Deck 60: Management of Clients with Upper Airway Disorders

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.

Answer 1

the nose cannot be set for 2 to 3 days if edema develops.

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.

Answer 2

there is a radical change in appearance as a result of this type of surgery.

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."

Answer 3

"I can shower if I am careful not to get water into the stoma."

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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."

Question 21

During a direct visual examination of the larynx, the best intervention the nurse could offer is to

A) give the client anti-anxiety medication.
B) help the client hold still.
C) hold the client's hand.
D) tell the client to "pant like a puppy."

Question 22

A client is trying unsuccessfully to clear the airway with a cough. The measure the nurse would suggest to help the client cough more effectively is

A) cough while leaning forward.
B) drink milk to coat the throat.
C) insert a large-lumen suction catheter before coughing.
D) place a clean finger over the tracheostomy tube and cough.

Question 23

When a client coughs violently and the tracheostomy tube falls out, the client becomes dyspneic and the nurse attempts to reinsert the tracheostomy tube over the next 60 seconds but is unable to do so. The nurse's next action would be

A) call a code.
B) perform a cricoidectomy.
C) place a finger in the stoma.
D) start oxygen via nasal prongs.

Question 24

When feeding a client with a tracheostomy, the nurse would

A) follow each spoon of food with liquid.
B) have the client in an upright sitting position.
C) inflate the cuff before the meal.
D) thin the food to liquid consistency.

Question 25

Noting the need to use 8 ml rather than 5 ml to inflate the tracheostomy cuff sufficiently, the nurse would

A) ask the client to swallow, and then cough.
B) completely deflate the cuff to relieve the dilation.
C) notify the physician to have an x-ray film obtained.
D) replace the entire tracheostomy tube with a larger size.

Question 26

A neighbor tells a nurse that s/he has been experiencing hoarseness for over 3 weeks. The nurse should advise the client to see a doctor for

A) a prescription for antacids.
B) possible laryngeal cancer.
C) throat cultures and antibiotics.
D) vocal cord paralysis.

Question 27

The spouse of a client who is receiving mechanical ventilation via tracheostomy asks why his wife cannot have a tracheostomy button. The nurse's most informative response would be

A) "A button cannot be used with a ventilator."
B) "Buttons make the work of breathing harder."
C) "Suctioning can't be done with buttons."
D) "That would decrease your wife's oxygenation."

Question 28

A client with a Jackson metal tracheostomy tube has been admitted with pneumonia and dyspnea. The nurse would make arrangements to have supplies on hand to compensate for the fact that this type of tracheostomy tube

A) does not have an inner cannula.
B) has a high-pressure cuff.
C) has no respirator adapter.
D) is very short.

Question 29

A busy nurse in the ICU wishes to delegate aspects of respiratory care to an unlicensed assistive personnel (UAP). Which of the following actions can the nurse delegate? (Select all that apply.)

A) Measuring and recording oxygen saturations
B) Setting up oxygen delivery and suction equipment
C) Suctioning secretions of a client with a long-standing tracheostomy
D) Teaching the client how to cough with a tracheostomy
E) Verifying that the correct amount of oxygen is being delivered

Question 30

The nurse working with a client who has acute sinusitis plans to teach the client about the routinely-used treatments for this condition, which include (Select all that apply)

A) antibiotics.
B) antihistamines.
C) mucolytic agents.
D) oral alpha-adrenergic vasoconstrictors.