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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter22:ManagementofPatientsWithUpperRespiratoryTract Disorders  1.

Thenurseisprovidingpatientteachingtoayoungmotherwhohasbroughther3-month-oldinfanttothe clinicforawell-babycheckup.Whatactionshouldthenurserecommendtothewomantopreventthe transmissionoforganismstoherinfantduringthecoldseason?

A)

Takepreventativeantibiotics,asordered.

B)

Garglewithwarmsaltwaterregularly.

C)

Dressherselfandherinfantwarmly.

D)

Washherhandsfrequently.

Ans:

D Feedback: Handwashingremainsthemosteffectivepreventivemeasuretoreducethetransmissionoforganisms. Takingprescribedantibiotics,usingwarmsalt-watergargles,anddressingwarmlydonotsuppress transmission.Antibioticsarenotprescribedforacold.

2.

Apatientvisitingtheclinicisdiagnosedwithacutesinusitis.Topromotesinusdrainage,thenurse shouldinstructthepatienttoperformwhichofthefollowing?

A)

Applyacoldpacktotheaffectedarea.

B)

Applyamustardpoulticetotheforehead.

C)

Performposturaldrainage.

D)

Increasefluidintake.

Ans:

D Feedback: Forapatientdiagnosedwithacutesinusitis,thenurseshouldinstructthepatientthathotpacks, increasingfluidintake,andelevatingtheheadofthebedcanpromotedrainage.Applyingamustard poulticewillnotpromotesinusdrainage.Posturaldrainageisusedtoremovebronchialsecretions.

3.

Thenurseiscreatingaplanofcarforapatientdiagnosedwithacutelaryngitis.Whatinterventionshould

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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beincludedinthepatientsplanofcare? A)

Placewarmclothsonthepatientsthroat,asneeded.

B)

Havethepatientinhalewarmsteamthreetimesdaily.

C)

Encouragethepatienttolimitspeechwheneverpossible.

D)

Limitthepatientsfluidintaketo1.5L/day.

Ans:

C Feedback: Managementofacutelaryngitisincludesrestingthevoice,avoidingirritants(includingsmoking), resting,andinhalingcoolsteamoranaerosol.Fluidintakeshouldbeincreased.Warmclothsonthe throatwillnothelprelievethesymptomsofacutelaryngitis.

4.

ApatientcomestotheEDandisadmittedwithepistaxis.Pressurehasbeenappliedtothepatients midlineseptumfor10minutes,butthebleedingcontinues.Thenurseshouldanticipateusingwhat treatmenttocontrolthebleeding?

A)

Irrigationwithahypertonicsolution

B)

Nasopharyngealsuction

C)

Normalsalineapplication

D)

Silvernitrateapplication

Ans:

D Feedback: Ifpressuretothemidlineseptumdoesnotstopthebleedingforepistaxis,additionaltreatmentofsilver nitrateapplication,Gelfoam,electrocautery,orvasoconstrictorsmaybeused.Suctionmaybeusedto visualizethenasalseptum,butitdoesnotalleviatethebleeding.Irrigationwithahypertonicsolutionis notusedtotreatepistaxis.

5.

Thenurseisplanningthecareofapatientwhoisscheduledforalaryngectomy.Thenurseshouldassign thehighestprioritytowhichpostoperativenursingdiagnosis?

A)

Anxietyrelatedtodiagnosisofcancer

B)

Alterednutritionrelatedtoswallowingdifficulties

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Ineffectiveairwayclearancerelatedtoairwayalterations

D)

Impairedverbalcommunicationrelatedtoremovalofthelarynx

Ans:

C

438

Feedback: Eachofthelisteddiagnosesisvalid,butineffectiveairwayclearanceistheprioritynursingdiagnosisfor allconditions. 6.

Thehomecarenurseisassessingthehomeenvironmentofapatientwhowillbedischargedfromthe hospitalshortlyafterhislaryngectomy.Thenurseshouldinformthepatientthathemayneedtoarrange fortheinstallationofwhichsysteminhishome?

A)

Ahumidificationsystem

B)

Anairconditioningsystem

C)

Awaterpurificationsystem

D)

Aradiantheatingsystem

Ans:

A Feedback: Thenursestressestheimportanceofhumidificationathomeandinstructsthefamilytoobtainandsetup ahumidificationsystembeforethepatientreturnshome.Air-conditioningmaybetoocoolandtoo dryingforthepatient.Awaterpurificationsystemoraradiantheatingsystemisnotnecessary.

7.

Thenurseiscaringforapatientwhoserecentunexplainedweightlossandhistoryofsmokinghave prompteddiagnostictestingforcancer.Whatsymptomismostcloselyassociatedwiththeearlystages oflaryngealcancer?

A)

Hoarseness

B)

Dyspnea

C)

Dysphagia

D)

Frequentnosebleeds

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Hoarsenessisanearlysymptomoflaryngealcancer.Dyspnea,dysphagia,andlumpsarelatersignsof laryngealcancer.Alopeciaisnotassociatedwithadiagnosisoflaryngealcancer. 8.

Thenurseiscaringforapatientwhoneedseducationonhismedicationtherapyforallergicrhinitis.The patientistotakecromolyn(Nasalcrom)daily.Inprovidingeducationforthispatient,howshouldthe nursedescribetheactionofthemedication?

A)

Itinhibitsthereleaseofhistamineandotherchemicals.

B)

Itinhibitstheactionofprotonpumps.

C)

Itinhibitstheactionofthesodium-potassiumpumpinthenasalepithelium.

D)

Itcausesbronchodilationandrelaxessmoothmuscleinthebronchi.

Ans:

A Feedback: Cromolyn(Nasalcrom)inhibitsthereleaseofhistamineandotherchemicals.Itisprescribedtotreat allergicrhinitis.Beta-adrenergicagentsleadtobronchodilationandstimulatebeta-2adrenergicreceptors inthesmoothmuscleofthebronchiandbronchioles.Itdoesnotaffectprotonpumpactionorthe sodium-potassiumpumpinthenasalcells.

9.

Thecampusnurseatauniversityisassessinga21-year-oldstudentwhopresentswithasevere nosebleed.Thesiteofbleedingappearstobetheanteriorportionofthenasalseptum.Thenurse instructsthestudenttotiltherheadforwardandthenurseappliespressuretothenose,butthestudents nosecontinuestobleed.Whichinterventionshouldthenursenextimplement?

A)

Applyicetothebridgeofhernose

B)

Laythepatientdownonacot

C)

ArrangefortransfertothelocalED

D)

Insertatamponintheaffectednare

Ans:

D Feedback: Acottontamponmaybeusedtotrytostopthebleeding.Theuseoficeonthebridgeofthenosehasno

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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scientificrationaleforcare.Layingtheclientdownonthecotcouldblocktheclientsairway.Hospital admissionisnecessaryonlyifthebleedingbecomesserious. 10. TheEDnurseisassessingayounggymnastwhofellfromabalancebeam.Thegymnastpresentswitha clearfluidleakingfromhernose.WhatshouldtheEDnursesuspect? A)

Fractureofthecribriformplate

B)

Ruptureofanethmoidsinus

C)

Abrasionofthesofttissue

D)

Fractureofthenasalseptum

Ans:

A Feedback: Clearfluidfromeithernostrilsuggestsafractureofthecribriformplatewithleakageofcerebrospinal fluid.Thesymptomsarenotindicativeofanabrasionofthesofttissueorruptureofasinus.Clearfluid leakagefromthenosewouldnotbeindicativeofafractureofthenasalseptum.

11. A42-year-oldpatientisadmittedtotheEDafteranassault.Thepatientreceivedblunttraumatotheface andhasasuspectednasalfracture.Whichofthefollowinginterventionsshouldthenurseperform? A)

Administernasalsprayandapplyanocclusivedressingtothepatientsface.

B)

Positionthepatientsheadinadependentposition.

C)

Irrigatethepatientsnosewithwarmtapwater.

D)

Applyiceandkeepthepatientsheadelevated.

Ans:

D Feedback: Immediatelyafterthefracture,thenurseappliesiceandencouragesthepatienttokeepthehead elevated.Thenurseinstructsthepatienttoapplyicepackstothenosetodecreaseswelling.Dependent positioningwouldexacerbatebleedingandthenoseisnotirrigated.Occlusivedressingsarenotused.

12. Theoccupationalhealthnurseisobtainingapatienthistoryduringapre-employmentphysical.During thehistory,thepatientstatesthathehashereditaryangioedema.Thenurseshouldidentifywhat implicationofthishealthcondition?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Itwillresultinincreasedlossofworkdays.

B)

Itmaycauseepisodesofweaknessduetoreducedcardiacoutput.

C)

Itcancauselife-threateningairwayobstruction.

D)

Itisunlikelytointerferewiththeindividualshealth.

Ans:

C

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Feedback: Hereditaryangioedemaisaninheritedconditionthatischaracterizedbyepisodesoflife-threatening laryngealedema.Noinformationsupportslostdaysofworkorreducedcardiacfunction. 13. Thenurseisconductingapresurgicalinterviewforapatientwithlaryngealcancer.Thepatientstates thathedrinksapproximatelysixtoeightshotsofvodkaperday.Itisimperativethatthenurseinform thesurgicalteamsothepatientcanbeassessedforwhat? A)

Increasedriskforinfection

B)

Deliriumtremens

C)

Depression

D)

Nonadherencetopostoperativecare

Ans:

B Feedback: Consideringtheknownriskfactorsforcancerofthelarynx,itisessentialtoassessthepatientshistoryof alcoholintake.Infectionisariskinthepostoperativeperiod,butnotanappropriateanswerbasedonthe patientshistory.Depressionandnonadherencearerisksinthepostoperativephase,butwouldnotbe criticalshort-termassessments.

14. Thenurseisexplainingthesafeandeffectiveadministrationofnasalspraytoapatientwithseasonal allergies.Whatinformationismostimportanttoincludeinthisteaching? A)

Finishthebottleofnasalspraytocleartheinfectioneffectively.

B)

Nasalspraycanonlybesharedbetweenimmediatefamilymembers.

C)

Nasalsprayshouldbeadministeredinaproneposition.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Overuseofnasalspraymaycausereboundcongestion.

Ans:

D

442

Feedback: Theuseoftopicaldecongestantsiscontroversialbecauseofthepotentialforareboundeffect.The patientshouldholdhisorherheadbackformaximaldistributionofthespray.Onlythepatientshould usethebottle. 15. Asaclinicnurse,youarecaringforapatientwhohasbeenprescribedanantibioticfortonsillitisandhas beeninstructedtotaketheantibioticfor10days.Whenyoudoafollow-upcallwiththispatient,youare informedthatthepatientisfeelingbetterandisstoppingthemedicationaftertakingitfor4days.What informationshouldyouprovidetothispatient? A)

Keeptheremainingtabletsforaninfectionatalatertime.

B)

Discontinuethemedicationsifthefeverisgone.

C)

Disposeoftheremainingmedicationinabiohazardreceptacle.

D)

Finishalltheantibioticstoeliminatetheorganismcompletely.

Ans:

D Feedback: Thenurseinformsthepatientabouttheneedtotakethefullcourseofanyprescribedantibiotic. Antibioticsshouldbetakenfortheentire10-dayperiodtoeliminatethemicroorganisms.Apatient shouldneverbeinstructedtokeepleftoverantibioticsforuseatalatertime.Evenifthefeverorother symptomsaregone,themedicationsshouldbecontinued.Antibioticsdonotneedtobedisposedofina biohazardreceptacle,thoughtheyshouldbediscardedappropriately.

16. Anursepractitionerhasprovidedcareforthreedifferentpatientswithchronicpharyngitisoverthepast severalmonths.Whichpatientsareatgreatestriskfordevelopingchronicpharyngitis? A)

Patientswhoarehabitualusersofalcoholandtobacco

B)

Patientswhoarehabitualusersofcaffeineandotherstimulants

C)

Patientswhoeatadiethighinspicyfoods

D)

Patientswhohavegastrointestinalrefluxdisease(GERD)

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

443

Feedback: Chronicpharyngitisiscommoninadultswholiveandworkindustysurroundings,usethevoiceto excess,sufferfromchronicchough,andhabituallyusealcoholandtobacco.Caffeineandspicyfoods havenotbeenlinkedtochronicpharyngitis.GERDisnotanotedriskfactor. 17. Theperioperativenursehasadmittedapatientwhohasjustunderwentatonsillectomy.Thenurses postoperativeassessmentshouldprioritizewhichofthefollowingpotentialcomplicationsofthis surgery? A)

Difficultyambulating

B)

Hemorrhage

C)

Infrequentswallowing

D)

Bradycardia

Ans:

B Feedback: Hemorrhageisapotentialcomplicationofatonsillectomy.Increasedpulse,fever,andrestlessnessmay indicateapostoperativehemorrhage.Difficultyambulatingandbradycardiaarenotcommon complicationsinapatientafteratonsillectomy.Infrequentswallowingdoesnotindicatehemorrhage; frequentswallowingdoes.

18. A45-year-oldobesemanarrivesinaclinicwithcomplaintsofdaytimesleepiness,difficultygoingto sleepatnight,andsnoring.Thenurseshouldrecognizethemanifestationsofwhathealthproblem? A)

Adenoiditis

B)

Chronictonsillitis

C)

Obstructivesleepapnea

D)

Laryngealcancer

Ans:

C Feedback: Obstructivesleepapneaoccursinmen,especiallythosewhoareolderandoverweight.Symptoms includeexcessivedaytimesleepiness,insomnia,andsnoring.Daytimesleepinessanddifficultygoingto sleepatnightarenotindicationsoftonsillitisoradenoiditis.Thispatientssymptomsarenotsuggestive oflaryngealcancer.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

444

19. ThenurseiscaringforapatientintheEDforepistaxis.Whatinformationshouldthenurseincludein patientdischargeteachingasawaytopreventepistaxis? A)

Keepnasalpassagesclear.

B)

Usedecongestantsregularly.

C)

Humidifytheindoorenvironment.

D)

Useatissuewhenblowingthenose.

Ans:

C Feedback: Dischargeteachingforpreventionofepistaxisshouldincludethefollowing:avoidforcefulnose bleeding,straining,highaltitudes,andnasaltrauma(nosepicking).Adequatehumidificationmay preventdryingofthenasalpassages.Keepingnasalpassagesclearandusingatissuewhenblowingthe nosearenotincludedindischargeteachingforthepreventionofepistaxis.Decongestantsarenot indicated.

20. Thenurseiscaringforapatientwhoispostoperativeday2followingatotallaryngectomyfor supraglotticcancer.Thenurseshouldprioritizewhatassessment? A)

Assessmentofbodyimage

B)

Assessmentofjugularvenouspressure

C)

Assessmentofcarotidpulse

D)

Assessmentofswallowingability

Ans:

D Feedback: Acommonpostoperativecomplicationfromthistypeofsurgeryisdifficultyinswallowing,which createsapotentialforaspiration.Cardiovascularcomplicationsarelesslikelyatthisstageofrecovery. Thepatientsbodyimageshouldbeassessed,butdysphagiahasthepotentialtoaffectthepatients airway,andisaconsequentpriority.

21. Thenurseisperformingthehealthinterviewofapatientwithchronicrhinosinusitiswhoexperiences frequentnosebleeds.Thenurseasksthepatientabouthercurrentmedicationregimen.Which medicationwouldputthepatientatahigherriskforrecurrentepistaxis?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Afrin

B)

Beconase

C)

SinustopPro

D)

Singulair

Ans:

B

445

Feedback: Beconaseshouldbeavoidedinpatientswithrecurrentepistaxis,glaucoma,andcataracts.SinustopPro andAfrinarepseudoephedrineanddonothaveasideeffectofepistaxis.Singulairisabronchodilator anddoesnothaveepistaxisasasideeffect. 22. Thenurseisperforminganassessmentonapatientwhohasbeendiagnosedwithcancerofthelarynx. Partofthenursesassessmentaddressesthepatientsgeneralstateofnutrition.Whichlaboratoryvalues wouldbeassessedwhendeterminingthenutritionalstatusofthepatient?Selectallthatapply. A)

Whitebloodcellcount

B)

Proteinlevel

C)

Albuminlevel

D)

Plateletcount

E)

Glucoselevel

Ans:

B,C,E Feedback: Thenursealsoassessesthepatientsgeneralstateofnutrition,includingheightandweightandbody massindex,andreviewslaboratoryvaluesthatassistindeterminingthepatientsnutritionalstatus (albumin,protein,glucose,andelectrolytelevels).Thewhitebloodcellcountandtheplateletcount wouldnotnormallyassistindeterminingthepatientsnutritionalstatus.

23. Thenurseisteachingapatientwithallergicrhinitisaboutthesafeandeffectiveuseofhismedications. Whatwouldbethemostessentialinformationtogivethispatientaboutpreventingpossibledrug interactions? A)

PrescriptionmedicationscanbesafelysupplementedwithOTCmedications.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Useonlyonepharmacysothepharmacistcancheckdruginteractions.

C)

Readdrug...