Question 1

When a friend comes to the nurse's apartment to seek help to stop the bleeding from a broken nose, the nurse would attempt to convince the friend to seek treatment in the emergency department primarily because
A) cosmetic results are poor when treatment is delayed.
B) general anesthesia may be needed to locate the bleeding vessels.
C) it will be very difficult to stop the bleeding if the nose is fractured.
D) the nose cannot be set for 2 to 3 days if edema develops.

Accepted Answer

If a nasal fracture occurs, immediate medical management is advised. Within several hours of nasal injury, severe edema may occur, which causes difficulty in reducing the fracture.

Question 2

In planning postoperative nursing care for a client who has undergone radical neck dissection and total laryngectomy, the nurse would give priority to the fact that
A) esophageal speech is relatively difficult to learn and takes practice.
B) prognosis after treatment is moderate, depending on findings.
C) the stoma should never be covered after this type of surgery.
D) there is a radical change in appearance as a result of this type of surgery.

Accepted Answer

Surgical management of laryngeal tumors often includes neck dissection. Radical neck dissection is the removal of lymphatic drainage channels and nodes, sternocleidomastoid muscle, spinal accessory nerve, jugular vein, and submandibular area. The radical approach to surgery results in a drastic change in appearance. Esophageal speech is not difficult to learn. Laryngeal cancer is potentially curable if caught early enough. Clients often learn to camouflage their stomas by covering them with articles of clothing, such as scarves or turtleneck sweaters.

Question 3

A nurse is teaching a client with a new tracheostomy self-care measures and evaluates that teaching goals have been met when the client says
A) "I can shower if I am careful not to get water into the stoma."
B) "I don't see why I should quit smoking now; what more could happen?"
C) "Stoma covers aren't used because they can lead to suffocation."
D) "When my tube comes out I can go swimming again."

Accepted Answer

Showers and tub baths are allowed as long as water does not enter the stoma. Quitting smoking, even at this late date still helps preserve lung function and should be encouraged. Stoma covers or bibs are often used to hide the stoma. Swimming and other water sports are prohibited.

Question 4

Which intervention would probably help most when teaching a client to speak again after a laryngectomy?
A) Give the client contact information so speech therapy can continue at home.
B) Help the client and family understand that this is a frustrating experience.
C) Make sure the client has a supply of paper and pens.
D) Obtain several different speaking aids for the client to try at home.

Accepted Answer

The client needs to be encouraged to continue speech therapy until speech is relearned. This is a time-consuming and frustrating experience for both the client and others. The nurse can decrease stress and frustration by explaining the frustrating nature of this experience to the client/family.

Question 5

After a posterior nasal pack is inserted by the physician, the client is very anxious and states, "I don't feel like I'm breathing right." The immediate intervention the nurse would initiate is
A) collect a specimen for arterial blood gases (ABGs).
B) cut the pack strings and pull the packing out.
C) inspect the client's oral cavity using a flashlight.
D) reassure the client that this is normal discomfort.

Accepted Answer

The nurse should inspect the oral cavity for the presence of blood, soft palate necrosis, and proper placement of the posterior plug. If the posterior plug is visible, the physician is notified for readjustment of the packing. Having posterior packing is very uncomfortable and clients may need both analgesics and anxiolytics to tolerate it. But before medicating the client, a thorough assessment is warranted.

Question 6

The priority nursing intervention for a client experiencing a laryngospasm would be
A) administering 100% oxygen.
B) calling the resuscitation team.
C) positioning the client in high-Fowler position.
D) starting in IV with a large-bore catheter.

Accepted Answer

Management is directed at reestablishing the airway as quickly and efficiently as possible. The nurse should administer 100% oxygen and then call for assistance. Oxygen is continued until the spasms stop and the client is breathing easily. The client may need paralysis with neuromuscular blocking agents and mechanical ventilation.

Question 7

A client has a fenestrated tracheostomy tube in place. A tracheostomy plug will be used to allow the client to talk. The intervention by the nurse that would be essential before inserting the plug is
A) alerting the client to a new system of communication.
B) deflating the cuff on the tracheostomy tube.
C) evaluating the client's tidal volume.
D) positioning the client to facilitate air flow.

Accepted Answer

A cuffed tracheostomy tube is always deflated before using a talking tracheostomy adapter. Cuff inflation prevents exhalation, causing suffocation.

Question 8

During a community screening event, the nurse would identify that the client at highest risk for development of laryngeal cancer is
A) a 30-year-old man who smokes one pack of cigarettes per day.
B) a 60-year-old woman who smokes occasionally and is easily fatigued.
C) a 70-year-old man with a 40-year history of alcohol use and heavy smoking.
D) an 80-year-old man who has a very high intake of caffeinated beverages.

Accepted Answer

The primary etiologic agent in laryngeal cancer is cigarette smoking. Three of four clients who develop laryngeal cancer have smoked or currently smoke. Alcohol appears to act synergistically with tobacco, increasing the risk of developing a malignant tumor in the upper airway.

Question 9

A nurse is assessing a client who complains of hoarseness, frequent choking, and the feeling of something stuck in the throat. The nurse should plan to include teaching on the diagnostic tests for
A) a glottic tumor.
B) laryngeal paralysis.
C) tracheal deviation.
D) vocal cord disruption.

Accepted Answer

Other manifestations include pain in the throat, especially when swallowing, neck masses, or pain radiating to the ear by way of the glossopharyngeal and vagus nerves.

Question 10

The observation that would require an immediate nursing intervention for a client recently returned to the unit following partial laryngectomy is
A) blood-tinged sputum.
B) copious respiratory secretions.
C) difficulty swallowing.
D) pulsating tracheostomy tube.

Accepted Answer

A pulsating tracheostomy tube may indicate that the tip of the tube is resting on the innominate artery and may cause injury to the artery, resulting in hemorrhage.

Question 11

For an elderly client who has a posterior nasal plug and anterior nasal packing in place to control an episode of severe epistaxis, the priority assessment for the nurse would be assessing for
A) continuing nasal pain.
B) dislodged packing.
C) presence of hypoxia.
D) swallowing blood.

Accepted Answer

Clients with posterior plugs and anterior nasal packing are admitted to the hospital and monitored closely for hypoxia. Posterior packing can affect both level of consciousness and respiratory status, especially in the elderly client.

Question 12

A client recently had a total laryngectomy and plans to use an artificial larynx for speech. The common problem the nurse would address regarding the artificial larynx is that
A) it is a device that is difficult to use.
B) it has a masculine-sounding voice quality.
C) it has a monotone speech quality.
D) it causes neck discomfort.

Accepted Answer

The speech quality is monotone and mechanical sounding but intelligible. The artificial larynx can be used starting about 3-4 days after surgery.

Question 13

The nurse would explain to a client that laser surgery to remove laryngeal tumors has the major benefit of
A) a usable voice.
B) complete cure.
C) minimal blood loss.
D) reduced edema.

Accepted Answer

Laser excision of laryngeal tumors usually results in a usable voice after surgery. Sometimes laser surgery is combined with radiation for better outcomes.

Question 14

A nurse is conducting health seminars in the community. Besides instructing the audience to not abuse alcohol and to stop smoking, other preventive measures the nurse could suggest include
A) exercising at least 30 minutes on most days of the week.
B) increasing daily fiber intake to 20-30 grams a day.
C) limiting intake of saturated fats and trans fats.
D) wearing respiratory protective equipment if exposed to asbestos.

Accepted Answer

Smoking and alcohol abuse are major risk factors for developing laryngeal cancer. Other risks include exposure to asbestos, wood dust, mustard gas, and petroleum products and inhalation of other noxious fumes.

Question 15

A client is in the recovery room after surgical removal of nasal polyps. The nurse notices the client is swallowing frequently. The most appropriate action by the nurse is to
A) assess the client's mouth for blood.
B) continue to monitor and assess the client.
C) notify the physician immediately.
D) turn the client on the left side.

Accepted Answer

After surgery to remove nasal polyps, the client will have nasal packing. Because the packing will simply absorb any anterior bleeding, it is necessary to assess for posterior bleeding. The only manifestation may be excessive swallowing. The nurse should assess for posterior bleeding and call the surgeon.

Question 16

A client has frequent bouts of laryngitis. When assessing the client the nurse should specifically ask questions regarding the presence of
A) a family history of idiopathic hoarseness.
B) frequent upper respiratory tract infections.
C) gastroesophageal reflux disorder.
D) a history of stomach cancer.

Accepted Answer

In GERD, the cardiac sphincter relaxes, allowing gastric acid to enter the esophagus. The secretions may be allowed to enter the larynx, causing chemical irritation. Chronic irritation can lead to bouts of laryngitis. The other three options are not related.

Question 17

The measure that would best aid the nurse in removing heavy, tenacious secretions during suctioning is
A) encouraging frequent coughing and deep breathing.
B) employing postural drainage before suctioning.
C) hyperinflating the lungs before suctioning.
D) instilling sterile saline directly into the trachea.

Accepted Answer

If tracheal secretions are thick and not easily removed, the nurse should directly instill 3 ml of sterile normal saline into the trachea. The saline reduces the viscosity of secretions for easier removal. This is not a routine intervention; however, if it is needed, the nurse should collaborate with the respiratory therapist to ensure the client is receiving adequate humidity and should assess the client for adequate hydration. These measures will help prevent the client from having heavy secretions.

Question 18

The nurse explaining the pieces of a tracheostomy to a client would note that the portion of the tracheostomy apparatus used to round the end of the tube for insertion is the
A) flange.
B) inner cannula.
C) obturator.
D) pilot tube.

Accepted Answer

The obturator is placed into the outer tube before insertion. Its rounded tip smoothes the end of the cannula and facilitates nontraumatic insertion of the tube into the stoma.

Question 19

In the preoperative teaching plan for a client scheduled for total laryngectomy and radical neck resection, the nurse would give highest priority to the
A) client not being able to perform deep-breathing exercises.
B) client not being able to speak normally again.
C) endotracheal tube being in place for 2 to 3 days.
D) insertion of a gastrostomy tube during surgery for feeding.

Accepted Answer

The greatest problem for the client after laryngectomy is loss of voice. The client should be made aware that without surgery, the voice quality will worsen as the tumor enlarges. In any case, loss of voice constitutes a serious psychological issue.

Question 20

For a client who has undergone functional endoscopic sinus surgery (FESS) as part of the surgical management of sinusitis, the nurse would instruct the client
A) "Don't blow your nose for 1 week."
B) "Eat only semi-solid foods."
C) "Lean forward when eating."
D) "Limit the amount of fluids you drink."

Accepted Answer

FESS clients should avoid blowing the nose for 7 days after surgery. They should sniff backward or spit, not blow. Clients should increase their fluid intake.

Quiz 60: Management of Clients with Upper Airway Disorders

When a friend comes to the nurse's apartment to seek help to stop the bleeding from a broken nose, the nurse would attempt to convince the friend to seek treatment in the emergency department primarily because

In planning postoperative nursing care for a client who has undergone radical neck dissection and total laryngectomy, the nurse would give priority to the fact that

A nurse is teaching a client with a new tracheostomy self-care measures and evaluates that teaching goals have been met when the client says

Which intervention would probably help most when teaching a client to speak again after a laryngectomy?

After a posterior nasal pack is inserted by the physician, the client is very anxious and states, "I don't feel like I'm breathing right." The immediate intervention the nurse would initiate is

The priority nursing intervention for a client experiencing a laryngospasm would be

A client has a fenestrated tracheostomy tube in place. A tracheostomy plug will be used to allow the client to talk. The intervention by the nurse that would be essential before inserting the plug is

During a community screening event, the nurse would identify that the client at highest risk for development of laryngeal cancer is

A nurse is assessing a client who complains of hoarseness, frequent choking, and the feeling of something stuck in the throat. The nurse should plan to include teaching on the diagnostic tests for

The observation that would require an immediate nursing intervention for a client recently returned to the unit following partial laryngectomy is

For an elderly client who has a posterior nasal plug and anterior nasal packing in place to control an episode of severe epistaxis, the priority assessment for the nurse would be assessing for

A client recently had a total laryngectomy and plans to use an artificial larynx for speech. The common problem the nurse would address regarding the artificial larynx is that

The nurse would explain to a client that laser surgery to remove laryngeal tumors has the major benefit of

A nurse is conducting health seminars in the community. Besides instructing the audience to not abuse alcohol and to stop smoking, other preventive measures the nurse could suggest include

A client is in the recovery room after surgical removal of nasal polyps. The nurse notices the client is swallowing frequently. The most appropriate action by the nurse is to

A client has frequent bouts of laryngitis. When assessing the client the nurse should specifically ask questions regarding the presence of

The measure that would best aid the nurse in removing heavy, tenacious secretions during suctioning is

The nurse explaining the pieces of a tracheostomy to a client would note that the portion of the tracheostomy apparatus used to round the end of the tube for insertion is the

In the preoperative teaching plan for a client scheduled for total laryngectomy and radical neck resection, the nurse would give highest priority to the

For a client who has undergone functional endoscopic sinus surgery (FESS) as part of the surgical management of sinusitis, the nurse would instruct the client