Deck 29: Nursing Management: Upper Respiratory Problems

Question 1

A home care nurse is completing a follow-up visit with a patient who has recently undergone a radical neck dissection.The nurse will assess the patient for signs and symptoms of which of the following emotional concerns?

A) Anxiety
B) Anorexia
C) Depression
D) Speech impediment

Answer 1

Depression

Question 2

When the nurse removes a nasogastric tube that has been in place for 7 days postoperatively,the patient develops a nosebleed.To control the bleeding,what should the nurse do?

A) Pinch the soft lower portion of the nose for 10 to 15 minutes.
B) Place the patient in a sitting position with the head hyperextended.
C) Apply ice compresses to the patient's forehead and back of the neck.
D) Pack the nares with ribbon gauze to apply pressure to the source of the bleeding.

Answer 2

Pinch the soft lower portion of the nose for 10 to 15 minutes.

Question 3

When doing nutrition-related teaching with a patient who has acute pharyngitis,what should the nurse tell the patient to avoid ingesting?

A) Orange Jell-o
B) Vanilla ice cream
C) Grape popsicles
D) Orange juice

Answer 3

Orange juice

Question 4

In teaching the patient with allergic rhinitis about management of the condition,what should the nurse explain?

A) Identification and avoidance of triggers of the symptoms are important to avoid reactions.
B) Allergic reactions can be prevented if oral antihistamines are taken before exposure to allergens.
C) Corticosteroid nasal sprays are the only topical drugs recommended for treatment of hay fever.
D) Prescription antihistamine drugs should be requested because over-the-counter preparations are ineffective for allergic rhinitis.

Question 5

When the nurse is deflating the cuff of a tracheostomy tube to evaluate the patient's ability to swallow,what is it most important to do?

A) Deflate the cuff during the patient's inhalation.
B) Clean the inner cannula of the tracheostomy tube.
C) Suction the mouth and trachea before deflation of the tube.
D) Measure the amount of air removed from the cuff during deflation.

Question 6

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse how the surgery will affect his throat.What is the best response?

A) "You will breathe through a permanent opening in your neck,and you will not be able to speak."
B) "You will have a permanent opening into your neck,and you will need to have rehabilitation for some type of voice restoration."
C) "You won't be able to speak as you used to,but a lot of artificial voice devices are available that will give you the ability to speak normally."
D) "You will have a tube into your trachea through which you will breathe,but you will be able to speak when the stoma heals and the tube is removed."

Question 7

A patient with a tracheostomy is to use a fenestrated tracheostomy tube to provide for speech.What is it important that the nurse do?

A) Place the decannulation cap in the tube before cuff deflation.
B) Assess the patient's ability to swallow without risk of aspiration.
C) Remove the inner cannula of the tracheostomy tube after deflating the cuff.
D) Connect oxygen at 4 to 6 L/min to the second pigtail tubing of the tracheostomy tube.

Question 8

A woman calls the clinic and tells the nurse that her mother,an older adult,has had a cold for the past week.The woman is worried that pneumonia will develop.After the nurse discusses care of upper respiratory infections and prevention of secondary infections,which of the following responses by the woman alerts the nurse that additional teaching is needed?

A) "I should encourage my mother to drink a lot of juices and other fluids."
B) "I should watch for changes in nasal secretions or the sputum she coughs up."
C) "I can give my mother aspirin or acetaminophen to make her more comfortable."
D) "I can encourage my mother to continue to use nasal decongestant spray until the congestion is gone."

Question 9

The nurse determines that complications of influenza are developing in a patient who experiences which of the following?

A) Myalgia and headache
B) Diffuse crackles in the lungs
C) Sore throat and productive cough
D) A fever of 38°C with chills

Question 10

A patient with laryngeal cancer has received teaching about radiation therapy.Which statement by the patient indicates that the teaching has been effective?

A) "I will need to buy a water bottle to carry with me."
B) "Until the radiation is complete,I may have diarrhea."
C) "Alcohol-based mouthwashes will help clean oral ulcers."
D) "I can use lotions to moisturize the skin on my throat."

Question 11

When obtaining a health history from a patient with hoarseness and tightness in his throat,the nurse should specifically ask the patient about which of the following information?

A) Alcohol and tobacco use
B) The presence of dentures
C) A history of allergic rhinitis
D) A history of streptococcal pharyngitis

Question 12

A patient is discharged from the hospital with a tracheostomy tube for long-term airway management.Which of the following responses by the patient helps the nurse determine that teaching related to care of the tracheostomy has been effective?

A) "I must use sterile gloves and catheters to suction my tracheostomy."
B) "I should maintain a liquid diet as long as I have the tracheostomy tube in place."
C) "I will be changing my tracheostomy tube at home about once a month."
D) "If I have thick mucus,I can instill about a teaspoon of tap water into my tracheostomy tube."

Question 13

A patient with an uncuffed tracheostomy tube coughs violently during suctioning and dislodges the tracheostomy tube.Initially,what should the nurse do?

A) Call the physician.
B) Attempt to reinsert the tracheostomy tube.
C) Position the patient in a lateral position with the neck extended.
D) Cover the stoma with a sterile dressing,and ventilate the patient with a manual bag-mask until the physician arrives.

Question 14

A patient returns from surgery with a cuffed,single-cannula tracheostomy tube after a total laryngectomy and radical neck dissection.In planning tracheostomy care for the patient during the first 24 hours after surgery,what is the priority nursing intervention?

A) The tracheostomy ties should not be changed.
B) The tracheostomy dressings should not be changed.
C) The patient should be encouraged to assist in the procedure.
D) Assess the airway and breath sounds.

Question 15

The nurse is caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed.Which of these assessments will require the most immediate nursing action?

A) The patient's temperature is 38.3°C.
B) The nose appears red and swollen.
C) The patient's oxygen saturation is 89%.
D) The patient complains of pain rated as 7 on a 10-point scale.

Question 16

Which is the most common infection causing acute pharyngitis?

A) Fungal
B) Viral
C) Acute follicular
D) Peritonsillar

Question 17

Which of the following is the most commonly used voice prosthesis?

A) Electrolarynx
B) Blom-Singer
C) Cooper-Rand
D) Artificial larynx

Question 18

When inflating the cuff on a tracheostomy tube to the appropriate level,the best nursing action will be which of the following?

A) Use a manometer to ensure cuff pressure is at an appropriate level.
B) Verify the health care provider's order for the amount of cuff pressure required.
C) Fill the balloon until no leakage around the cuff is auscultated.
D) Check the pilot balloon after inflation to ensure that it is firm.

Question 19

To which one of the following patients should the nurse strongly recommend an influenza immunization in the autumn each year?

A) A 24-year-old woman who has an allergy to penicillin
B) A 42-year-old man who has a history of smoking for 20 years
C) A 36-year-old man who had pneumonia when he was in university
D) A 30-year-old woman who takes corticosteroids for rheumatoid arthritis

Question 20

A registered nurse is observing a nursing student who is suctioning a hospitalized patient with a tracheostomy in place.Which action by the student requires the registered nurse to intervene?

A) The student preoxygenates the patient for 2 minutes before suctioning.
B) The student applies suction for 10 seconds while withdrawing the catheter.
C) The student puts on clean gloves and uses a sterile catheter to suction.
D) The student inserts the catheter about 12.7 cm into the tracheostomy tube.

Question 21

In which position should the nurse position the patient before commencing tracheostomy care?

A) Prone position
B) Supine position
C) Semi-Fowler's position
D) High-Fowler's position

Question 22

After completing discharge instructions for a patient with a total laryngectomy,the nurse determines that additional instruction is needed when the patient makes which of the following responses?

A) "I must keep the stoma covered with a dressing at all times."
B) "I can participate in most of my prior fitness activities except swimming."
C) "I need to eat nutritious meals even though I can't smell or taste very well."
D) "I should wear a MedicAlert bracelet that identifies me as a neck breather."

Question 23

On entering the room of the patient who has just returned from surgery for a total laryngectomy and radical neck dissection,the nurse recognizes a need for intervention upon making which one of the following observations?

A) The gastrostomy tube is clamped.
B) The patient is coughing blood-tinged secretions from the tracheostomy.
C) The patient is positioned in a lateral position with the head of the bed flat.
D) There are 200 mL of serosanguineous drainage in the patient's portable drainage device.