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The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a patient who is postoperative day 1 following total laryngectomy. How should the nurse respond to this development?
- A. Remove the patients drain and apply pressure with a sterile gauze.
- B. Assess the patient, reposition the patient supine, and apply wall suction to the drain.
- C. Rapidly assess the patient and notify the surgeon about the patients bleeding.
- D. Administer a STAT dose of vitamin K to aid coagulation.
Correct Answer: C
Rationale: The nurse promptly notifies the surgeon of any active bleeding, which can occur at a variety of sites, including the surgical site, drains, and trachea. The drain should not be removed or connected to suction. Supine positioning would exacerbate the bleeding. Vitamin K would not be administered without an order.
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The nurse is caring for a patient who is postoperative day 2 following a total laryngectomy for supraglottic cancer. The nurse should prioritize what assessment?
- A. Assessment of body image
- B. Assessment of jugular venous pressure
- C. Assessment of carotid pulse
- D. Assessment of swallowing ability
Correct Answer: D
Rationale: A common postoperative complication from this type of surgery is difficulty in swallowing, which creates a potential for aspiration. Cardiovascular complications are less likely at this stage of recovery. The patients body image should be assessed, but dysphagia has the potential to affect the patients airway, and is a consequent priority.
The nurse is caring for a patient who has just been diagnosed with chronic rhinosinusitis. While being admitted to the clinic, the patient asks, Will this chronic infection hurt my new kidney? What should the nurse know about chronic rhinosinusitis in patients who have had a transplant?
- A. The patient will have exaggerated symptoms of rhinosinusitis due to immunosuppression.
- B. Taking immunosuppressive drugs can contribute to chronic rhinosinusitis.
- C. Chronic rhinosinusitis can damage the transplanted organ.
- D. Immunosuppressive drugs can cause organ rejection.
Correct Answer: B
Rationale: URIs, specifically chronic rhinosinusitis and recurrent acute rhinosinusitis, may be linked to primary or secondary immune deficiency or treatment with immunosuppressive therapy (i.e., for cancer or organ transplantation). Typical symptoms may be blunted or absent due to immunosuppression. No evidence indicates damage to the transplanted organ due to chronic rhinosinusitis. Immunosuppressive drugs do not cause organ rejection.
The perioperative nurse has admitted a patient who has just undergone a tonsillectomy. The nurses postoperative assessment should prioritize which of the following potential complications of this surgery?
- A. Difficulty ambulating
- B. Hemorrhage
- C. Infrequent swallowing
- D. Bradycardia
Correct Answer: B
Rationale: Hemorrhage is a potential complication of a tonsillectomy. Increased pulse, fever, and restlessness may indicate a postoperative hemorrhage. Difficulty ambulating and bradycardia are not common complications in a patient after a tonsillectomy. Infrequent swallowing does not indicate hemorrhage; frequent swallowing does.
The occupational health nurse is obtaining a patient history during a pre-employment physical. During the history, the patient states that he has hereditary angioedema. The nurse should identify what implication of this health condition?
- A. It will result in increased loss of work days.
- B. It may cause episodes of weakness due to reduced cardiac output.
- C. It can cause life-threatening airway obstruction.
- D. It is unlikely to interfere with the individuals health.
Correct Answer: C
Rationale: Hereditary angioedema is an inherited condition that is characterized by episodes of life-threatening laryngeal edema. No information supports lost days of work or reduced cardiac function.
The nurse is creating a care plan for a patient who is status post-total laryngectomy. Much of the plan consists of a long-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen?
- A. Esophageal speech
- B. Electric larynx
- C. Tracheoesophageal puncture
- D. American sign language (ASL)
Correct Answer: C
Rationale: Tracheoesophageal puncture is simple and has few complications. It is associated with high phonation success, good phonation quality, and steady long-term results. As a result, it is preferred over esophageal speech, and electric larynx or ASL.