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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.
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The nurse is providing care for a patient who has just been admitted to the postsurgical unit following a laryngectomy. What assessment should the nurse prioritize?
- A. The patients swallowing ability
- B. The patients airway patency
- C. The patients carotid pulses
- D. Signs and symptoms of infection
Correct Answer: B
Rationale: The patient with a laryngectomy is at risk for airway occlusion and respiratory distress. As in all nursing situations, assessment of the airway is a priority over other potential complications and assessment parameters.
A patients total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the patient when teaching him about this process?
- A. Training on how to perform controlled belching
- B. Use of an electronically enhanced artificial pharynx
- C. Insertion of a specialized nasogastric tube
- D. Fitting for a voice prosthesis
Correct Answer: D
Rationale: In patients receiving transesophageal puncture, a valve is placed in the tracheal stoma to divert air into the esophagus and out the mouth. Once the puncture is surgically created and has healed, a voice prosthesis (Blom-Singer) is fitted over the puncture site. A nasogastric tube and belching are not required. An artificial pharynx is not used.
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 nurse is conducting a presurgical interview for a patient with laryngeal cancer. The patient states that he drinks approximately six to eight shots of vodka per day. It is imperative that the nurse inform the surgical team so the patient can be assessed for what?
- A. Increased risk for infection
- B. Delirium tremens
- C. Depression
- D. Nonadherence to postoperative care
Correct Answer: B
Rationale: Considering the known risk factors for cancer of the larynx, it is essential to assess the patients history of alcohol intake. Infection is a risk in the postoperative period, but not an appropriate answer based on the patients history. Depression and nonadherence are risks in the postoperative phase, but would not be critical short-term assessments.
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.