Deck 19: Otorhinolaryngologic Surgery

Question 1

A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures.A selection of burrs including assorted sizes of round cutting burrs and diamond polishing burrs should be available.During drill and power saw use,the scrub person keeps irrigation solution on the sterile field to:

A) keep the drill bit or burr cool and prevent breaking.
B) prevent clogging of the burr and contamination of the area with bone dust.
C) prevent aerosolized bone dust particles, because they are an occupational hazard.
D) avoid using a wire brush.

Answer 1

B
Bone dust must be prevented from settling in areas such as those in stapedectomy,tympanoplasty,endolymphatic sac,or fenestration surgery.A sterile field continuously flooded with irrigation solution helps to lessen clogging of the burr and washes bone dust from the field.The grooves or teeth of burrs must be clean of bone dust.Bone-cutting burrs tend to clog more easily than coarse-toothed burrs.A sterile wire brush may be used to keep burrs clean intraoperatively.

Question 2

The nasal sinuses serve as airspaces and communicate with the nasal cavity through the __________.Anteriorly,on each side of the skull,the frontal sinus,the anterior ethmoidal sinus,and the maxillary sinus (antrum of Highmore)drain into the middle meatus; the posterior ethmoid and the sphenoid sinuses drain into the ______________ recess.

A) septum; maxillary
B) middle concha; ethmoidal
C) crista galli; anteriomaxillary
D) meatus; sphenoethmoidal

Answer 2

D
The nasal sinuses serve as airspaces and communicate with the nasal cavity through the meatus.Anteriorly,on each side of the skull,the frontal sinus,the anterior ethmoidal sinus,and the maxillary sinus (antrum of Highmore)drain into the middle meatus; the posterior ethmoid and the sphenoid sinuses drain into the sphenoethmoidal recess.

Question 3

Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes,highlighting specific structures,or tissue densities.Examples of these imaging diagnostics would be:

A) complementary computed tomography (CT) scan with magnetic resonance imaging (MRI).
B) positron emission tomography (PET).
C) audiometry scan with photoacoustic spectrometry (PAT).
D) tuning-fork conduction scan with electrical capacitance volume tomography (ECVT).

Answer 3

A
CT scans are radiographic studies that visualize structures by producing serial sections,many times clinically referred to as cuts,through planes of the head and neck.CT imaging provides visualization of bone,soft tissue,and adjacent intracranial and extracranial pathologic conditions.MRI is an imaging modality using powerful magnetic and radiofrequency waves to reproduce cross-sectional images of the human body without exposing the patient to ionizing radiation.On an MRI scan,fat and fluid produce high-intensity signals,which appear as bright areas,whereas bone and air emit weak signals and appear as darkened areas.MRI is often used with CT imaging in a complementary fashion when evaluating lesions in and around bone for a variety of head and neck conditions,including tumors in the oral cavity,external auditory canal,middle ear,and mastoid.

Question 4

The external ear canal lining is protected and lubricated with cerumen (earwax),which traps foreign material and:

A) liquefies foreign matter in the ear canal.
B) lubricates the external ear.
C) maintains the high acidic pH in the ear canal.
D) reduces bacterial levels in the outer ear.

Question 5

The cricoid cartilage is a complete cartilaginous ring that resembles a signet ring; it rests beneath the thyroid cartilage and supports the airway.What membrane,attached to the midline of the upper thyroid cartilage,protects the larynx during swallowing?

A) False vocal cords
B) True vocal cords
C) Arytenoids
D) Epiglottis

Question 6

The nasal turbinates increase the turbulence of the airflow through the nose to humidify the air.The turbinates also serve another function to the accessory sinuses by:

A) filtering inspired air and preventing sinusitis.
B) warming and humidifying inspired air.
C) giving resonance to the voice.
D) trapping particle matter before it reaches the nasopharynx.

Question 7

The salivary glands produce saliva,which serves to moisten the mouth and initiate:

A) antibacterial activity in the mouth.
B) carbohydrate digestion.
C) protein breakdown.
D) alimentary (gastrointestinal [GI]) tract peristalsis.

Question 8

The palatine and lingual tonsils are situated in the oropharynx,while the adenoids are located in the nasopharynx.Both adenoids and tonsils consist of:

A) lymphoid tissue.
B) glandular tissue.
C) vascular tissue.
D) mucosal tissue.

Question 9

The surgical microscope is often used to provide illumination and magnification for complex procedures to the ear,laryngeal surgery,or reconstructive free flap procedures following neck surgery.A common eyepiece magnification for an otologic microscope is ´12.5,and the usual objective (lens)is ______-mm focal length (f).A _______-mm lens is used for laryngeal surgery.

A) 250- or 300; 400
B) 400; 150
C) 150; 400
D) 400; 250 or 300

Question 10

Audible facial nerve monitors (nerve integrity monitor systems)are used intraoperatively during procedures in which the facial nerve is at risk for injury.The purpose of this monitoring technique is to assist in the early identification of the nerve,to increase the possibility of its preservation by minimizing trauma,and to assess its integrity after dissection.Communication with the anesthesia provider is essential because:

A) the electrodes are often in proximity to the anesthetic airway.
B) manipulation of the anesthetic airway during the procedure can misplace the electrodes.
C) muscle relaxants, paralyzing agents, and some local anesthetics must be avoided.
D) the anesthesia provider is responsible for the facial nerve monitoring.

Question 11

Of the three salivary glands,which one is the largest?

A) Sublingual
B) Submandibular
C) Zygomatic
D) Parotid

Question 12

The nasal cavity is associated with the ear by way of the ____________,and communicates with the conjunctiva through the __________________.Select the options that are appropriate to complete the sentence.

A) torus tubarius; canaliculi
B) eustachian tube; nasolacrimal duct
C) nasopharynx; medial caruncle
D) middle ear; lacrimal sac

Question 13

Both ears provide stereophonic hearing that gives us very specific hearing capabilities.Binaural hearing makes it possible for:

A) determination of the source location of sounds.
B) enhanced voice recognition.
C) amplification and resolution of sound properties.
D) recognition of more than one sound at a time.

Question 14

A chain of three small articulated bones extends across the middle ear cavity and conducts vibrations from the tympanic membrane across the middle ear into the oval window and the fluid-filled inner ear.What are the names of those three small articulating bones?

A) Ossicles, incus, and crura
B) Stapes, capitulum, and stirrup
C) Malleus, incus, and stapes
D) Anvil, head, and hammer

Question 15

The nasal septum is lined with blood vessels and mucus-secreting cells.The proper name of this lining is the:

A) mucoperichondrium.
B) columella.
C) nasoseptal mucosa.
D) cartilaginous vascular bed.

Question 16

Select the structure of the trachea that is a landmark during bronchoscopy.

A) Cartilaginous ring
B) Cricoid cartilage
C) Carina
D) Right main bronchus

Question 17

Which mouth structure is considered the boundary between the buccal cavity and the lingual cavity?

A) Hard palate
B) Soft palate
C) Teeth
D) Floor of the mouth

Question 18

The external ear,which includes the auricle (or pinna)and external auditory canal,is composed of cartilage covered with skin.The primary function of the auricle is to:

A) gather and direct sound waves toward the inner ear.
B) concentrate and conduct incoming sound waves into the external auditory canal.
C) collect and amplify incoming sound waves by facilitating tympanic membrane vibration.
D) facilitate air conduction of sound waves.

Question 19

Lasers assist in vaporization of scar tissue,granulomas,and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures.Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a:

A) fiberoptic probe.
B) beam separator.
C) micromanipulator.
D) flexible microlaser fiber.

Question 20

The supraglottis,glottis,and the subglottis represent three portions of which structure of the throat?

A) Epiglottis
B) Tongue
C) Larynx
D) Pharynx

Question 21

Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors.What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve?

A) Postauricular
B) Supra-aural
C) Translabyrinthine
D) Intravestibular

Question 22

Depending on the surgical defect,head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures.The wound may be closed primarily,or local flaps and split-thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects.An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool?

A) Skin-adhering adhesive temperature probe to detect subtle changes in graft perfusion
B) Light-pressure skin blanch test for return perfusion and viability of graft
C) Use of intraoperative and postoperative Doppler to detect presence of blood flow
D) Interval flow cytometry readings of vascular perfusion to the graft

Question 23

Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain.Conductive hearing loss is caused by an obstruction in the external canal or middle ear,which impedes the passage of sound waves to the inner ear.A common cause of conductive hearing loss would be:

A) AOM.
B) fluid extravasation in the ear canal.
C) perforation of the tympanic membrane.
D) a healed myringotomy.

Question 24

During the preoperative assessment for a patient scheduled for nasal surgery using a local anesthetic that includes epinephrine,what important consideration,relevant to epinephrine use,should be explored?

A) Coagulopathy
B) Renal status
C) Cardiac status
D) Anxiety

Question 25

Oral malignancies can be linked to specific carcinogens,the most important one being tobacco.Benign or malignant lesions of the tongue,floor of the mouth,alveolar ridge,buccal mucosa,or tonsillar area are excised depending on the extensiveness of disease,involvement of surrounding vessels and nerves,and candidacy for surgery.Benign or small malignant tumors of the oral cavity may be excised without a neck dissection.Which indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors?

A) The patient is a smoker
B) Suspicious metastatic disease
C) Presence of undiagnosed skin lesions of the head and neck
D) Benign growth in the lower jugular region

Question 26

Benign or small malignant tumors of the oral cavity may be excised without a neck dissection,though in the presence of diagnosed or highly suspicious metastatic disease,a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck.Typically,endotracheal anesthesia is used,and a pharyngeal pack of moist gauze may be inserted in the mouth.When head and neck surgery is performed,the perioperative nurse must be prepared for possible additional procedures.Of these possibilities,what is the highest priority consideration for the perioperative nurse?

A) Tracheostomy
B) Microscopic free flap graft
C) Laryngoscopy
D) Difficult airway protocol

Question 27

Microlaryngoscopy facilitates improved diagnosis and allows the laryngologist to view,with relative ease,areas that previously were inaccessible or difficult to visualize.What are the two most common indications for microlaryngoscopy?

A) Chronic hoarseness and cough
B) Laryngeal polyps and nodules
C) Epiglottitis and frequent choking
D) Laryngeal injury and cancer

Question 28

Excision of the submandibular gland is performed to remove mixed tumors and calculi associated with extensive chronic inflammation.The submandibular gland lies in close proximity to several important nerves and vessels.Of the following,what is the highest priority perioperative nursing action related to submandibular surgery?

A) Provide the scrub person with a bipolar electrosurgical unit (ESU).
B) Provide the scrub person with a nerve stimulator.
C) Avoid local anesthetics on the sterile field if identification of major nerves will take place.
D) Provide the anesthesia provider with an intraoperative nerve monitoring system.

Question 29

Myringotomy is often accompanied by the aspiration of fluid under pressure in the tympanum,and the subsequent placement of small,hollow pressure equalization tubes.It is indicated for acute otitis media (AOM)in the presence of an exudate that has not responded to antibiotic therapy.If left untreated,what is the main concern for a child with chronic otitis media?

A) Impaired language development
B) Encephalitis
C) Hearing loss
D) Impaired language development and hearing loss

Question 30

A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening)in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility.A prosthesis is placed to restore ossicular continuity and alleviate conductive hearing loss.The patient scheduled for a stapedotomy will probably have a surgical diagnosis of:

A) otosclerosis.
B) ossicular stenosis.
C) indeterminate hearing loss.
D) ossicular interruption.

Question 31

Uvulopalatopharyngoplasty (UPPP)is performed primarily to relieve obstructive sleep apnea (OSA)and snoring.Select two common indications for UPPP surgery.

A) O₂ saturation below 92%, and snoring
B) Cardiac dysrhythmia during sleep and awake, and snoring
C) O₂ saturation below 80%, and apnea index worse than 20
D) O₂ saturation below 85% on continuous positive airway pressure (CPAP), and apnea index below 20

Question 32

When laryngoscopy,bronchoscopy,and esophagoscopy are performed in a single session on a patient,the procedure is termed triple endoscopy or panendoscopy.The purpose of triple endoscopy is usually diagnostic.A procedure-specific perioperative nursing intervention is:

A) documenting the procedure in the perioperative record.
B) identifying, containing, and labeling all specimens accurately.
C) carefully handling and reprocessing the endoscopes.
D) providing calm, careful, and comforting nursing measures to reduce the patient's anxiety.

Question 33

When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords,which important postoperative instruction must the nurse give the patient during discharge teaching?

A) Complete voice rest is essential.
B) Coughing and deep-breathing exercises should be performed.
C) Clearing the throat to remove secretions is advised.
D) The patient should use a humidifier.

Question 34

During otolaryngologic procedures using local anesthetic,the perioperative nurse plans the environment of care as a quiet,warm,and functional domain of healing and comfort.An important consideration with most otolaryngologic patients identifies their specific _________ needs.

A) Communication
B) Anxiety
C) Airway
D) Pain

Question 35

During a stapedotomy or stapedectomy procedure,the perioperative nurse manages and controls the environment of care by maintaining a quiet,warm,and comfortable operating room (OR).Energy modality devices and monitor alarms are turned down to the lowest audible setting for the team to hear without startling the patient.The English-speaking,nonanxious patient sedated using local or monitored anesthesia care (MAC)anesthetics is well prepared by the perioperative nurse for sensory and procedural expectations.Which event occurs near the conclusion of the procedure that predicts patient outcome?

A) The surgeon whispers softly in the patient's operative ear to determine return of hearing.
B) The surgeon irrigates the middle ear to promote and visualize movement of the ossicles.
C) The surgeon asks the patient to repeat words as the external ear packing is placed.
D) The surgeon performs an acoustic reflex test.

Question 36

Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid,lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination.What risk reduction strategy should the perioperative nurse employ in preparing for the conclusion of the procedure?

A) Maintain instrument setup until the patient leaves the operating room (OR).
B) Determine fire risk score.
C) Place O₂ tank, nasal cannula, and bag-valve-mask on the transport vehicle.
D) Assist anesthesia provider with anesthesia emergence and transfer to the postanesthesia care unit (PACU).

Question 37

A nasal polypectomy is the removal of polyps from the nasal cavity.Nasal polyps are benign,grapelike clusters of mucous membrane and connective tissue.When the polyps become large,they obstruct the free passage of air,make breathing difficult,and cause a change in speech quality.Nasal polypectomies are typically performed endoscopically with the use of microdebriders,which remove the polyps by their mechanism of _______________.

A) ultrasonic cavitation
B) morcellation
C) radiofrequency ablation
D) laser vaporization

Question 38

Partial laryngectomy is removal of a portion of the larynx.It is done to remove superficial neoplasms that are confined to one vocal cord or to remove a tumor extending into the ventricle or the anterior commissure or a short distance below the cord.The perioperative nurse,in preparing the patient for surgery and postprocedure expectations,can describe the postoperative voice as:

A) enhanced voice with assistive tracheoesphageal puncture stoma.
B) muteness, because the patient breathes through a tracheostoma.
C) normal as the patient's preoperative voice.
D) hoarse but serviceable voice.

Question 39

During the preoperative assessment and teaching for a patient scheduled for otolaryngologic surgery performed using local anesthetic,the perioperative nurse reviews with the patient normal coping mechanisms that are personally effective and supports and encourages the patient during the surgical intervention.The nurse is preparing the patient to anticipate:

A) disturbed sensory perceptions.
B) tachypnea.
C) acute pain.
D) claustrophobia.

Question 40

During endoscopic sinus surgery,patient eye protection includes:

A) taping the eyelids closed.
B) placing moist gauze over the eyelids.
C) instilling eye lubricant into both eyes.
D) fitting the patient with appropriate sized goggles.

Question 41

The perioperative nurse and his orientee have returned from an airway fire simulation exercise with the otorhinolaryngologic surgeon,fellow,and anesthesia provider.They were amazed at the statistics for OR fires and the threat of serious injury to the patient and team.Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen.The team discussed a plan to change their practices.An example of a valid fire prevention strategy that involves the entire surgical team during otorhinolaryngologic surgery would be:

A) placing ESU active electrodes in a basin of sterile water.
B) keeping cottonoid patties and strings completely dry when used around the laser.
C) identifying the fire risk score during the postprocedure debriefing.
D) collaborating with the anesthesia provider and surgeon to prevent fire risks.

Question 42

Surgical removal of hypertrophic adenoids to relieve upper airway obstruction is often performed to create a patent nasal airway.The highly vascular adenoids are treated by which method(s)of hemostasis to control bleeding?

A) Pharyngeal packing
B) Cryotherapy
C) Radiofrequency current
D) Tannic acid and epinephrine paste

Question 43

An experienced perioperative nurse is orienting a new perioperative nurse to otolaryngologic surgery.The experienced nurse and the new nurse are the scrub persons and are preparing the sterile back table with instruments,accessory devices,and the medications used for the local anesthetics.They also set up a prep table with the initial local anesthetics to be given before the start of the procedure.The experienced nurse is determined to impart the critical nature of patient safety and prevention of medication errors during these procedures.The back table contains multiple medications that will be used for local anesthesia,vasoconstriction,and hemostasis.As a perioperative registered nurse (RN)scrub person,it is necessary that both the experienced and new nurse:

A) verify all medications that are transferred to the sterile field.
B) observe the four rights of medication administration.
C) accept transfer of medications to the sterile field without distractions and one medication at a time.
D) use appropriate ancillary equipment and supplies, such as filter needles, transfer devices, and infusion pumps.
E) be aware of the maximum recommended dosage of all local anesthetics and be alert for signs of reaction.

Question 44

FESS provides a more physiologic type of drainage by reducing trauma to normal tissues.FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses.Select the appropriate indications for FESS.

A) Inhibited mucociliary clearance
B) Outflow obstruction
C) Mucocele
D) Sinus infections