Deck 26: Caring for the Patient With Upper Airway Disorders

Question 1

A patient with nasal trauma has clear, watery fluid dripping from the nose. The nurse performs the halo test, which is positive. What does this positive result indicate?

A) A fracture of the ethmoid or sphenoid sinus
B) The need to suction the patient
C) The presence of cerebrospinal fluid (CSF)
D) A chyle leak

Answer 1

The presence of cerebrospinal fluid (CSF)

Question 2

It is most important for the nurse to include which instruction when educating a patient who has had laryngeal papillomas removed?

A) "If you experience recurrent hoarseness, come in for a check-up."
B) "You should come in if you have worsening respiratory distress so we can intubate you quickly."
C) "Next time we can remove them in the office, so no admission is necessary."
D) "Papillomas rarely cause airway obstruction."

Answer 2

"If you experience recurrent hoarseness, come in for a check-up."

Question 3

The nurse is teaching the parent of a child with allergic rhinitis about the disorder. Which statement indicates the parent understands the information?

A) "The only way to avoid these symptoms is to completely avoid the trigger."
B) "Since this has occurred only once, I can be sure it will not be a common problem for my child."
C) "It may not always be necessary for my child to take allergy medications to avoid these symptoms."
D) "Because my child has so many different triggers, antihistamines will not be effective in controlling symptoms."

Answer 3

"It may not always be necessary for my child to take allergy medications to avoid these symptoms."

Question 4

The nurse assesses a patient with a temporal bone fracture and notices drainage from the right nostril. Based on this assessment, which nursing diagnosis should the nurse document as priority?

A) Risk for Pain
B) Risk for Impaired Sensory Input
C) Ineffective Airway Clearance
D) Potential for Infection

Question 5

While eating a meal in the hospital, a patient demonstrates difficulty breathing and signs of choking. The nurse realizes that the patient is experiencing which condition?

A) Laryngeal obstruction
B) Pulmonary emboli
C) Epiglottitis
D) An acute myocardial infarction

Question 6

A patient who is scheduled for a partial laryngectomy asks if he will still be able to talk after the surgery. What are appropriate nursing responses to this patient?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "No, you will not."
B) "You will have to ask your physician."
C) "Yes, but it might sound a little different."
D) "You will be able to talk, but with an electronic device."
E) "Speech is usually preserved, but we will know better after surgery."

Question 7

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 situation?

A) Incorrect administration of the nasal spray
B) An acute sinus infection that needs to be treated with antibiotics
C) Side effect of the nasal spray
D) Rebound nasal congestion

Question 8

A patient asks the nurse why the health care provider wants to have a follow-up appointment 6 months after a polypectomy. Which is the most appropriate response?

A) "The insurance company requires the health care provider to recheck our patients."
B) "Cancerous polyps are likely to recur, so we need to recheck you for this."
C) "The health care provider always rechecks patients after surgical removal of polyps."
D) "Polyps can recur, so the health care provider wants to make sure they haven't returned."

Question 9

While recovering at home from a total laryngectomy and neck dissection, a patient notices an increase in left shoulder weakness. This symptom is consistent with which condition?

A) Normal recovery
B) Damage to the spinal accessory nerve
C) Side effect of neck radiation therapy
D) Medication complication

Question 10

The nurse observes a patient's respirations during sleep and notes the absence of respirations for periods lasting from 15 to 45 seconds. This finding is consistent with which condition?

A) Laryngeal spasm
B) Sleep apnea
C) Respiratory acidosis
D) Renal failure

Question 11

A patient being seen for a cough 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." Which nursing action is indicated?

A) End the visit so the patient can get to the dentist.
B) Assess the patient for a sinus infection.
C) Reschedule the appointment for another time.
D) Tell the patient there is nothing wrong with his teeth.

Question 12

The nurse suspects that a patient is demonstrating signs of tonsillitis. Which findings are indicative of this disorder?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Pain on swallowing
B) Thirst
C) Nuchal rigidity
D) Enlarged lymph nodes in the neck
E) Fever

Question 13

Which patient requires the most immediate intervention by the nurse?

A) A patient with a mandibular fracture who has facial numbness and tingling
B) A patient with a fractured nasal bone experiencing a nosebleed
C) A patient with a maxillary fracture who has been swallowing frequently
D) A patient with a temporal bone fracture experiencing hearing loss

Question 14

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) "Return to the clinic tomorrow afternoon to have the packing removed."
D) "The packing will be removed and new packing inserted in 2 days."

Question 15

A patient who has diabetes complains of a tingling sensation in the face and is running a fever. Two hours later, the nurse notes dark drainage coming from the patient's nose. Which is the nurse's priority action?

A) Encourage the patient to frequently blow the nose.
B) Notify the health care provider immediately.
C) Administer antipyretics.
D) Obtain a blood glucose level.

Question 16

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

A) Shortness of breath
B) Diaphoresis
C) Drop in blood pressure
D) Periorbital ecchymosis

Question 17

The nurse is assessing a patient who has received trauma to the face. It is suspected that damage to the facial nerve (CN VIII) has occurred. The nurse would prepare this patient for which intervention?

A) Surgery
B) Intubation
C) Placement of ice packs to the face for 24 hours
D) Consultation with the patient's dentist

Question 18

The nurse is providing care to a patient with a new tracheostomy. Which intervention is appropriate to include in this patient's care?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Do not remove tracheostomy ties.
B) Assess frequently to determine if sterile suctioning is needed.
C) Clean the inner cannula with sterile normal saline.
D) Remove crusted secretions with hydrogen peroxide and flush with normal saline.
E) Assess areas under the edges of the faceplate for breakdown.

Question 19

A female patient is seen for "increased hoarseness" and a change in "voice quality." There are no other symptoms. What is an appropriate assessment for the nurse to ask this patient?

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

Question 20

A patient tells the nurse he has a "cold" every spring that lasts for 8 to 10 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 21

A patient has had myocutaneous flap reconstruction for the defect caused by a neck tumor resection. What nursing interventions are indicated for care of this flap?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Keep the patient in the supine position for at least 24 hours after surgery.
B) Regularly assess the flap for capillary refill.
C) Use tracheostomy ties to help keep the flap in place.
D) Keep the patient's head turned slightly toward the operative side.
E) Keep the patient on strict bed rest until flap healing is established.

Question 22

The nurse is discussing common childhood illnesses with staff members of a day care center. The nurse determines that learning has taken place when a staff member makes which statement?

A) "Pharyngitis is not usually caused by bacteria, so I do not have to be concerned with getting it."
B) "Because the provider may not know for sure if the pharyngitis is caused by Streptococcus, antibiotics should be prescribed."
C) "Even though the child may have a fever and a sore throat, antibiotics may not be necessary."
D) "If a child has influenza, antibiotics are necessary to prevent pharyngitis."

Question 23

An 81-year-old woman who lives alone is in the clinic for an annual physical. She reports that she has noticed that her sense of smell is not as acute as it used to be. Which nursing interventions are indicated?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Ask the patient if her kitchen stove is gas or electric.
B) Remind the patient of the need to change batteries in her smoke detectors twice a year.
C) Suggest that the patient use fewer spices when cooking.
D) Recommend that the patient limit the amount she drives her car.
E) Ask the patient if she has a cat or dog living in her house.

Question 24

The nurse, suctioning a patient's tracheostomy, plans for each suctioning attempt to last no longer than _____ seconds.

Question 25

During medication instruction about a cough syrup, the nurse says, "This medicine has a really bad taste." The patient replies that she "can't taste anything anyway." Which nursing assessment questions are indicated?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "How long ago did you first notice your sense of taste has diminished?"
B) "Did you first notice this when you developed the cold you have now?"
C) "Have you noticed that you are having difficulty with your sense of smell as well?"
D) "Have you noticed any weight gain or puffiness around your eyes?"
E) "How many fluids are you drinking on an average day?"

Question 26

When a patient's airway becomes completely obstructed, which sign will the nurse see first?

A) Pallor changing to cyanosis
B) A sudden change in mentation
C) A decrease in urine output
D) Cyanosis changing to pallor

Question 27

A patient is being treated for laryngopharyngeal reflux disease. As part of behavioral modification treatment for this disorder, the nurse advises the patient not to eat for at least ______ hours before bedtime.

Question 28

Which individual is most at risk for head and neck cancer?

A) A young female infected with human papillomavirus
B) A male with a 15-year history of smoking and alcohol use
C) A young male who has used smokeless tobacco for 2 years
D) An older male with a history of preferring "meat and potatoes"

Question 29

When providing discharge instructions for the family and patient with a tracheostomy, which statement indicates the caregiver understands the instructions?

A) "He cannot resume normal activities as long as he has the tracheostomy in place."
B) "I will clean the site under the tracheostomy plate with half-strength hydrogen peroxide at least twice daily."
C) "I can suction the trachea as often as necessary to decrease secretions coming from the tube."
D) "When he is ready for decannulation, I will bring him back in to have the stoma sutured closed."

Question 30

A patient with an upper respiratory infection is prescribed ciprofloxacin (Cipro). Which teaching should the nurse provide about this medication?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Avoid exposure to sunlight while you are taking this medication."
B) "If you notice pain in your joints or tendons, call the office immediately."
C) "You should restrict caffeine intake while taking ciprofloxacin."
D) "If you develop stomach pain, immediately discontinue the medicine and call the office."
E) "If you develop difficulty swallowing, please call the office."

Question 31

The nurse is planning care for a patient who has just had a permanent tracheostomy following total laryngectomy. What should the nurse consider when planning this care?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The patient will require isolation until the site is healed.
B) The patient will require enteral feedings until healed.
C) Writing will be an important form of communication immediately postoperatively.
D) The patient will be unable to speak normally
E) The family will be unable to communicate with the patient.

Question 32

When planning care for a patient with a partial airway obstruction, which nursing intervention has the greatest priority?

A) Keeping the patient calm and relaxed
B) Providing pain medication around the clock
C) Ensuring the resuscitation team is on standby
D) Ensuring advanced airway equipment is at the bedside

Question 33

When preparing for a maxillary resection, the nurse should provide the patient and family with which instruction?

A) "It will be at least 3 to 4 days after surgery before you will be allowed out of bed."
B) "It is important to keep objects within reach and in the same place at all times."
C) "You will be given pain medication whenever you need it, so pain should not be a concern."
D) "Your speech will not be affected, so communication will not be a problem."