1. A client has had a laryngectomy as treatment for laryngeal cancer. Which postoperative instruction is of utmost importance to the client's health and
... [Show More] safety?
a. avoid swimming
b. avoid sponge baths
c. avoid covering the stoma
d. avoid coughing - a
Water should not enter the stoma because it will flow from the trachea to the lungs.
2. 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. Partial laryngectomy
b. Supraglottic laryngectomy
c. Hemilaryngectomy
d. Total laryngectomy - a
In a partial laryngectomy, a portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing. During a supraglottic laryngectomy, a tracheostomy is left in place until the glottic airway is established. Hemilaryngectomy is done by splitting the thyroid cartilage of the larynx in the midline of the neck, and the portion of the vocal cord is removed with the tumor. During a total laryngectomy, a complete removal of the larynx is performed, including the hyoid bone, epiglottis, cricoids cartilage, and two or three rings of the trachea.
3. Cuff pressure on the endotracheal or tracheostomy tube should be monitored by the nurse at least every:
a. 8 hours.
b. 2 hours.
c. 4 hours.
d. 6 hours. - a
Cuff pressure must be monitored at least every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique.
4. The nurse is creating a plan of care for a client diagnosed with acute laryngitis. What intervention should be included in the client's plan of care?
a. Place warm washcloths on the client's throat, as needed.
b. Have the client inhale warm steam three times daily.
c. Encourage the client to limit speech whenever possible.
d. Limit the client's fluid intake to 1.5 L/day. - c
Management of acute laryngitis includes resting the voice, avoiding irritants (including smoking), resting, and inhaling cool steam or an aerosol. Fluid intake should be increased. Warm washcloths on the throat will not help relieve the symptoms of acute laryngitis.
5. 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. - c
Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. The benefits of this treatment depend on the degree of heat that is applied. The nurse teaches about these procedures and about the recommended temperature of the solution: high enough to be effective and as warm as the client can tolerate, usually 105ºF to 110ºF (40.6ºC to 43.3ºC). Irrigating the throat may reduce spasm in the pharyngeal muscles and relieve soreness of the throat. You would not tell the parent teacher organization that there is no real treatment of pharyngitis.
6. 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. Makes a fist with one hand with the thumb outside the fist
d. Exerts pressure against the worker's abdomen - a
The description of the fellow worker is a person who is choking. Following guidelines set by the American Heart Association, the nurse first stands behind the person who is choking.
7. A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse's priority for patient education should be:
a. The need to use inhaled corticosteroids and bronchodilators each night prior to applying CPAP
b. The importance of participating in daily physical exercise when using CPAP on a regular basis
c. The need to have continuous pulse oximetry in place while the CPAP machine is in use
d. The importance of complying with CPAP despite the inconvenience associated with its use - d
Although CPAP is effective in management of OSA, patient compliance with the treatment continues to be a major concern. Nursing interventions aimed at increasing compliance are consequently a priority. Steroids, bronchodilators, and pulse oximetry are not normally necessary. Daily exercise is beneficial but the promotion of compliance is a priority for patients using CPAP.
8. The nurse is caring for a client admitted with a diagnosis of bacterial pharyngitis. The nurse anticipates the client will be ordered which medication?
a. Robitussin DM
b. Tylenol
c. Penicillin
d. Tylenol with codeine - c
The treatment of choice for bacterial pharyngitis is penicillin. Penicillin V potassium taken for 5 days is the regimen of choice. Traditionally, penicillin was administered as a single injection; however, oral forms are now used more often and are as effective as and less painful than injections. Penicillin injections are recommended only if there is a concern that the client will not comply with therapy. Robitussin DM may be used as an antitussive. Aspirin or Tylenol, or Tylenol with codeine, may be given for severe sore throats.
9. The nurse is creating a care plan for a client 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) - c
Tracheoesophageal puncture is simple and has few complications. It is associated with high phonation success, good phonation quality, and steady long-term results. As a result, it is preferred over esophageal speech, an electric larynx or ASL.
10. 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?
a. Preparing the patient for a septoplasty
b. Applying nasal packing
c. Administering nasal lavage
d. Applying steroidal nasal spray - b
A nasal fracture very often produces bleeding from the nasal passage. As a rule, bleeding is controlled with the use of packing. [Show Less]