Chapter 22 - Management of Patients With Conditions of the Upper Respiratory Tract

1. Nursing measures associated with the uncomplicated common cold include all of the following except:
a. administering prescribed antibiotics to decrease the severity of the viral infection.
b. informing the patient about the symptoms of secondary infection, the major complication of a cold.
c. suggesting adequate fluid intake and rest.
d. teaching people that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic
phase.

2. Acyclovir, an antiviral agent, is recommended for:

a. herpes simplex infection
b. rhinitis
c. sinusitis
d. bronchitis

3. The herpes virus, which remains latent in cells of the lips or nose, usually subsides spontaneously in:
a. 5 days.
b. 1 week.
c. 10 to 14 days.
d. 3 to 4 weeks.

4. Nursing suggestions for a patient with acute or chronic sinusitis include:

a. adequate fluid intake.
b. increased humidity
c. local heat applications to promote drainage.
d. all of the above.

5. About 60% of cases of acute sinusitis are caused by bacterial organisms. The antibiotic of choice is:
a. amoxicillin-clavulanate (Augmentin)
b. acydovir
c. erythromycin
d. cefotetan

6. Health teaching for viral rhinitis includes advising the patient to:
a. blow his or her nose gently to prevent spread of the infection.
b. blow through both nostrils to equalize the pressure.
c. rest, to promote overall comfort.
d. do all of the above.

7. Acute pharyngitis of a bacterial nature is most commonly caused by:

a. group A Streptococcus
b. gram-negative Klebsiella
c. Pseudomonas
d. Staphylococcus aureus

8. A complication (s) of acute pharyngitis is(are):

a. Mastoiditis
b. Nephritis
c. Rheumatic fever
d. All of the above.

9. Nursing management for a patient with acute pharyngitis includes:

a. applying an ice collar for symptomatic relief of a severe sore throat.
b. encouraging bed rest during the febrile stage of the illness.
c. suggesting a liquid or soft diet during the acute stage of the disease.
d. all of the above measures.

10. The most common organism associated with tonsillitis and adenoiditis is:
a. group A Streptococcus
b. gram-negative Klebsiella
c. Psuedomonas
d. Staphylococcus aureus

11. Potential complications of enlarged adenoids include all of the following except:
a. Bronchitis
b. nasal obstruction
c. allergies
d. acute otitis media

12. To assess for an upper respiratory tract infection, the nurse should palpate:
a. the frontal and maxillary sinuses
b. the trachea
c. the neck lymph nodes
d. all of the above areas

13. An early sign of cancer of the larynx in the glottic area (66% of cases) is:
a. Hoarseness of the voice
b. burning of the throat when hot liquids are ingested.
c. enlarged cervical nodes.
d. dysphagia.

14. Assessment of a patient admitted for laryngeal carcinoma includes:

a. palpation of the frontal and maxillary sinuses to detect infection or inflammation.
b. palpation of the neck for swelling.
c. inspection of the nasal mucosa for polyps.
d. all of the above techniques.

15. Patient education for a laryngectomy includes:

a. advising that large amounts of mucus can be coughed up through the stoma.
b. cautioning about preventing water from entering the stoma.
c. telling the patient to expect a diminished sense of taste and smell.
d. doing all of the above.

CASE STUDY: Epistaxis

Gilberts, a 14-year-old high school student, is sent with her mother to the emergency department of a local hospital for
uncontrolled epistaxis.

1. Initial nursing measures in the emergency room that can be used to stop the nasal bleeding include:
a. compressing the soft outer portion of the nose against the midline septum continuously for 5 to 10 minutes.
b. keeping Gilberta in the upright position with her head tilted forward to prevent swallowing and aspiration of blood.
c. telling her to breathe through her mouth and to refrain from talking.
d. all of the above.

2. The nurse expects that emergency medical treatment may include insertion of a cotton pledget moistened with:
a. an adrenergic blocking agent
b. epinephrine
c. protamine sulfate
d. vitamin K.

3. The nurse is aware that nasal packing used to control bleeding can be left in place:
a. no longer than 2 hours
b. an average of 12 hours
c. an average of 24 hours
d. anywhere from 2 to 6 days

CASE STUDY: Tonsillectomy and Adenoidectomy

Isabel, a 14-year-old, just had a tonsillectomy and adenoidectomy. The staff nurse assists her with her transport from the recovery
area to her room.

1. Based on her knowledge about tonsillar disease he nurse knows that Isabel must have experienced symptoms that required
surgical intervention. Clinical manifestations may have included:
a. hypertrophy of the tonsils.
b. repeated attacks of otitis media.
c. suspected hearing loss secondary to otitis media.
d. all of the above.

2. The nurse assesses Isabel's postoperative vital signs and checks for the most significant postoperative complication of:
a. Epiglottis
b. Eustachian tube perforation
c. Hemorrhage
d. Oropharyngeal edema.

3. The nurse maintains Isabel in the recommended postoperative position of:

a. prone with her head on a pillow and turned to the side.
b. reverse Trendelenburg with the neck extended.
c. semi-Fowler's with the neck flexed.
d. supine with her neck hyperextended and supported with a pillow.

4. Isabel is to be discharged the same day of her tonsillectomy The nurse makes sure that her family knows to:
a. encourage her to eat a house diet to build up her resistance to infection.
b. offer her only clear liquids for 3 days, to prevent pharyngeal irritation.
c. offer her soft foods for several days to minimize local discomfort and supply her with necessary nutrients.
d. supplement her diet with orange and lemon juices because of the need for vitamin C to heal.
CASE STUDY: Laryngectomy
Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor.

1. Before developing a care plan, the nurse needs to know if Jerome's voice will be preserved. The surgical procedure that
would not damage the voice box is a:
a. partial laryngectomy
b. supraglottic laryngectomy
c. thyrotomy
d. total laryngectomy
1. Jerome is scheduled for a total laryngectomy Preoperative education includes:
a. informing him that there are ways he will be able to carry on a conversation without his voice.
b. making sure that he knows he will require a permanent trachea stoma.
c. reminding him that he will not be able to sing, whistle, or laugh.
d. all of the above.
1. Postoperative nutrition is usually maintained by way of a nasogastric catheter. The nurse needs to tell Jerome that oral
feedings usually begin after.
a. 24 hours
b. 2 to 3 days
c. 5 to 6 days
d. 1 week
1. Postoperative nursing measures to promote respiratory effectiveness include:
a. assisting with turning and early ambulation.
b. positioning Jerome in semi-to high Fowler's position.
c. reminding him to cough and take frequent deep breaths.
d. all of the above.
1. Jerome needs to know that the laryngectomy tube will be removed when:
a. esophageal speech has been perfected
b. he requests that it be removed
c. oral feedings are initiated
d. the stoma is well healed.