Nokea
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
- C. Normal saline application
- D. Silver nitrate application
Correct Answer: D
Rationale: 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 visualize the nasal septum, but it does not alleviate the bleeding. Irrigation with a hypertonic solution is not used to treat epistaxis.
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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)
Correct Answer: A
Rationale: Chronic pharyngitis is common in adults who live and work in dusty surroundings, use the voice to excess, suffer from chronic cough, and habitually use alcohol and tobacco. Caffeine and spicy foods have not been linked to chronic pharyngitis. GERD is not a noted risk factor.
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
Correct Answer: A
Rationale: 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 blood-tinged mucus do not require follow-up if the patient has acute rhinosinusitis. A persistent headache does not necessarily warrant immediate follow-up.
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. Hoarseness
- B. Dyspnea
- C. Dysphagia
- D. Frequent nosebleeds
Correct Answer: A
Rationale: 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.
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.
Correct Answer: C
Rationale: 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.
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?
- A. Avoid blowing the nose for the next 45 minutes.
- 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.
Correct Answer: B
Rationale: 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 avoid blowing the nose for an extended period of time, not just 45 minutes.