NSG-1523 PrepU Respiratory 3

Flashcard maker : Jill Lopez
A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education?

a) Vocal cord stripping
b) Cordectomy
c) Total laryngectomy
d) Partial laryngectomy

D
A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?

a) “Oral intake of fluids should be limited for 1 week only.”
b) “Clean the tracheostomy tube with alcohol and water.”
c) “Limit the amount of protein in the diet.”
d) “Family members should continue to talk to the client.”

D
The nurse knows that there are three types of chronic pharyngitis. Which of the following is characterized by numerous swollen lymph follicles on the pharyngeal wall?

a) Aphonia
b) Hypertrophic
c) Chronic granular
d) Atrophic

C
Which of the following is a priority nursing intervention that the nurse should perform for a patient who has undergone surgery for a nasal obstruction?

a) Provide a splint postoperatively
b) Apply a warm pack postoperatively
c) Ensure mouth breathing
d) Apply pressure to the convex portion of the nose

C
Which assessment finding puts a client at increased risk for epistaxis?

a) History of nasal surgery
b) Use of a humidifier at night
c) Cocaine use
d) Hypotension

C
The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care?

a) Develop an alternate method of communication.
b) Assess the tracheostomy cuff for leaks.
c) Encourage oral nutrition on the second postoperative day.
d) Maintain the client in a low-Fowler’s position.

A
After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?

a) Bleeding
b) Throat pain
c) Difficulty swallowing
d) Difficulty talking

A
Late complications of radiation therapy may include which of the following? Select all that apply.

a) Fibrosis
b) Xerostomia
c) Laryngeal necrosis
d) Loss of taste
e) Edema

A, C, E
What client would be most in need of an endotracheal tube?

a) Comatose clients
b) A client status post tonsillectomy
c) Older adult clients
d) Ambulatory clients

A
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

a) Stands behind the worker, who has hands across the neck
b) Places both arms around the worker’s waist
c) Exerts pressure against the worker’s abdomen
d) Makes a fist with one hand with the thumb outside the fist

A
A 62-year-old male client with a history of chronic laryngitis arrives at the clinic complaining of a hoarseness “he can’t shake.” The nurse is aware that this client may be at risk for which of the following conditions?

a) Adenoiditis
b) Laryngeal cancer
c) Peritonsillar abscess
d) Coryza

B
The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis (ABRS) includes which of the following?

a) Levofloxacin (Levaquin)
b) Amoxicillin (Augmentin)
c) Keflex (Cephalexin)
d) Ceftin (Cefuroxime)

B
A client comes into the emergency department with epistaxis. What intervention should you perform when caring for a client with epistaxis?

a) Provide a nasal splint.
b) Place the client in a semi-Fowler’s position.
c) Apply a moustache dressing.
d) Apply direct continuous pressure.

D
A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, “If I am going to have radiation, I won’t need surgery.” What is the best response by the nurse?

a) “All patients have to have radiation before they have surgery. It is protocol.”
b) “You really don’t have to have radiation but you won’t have to have such invasive surgery if you have the radiation first.”
c) “That is correct. The radiation will eradicate the tumor and you won’t have to have further treatment.”
d) “Radiation is used to shrink the tumor size and is an adjunct to surgery.”

D
A patient has undergone a laryngectomy. The nurse notes evidence of wound breakdown. The nurse understands that the patient is at a high risk for developing which of the following?

a) Carotid hemorrhage
b) Pulmonary embolism
c) Pneumonia
d) Dehydration

A
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?

a) Clarithromycin (Biaxin)
b) Cefuroxime (Ceftin)
c) Amoxicillin-clavulanic acid (Augmentin)
d) Cephalexin (Keflex)

C
A client has a red pharyngeal membrane, reddened tonsils, and enlarged cervical lymph nodes. The client also reports malaise and sore throat. The nurse needs to assess first for:

a) Myalgias
b) Nausea
c) Fever
d) Headache

C
The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of

a) 2 to12 days.
b) 3 to 6 months.
c) 20 to 30 days.
d) 0 to 3 months.

A
You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis?

a) Monitor for signs of dysphagia.
b) Provide meticulous mouth care every 4 hours.
c) Caution against frequent coughing.
d) Encourage deep breathing every 2 hours.

D
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?

a) “Do you eat a lot of red meat?”
b) “Do you smoke cigarettes, cigars, or a pipe?”
c) “Do you eat spicy foods?”
d) “Have you strained your voice recently?”

B
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?

a) Total laryngectomy
b) Supraglottic laryngectomy
c) Hemilaryngectomy
d) Partial laryngectomy

D
A client exhibits a sudden and complete loss of voice and is coughing. The nurse states

a) “Do not smoke and avoid being around others who are smoking.”
b) “Do not use a humidifier; it will make your problem worse.”
c) “The ‘tickle’ in your throat will improve with cold liquids.”
d) “It is fine to speak in a whisper. This does not strain your voice.”

A
The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections?

a) Gently blow the nose to eliminate nasal secretions.
b) Use an anti-allergy medication to decrease rhinitis.
c) Administer an over-the-counter decongestant.
d) Place a warm cloth over the sinus area of the forehead.

C
The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised?

a) Auscultate lung sounds.
b) Monitor heart rhythm.
c) Assess capillary refill.
d) Obtain vital signs.

A
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?

a) Infection
b) Plugged tracheostomy tube
c) Post operative bleeding
d) Edema of the upper airway

D
Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require?

a) Family counseling
b) Emotional support
c) Referral for vocational training
d) Referral for counseling

B
Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?

a) The patient is able to assist with his own suctioning.
b) The surgical site is dry with encrustations.
c) The stoma is healed, about 6 weeks after surgery.
d) Drainage is <30 mL/day for 2 consecutive days.

D
A nurse is providing instructions for the client with chronic rhinosinusitis. The nurse accurately tells the client:

a) Caffeinated beverages are allowed.
b) You may drink 1 glass of alcohol daily.
c) Do not perform saline irrigations to the nares.
d) Sleep with the head of bed elevated.

D
A college student presents to the health clinical with signs and symptoms of viral rhinitis (common cold). The patient states, “I’ve felt terrible all week; what can I do to feel better?” Which of the following is the best response the nurse can give?

a) “Antibiotics will be prescribed, which will make you feel better.”
b) “You should rest, increase your fluids, and take Ibuprofen.”
c) “Your symptoms should go away soon, just try to get some rest.”
d) “Have you tried a topic nasal decongestant; they work well.”

B
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:

a) “I should become involved in a weight loss program.”
b) “I should sleep on my side all night long.”
c) “I need to keep my inhaler at the bedside.”
d) “I should eat a high-protein diet.”

A
The nurse is caring for a patient admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been completed. Which of the following interventions should the nurse include in the patient’s care?

a) Apply an ice pack.
b) Apply pressure to the convex of the nose.
c) Restrict fluid intake.
d) Position the patient in the side-lying position.

A
A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis?

a) Provide a nasal splint.
b) Place the client in a semi-Fowler’s position.
c) Apply direct continuous pressure.
d) Apply a moustache dressing.

C
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) A nasal cannula
b) A ventilator
c) A rigid shell
d) A face mask

D
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

a) Deficient fluid volume related to increased fluid needs
b) Ineffective airway clearance related to excess mucus production
c) Deficient knowledge related to prevention of upper respiratory infections
d) Acute pain related to upper airway irritation

B
The nurse is providing discharge instructions for a patient following laryngeal surgery. The nurse instructs the patient to avoid which of the following?

a) Wearing a plastic bib while showering
b) Swimming
c) Wearing a scarf over the stoma
d) Coughing

B
Which of the following is the most effective treatment for obstructive sleep apnea (OSA)?

a) Bilevel positive airway pressure (BiPAP)
b) Oxygen by nasal cannula
c) Continuous positive airway pressure (CPAP)
d) Mechanical ventilation

C
The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice?

a) Partial laryngectomy
b) Total laryngectomy
c) Radiation therapy
d) Laser surgery

B
You are caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids?

a) Hardened secretions
b) Erosion of the trachea
c) Noisy breathing
d) Incrusted mucous membranes

C
The nurse is providing discharge instructions to a patient following nasal surgery who has nasal packing. Which of the following discharge instructions would be most appropriate for the patient?

a) Administer normal saline nasal drops as ordered.
b) Avoid sports activities for 6 weeks.
c) Decrease the amount of daily fluids.
d) Take aspirin for nasal discomfort.

B
The nurse should advise the patient who has nasal packing for epistaxis that the packing can be left in place:

a) An average of 12 hours.
b) Anywhere from 2 to 6 days.
c) An average of 24 hours.
d) No longer than 2 hours.

B
Choice Multiple question – Select all answer choices that apply.
A patient comes to the clinic with a cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold? (Select all that apply.)

a) Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase.
b) Suggest that the patient take adequate fluids and get plenty of rest.
c) Tell the patient to take prescribed antibiotics to decrease the severity of symptoms.
d) Inform the patient about the symptoms of secondary infection.
e) Inform the patient that taking an antihistamine will help to decrease the duration of the cold.

A, B, D
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?

a) Diminished breath sounds throughout
b) Rhonchi in the bronchial region
c) Audible stridor without using a stethoscope
d) Crackles in the bases of the lungs

C
During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events?

a) Systemic hypotension
b) Increased smooth muscle contractility
c) Hypercapnia
d) Pulmonary hypotension

C
The nurse is caring for a patient who underwent a laryngectomy. Which of the following interventions will the nurse initially complete in an effort to meet the patient’s nutritional needs?

a) Offer plenty of thin liquids.
b) Encourage sweet foods.
c) Liberally season foods.
d) Initiate enteral feedings.

D
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?

a) Group A, beta-hemolytic streptococcus
b) Pseudomonas aeruginosa
c) Gram-negative Klebsiella
d) Staphylococcus aureus

A
A client is being discharged from an outpatient surgery center following a tonsillectomy. The nurse gives the following instructions:

a) “You are allowed to have hot tea or coffee.”
b) “Gargle vigorously to clean your throat.”
c) “Gargle with a warm salt solution.”
d) “You may have a sore throat for 1 week.”

C
Which of the following diagnostic tests is used to confirm the diagnosis of maxillary and frontal sinusitis?

a) MRI
b) Sinus x-rays
c) CT scan
d) Sinus aspirates

D
A client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?

a) “Keep the stoma uncovered.”
b) “Keep the stoma moist.”
c) “Have a family member perform stoma care initially until you get used to the procedure.”
d) “Keep the stoma dry.”

B
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:

a) blow his nose and then put lateral pressure on his nose.
b) sit upright, leaning slightly forward.
c) hold his nose while bending forward at the waist.
d) lie supine with his neck extended.

B
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?

a) Hoarseness for 2 weeks
b) Aphonia following a football game
c) Epistaxis, twice last week
d) Laryngitis following a cold

A
Which of the following is the priority nursing diagnosis for the patient undergoing a laryngectomy?

a) Ineffective airway clearance
b) Anxiety and depression
c) Imbalanced nutrition: Less than body requirements
d) Impaired verbal communication

A
Choice Multiple question – Select all answer choices that apply.
The nurse is caring for a geriatric client brought to the emergency department after being found by her children feeling poorly with an elevated temperature. Laboratory tests confirm influenza type A, a respiratory virus. Which medical treatment would the nurse anticipate in the discharge instructions? Select all that apply.

a) Antitussives
b) Rest
c) Saline gargles
d) Antiemetics
e) Antibiotics
f) Increased fluids

A, B, C, F
Bleeding from the drains at the surgical site or with tracheal suctioning may signal the occurrence of hemorrhage. Which of the following is a clinical manifestations associated with hemorrhage?

a) Rapid, deep respirations
b) Warm, moist skin
c) Increased blood pressure
d) Decreased pulse rate

A
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

a) Blow the nose before applying medication into the nares.
b) Wait 10 seconds before administering the second spray.
c) Clean the medication container once each day.
d) Tilt the head back when activating the spray of the medication.

A
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:

a) laryngeal cancer is one of the most preventable types of cancer.
b) laryngeal cancer occurs primarily in women.
c) adenocarcinoma accounts for most cases of laryngeal cancer.
d) inhaling polluted air isn’t a risk factor for laryngeal cancer.

A
A 76-year-old man presents to the ED complaining of “laryngitis.” The triage nurse should ask if the patient has a past medical history that includes which of the following?

a) Chronic obstructive pulmonary disease (COPD)
b) Congestive heart failure (CHF)
c) Respiratory failure (RF)
d) Gastroesophageal reflux disease (GERD)

D
The nurse is instructing a client who is scheduled for a laryngectomy about methods of alaryngeal speech. Which of the following best describes tracheoesophageal puncture (TEP)?

a) It requires the client to hold a throat vibrator against the neck.
b) It will result in a low, gruff-sounding voice.
c) It requires the insertion of a prosthesis into the trachea.
d) It enables the client to form words with the lips.

C
A client is in the emergency department following a fall on the face. The client reports facial pain. The nurse assesses bleeding from nasal cuts and from the nares, a deformity to the nose, periorbital ecchymoses, and some clear fluid draining from the right nostril. The first action of the nurse is to

a) Administer prescribed oral ibuprofen (Motrin).
b) Check the clear fluid for glucose.
c) Reassure the client that the nose is not fractured.
d) Apply an ice pack to the nose.

B
Your client has had laryngeal surgery. What is as expected outcome in this client?

a) The client’s suture line remains intact.
b) The client can swallow without difficulty.
c) The client maintains an adequate caloric intake.
d) The client’s breathing patterns improve.

C
The nurse is caring for a client with allergic rhinitis. The patient asks the nurse about measures to help decrease allergic symptoms. The best response by the nurse is which of the following?

a) “You should try to reduce exposure to irritants and allergens.”
b) “Be sure to receive your influenza vaccination each year.”
c) “You need to see your ear, nose, and throat specialist monthly.”
d) “Take over-the-counter (OTC) nasal congestions when you experience symptoms.”

A
A client who has been diagnosed with an early glottis cancer would most likely undergo which type of surgery?

a) Vocal cord stripping
b) Laser microsurgery
c) Total laryngectomy
d) Partial laryngectomy

B
When a patient has undergone a laryngectomy and there is evidence of wound breakdown, the nurse monitors the patient very carefully because he or she is at high risk for

a) carotid artery hemorrhage.
b) pulmonary embolism.
c) dehydration.
d) pneumonia.

A
A first-line antibiotic utilized in the treatment of acute sinusitis includes

a) Cefzil
b) Ampicillin
c) Ceftin
d) Augmentin

B
The nurse at an employee wellness clinic is meeting with a client who reports voice hoarseness for more than 2 weeks. To determine if the client may have symptoms of early laryngeal cancer, the next question the nurse should ask is, “Do you have

a) a persistent cough or sore throat”
b) a foul odor to your breath”
c) difficulty swallowing foods”
d) trouble with your breathing”

A
Which of the following methods most resembles normal speech following a total laryngectomy?

a) Lip speaking
b) Blom-Singer voice prosthesis
c) Electrolarynx held at neck
d) Esophageal speech

B

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