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Ch35 Nursing Care Of Patients With Upper Test Bank + Answers

LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 35 Nursing Care of Patients with Upper Respiratory Disorders

1) A patient tells the nurse he has a "cold" every spring that lasts a few weeks. Which health problem should the nurse suspect the patient is experiencing?

1. Acute viral rhinitis

2. Allergic rhinitis

3. Vasomotor rhinitis

4. Atrophic rhinitis

Page Ref: 1234

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 35.1 Describe the pathophysiology and manifestations of infectious and inflammatory upper respiratory disorders and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

2) A patient reports having a congested nose that is worse after using a nasal spray. Which manifestation is this patient describing?

1. Incorrect use of the nasal spray

2. Acute sinus infection that needs to be treated with antibiotics

3. Adverse effect of the nasal spray

4. Rebound nasal congestion

Page Ref: 1235

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

3) A middle-aged patient is seen in the clinic for a continuing cough after recovering from the flu "a few weeks ago." What should the nurse suspect is occurring with this patient?

1. Viral pneumonia

2. Sinus infection

3. Otitis media

4. Tracheobronchitis

Page Ref: 1240

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

4) A patient who was diagnosed with the flu is demonstrating rapid, shallow respirations. For which health problem should the nurse suspect the patient is at risk for developing?

1. Atelectasis

2. Pneumonia

3. Dehydration

4. Increased tidal volume

Page Ref: 1241

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with upper respiratory disorders.

5) A patient reports needing to see a dentist because of upper teeth pain. Which action should the nurse take?

1. Suggest the patient see the dentist immediately.

2. Assess the patient for a sinus infection.

3. Schedule an appointment with the healthcare provider.

4. Inform the patient there is nothing wrong with the teeth.

Page Ref: 1243

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

6) During an assessment, the nurse learns that the only thing that helps a patient with a daily morning headache is "using a vaporizer with eucalyptus" before breakfast. Which health problem should the nurse suspect the patient is experiencing?

1. Acute rhinitis

2. Allergic rhinitis

3. Symptoms of sinusitis

4. After-effects from the flu

Page Ref: 1245

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

7) The nurse suspects that a patient has tonsillitis. What did the nurse assess to make this clinical decision? Select all that apply.

1. Hoarse voice

2. Thirst

3. Nucal rigidity

4. Pain around the ears

5. Low-grade fever

Page Ref: 1246

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

8) A middle-aged adult patient who is diagnosed with pertussis is complaining of right-sided thoracic pain. For which health problem should the nurse assess this patient? Select all that apply.

1. Pleural effusion

2. Pneumothorax

3. Pulmonary emboli

4. Rib fractures

5. Pleurisy

Page Ref: 1252

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

9) A patient is receiving anterior nasal packing for a nosebleed. What should be included in the instructions for this patient?

1. Remove the packing in the morning.

2. The packing will stay in place for at least 5 days.

3. The packing will be in place for at least 24 hours and up to 3 days.

4. The packing will be needed for at least 1 week.

Page Ref: 1255

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 35.2 Describe the pathophysiology and manifestations of disorders of upper respiratory trauma or obstruction and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

10) While engaging in a high school sports activity, an adolescent sustains an injury to the nose. Which assessment finding indicates that the patient has a nasal fracture? Select all that apply.

1. Shortness of breath

2. Diaphoresis

3. Drop in blood pressure

4. Periorbital ecchymosis

5. Nasal bridge instability

Page Ref: 1257

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

11) A patient with multiple facial and nasal injuries needs a nasogastric tube placed. Which method should the nurse use to place this tube?

1. Through the mouth

2. Through the unobstructed nare

3. Through the obstructed nare

4. After the edema in the nares subsides

Page Ref: 1258

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Content and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

12) While eating a meal in the hospital, a patient exhibits difficulty breathing and signs of choking. What should the nurse realize the patient is experiencing?

1. Laryngeal obstruction

2. Pulmonary emboli

3. Epiglottitis

4. Acute myocardial infarction

Page Ref: 1259

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

13) The nurse observes a patient's respirations during sleep and notes the absence of respirations that lasts from 15 to 45 seconds. What should the nurse consider this patient is experiencing?

1. Laryngeal spasm

2. Sleep apnea

3. Respiratory acidosis

4. Renal failure

Page Ref: 1263

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

14) A patient who is scheduled for a partial laryngectomy asks if he will still be able to talk after the surgery. Which response would be appropriate for the nurse to make? Select all that apply.

1. "No."

2. "You will have to ask your physician."

3. "Yes, but it might sound a little different."

4. "You will, but with an electronic device."

5. "Normal speaking, breathing, and swallowing will return as you recover."

Page Ref: 1269

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 35.3 Describe the pathophysiology and manifestations of upper respiratory tumors and outline the interprofessional care and nursing care of patients with upper respiratory tumors.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

15) While recovering at home from a total laryngectomy, a patient notices an increase in left shoulder weakness. With what should the nurse realize this symptom is consistent?

1. Normal recovery

2. Damage to the spinal accessory nerve

3. Side effect of neck radiation therapy

4. Medication complication

Page Ref: 1270

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Learning Outcome: 35.3 Describe the pathophysiology and manifestations of upper respiratory tumors and outline the interprofessional care and nursing care of patients with upper respiratory tumors.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

16) A patient with laryngeal cancer is found to have carcinoma in situ. For which stage of cancer should the nurse plan care for this patient?

1. Stage 0

2. Stage I

3. Stage II

4. Stage III

Page Ref: 1269

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Content and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 35.3 Describe the pathophysiology and manifestations of upper respiratory tumors and outline the interprofessional care and nursing care of patients with upper respiratory tumors.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with upper respiratory disorders.

17) A patient with nasal trauma has clear, watery fluid dripping from the nose. After testing, the nurse learns this fluid contains glucose. What should this finding indicate to the nurse?

1. There is a fracture of the ethmoid or sphenoid sinus.

2. The patient needs to be suctioned.

3. Cerebrospinal fluid is present.

4. The patient has coryza.

Page Ref: 1257

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with upper respiratory disorders.

18) During a health history, the nurse learns that a patient experiences several head colds each year. What teaching should the nurse consider providing to this patient? Select all that apply.

1. Limit physical stress.

2. Avoid getting chilled.

3. Stay away from crowds.

4. Stay indoors when it rains.

5. Frequently wash the hands.

Page Ref: 1237

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

19) The nurse is caring for patients who have been exposed to the influenza virus. For which patient should the nurse question the use of the antiviral drug zanamivir (Relenza)? Select all that apply.

1. Patient with arthritis

2. Patient with heart failure

3. Patient diagnosed with COPD

4. Patient being treated for asthma

5. Patient with type 2 diabetes mellitus

Page Ref: 1241

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Content and Environment; Practice; conduct population-based transcultural health assessments and interventions | Nursing/Integrated Concepts: Nursing Process: Assessment

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with upper respiratory disorders.

20) A patient has an ongoing sinus infection. In addition to antibiotics, which treatment should the nurse expect to be prescribed for this patient? Select all that apply.

1. Topical steroids

2. Saline nose drops

3. Saltwater gargles

4. Oral decongestants

5. Warm steam inhalation

Page Ref: 1244

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

21) The nurse provides discharge instructions to a patient recovering from endoscopic sinus surgery. Which patient statement indicates that teaching has been effective? Select all that apply.

1. "I need to sneeze with my mouth open."

2. "I should avoid heavy lifting for a week."

3. "I am to avoid blowing my nose for a week."

4. "I am to irrigate the sinuses with normal saline."

5. "The nasal packing will be removed in 2 days."

Page Ref: 1244

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

22) A patient with a penicillin allergy is diagnosed with scarlet fever. Which medication should the nurse anticipate being prescribed for this patient? Select all that apply.

1. Amoxicillin

2. Cefuroxime

3. Erythromycin

4. Dexamethasone

5. Pseudoephedrine

Page Ref: 1247

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

23) The community health nurse learns that an adult community member has been diagnosed with diphtheria. What should the nurse do to prevent the spread of this infection? Select all that apply.

1. Provide the Tdap vaccine as prescribed.

2. Instruct the patient to ingest milk and dairy products.

3. Obtain throat cultures from the patient's close contacts.

4. Ensure the patient's diagnosis has been reported to the local health department.

5. Counsel the patient's family members to take antibiotics for 3 days as prescribed.

Page Ref: 1251

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

24) A patient seeks medical attention for a nosebleed. Which action should the nurse take to help this patient? Select all that apply.

1. Pinch the nose toward the septum.

2. Apply ice to the nose and forehead.

3. Place the patient in a seated position.

4. Insert rolled gauze pads into each nare.

5. Assist the patient to lean back when seated.

Page Ref: 1254

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

25) The nurse is preparing discharge instructions for a patient recovering from a rhinoplasty. What should the nurse include in these instructions? Select all that apply.

1. Apply ice to the nose.

2. Restrict oral fluid intake.

3. Avoid vigorous coughing.

4. Elevate the head of the bed on blocks.

5. Expect eye bruising for several weeks.

Page Ref: 1259

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

26) The public health nurse is preparing an education program on preventing laryngeal trauma and obstruction for community members. What should the nurse include in this program? Select all that apply.

1. How to perform the Heimlich maneuver.

2. Abstain from eating when ingesting alcohol.

3. Carry a list of medications in a wallet at all times.

4. Wear a medical alert bracelet if allergic to stinging insects.

5. People who wear dentures should take small bites when eating.

Page Ref: 1263

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

27) During a health history, the nurse suspects that a patient may be experiencing sleep apnea. What finding led the nurse to make this clinical decision? Select all that apply.

1. The patient is yawning.

2. Blood pressure is 188/92 mmHg.

3. The patient reports having a headache every morning.

4. The patient reports a change in appetite and a 10 lb weight loss in 2 months.

5. The patient says family members complain about snoring.

Page Ref: 1263

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with upper respiratory disorders.

28) A patient recovering from a total laryngectomy and permanent tracheostomy is being discharged. What observation indicates that discharge teaching has been effective? Select all that apply.

1. The patient supports the head when moving in bed.

2. The patient drinks cool fluids throughout the day.

3. The patient is eager to go to the pool to go swimming.

4. The patient places a gauze sponge around the gastrostomy tube.

5. The patient covers the tracheostomy with a light gauze sponge.

Page Ref: 1271

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Learning Outcome: 35.3 Describe the pathophysiology and manifestations of upper respiratory tumors and outline the interprofessional care and nursing care of patients with upper respiratory tumors.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

29) A patient avoids people with obvious colds and does not understand why colds continue to develop throughout the winter. What should the nurse respond to this patient? Select all that apply.

1. Vaccinations would prevent the development of colds.

2. There are more than 200 strains of viruses that cause colds.

3. People can be infected with a virus before symptoms occur.

4. Drinking more fluids will prevent the development of colds.

5. Viruses can be spread through direct contact from contaminated objects.

Page Ref: 1234

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

30) A patient is prescribed fexofenadine (Allegra) for allergic rhinitis. For which reason should the nurse question providing the medication to this patient? Select all that apply.

1. History of asthma

2. Treatment for glaucoma

3. Type 2 diabetes mellitus controlled by diet

4. Medication for benign prostatic hypertrophy

5. Over-the-counter pain medication for arthritis

Page Ref: 1235

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

MNL Learning Outcome: 2. Consider intraprofessional care for patients with upper respiratory disorders.

31) An older patient with influenza is encouraged to drink plenty of fluids and get adequate rest to prevent the development of complications. What physiological change is the nurse most concerned about in this patient? Select all that apply.

1. Reduced thirst reflex

2. Altered hypothalamic response

3. Increased residual lung volume

4. Reduced effectiveness of cough

5. Muted chemoreceptors in the aortic arch

Page Ref: 1240

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

32) A hospitalized patient is diagnosed with influenza. What action should the nurse take to help this patient? Select all that apply.

1. Assign the patient to a private room.

2. Implement droplet precautions.

3. Wear a mask when caring for the patient.

4. Measure the patient for a HEPA filter face mask.

5. Apply a mask to the patient when transporting the patient out of the room.

Page Ref: 1242

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

33) A patient with chronic sinus infections is scheduled for the Caldwell-Luc procedure. What should the nurse include when teaching the patient about this procedure? Select all that apply.

1. Dentures should be inserted immediately after the surgery.

2. Avoid the Valsalva maneuver for 2 weeks after the surgery.

3. Packing will be present for 24 to 48 hours after the procedure.

4. A liquid diet will be permitted for the first day after the surgery.

5. The upper lip and teeth may be numb for several months after the surgery.

Page Ref: 1244

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

34) The nurse is planning care for a patient with viral laryngitis. What should the nurse include when teaching the patient about care for this condition? Select all that apply.

1. Avoid all tobacco.

2. Do not use the voice.

3. Avoid ingesting alcohol.

4. Take all antibiotics as prescribed.

5. Spray the throat with antiseptic solution as prescribed.

Page Ref: 1249

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

35) A patient's nasopharyngeal culture results are positive for B. pertussis. What action should the nurse take for this patient? Select all that apply.

1. Restrict fluids.

2. Monitor intake and output.

3. Place in respiratory isolation.

4. Administer erythromycin as prescribed.

5. Report the test results to the local health department.

Page Ref: 1253-1254

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with upper respiratory disorders.

36) During an assessment, the nurse is concerned that a patient is at risk for developing laryngeal cancer. What did the nurse assess to make this clinical decision? Select all that apply.

1. The patient works in a steel mill.

2. The patient is a 68-year-old African American male.

3. The patient smokes two packs of cigarettes a day.

4. The patient eats a salad every night with dinner.

5. The patient drinks beer and whiskey every night.

Page Ref: 1268

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: High Risk Behaviors

Learning Outcome: 35.3 Describe the pathophysiology and manifestations of upper respiratory tumors and outline the interprofessional care and nursing care of patients with upper respiratory tumors.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with upper respiratory disorders.

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Created Date:

Aug 21, 2025

Chapter Name:

Chapter 35 Nursing Care Of Patients With Upper Respiratory Disorders

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LeMone, Burke, Gerene Bauldoff

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Ch35 Nursing Care Of Patients With Upper Test Bank + Answers

LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 35 Nursing Care of Patients with Upper Respiratory Disorders

1) A patient tells the nurse he has a "cold" every spring that lasts a few weeks. Which health problem should the nurse suspect the patient is experiencing?

2) A patient reports having a congested nose that is worse after using a nasal spray. Which manifestation is this patient describing?

3) A middle-aged patient is seen in the clinic for a continuing cough after recovering from the flu "a few weeks ago." What should the nurse suspect is occurring with this patient?

4) A patient who was diagnosed with the flu is demonstrating rapid, shallow respirations. For which health problem should the nurse suspect the patient is at risk for developing?

5) A patient reports needing to see a dentist because of upper teeth pain. Which action should the nurse take?

6) During an assessment, the nurse learns that the only thing that helps a patient with a daily morning headache is "using a vaporizer with eucalyptus" before breakfast. Which health problem should the nurse suspect the patient is experiencing?

7) The nurse suspects that a patient has tonsillitis. What did the nurse assess to make this clinical decision? Select all that apply.

8) A middle-aged adult patient who is diagnosed with pertussis is complaining of right-sided thoracic pain. For which health problem should the nurse assess this patient? Select all that apply.

9) A patient is receiving anterior nasal packing for a nosebleed. What should be included in the instructions for this patient?

10) While engaging in a high school sports activity, an adolescent sustains an injury to the nose. Which assessment finding indicates that the patient has a nasal fracture? Select all that apply.

11) A patient with multiple facial and nasal injuries needs a nasogastric tube placed. Which method should the nurse use to place this tube?

12) While eating a meal in the hospital, a patient exhibits difficulty breathing and signs of choking. What should the nurse realize the patient is experiencing?

13) The nurse observes a patient's respirations during sleep and notes the absence of respirations that lasts from 15 to 45 seconds. What should the nurse consider this patient is experiencing?

14) A patient who is scheduled for a partial laryngectomy asks if he will still be able to talk after the surgery. Which response would be appropriate for the nurse to make? Select all that apply.

15) While recovering at home from a total laryngectomy, a patient notices an increase in left shoulder weakness. With what should the nurse realize this symptom is consistent?

16) A patient with laryngeal cancer is found to have carcinoma in situ. For which stage of cancer should the nurse plan care for this patient?

17) A patient with nasal trauma has clear, watery fluid dripping from the nose. After testing, the nurse learns this fluid contains glucose. What should this finding indicate to the nurse?

18) During a health history, the nurse learns that a patient experiences several head colds each year. What teaching should the nurse consider providing to this patient? Select all that apply.

19) The nurse is caring for patients who have been exposed to the influenza virus. For which patient should the nurse question the use of the antiviral drug zanamivir (Relenza)? Select all that apply.

20) A patient has an ongoing sinus infection. In addition to antibiotics, which treatment should the nurse expect to be prescribed for this patient? Select all that apply.

21) The nurse provides discharge instructions to a patient recovering from endoscopic sinus surgery. Which patient statement indicates that teaching has been effective? Select all that apply.

22) A patient with a penicillin allergy is diagnosed with scarlet fever. Which medication should the nurse anticipate being prescribed for this patient? Select all that apply.

23) The community health nurse learns that an adult community member has been diagnosed with diphtheria. What should the nurse do to prevent the spread of this infection? Select all that apply.

24) A patient seeks medical attention for a nosebleed. Which action should the nurse take to help this patient? Select all that apply.

25) The nurse is preparing discharge instructions for a patient recovering from a rhinoplasty. What should the nurse include in these instructions? Select all that apply.

26) The public health nurse is preparing an education program on preventing laryngeal trauma and obstruction for community members. What should the nurse include in this program? Select all that apply.

27) During a health history, the nurse suspects that a patient may be experiencing sleep apnea. What finding led the nurse to make this clinical decision? Select all that apply.

28) A patient recovering from a total laryngectomy and permanent tracheostomy is being discharged. What observation indicates that discharge teaching has been effective? Select all that apply.

29) A patient avoids people with obvious colds and does not understand why colds continue to develop throughout the winter. What should the nurse respond to this patient? Select all that apply.

30) A patient is prescribed fexofenadine (Allegra) for allergic rhinitis. For which reason should the nurse question providing the medication to this patient? Select all that apply.

31) An older patient with influenza is encouraged to drink plenty of fluids and get adequate rest to prevent the development of complications. What physiological change is the nurse most concerned about in this patient? Select all that apply.

32) A hospitalized patient is diagnosed with influenza. What action should the nurse take to help this patient? Select all that apply.

33) A patient with chronic sinus infections is scheduled for the Caldwell-Luc procedure. What should the nurse include when teaching the patient about this procedure? Select all that apply.

34) The nurse is planning care for a patient with viral laryngitis. What should the nurse include when teaching the patient about care for this condition? Select all that apply.

35) A patient's nasopharyngeal culture results are positive for B. pertussis. What action should the nurse take for this patient? Select all that apply.

36) During an assessment, the nurse is concerned that a patient is at risk for developing laryngeal cancer. What did the nurse assess to make this clinical decision? Select all that apply.

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