Nokea
The nurse is caring for a patient who is scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx. The patient asks the nurse, 'How will I talk after the surgery?' Which of the following responses by the nurse is best?
- A. You will breathe through a permanent opening in your neck, but you will not be able to communicate orally.
- B. You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed.
- C. You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally.
- D. You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration.
Correct Answer: D
Rationale: Voice restoration is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be appropriate to tell a patient that this ability would be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible.
You may also like to solve these questions
The nurse is providing discharge instructions for a patient with a total laryngectomy. Which of the following patient statements indicate that additional instruction is required?
- A. I must keep the stoma covered with a loose sterile dressing at all times.
- B. I can participate in most of my prior fitness activities except swimming.
- C. I should wear a Medic Alert bracelet that identifies me as a neck breather.
- D. I need to be sure that I have smoke and carbon monoxide detectors installed.
Correct Answer: A
Rationale: The stoma may be covered with clothing or a loose dressing, but this is not essential. The other patient comments are all accurate and indicate that the teaching has been effective.
The nurse is caring for a patient with an uncuffed tracheostomy tube who coughs violently during suctioning and dislodges the tracheostomy tube. Which of the following actions should the nurse take first?
- A. Insert the obturator and attempt to reinsert the tracheostomy tube.
- B. Position the patient in an upright position with the neck extended.
- C. Assess the patient's oxygen saturation and notify the health care provider.
- D. Ventilate the patient with a manual bag until the health care provider arrives.
Correct Answer: A
Rationale: The first action should be to attempt to reinsert the tracheostomy tube to maintain the patient's airway. Assessing the patient's oxygenation is an important action, but it is not the most appropriate first action in this situation. Covering the stoma with a dressing and manually ventilating the patient may be an appropriate action if the nurse is unable to reinsert the tracheostomy tube. The patient should be placed in a semi-Fowler's position if reinsertion of the tracheostomy tube is not successful.
The nurse is teaching a patient with allergic rhinitis about management of the condition. Which of the following information should the nurse include in the teaching plan?
- A. Over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered.
- B. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use
- C. Use of oral antihistamines for a few weeks before the allergy season may prevent reactions.
- D. Identification and avoidance of environmental triggers are the best ways to avoid symptoms.
Correct Answer: D
Rationale: The most important intervention is to assist the patient in identifying and avoiding potential allergens. Intranasal corticosteroids (not oral antihistamines) should be started several weeks before the allergy season. Corticosteroid nasal sprays have minimal systemic absorption. Nonsedating antihistamines are available OTC.
The nurse is caring for a patient with a tracheostomy tube and is inflating the cuff to the appropriate level. Which of the following actions is best for the nurse to implement?
- A. Check the pilot balloon after inflation to ensure that it is firm.
- B. Use a manometer to ensure cuff pressure is at an appropriate level.
- C. Check the amount of cuff pressure ordered by the health care provider.
- D. Fill the balloon until minimal air leakage around the cuff is auscultated.
Correct Answer: B
Rationale: Measurement of cuff pressure using a manometer to ensure that cuff pressure is 20 mm Hg or lower will avoid compression of the tracheal capillaries. A firm pilot balloon indicates that the cuff is inflated but does not assess for over-inflation. A health care provider's order is not required to determine safe cuff pressure. A minimal leak technique is an alternate means for cuff inflation, but this technique does allow a small air leak around the cuff and increases the risk for aspiration.
The nurse is caring for a patient who has had an anterior packing for severe epistaxis. Which of the following nursing interventions should be included in the plan of care?
- A. Educate the patient to return in 3 days to have the nasal packing removed.
- B. Reassure the patient that the nose will look normal when the swelling subsides.
- C. Instruct the patient to keep the head elevated for 48 hours to minimize pain
- D. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDS) for pain control.
Correct Answer: A
Rationale: The patient should be instructed to return in 48-72 hours to have the anterior packing removed. Maintaining the head in an elevated position is not required. NSAIDs increase the risk for bleeding and should not be used. Although return to a preinjury appearance is the goal, it is not always possible to achieve this result and the nurse should not provide false reassurance.