Deck 18: Otorhinolaryngologic Surgery

Question 1

What 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

Answer 1

C
The portion of the mouth outside the teeth is the buccal cavity,and that on the inner side of the teeth is the lingual cavity.The hard palate forms the upper boundary of the oral cavity.The hard palate is formed by the maxilla and palatine bones.The mandible and floor of the mouth form the lower boundary of the oral cavity.

Question 2

What is the purpose of using an intravenous injection of a radiopaque contrast dye during select imaging diagnostic studies?

A) There is enhanced uptake of radiation in areas of suspicion.
B) It provides visual enhancement of anatomic structures.
C) It minimizes ionizing radiation scatter to noninvolved anatomic structures.
D) Contrast dye leaves a locator marker for impending surgery.

Answer 2

B
Intravenous (IV)injection of iodine contrast agents produces visual enhancement of some anatomic structures and pathologic tissues,including highly vascularized tumors.

Question 3

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.

Answer 3

C
Electrodes are placed into the facial muscles before the patient is draped.Consultation and communication with the anesthesia provider are essential because the use of muscle relaxants and long-term paralyzing agents must be avoided.In the setting of a tympanic membrane perforation,lidocaine should not be allowed to spill into the middle ear space when injecting the ear canal,as temporary facial paralysis can ensue from topical anesthesia of a dehiscent facial nerve in the tympanic segment.Facial nerve monitoring is commonly used during acoustic neuroma and mastoid surgery.

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 acidic pH in the ear canal.
D) reduces bacterial levels in the outer ear.

Question 5

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 6

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 7

Which of the diagnostic modalities listed below does not employ the use of ionizing radiation?

A) Audiogram
B) Magnetic resonance imaging (MRI)
C) Computed tomography (CT)
D) Both audiogram and magnetic resonance imaging (MRI)

Question 8

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 9

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 10

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

A) antibacterial activity in the mouth.
B) carbohydrate digestion.
C) enzymatic activity on all ingested food.
D) alimentary (GI) tract peristalsis.

Question 11

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

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

Question 12

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 CT scan with MRI.
B) MRI scan.
C) CT scan.
D) All of the options

Question 13

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

A) Mucoperichondrium
B) Septochondrium
C) Nasoseptal mucosa
D) Cartilaginous vascular bed

Question 14

The nose is divided into the prominent external portion and the internal portion known as the nasal cavity.The primary purpose of the nose is to:

A) facilitate the sense of smell.
B) warm inspired air.
C) moisturize inspired air.
D) prepare inspired air for the lungs.

Question 15

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 16

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 17

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) acting as drainage passageways.
C) giving resonance to the voice.
D) trapping particle matter before it reaches the nasopharynx.

Question 18

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 19

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

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

Question 20

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 21

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 ___ the polyp and suctioning the tissue.

A) ultrasonic cavitating
B) morcellating
C) radiofrequency ablating
D) laser vaporizing

Question 22

During a stapedotomy or stapedectomy procedure,the perioperative nurse manages and controls the environment of care by maintaining a quiet,warm,and comfortable 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 MAC anesthetics is well prepared by the perioperative nurse for sensory and procedural expectations.What 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 whispers in the patient's operative ear to determine delayed tympanoplasty.

Question 23

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 patient should be prepared for an altered voice quality postoperatively as well as for the possibility of total laryngectomy if the tumor proves too extensive for partial resection.The perioperative nurse,in preparing the patient for surgery and post procedure expectations,can describe the postoperative voice as:

A) enhanced voice with assistive tracheoesphageal puncture stoma.
B) no voice,breathes through tracheostoma.
C) normal as the patient's preoperative voice.
D) a hoarse but serviceable voice.

Question 24

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 graft pulse
D) Interval flow cytometry readings of vascular perfusion to the graft

Question 25

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 CPAP,and apnea index below 20

Question 26

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) All of the options apply

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

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 critical role of the perioperative nurse during this complex diagnostic procedure is that of:

A) documenting the serial numbers of the scopes in the perioperative record.
B) identifying,containing,and labeling all specimens accurately.
C) carefully handling and reprocessing the endoscopes.
D) assisting the anesthesia provider with maintaining the airway.

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

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) Transaural
B) Supraaural
C) Translabyrinthine
D) Intravestibular

Question 31

The Caldwell-Luc procedure is a radical antrostomy used to establish a large opening into the wall of the inferior meatus leading to the sinuses.Where is this large incisional approach made?

A) Proximal to the maxillary artery
B) Antrum wall on the affected sinus side
C) Canine fossa of the upper jaw
D) Intranasally on the affected sinus side

Question 32

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.

Question 33

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.The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed?

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

Question 34

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) acute otitis media.
B) fluid invasion of the ear canal.
C) perforation of the tympanic membrane.
D) a healed myringotomy.

Question 35

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 micro laser fiber.

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 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 PACU.

Question 37

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 immobility.
C) indeterminate hearing loss.
D) All of the options apply.

Question 38

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.What perioperative nursing consideration is significant relative to submandibular surgery?

A) Provide the scrub person with a bipolar 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 39

Type I thyroplasty is a form of phonosurgery for the treatment of unilateral vocal cord paralysis,which may be caused by trauma,neoplasms,paralysis from thyroidectomy or after extensive aortic and mediastinal vascular surgery,and mechanical and central nervous system dysfunctions.During the preoperative assessment,the perioperative nurse should inform the patient about postoperative voice care,which includes:

A) voice exercises,such as singing scales.
B) humming in the presence of humidified air.
C) complete voice rest.
D) normal voice as usual.

Question 40

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.What indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors?

A) Evidence of disease in the upper lymphatic chain
B) Suspicious metastatic disease
C) Presence of diagnosed malignancy
D) All of the options would be indications for neck dissection

Question 41

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 clearance
C) Cardiac status
D) Anxiety

Question 42

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

A) Complete voice rest is important.
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 43

Sally Andres and her 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 risk reduction strategy that involves collaboration of the entire surgical team during otorhinolaryngologic surgery would be:

A) placing ESU active electrodes in a secure holster.
B) maintaining the laser on standby until needed.
C) identifying the fire risk score during the preincision time-out.
D) conducting regularly scheduled team simulations that rehearse an airway fire protocol.

Question 44

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 and self-control physiologic indicators of:

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

Question 45

Marci Williams,a 62-year-old woman,had a tympanoplasty 6 weeks ago and has been cleared by her otorhinolaryngologist to undergo a restorative dental procedure in which light anesthesia will be used.The dental procedure was uneventful,but Marci experienced ear pain,nausea and vomiting,and hearing loss in the former operative ear after the dental procedure.What could have been a probable cause of Marci's untoward recovery and hearing loss?

A) Presbycusis with impacted cerumen
B) Head position with ear pressure during the dental procedure
C) Early signs of surgical site infection
D) The use of nitrous oxide as an anesthetic during dental surgery

Question 46

Functional endoscopic sinus surgery (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) Impaired nasal ventilation
C) Mucocele
D) Sinus infections

Question 47

Sally Anders,a perioperative nurse,is orienting a new perioperative nurse to otolaryngologic surgery.She 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.Sally is determined to impart the critical nature of patient safety and prevention of medication errors during these procedures.Her back table contains multiple medications that will be used for local anesthesia,vasoconstriction,and hemostasis.As a perioperative registered nurse scrub person,it is necessary that she and her orientee:

A) label any high-risk medication with its name,dose,percentage or strength,and amount.
B) observe the 6 rights of medication administration.
C) double-check any high-alert medications such as concentrated epinephrine.
D) be aware of the maximum recommended dosage of local anesthetics and signs of reaction.

Question 48

Patients scheduled for otologic surgery may have undergone evaluation of their hearing through audiograms to determine whether they have which of these diagnoses? Select all that apply.

A) Normal hearing
B) Sensorineural hearing loss
C) Conductive hearing loss
D) Mixed loss of hearing from combination of conductive and sensorineural

Question 49

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