, the nurse should initially

A) place the patient in a sitting position with the head hyperextended.
B) apply ice compresses over the patient's nose and cheeks.
C) pinch the soft lower portion of the nose for about 10 to 15 minutes.
D) pack the nares with ribbon gauze to apply pressure to the area.

Question 8

A patient who has sleep apnea and has been using CPAP for 2 weeks returns to the sleep clinic and tells the nurse, "My sleep has not improved at all." Which response by the nurse is most appropriate?

A) "CPAP takes more than a few weeks to achieve the maximum effect."
B) "Have you been using the CPAP every night?"
C) "Do you want to talk to the doctor about surgery?"
D) "Perhaps the CPAP pressure should be increased to a higher level."

Question 9

A patient with a tracheostomy is to use a fenestrated tracheostomy tube to provide for speech. Which of the following interventions will be included in the plan of care?

A) Placing the decannulation cap in the tube before cuff deflation
B) Assessing the patient's ability to swallow without choking
C) Keeping the cuff inflated to prevent aspiration of secretions
D) Leaving the inner cannula in place to facilitate suctioning

Question 10

The nurse is reviewing the charts for these patients who are scheduled in October for their yearly physical examinations. The nurse will plan on administration of the influenza vaccine injection to the

A) 24-year-old patient who has allergies to penicillin and the cephalosporins.
B) 30-year-old patient who is takes corticosteroids for rheumatoid arthritis.
C) 36-year-old patient who has a history of a positive PPD test.
D) 42-year-old patient who has a 20 pack-year smoking history.

Question 11

When the nurse is deflating the cuff of a tracheostomy tube to evaluate the patient's ability to swallow, it is important to

A) suction the patient's mouth and trachea before deflation of the cuff.
B) measure the amount of air removed from the cuff during deflation.
C) deflate the cuff during the inhalation phase of the respiratory cycle.
D) clean the inner cannula of the tracheostomy tube before deflation.

Question 12

A patient with laryngeal cancer has received teaching about radiation therapy. Which statement by the patient indicates that the teaching has been effective?

A) "I will need to buy a water bottle to carry with me."
B) "Until the radiation is complete, I may have diarrhea."
C) "Alcohol-based mouthwashes will help clean oral ulcers."
D) "I can use lotions to moisturize the skin on my throat."

Question 13

A patient has undergone a rhinoplasty to correct nasal deformities resulting from trauma during an automobile accident. The nursing intervention that is most appropriate postoperatively is to

A) teach the patient to use aspirin or acetaminophen to control the postoperative pain.
B) remind the patient that the nasal packing will not be removed for several weeks.
C) reassure the patient that the nose will look normal when the swelling subsides.
D) instruct the patient to keep the head elevated for 48 hours to minimize swelling.

Question 14

A nursing diagnosis of body image disturbance related to loss of control of personal care is identified for a patient with a total laryngectomy and radical neck dissection. The nurse evaluates that an expected outcome for the problem has been met when the patient

A) wears clothing that minimizes the disfigurement caused by surgery.
B) lets the spouse provide hygiene and stoma care.
C) asks that only family members be allowed to visit.
D) learns to remove and clean the laryngectomy tube independently.

Question 15

When inflating the cuff on a tracheostomy tube to the appropriate level, the best action by the nurse will be to

A) use a manometer to assure cuff pressure is at an appropriate level.
B) verify the health care provider's order for the amount of cuff pressure required.
C) fill the balloon until no leakage around the cuff is auscultated.
D) check the pilot balloon after inflation to assure that it is firm.

Question 16

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse, "How will I talk after the surgery?" The best response by the nurse is,

A) "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally."
B) "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally."
C) "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration."
D) "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed."

Question 17

When teaching the patient with allergic rhinitis about management of the condition, the nurse explains that

A) identification and avoidance of triggers are the best way to avoid allergic reactions.
B) use of oral antihistamines for a few weeks before the allergy season may prevent reactions.
C) corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.
D) OTC antihistamines cause sedation, so prescription antihistamines are usually ordered.

Question 18

A patient with an uncuffed tracheostomy tube coughs violently during suctioning and dislodges the tracheostomy tube. The nurse's first action should be to

A) assess the patient's oxygen saturation and call the health care provider.
B) ventilate the patient with a manual bag mask until the health care provider arrives.
C) insert the obturator and attempt to reinsert the tracheostomy tube.
D) position the patient in an upright position with the neck extended.

Question 19

After discussing care of upper respiratory infections (URI) and prevention of secondary infections with a patient who has a URI, the nurse determines that additional teaching is needed when the patient says

A) "I will drink lots of juices and other fluids to stay hydrated."
B) "I will watch for changes in nasal secretions or the sputum that I cough up."
C) "I can take acetaminophen (Tylenol) to treat discomfort."
D) "I can use my nasal decongestant spray until the congestion is all gone."

Question 20

A patient who has been diagnosed with sleep apnea has CPAP ordered. Which of these nursing actions in the plan of care can the RN delegate to a nursing assistant?

A) Monitor the patient's oxygen saturation during the night.
B) Remind the patient to apply the CPAP at bedtime.
C) Assess for fatigue or depression caused by poor sleep.
D) Teach the patient how to apply the CPAP mask.

Question 21

The teaching plan for a patient with acute sinusitis will need to include which of the following interventions? (Select all that apply.)

A) You will be more comfortable if you keep your head in an upright position.
B) Application of cool compresses to your face will improve sinus drainage.
C) OTC antihistamines can be used to relieve congestion and inflammation.
D) Taking a hot shower will increase sinus drainage and decrease pain.
E) Blowing the nose forcefully should be avoided to decrease nosebleed risk.
F) Saline nasal spray can be made at home and used to wash out secretions.

Question 22

After teaching a patient with allergic rhinitis how to use a nasal inhaler, the nurse observes the patient self-administering a medication with the inhaler. Which patient action indicates that more teaching is needed?

A) The patient gently blows the nose before using the inhaler.
B) The patient tilts the head back before inhaling the medication.
C) The patient breathes out slowly through the nostrils following inhaler use.
D) The patient waits a few seconds before exhaling after using the inhaler.

Question 23

The nurse enters the room of a patient who has just returned from surgery for a total laryngectomy and radical neck dissection and notes the following problems. In which order should the nurse address the problems?

A) The NG tube is disconnected from suction and clamped off.
B) The patient is coughing blood-tinged secretions from the tracheostomy.
C) The patient is lying in a lateral position with the head of the bed flat.
D) The Hemovac in the neck incision contains 200 ml of bloody drainage.

Question 24

The nurse is caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of these assessments will require the most immediate action by the nurse?

A) The patient's temperature is 100.1° F.
B) The nose appears red and swollen.
C) The oxygen saturation is 89%.
D) The patient complains of pain rated as 7 of a 10-point scale.

Question 25

After completing discharge instructions for a patient with a total laryngectomy, the nurse determines that additional instruction is needed when the patient says,

A) "I can participate in most of my prior fitness activities except swimming."
B) "I must keep the stoma covered with a loose sterile dressing at all times."
C) "I need to eat nutritious meals even though I can't smell or taste very well."
D) "I should wear a Medic Alert bracelet that identifies me as a neck breather."