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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.
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A patient states that her family has had several colds during this winter and spring despite their commitment to handwashing. The high communicability of the common cold is attributable to what factor?
- A. Cold viruses are increasingly resistant to common antibiotics.
- B. The virus is shed for 2 days prior to the emergence of symptoms.
- C. A genetic predisposition to viral rhinitis has recently been identified.
- D. Overuse of OTC cold remedies creates a rebound susceptibility to future colds.
Correct Answer: B
Rationale: Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase. Antibiotic resistance is not relevant to viral illnesses and OTC medications do not have a rebound effect. Genetic factors do not exist.
A nursing student is discussing a patient with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for patients with viral pharyngitis?
- A. Teaching focuses on safe and effective use of antibiotics.
- B. The patient should be preliminarily screened for surgery.
- C. Symptom management is the main focus of medical and nursing care.
- D. The focus of care is resting the voice to prevent chronic hoarseness.
Correct Answer: C
Rationale: Nursing care for patients with viral pharyngitis focuses on symptomatic management. Antibiotics are not prescribed for viral etiologies. Surgery is not indicated in the treatment of viral pharyngitis. Chronic hoarseness is not a common sequela of viral pharyngitis, so teaching ways to prevent it would be of no use in this instance.
A patient is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the patients nutrition during treatment?
- A. A 1.5 L/day fluid restriction
- B. A high-potassium, low-sodium diet
- C. A liquid or soft diet
- D. A high-protein diet
Correct Answer: C
Rationale: A liquid or soft diet is provided during the acute stage of the disease, depending on the patients appetite and the degree of discomfort that occurs with swallowing. The patient is encouraged to drink as much fluid as possible (at least 2 to 3 L/day). There is no need for increased potassium or protein intake.
A mother calls the clinic asking for a prescription for Amoxicillin for her 2-year-old son who has what the nurse suspects to be viral rhinitis. What should the nurse explain to this mother?
- A. I will relay your request promptly to the doctor, but I suspect that she wont get back to you if its a cold.
- B. Ill certainly inform the doctor, but if it is a cold, antibiotics wont be used because they do not affect the virus.
- C. Ill phone in the prescription for you since it can be prescribed by the pharmacist.
- D. Amoxicillin is not likely the best antibiotic, but Ill call in the right prescription for you.
Correct Answer: B
Rationale: Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications. In addition, their inappropriate use has been implicated in development of organisms resistant to therapy. It would be inappropriate to tell the patient that the physician will not respond to her request.
A patient has just been diagnosed with squamous cell carcinoma of the neck. While the nurse is doing health education, the patient asks, Does this kind of cancer tend to spread to other parts of the body? What is the nurses best response?
- A. In many cases, this type of cancer spreads to other parts of the body.
- B. This cancer usually does not spread to distant sites in the body.
- C. You will have to speak to your oncologist about that.
- D. Squamous cell carcinoma is nothing to be concerned about, so try to focus on your health.
Correct Answer: B
Rationale: The incidence of distant metastasis with squamous cell carcinoma of the head and neck (including larynx cancer) is relatively low. The patients prognosis is determined by the oncologist, but the patient has asked a general question and it would be inappropriate to refuse a response. The nurse must not downplay the patients concerns.