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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.
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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.
The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk?
- A. Facilitate total parenteral nutrition (TPN).
- B. Keep a complete suction setup at the bedside.
- C. Feed the patient several small meals daily.
- D. Refer the patient for occupational therapy.
Correct Answer: B
Rationale: Due to the risk for aspiration, the nurse keeps a suction setup available in the hospital and instructs the family to do so at home for use if needed. TPN is not indicated and small meals do not necessarily reduce the risk of aspiration. Physical therapists do not address swallowing ability.
A 42-year-old patient is admitted to the ED after an assault. The patient received blunt trauma to the face and has a suspected nasal fracture. Which of the following interventions should the nurse perform?
- A. Administer nasal spray and apply an occlusive dressing to the patients face.
- B. Position the patients head in a dependent position.
- C. Irrigate the patients nose with warm tap water.
- D. Apply ice and keep the patients head elevated.
Correct Answer: D
Rationale: Immediately after the fracture, the nurse applies ice and encourages the patient to keep the head elevated. The nurse instructs the patient to apply ice packs to the nose to decrease swelling. Dependent positioning would exacerbate bleeding and the nose is not irrigated. Occlusive dressings are not used.
The nurse is explaining the safe and effective administration of nasal spray to a patient with seasonal allergies. What information is most important to include in this teaching?
- A. Finish the bottle of nasal spray to clear the infection effectively.
- B. Nasal spray can only be shared between immediate family members.
- C. Nasal spray should be administered in a prone position.
- D. Overuse of nasal spray may cause rebound congestion.
Correct Answer: D
Rationale: The use of topical decongestants is controversial because of the potential for a rebound effect. The patient should hold his or her head back for maximal distribution of the spray. Only the patient should use the bottle.
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.