1. A patient who has cancer of the larynx has been told that he needs a total laryngectomy:
What action should this nurse consider to help the patient cope with the loss of his voice?
a. Offer to have a volunteer from a local laryngectomy organization visit the patient:
b. Explain in detail the available vocalization aids and techniques:
c. Explain to the patient what will happen directly after the surgery:
d. Notify the hospital chaplain of the patient’s needs:
ANS: A
Offering to request a volunteer from the laryngectomy organization is a recommended
implementation to reduce the stress of losing the ability to speak: You should consult
the patient before making the referral:
DIF: Cognitive Level: Application REF: p: 480 OBJ: 1
TOP: Cancer of the Larynx KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
2. Which nursing concern takes priority in the care of a patient after a laryngectomy?
a. Encouraging nutrition
b. Avoiding infection
c. Establishing a communication system
d. Ensuring adequate fluid intake
ANS: C
Establishing a communication system with the patient who has undergone a
laryngectomy is a primary concern:
DIF: Cognitive Level: Application REF: p: 481 OBJ: 1
TOP: Postoperative Laryngectomy KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
3. A patient who had a laryngectomy 3 months earlier returns to the physician’s office with
the complaint of increasing dyspnea: Which common post laryngectomy complication
should the nurse recognize this complaint as indicating?
a. Hypertrophied stoma
b. Salivary fistula
c. Carotid blowout
d. Tracheal stenosis
ANS: D
, Tracheal stenosis causes the otherwise healthy recovering patient who has undergone
a laryngectomy to experience increased dyspnea:
DIF: Cognitive Level: Comprehension REF: p: 481 OBJ: 1
TOP: Postoperative Complications of Laryngectomy
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early
Detection of Disease
4. What is one major postoperative difficulty for a patient having a supraglottic
laryngectomy?
a. Teaching the patient to use an assistive device to speak
b. Coughing without letting food escape through the tracheostomy
c. Taking care of the tracheostomy, because the patient will always have to have one
d. Teaching the patient to swallow without aspiration
ANS: D
The patient who has had a supraglottic laryngectomy may never be able to swallow
correctly, which could easily lead to aspiration pneumonia:
DIF: Cognitive Level: Comprehension REF: p: 482 OBJ: 1
TOP: Supraglottic Laryngectomy KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early
Detection of Disease
5. What should the initial action of a nurse be when providing first aid to a person with
spontaneous epistaxis?
a. Apply direct pressure for 3 to 5 minutes:
b. Have the person sit down and lean forward:
c. Have the person lie down and apply an ice pack:
d. Have the person clear the nasal passages by blowing the nose:
ANS: B
The first action is to sit down and lean forward: Applying pressure just below the nose
will also help:
DIF: Cognitive Level: Application REF: p: 473 OBJ: 1
TOP: Epistaxis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk
6. What is true regarding bacterial pharyngitis that is untrue for viral pharyngitis?
a. Has an abrupt onset
b. Presents a normal complete blood count (CBC)
c. Presents a negative culture
d. Has no serious complications
ANS: A
, Bacterial pharyngitis has an abrupt onset, an elevated white count on the CBC, and a
positive culture and can lead to glomerulonephritis, rheumatic fever, and mastoiditis:
DIF: Cognitive Level: Comprehension REF: p: 474 OBJ: 1
TOP: Bacterial Pharyngitis KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
7. Which is the best candidate for a tonsillectomy?
a. A 52-year-old patient with a hearing deficit related to otitis media from tonsillitis
b. A 23-year-old patient with a peritonsillar abscess
c. A 34-year-old patient with enlarged tonsils and adenoids
d. A 15-year-old patient with one bout of tonsillitis in the previous 12 months
ANS: B
The patient with the peritonsillar abscess is the most likely candidate: the hearing
deficit in a middle-aged person would need more investigation before surgery:
Enlarged tonsils and adenoids without a respiratory obstruction does not qualify as a
need for surgery; only one episode of tonsillitis in a year does not qualify:
DIF: Cognitive Level: Analysis REF: p: 476 OBJ: 1
TOP: Tonsillitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early
Detection of Disease
8. A patient complains of morning headaches, a feeling of fullness in her head, and a pain
similar to that of a toothache under her eye: What should the nurse recognize that these
symptoms indicate?
a. Nasal polyps
b. Impacted wisdom teeth
c. Allergic rhinitis
d. Sinusitis
ANS: D
Sinusitis has the classic signs of headache, sense of fullness in the head, and a
sensitive area over the sinuses:
DIF: Cognitive Level: Comprehension REF: p: 470 OBJ: 1
TOP: Sinusitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
9. A patient complains that he wants an antibiotic medication for his cold: What is the best
response by the nurse?
a. “Antibiotics are not effective with viral infections:”
b. “You will get better faster without the antibiotics:”
c. “You might try echinacea or vitamin C:”
d. “A cold is not that serious: Try forcing fluids:”
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