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?
visualize the nasal septum, but it does not alleviate the bleeding.
Irrigation with a hypertonic solution is not used to treat epistaxis.
A) Take preventative antibiotics, as ordered.
A) Anxiety related to diagnosis of cancer
B) Gargle with warm salt water regularly.
B) Altered nutrition related to swallowing difficulties
C) Dress herself and her infant warmly.
C) Ineffective airway clearance related to airway alterations
D) Wash her hands frequently.
D) Impaired verbal communication related to removal of the larynx
Ans: D
Ans: C
Feedback:
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.
Each of the listed diagnoses is valid, but ineffective airway clearance
is the priority nursing diagnosis for all conditions.
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.
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?
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.
3. The nurse is creating a plan of car for a patient diagnosed with acute
laryngitis. What intervention should be included in the patients plan of
care?
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) Place warm cloths on the patients throat, as needed.
A) Hoarseness
B) Have the patient inhale warm steam three times daily.
B) Dyspnea
C) Encourage the patient to limit speech whenever possible.
C) Dysphagia
D) Limit the patients fluid intake to 1.5 L/day.
D) Frequent nosebleeds
Ans: C
Ans: A
Feedback:
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.
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.
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
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) Normal saline application
C) It inhibits the action of the sodium-potassium pump in the nasal
epithelium.
D) Silver nitrate application
D) It causes bronchodilation and relaxes smooth muscle in the bronchi.
Ans: D
Ans: A
Feedback:
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
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:
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:
A cotton tampon may be used to try to stop the bleeding. The use of
ice on the bridge of the nose has no 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.
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.
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?
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) Fracture of the cribriform plate
A) Finish the bottle of nasal spray to clear the infection effectively.
B) Rupture of an ethmoid sinus
B) Nasal spray can only be shared between immediate family
members.
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?
C) Nasal spray should be administered in a prone position.
D) Overuse of nasal spray may cause rebound congestion.
Ans: D
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.
A) Administer nasal spray and apply an occlusive dressing to the
patients face.
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?
B) Position the patients head in a dependent position.
A) Keep the remaining tablets for an infection at a later time.
C) Irrigate the patients nose with warm tap water.
B) Discontinue the medications if the fever is gone.
D) Apply ice and keep the patients head elevated.
C) Dispose of the remaining medication in a biohazard receptacle.
Ans: D
D) Finish all the antibiotics to eliminate the organism completely.
Feedback:
Ans: D
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.
Feedback:
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?
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
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 10day 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
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.
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.
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?
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?
A) Difficulty ambulating
A) Afrin
B) Hemorrhage
B) Beconase
C) Infrequent swallowing
C) Sinustop Pro
D) Bradycardia
D) Singulair
Ans: B
Ans: B
Feedback:
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.
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.
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?
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) 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.
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:
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.
B) Use only one pharmacy so the pharmacist can check drug
interactions.
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.
C) Read drug labels carefully before taking OTC medications.
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?
Patient education is essential when assisting the patient in the use of
all medications. To prevent possible drug interactions, the patient is
cautioned to read drug labels before taking any OTC medications.
Some Web sites are reliable and valid information sources, but this is
not always the case. Patients do not necessarily need to limit
themselves to one pharmacy, though checking for potential
interactions is important. Not all OTC medications are safe additions
to prescription medication regimens.
A) Assessment of body image
B) Assessment of jugular venous pressure
C) Assessment of carotid pulse
D) Assessment of swallowing ability
Ans: D
Feedback:
D) Consult the Internet before selecting an OTC medication.
Ans: C
Feedback:
24. The nurse is caring for a patient who has just been diagnosed with
chronic rhinosinusitis. While being
admitted to the clinic, the patient asks, Will this chronic infection hurt
my new kidney? What should the nurse know about chronic
rhinosinusitis in patients who have had a transplant?
A) The patient will have exaggerated symptoms of rhinosinusitis due
to immunosuppression.
B) Taking immunosuppressive drugs can contribute to chronic
rhinosinusitis.
C) Chronic rhinosinusitis can damage the transplanted organ.
D) Immunosuppressive drugs can cause organ rejection.
Ans: B
Feedback:
URIs, specifically chronic rhinosinusitis and recurrent acute
rhinosinusitis, may be linked to primary or secondary immune
deficiency or treatment with immunosuppressive therapy (i.e., for
cancer or organ transplantation). Typical symptoms may be blunted or
absent due to immunosuppression. No evidence indicates damage to
the transplanted organ due to chronic rhinosinusitis.
Immunosuppressive drugs do not cause organ rejection.
25. The nurse is caring for a patient with a severe nosebleed. The
physician inserts a nasal sponge and tells the patient it may have to
remain in place up to 6 days before it is removed. The nurse should
identify that this patient is at increased risk for what?
A) Viral sinusitis
B) Toxic shock syndrome
C) Pharyngitis
D) Adenoiditis
Patient teaching is an important aspect of nursing care for the patient
with acute rhinosinusitis. The nurse instructs the patient about
symptoms of complications that require immediate follow-up. Referral
to a physician is indicated if periorbital edema and severe pain on
palpation occur. Clear drainage and bloodtinged mucus do not require
follow-up if the patient has acute rhinosinusitis. A persistent headache
does not necessarily warrant immediate follow-up.
28. A patient states that her family has had several colds during this
winter and spring despite their commitment to handwashing. The high
communicability of the common cold is attributable to whatfactor?
A) Cold viruses are increasingly resistant to common antibiotics.
B) The virus is shed for 2 days prior to the emergence of symptoms.
C) A genetic predisposition to viral rhinitis has recently been
identified.
D) Overuse of OTC cold remedies creates a rebound susceptibility to
future colds.
Ans: B
Feedback:
Colds are highly contagious because virus is shed for about 2 days
before the symptoms appear and during the first part of the
symptomatic phase. Antibiotic resistance is not relevant to viral
illnesses and OTC medications do not have a rebound effect. Genetic
factors do not exist.
29. It is cold season and the school nurse been asked to provide an
educational event for the parent teacher organization of the local
elementary school. What should the nurse include in teaching about
the treatment of pharyngitis?
Ans: B
A) Pharyngitis is more common in children whose immunizations are
not up to date.
Feedback:
B) There are no effective, evidence-based treatments for pharyngitis.
A compressed nasal sponge may be used. Once the sponge becomes
saturated with blood or is moistened with a small amount of saline, it
will expand and produce tamponade to halt the bleeding. The packing
may remain in place for 48 hours or up to 5 or 6 days if necessary to
control bleeding. Antibiotics may be prescribed because of the risk of
iatrogenic sinusitis and toxic shock syndrome.
C) Use of warm saline gargles or throat irrigations can relieve
symptoms.
D) Heat may increase the spasms in pharyngeal muscles.
Ans: C
Feedback:
26. A nursing student is discussing a patient with viral pharyngitis with
the preceptor at the walk-in clinic. What should the preceptor tell the
student about nursing care for patients with viral pharyngitis?
A) Teaching focuses on safe and effective use of antibiotics.
B) The patient should be preliminarily screened for surgery.
C) Symptom management is the main focus of medical and nursing
care.
D) The focus of care is resting the voice to prevent chronic hoarseness.
Ans: C
Depending on the severity of the pharyngitis and the degree of pain,
warm saline gargles or throat irrigations are used. The benefits of this
treatment depend on the degree of heat that is applied. The nurse
teaches about these procedures and about the recommended
temperature of the solution: high enough to be effective and as warm
as the patient can tolerate, usually 105F to 110F (40.6C to 43.3C).
Irrigating the throat may reduce spasm in the pharyngeal muscles and
relieve soreness of the throat. You would not tell the parent teacher
organization that there is no real treatment of pharyngitis.
30. The nurse is doing discharge teaching in the ED with a patient who
had a nosebleed. What should the nurse include in the discharge
teaching of this patient?
Feedback:
A) Avoid blowing the nose for the next 45 minutes.
Nursing care for patients with viral pharyngitis focuses on
symptomatic management. Antibiotics are not prescribed for viral
etiologies. Surgery is not indicated in the treatment of viral pharyngitis.
Chronic hoarseness is not a common sequela of viral pharyngitis, so
teaching ways to prevent it would be of no use in this instance.
27. The nurse is providing patient teaching to a patient diagnosed with
acute rhinosinusitis. For what possible complication should the nurse
teach the patient to seek immediate follow-up?
A) Periorbital edema
B) Headache unrelieved by OTC medications
C) Clear drainage from nose
D) Blood-tinged mucus when blowing the nose
Ans: A
B) In case of recurrence, apply direct pressure for 15 minutes.
C) Do not take aspirin for the next 2 weeks.
D) Seek immediate medical attention if the nosebleed recurs.
Ans: B
Feedback:
The nurse explains how to apply direct pressure to the nose with the
thumb and the index finger for 15 minutes in case of a recurrent
nosebleed. If recurrent bleeding cannot be stopped, the patient is
instructed to seek additional medical attention. ASA is not
contraindicated in most cases and the patient should avoiding blowing
the nose for an extended period of time, not just 45 minutes.
31. The nurse recognizes that aspiration is a potential complication of
a laryngectomy. How should the nurse best manage this risk?
Feedback:
A) Facilitate total parenteral nutrition (TPN).
B) Keep a complete suction setup at the bedside.
C) Feed the patient several small meals daily.
D) Refer the patient for occupational therapy.
Ans: B
Feedback:
Due to the risk for aspiration, the nurse keeps a suction setup available
in the hospital and instructs the family to do so at home for use if
needed. TPN is not indicated and small meals do not necessarily reduce
the risk of aspiration. Physical therapists do not address swallowing
ability.
32. A patient has had a nasogastric tube in place for 6 days due to the
development of paralytic ileus after surgery. In light of the prolonged
presence of the nasogastric tube, the nurse should prioritize
assessments related to what complication?
A) Sinus infections
B) Esophageal strictures
C) Pharyngitis
35. The nurse has noted the emergence of a significant amount of fresh
blood at the drain site of a patient who is postoperative day 1 following
total laryngectomy. How should the nurse respond to this
development?
A) Remove the patients drain and apply pressure with a sterile gauze.
B) Assess the patient, reposition the patient supine, and apply wall
suction to the drain.
C) Rapidly assess the patient and notify the surgeon about the patients
bleeding.
D) Administer a STAT dose of vitamin K to aid coagulation.
Ans: C
Feedback:
The nurse promptly notifies the surgeon of any active bleeding, which
can occur at a variety of sites, including the surgical site, drains, and
trachea. The drain should not be removed or connected to suction.
Supine positioning would exacerbate the bleeding. Vitamin K would
not be administered without an order.
Ans: A
36. The nurse is creating a care plan for a patient who is status posttotal laryngectomy. Much of the plan consists of a long-term
postoperative communication plan for alaryngeal communication.
What form of alaryngeal communication will likely be chosen?
Feedback:
A) Esophageal speech
Patients with nasotracheal and nasogastric tubes in place are at risk for
development of sinus infections. Thus, accurate assessment of patients
with these tubes is critical. Use of a nasogastric tube is not associated
with the development of the other listed pathologies.
B) Electric larynx
33. A mother calls the clinic asking for a prescription for Amoxicillin
for her 2-year-old son who has what the nurse suspects to be viral
rhinitis. What should the nurse explain to this mother?
Ans: C
A) I will relay your request promptly to the doctor, but I suspect that
she wont get back to you if its a
Tracheoesophageal puncture is simple and has few complications. It is
associated with high phonation success, good phonation quality, and
steady long-term results. As a result, it is preferred over esophageal
speech, and electric larynx or ASL.
D) Laryngitis
cold.
B) Ill certainly inform the doctor, but if it is a cold, antibiotics wont be
used because they do not affect
the virus.
C) Ill phone in the prescription for you since it can be prescribed by
the pharmacist.
D) Amoxicillin is not likely the best antibiotic, but Ill call in the right
prescription for you.
Ans: B
Feedback:
C) Tracheoesophageal puncture
D) American sign language (ASL)
Feedback:
37. A patient is being treated for bacterial pharyngitis. Which of the
following should the nurse recommend when promoting the patients
nutrition during treatment?
A) A 1.5 L/day fluid restriction
B) A high-potassium, low-sodium diet
C) A liquid or soft diet
D) A high-protein diet
Ans: C
Feedback:
Antimicrobial agents (antibiotics) should not be used because they do
not affect the virus or reduce the incidence of bacterial complications.
In addition, their inappropriate use has been implicated in development
of organisms resistant to therapy. It would be inappropriate to tell the
patient that the physician will not respond to her request.
34. The nurse is providing care for a patient who has just been admitted
to the postsurgical unit following a laryngectomy. What assessment
should the nurse prioritize?
A liquid or soft diet is provided during the acute stage of the disease,
depending on the patients appetite and the degree of discomfort that
occurs with swallowing. The patient is encouraged to drink as much
fluid as possible (at least 2 to 3 L/day). There is no need for increased
potassium or protein intake.
A) The patients swallowing ability
38. A patient has just been diagnosed with squamous cell carcinoma of
the neck. While the nurse is doing health education, the patient asks,
Does this kind of cancer tend to spread to other parts of the body? What
is the nurses best response?
B) The patients airway patency
A) In many cases, this type of cancer spreads to other parts of the body.
C) The patients carotid pulses
B) This cancer usually does not spread to distant sites in the body.
D) Signs and symptoms of infection
C) You will have to speak to your oncologist about that.
Ans: B
D) Squamous cell carcinoma is nothing to be concerned about, so try
to focus on your health.
Feedback:
The patient with a laryngectomy is a risk for airway occlusion and
respiratory distress. As in all nursing situations, assessment of the
airway is a priority over other potential complications and assessment
parameters.
Ans: B
Feedback:
The incidence of distant metastasis with squamous cell carcinoma of
the head and neck (including larynx
cancer) is relatively low. The patients prognosis is determined by the
oncologist, but the patient hasasked a general question and it would be
inappropriate to refuse a response. The nurse must notdownplay the
patients concerns.
39. The nurse is performing preoperative teaching with a patient who
has cancer of the larynx. After completing patient teaching, what
would be most important for the nurse to do?
A) Give the patient his or her cell phone number.
B) Refer the patient to a social worker or psychologist.
C) Provide the patient with audiovisual materials about the surgery.
D) Reassure the patient and family that everything will be alright.
Ans: C
Feedback:
Informational materials (written and audiovisual) about the surgery are
given to the patient and family for review and reinforcement. The nurse
never gives personal contact information to the patient. Nothing in the
scenario indicates that a referral to a social worker or psychologist is
necessary. False reassurance must always be avoided.
40. A patients total laryngectomy has created a need for alaryngeal
speech which will be achieved through the use of tracheoesophageal
puncture. What action should the nurse describe to the patient when
teaching him about this process?
A) Training on how to perform controlled belching
B) Use of an electronically enhanced artificial pharynx
C) Insertion of a specialized nasogastric tube
D) Fitting for a voice prosthesis
Ans: D
Feedback:
In patients receiving transesophageal puncture, a valve is placed in the
tracheal stoma to divert air into the esophagus and out the mouth. Once
the puncture is surgically created and has healed, a voice prosthesis
(Blom-Singer) is fitted over the puncture site. A nasogastric tube and
belching are not required. An artificial pharynx is not used