Deck 35: Nursing Care of Patients With Upper Respiratory Disorders

Question 1

While engaging in a high school sports activity, an adolescent sustains an injury to the nose. Which assessment findings indicate that the patient has a nasal fracture?

A) shortness of breath
B) diaphoresis
C) drop in blood pressures
D) periorbital ecchymosis
E) nasal bridge instability

Answer 1

periorbital ecchymosis
nasal bridge instability

Question 2

The nurse suspects that a patient has tonsillitis. What did the nurse assess to make this clinical decision?

A) hoarse voice
B) thirst
C) nucal rigidity
D) pain around the ears
E) low-grade fever

Answer 2

hoarse voice
pain around the ears
low-grade fever

Question 3

During an assessment, the nurse learns that the only thing that helps a patient with a daily morning headache is "using a vaporizer with eucalyptus" before breakfast. Which health problem should the nurse suspect the patient is experiencing?

A) acute rhinitis
B) allergic rhinitis
C) symptoms of sinusitis
D) after-effects from the flu

Answer 3

symptoms of sinusitis

Question 4

While recovering at home from a total laryngectomy, a patient notices an increase in left shoulder weakness. With what should the nurse realize this symptom is consistent?

A) normal recovery
B) damage to the spinal accessory nerve
C) side effect of neck radiation therapy
D) medication complication

Question 5

A middle-aged adult patient who is diagnosed with pertussis is complaining of right-sided thoracic pain. The nurse recognizes that this patient should be assessed for which conditions?

A) pleural effusion
B) pneumothorax
C) pulmonary emboli
D) rib fractures
E) pleurisy

Question 6

A middle-aged patient is seen in the clinic for a continuing cough after recovering from the flu "a few weeks ago." What should the nurse suspect is occurring with this patient?

A) viral pneumonia
B) sinus infection
C) otitis media
D) tracheobronchitis

Question 7

A female patient is seen for "increased hoarseness" and "a change in voice quality." What is an appropriate assessment question for the nurse to ask this patient?

A) "What medications are you currently taking?"
B) "Have you recently had a cold?"
C) "Have you recently visited another country?"
D) "What is your occupation?"

Question 8

A patient who was diagnosed with the flu is demonstrating rapid, shallow respirations. The nurse should be concerned that the patient is at risk for developing which condition?

A) atelectasis
B) pneumonia
C) dehydration
D) increased tidal volume

Question 9

The nurse is reviewing a patient's clinical record. Which teaching should the nurse identify as a priority for this patient? $\begin{array}{|l|l|l|}\hline \text { Laboratory Results }& \text { Subjective Data } & \text { Objective Data } \\\hline \text { LA antigen - positive for strep}&\begin{array}{l}\text { Comp lains of "sore throat," } \\\text { ear pain, difficulty } \\\text { swallowing }\end{array} & \begin{array}{l}\text { Foul breath odor noted; } \\\text { exudates present on posterior } \\\text { pharynx }\end{array} \\\hline \mathrm{WBC}-15,000 \mathrm{~mm}^{3}&\begin{array}{l}\text { States, "I feel so tired and } \\\text { have no energy." }\end{array} & \begin{array}{l}\text { Anterior cervical lymph } \\\text { nodes enlarged and palpable }\end{array} \\\hline& \begin{array}{l}\text { States, "I'm not hungry and } \\\text { nothing sounds good." }\end{array} & \begin{array}{l}\text { Soft palate and mucous } \\\text { membranes edematous and } \\\text { red }\end{array}\\\hline &&\mathrm{T} 102^{\circ} \mathrm{F}\left(38.8^{\circ} \mathrm{C}\right)\\\hline\end{array}$

A) Antibiotics should be taken as directed for 10 days.
B) The oral intake of warm liquids should be encouraged.
C) The diet can include toast, citrus juices, and pizza as preferred.
D) The patient should return to the clinic tomorrow for a flu immunization.

Question 10

A patient tells the nurse he has a "cold" every spring that lasts a few weeks. The nurse suspects that the patient is experiencing which condition?

A) acute viral rhinitis
B) allergic rhinitis
C) vasomotor rhinitis
D) atrophic rhinitis

Question 11

A patient tells the nurse, "After I leave here, I need to get to the dentist. My upper teeth are hurting and I don't know why." What should the nurse do?

A) end the visit so the patient can get to the dentist
B) assess the patient for a sinus infection
C) reschedule the appointment
D) tell the patient there is nothing wrong with the teeth

Question 12

The nurse observes a patient using this gesture (see diagram). What should the nurse do?

A) assume the patient is having throat pain and administer pain medication
B) prepare to perform the Heimlich maneuver
C) assess the patient for cyanosis, difficulty breathing, and stridor and wait until normal breathing resumes
D) sit with the patient until the laryngospasm passes and encourage deep breathing

Question 13

A patient who is scheduled for a partial laryngectomy asks if he will still be able to talk after the surgery. Which response would be appropriate for the nurse to make?

A) "No."
B) "You will have to ask your physician."
C) "Yes, but it might sound a little different."
D) "You will, but with an electronic device."
E) "Normal speaking, breathing, and swallowing will return as you recover."

Question 14

The nurse is assessing a patient's incision after an external sphenoethmoidectomy. Place an "X" on the area of the diagram where this incision would be located.

Question 15

A patient with laryngeal cancer is found to have carcinoma in situ. The nurse understands that this cancer is in which stage?

A) stage 0
B) stage I
C) stage II
D) stage III

Question 16

A patient is receiving anterior nasal packing for a nosebleed. What should be included in the instructions for this patient?

A) Remove the packing in the morning.
B) The packing will stay in place for at least 5 days.
C) The packing will be in place for at least 24 hours and up to 3 days.
D) The packing will be needed for at least 1 week.

Question 17

A patient says, "My nose is always congested and it just seems to get worse with the nasal spray I've been using." The nurse realizes that this patient is describing which manifestation?

A) incorrect use of the nasal spray
B) acute sinus infection that needs to be treated with antibiotics
C) adverse effect of the nasal spray
D) rebound nasal congestion

Question 18

The nurse observes a patient's respirations during sleep and notes the absence of respirations that lasts from 15 to 45 seconds. What should the nurse consider this patient is experiencing?

A) laryngeal spasm
B) sleep apnea
C) respiratory acidosis
D) renal failure

Question 19

A patient with multiple facial and nasal injuries needs a nasogastric tube placed. Which method should the nurse use to place this tube?

A) through the mouth
B) through the unobstructed nare
C) through the obstructed nare
D) after the edema in the nares subsides

Question 20

While eating a meal in the hospital, a patient exhibits difficulty breathing and signs of choking. What should the nurse realize the patient is experiencing?

A) laryngeal obstruction
B) pulmonary emboli
C) epiglottitis
D) acute myocardial infarction

Question 21

The public health nurse is preparing an education program on preventing laryngeal trauma and obstruction for community members. What should the nurse include in this program?

A) how to perform the Heimlich maneuver
B) the need to abstain from eating when ingesting alcohol
C) the need to carry a list of medications in a wallet at all times
D) the need to wear a medical alert bracelet if allergic to stinging insects
E) the need for people who wear dentures to take small bites when eating

Question 22

During a health history the nurse learns that a patient experiences several head colds each year. What teaching should the nurse consider providing to this patient?

A) Limit physical stress.
B) Avoid getting chilled.
C) Stay away from crowds.
D) Stay indoors when it rains.
E) Frequently wash the hands.

Question 23

The community health nurse learns that an adult community member has been diagnosed with diphtheria. What should the nurse do to prevent the spread of this infection?

A) provide the Tdap vaccine as prescribed
B) instruct the patient to ingest milk and dairy products
C) obtain throat cultures from the patient's close contacts
D) ensure the patient's diagnosis has been reported to the local health department
E) counsel the patient's family members to take antibiotics for 3 days as prescribed

Question 24

The nurse is caring for patients who have been exposed to the influenza virus. For which patients should the nurse recognize that the antiviral drug zanamivir (Relenza) would be contraindicated?

A) patient with arthritis
B) patient with heart failure
C) patient diagnosed with COPD
D) patient being treated for asthma
E) patient with type 2 diabetes mellitus

Question 25

During an assessment the nurse is concerned that a patient is at risk for developing laryngeal cancer. What did the nurse assess to make this clinical decision?

A) The patient works in a steel mill.
B) The patient is a 68-year-old African American male.
C) The patient smokes two packs of cigarettes a day.
D) The patient eats a salad every night with dinner.
E) The patient drinks beer and whiskey every night.

Question 26

The nurse is preparing discharge instructions for a patient recovering from a rhinoplasty. What should the nurse include in these instructions?

A) Apply ice to the nose.
B) Restrict oral fluid intake.
C) Avoid vigorous coughing.
D) Elevate the head of the bed on blocks.
E) Expect eye bruising for several weeks.

Question 27

During a health history the nurse suspects that a patient may be experiencing sleep apnea. What findings led the nurse to make this clinical decision?

A) The patient is yawning.
B) Blood pressure is 188/92 mmHg.
C) The patient reports having a headache every morning.
D) The patient reports a change in appetite and a 10 lb weight loss in 2 months.
E) The patient says family members complain about her snoring.

Question 28

The nurse caring for an older patient with influenza emphasizes the importance of drinking plenty of fluids and getting adequate rest to prevent the development of complications. What physiological changes is the nurse most concerned about in this patient?

A) reduced thirst reflex
B) altered hypothalamic response
C) increased residual lung volume
D) reduced effectiveness of cough
E) muted chemoreceptors in the aortic arch

Question 29

The nurse is planning care for a patient with viral laryngitis. What should the nurse include when teaching the patient about care for this condition?

A) Avoid all tobacco.
B) Do not use the voice.
C) Avoid ingesting alcohol.
D) Take all antibiotics as prescribed.
E) Spray the throat with antiseptic solution as prescribed.

Question 30

A patient with an ongoing sinus infection is admitted for treatment. In addition to antibiotics, which treatments should the nurse expect to be prescribed for this patient?

A) topical steroids
B) saline nose drops
C) saltwater gargles
D) oral decongestants
E) warm steam inhalation

Question 31

A patient is prescribed fexofenadine (Allegra) for allergic rhinitis. For which reasons in the patient's medical history should the nurse question providing the medication to this patient?

A) history of asthma
B) treatment for glaucoma
C) type 2 diabetes mellitus controlled by diet
D) medication for benign prostatic hypertrophy
E) over-the-counter pain medication for arthritis

Question 32

A patient with a penicillin allergy is diagnosed with scarlet fever. Which medications should the nurse anticipate being prescribed for this patient?

A) amoxicillin
B) cefuroxime
C) erythromycin
D) dexamethasone
E) pseudoephedrine

Question 33

A patient comes to the community clinic seeking help for a nosebleed. Which actions should the nurse take to help this patient?

A) pinch the nose towards the septum
B) apply ice to the nose and forehead
C) place the patient in a seated position
D) insert rolled gauze pads into each nare
E) assist the patient to lean back when seated

Question 34

A patient with chronic sinus infections is scheduled for the Caldwell-Luc procedure. What should the nurse include when teaching the patient about this procedure?

A) Dentures should be inserted immediately after the surgery.
B) Avoid the Valsalva maneuver for 2 weeks after the surgery.
C) Packing will be present for 24 to 48 hours after the procedure.
D) A liquid diet will be permitted for the first day after the surgery.
E) The upper lip and teeth may be numb for several months after the surgery.

Question 35

A patient avoids people with obvious colds and does not understand why she continues to develop colds throughout the winter. What should the nurse respond to this patient?

A) Vaccinations would prevent the development of colds.
B) There are more than 200 strains of viruses that cause colds.
C) People can be infected with a virus before symptoms occur.
D) Drinking more fluids will prevent the development of colds.
E) Viruses can be spread through direct contact from contaminated objects.

Question 36

A patient's nasopharyngeal culture results are positive for B. pertussis. What actions should the nurse take for this patient?

A) restrict fluids
B) monitor intake and output
C) place in respiratory isolation
D) administer erythromycin as prescribed
E) report the test results to the local health department

Question 37

A patient with nasal trauma has clear, watery fluid dripping from the nose. After testing, the nurse learns this fluid contains glucose. What should this finding indicate to the nurse?

A) There is a fracture of the ethmoid or sphenoid sinus.
B) The patient needs to be suctioned.
C) Cerebrospinal fluid is present.
D) The patient has coryza.

Question 38

A patient recovering from a total laryngectomy and permanent tracheostomy is being discharged. What observations indicate that discharge teaching has been effective?

A) The patient supports the head when moving in bed.
B) The patient drinks cool fluids throughout the day.
C) The patient is eager to go to the pool to go swimming.
D) The patient places a gauze sponge around the gastrostomy tube.
E) The patient covers the tracheostomy with a light gauze sponge.

Question 39

A hospitalized patient is diagnosed with influenza. What actions should the nurse take to help this patient?

A) assign the patient to a private room
B) implement droplet precautions
C) wear a mask when caring for the patient
D) measure the patient for a HEPA filter face mask
E) apply a mask to the patient when transporting the patient out of the room

Question 40

The nurse provides discharge instructions to a patient recovering from endoscopic sinus surgery. Which patient statements indicate that teaching has been effective?

A) "I need to sneeze with my mouth open."
B) "I should avoid heavy lifting for a week."
C) "I am to avoid blowing my nose for a week."
D) "I am to irrigate the sinuses with normal saline."
E) "The nasal packing will be removed in 2 days."