(Osborn) Chapter 34 Learning Outcomes (Number and Title)

[Osborn] chapter 34
Learning Outcomes [Number and Title ]

Learning Outcome 1
Compare and contrast nursing management of the most
common facial fractures.
Learning Outcome 2
Explain nursing care for a patient with sinus disease.
Learning Outcome 3
Differentiate the essential components for developing a
teaching plan for patients with infections of the upper airway.
Learning Outcome 4
Discuss the implications of the loss of the senses of smell,
sight, and taste in patients with upper airway disorders and
disfigurement.
Learning Outcome 5
Compare and contrast the nursing management of patients with
partial versus total airway obstruction
Learning Outcome 6
Identify the risk factors of head and neck cancer.
Learning Outcome 7
Explain the nursing management of a patient with head and
neck cancer in the acute care setting related to airway, wounds,
pain, and nutrition.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.
1. Which client requires the most immediate intervention by the nurse?

1.
2.
3.
4.
A client with a maxillary fracture who has been swallowing frequently

A client with a temporal bone fracture experiencing hearing loss
A client with a fractured nasal bone experiencing a nosebleed
A client with a mandibular fracture who has facial numbness and tingling
Correct Answer: A client with a maxillary fracture who has been swallowing frequently
Rationale: The client with a maxillary fracture who is swallowing frequently is the priority,
as this client is experiencing increased bleeding. This is likely to quickly cause airway
obstruction and hemorrhage, especially if a LeFort III maxillary fracture is suspected.
Transient hearing loss is common with temporal bone fractures, as these fractures frequently
affect the tympanic membrane. The client with the fractured nasal bone will experience a
nosebleed, but is not in danger of hemorrhage as is the client with the maxillary fracture. The
numbness and tingling in the client with the mandibular fracture is not the priority, as this is
expected and transient as the edema of the trigeminal facial nerves dissipates.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 1
2. The nurse is assessing a client who has received trauma to the face. If the client states,
My gums feel like they do when I have a cavity filled, which nursing action would the
nurse expect to include in the plan of care?
1. Preparing the client for surgery
2. Calling the clients dentist
3. Preparing equipment for intubation
4. Keeping ice packs available for the next 24 hours
Correct Answer: Preparing the client for surgery
Rationale: Most likely, the client has a mandibular fracture causing trauma to cranial nerve V,
or the trigeminal nerve. As the trigeminal nerve supplies sensation to the teeth, the numbness
indicates a mandibular fracture, requiring surgery. Planning to call the dentist is not helpful at
present since the client requires surgery. There is no indication the client requires intubation
at this time. The client may need ice packs, but the priority for planning is surgery.
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 1
3. The nurse assesses a client with a temporal bone fracture and notices drainage from the
right nare. Based on this assessment, which nursing diagnosis should the nurse document as
priority for this client?
1. Potential for infection
2. Risk for pain
3. Risk for impaired sensory input
4. Foreign body
Correct Answer: Potential for infection
Rationale: Potential for infection is the nursing diagnosis that should be documented in the
chart, as the drainage may indicate a cerebrospinal fluid leak. While the client may be in pain
and may have an impaired sense of smell, the potential for infection from meningitis is the
priority. There is no indication the client has a foreign body.
Nursing Process: Diagnosis
LO: 1
4. A client in the unit who has diabetes complains of a tingling sensation in the face and has a
started running a fever. Two hours later, the nurse notes a dark nasal drainage coming from
the clients nose. Which is the nurses priority action?
1.
2.
3.
4.
Notify the healthcare provider immediately.

Administer antipyretics.
Obtain a blood glucose level.
Encourage the client to frequently blow his or her nose.
Correct Answer: Notify the healthcare provider immediately.

Rationale: When a diabetic client complains of a tingling sensation and has an elevated
temperature, the nurse must notify the provider of these signs of mucormycosis. The provider
needs to treat with antifungal therapy and surgical removal of the affected tissue.
Administering antipyretics is a comfort measure for the client, but is not the priority.
Obtaining a blood glucose level and frequent nose blowing is not necessary, and therefore not
a priority.
LO: 2
5. The client asks the nurse why the health care provider wants to have a follow-up
appointment 6 months after a polypectomy. Which is the most appropriate response?
1. Polyps can return, so the health care provider wants to make sure they
havent returned.
2. The health care provider always rechecks clients after surgical removal of
polyps.
3. The insurance company requires the health care provider to recheck our
clients.
4. Cancerous polyps are likely to recur, so we need to recheck you for this.
Correct Answer: Polyps can return, so the health care provider wants to make sure they
havent returned.
Rationale: Polyps can grow back, and if they do so in a few months, the client may require
further testing to determine the exact cause. Just because they grew back does not make them
more likely to be cancerous. The other options are not addressing the reason behind the
recheck for the clients health.
Cognitive Level: Application
LO: 2
6. The nurse is discussing care of the client with rhinitis. Which of the following statements
indicates the caregiver understands the content of the teaching session?
1. It may not always be necessary to take allergy medications to avoid these
symptoms.
2. Since there are so many different triggers, it will be necessary to take allergy
injections forever.
3. The only way to avoid these symptoms is to completely avoid the trigger.
4. Since this has only occurred once, I can be sure it is not allergic in nature.
Correct Answer: It may not always be necessary to take allergy medications to avoid these
symptoms.
Rationale: It is possible for clients to outgrow allergies as the immune system becomes less
sensitive to the trigger. In some clients with allergies, injections are given until the client
reaches a maintenance dose, when it is possible for the injections to be discontinued. There
are ways to avoid symptoms other than completely avoiding the trigger, including taking
allergy medications on a daily basis. There is no way to be certain the symptoms will not
recur just because it is the first episode.
Nursing Process: Evaluation
Client Need: Health Promotion and Maintenance
LO: 2
7. When caring for a client after dental surgery, which nursing action is most essential?
1.
2.
3.
4.
Educating the client about proper oral care

Administering analgesics as ordered
Encouraging the client to floss daily
Administering antipyretics as ordered
Correct Answer: Educating the client about proper oral care

Rationale: Once a dental abscess is drained and the affected areas cleaned, the most essential
nursing action is educating the client about proper oral care. This includes both wound care
after surgery and oral care to help prevent further abscesses in the future. Analgesics and
antipyretics are important, but physical needs such as wound care take priority. Encouraging
the client to floss daily is included in education on proper oral care. There is more to proper
oral care than just daily flossing.
LO: 3
8. It is most important for the nurse to include which instruction in the healthcare teaching of
a client who has had laryngeal papillomas removed?
1.
2.
3.
4.
If you experience recurrent hoarseness, come in for a check-up.

Papillomas rarely cause airway obstruction.
Next time, we can remove them in the office, so no admission is necessary.
You should come in if you have worsening respiratory distress, so we can
intubate you quickly.
Correct Answer: If you experience recurrent hoarseness, come back in for a check-up.
Rationale: Since laryngeal papillomas can recur, it is important for the client to be aware and
return if hoarseness occurs. Papillomas can cause airway obstruction, but intubation should
be avoided to lessen the likelihood they spread to the trachea and lungs. Anytime a procedure
must be done involving close proximity to the airway, admission and observation should be a
priority.
LO: 3
9. The nurse is discussing common illnesses experienced in childhood with staff members of
a daycare. Appropriate learning has taken place when which of the following statements is
made?
1. Even though the child may have a fever and a sore throat, antibiotics may not
be necessary.
2. Since the provider may not know for sure if the pharyngitis is caused by
streptococcus or not, antibiotics should be prescribed.
3. The child diagnosed with pharyngitis cannot return to school until the
antibiotics are completed.
4. Since pharyngitis is not usually caused by bacteria, I do not have to be
concerned with getting it.
Correct Answer: Even though the child may have a fever and a sore throat, antibiotics may
not be necessary.
Rationale: Antibiotics are only necessary for pharyngitis if caused by bacteria such as
streptococcus. This is known through a rapid strep test and/or a throat culture. If it is
bacterial in origin, the child can return to school when he or she has been on antibiotics for a
full 24 hours. Pharyngitis should be considered contagious, as it is the direct result of an
upper respiratory infection such as a cold or influenza.
LO: 3
10. A client states, I dont watch television because I cannot stand how the people look on
my television. Which question should the nurse ask next?
1.
2.
3.
4.
What is it about how the people look on the television that bothers you?
Do you have an older television set that needs repair?
Is the screen on your television dusty?
Can you see the writing on your prescription bottles?
Correct Answer: What is it about how the people look on the television that bothers you?
Rationale: Asking the client what bothers him or her about the television allows the client to
elaborate on the issue without making assumptions. Open-ended questions are usually more
appropriate because they elicit more information. Asking about the television set diverts
attention from the client, and asking about the writing on the prescription bottles assumes the
client cannot see well enough to view television.
Nursing Process: Assessment
LO: 4
11. When planning care for a client with a permanent laryngectomy airway, the nurse should
include which considerations?
Select all that apply.
1.
2.
3.
4.
5.
The client will be unable to speak.

The client will require enteral feedings until healed.
The family and client cannot read.
The family may be unable to communicate with the client.
The client requires isolation until the site is healed.
Correct Answer:
1. The client will be unable to speak.
2. The client will require enteral feedings until healed.
3. The family and client cannot read.
Rationale:
The client will be unable to speak. Until the surgical site is healed, the client will be unable
to speak. The client will require enteral feedings until healed. The client will require
enteral feedings until healed. The family and client cannot read. Until the surgical site is
healed, the client will be unable to speak. Communication will be much more difficult when
both family and client cannot read. The family may be unable to communicate with the
client. The nurse must devise methods for family, nurse, and client to communicate before
the surgery takes place. The client requires isolation until the site is healed. There is no
reason for isolation until healed, but meticulous wound care is paramount.
LO: 4
12. When preparing for a maxillary resection, the nurse should provide the client and family
with which instruction?
1. It is important to keep objects within reach and in the same place at all
times.
2. Your speech will not be affected, so communication will not be a problem.
3. You will be given pain medication whenever you need it, so pain should not
be a concern.
4. It will be at least 3 to 4 days after surgery before you will be allowed out of
bed.
Correct Answer: It is important to keep objects within reach and in the same place at all
times.
Rationale: Maxillary resection will most likely result in some changes in eyesight, and could
include blindness depending on tumor location. Therefore, it is imperative to keep objects
within reach and in the same place. Speech will most likely be affected, and clients will be
concerned about pain and may not be able to get medication whenever they request it. Clients
will most likely be mobile on day 1 postoperatively to decrease joint pain from the long
surgery, decrease the likelihood of ulcer formation, and decrease the likelihood of deep vein
thromboses.
LO: 4
13. When planning care for a client with a partial airway obstruction, which nursing
intervention has the greatest priority?
1. Ensuring advanced airway equipment is at the bedside
2. Ensuring the resuscitation team is on standby
3. Keeping the client calm and relaxed
4. Providing pain medication around the clock
Correct Answer: Ensuring advanced airway equipment is at the bedside
Rationale: Whenever a client has the potential to quickly lose the airway, advanced airway
tools such as intubation equipment and tracheotomy supplies should always remain at the
bedside. The resuscitation team, keeping the client calm, and providing pain medication are
needed, but maintaining the airway is priority.
LO: 5
14. When a clients airway becomes completely obstructed, which sign will the nurse see
first?
1. A sudden inability to follow directions
2. Cyanosis changing to pallor
3. Pallor changing to cyanosis
4. A decrease in urine output
Correct Answer: A sudden inability to follow directions
Rationale: When the client loses the airway, he or she will have a change in the level of
consciousness that the nurse will first see as an altered mental status. This change precedes
any color changes and a decrease in urine output.
LO: 5
15. When providing discharge instructions for the family and client with a tracheostomy,
which of the following statements indicates the caregiver understands the instructions?
1. I will clean the site under the tracheostomy plate with half-strength hydrogen
peroxide at least twice daily.
2. When he is ready for decannulation, I will bring him back in to have the
stoma sutured closed.
3. I can suction the trachea as often as necessary to decrease secretions coming
from the tube.
4. He cannot resume normal activities as long as he has the trachesostomy in
place.
Correct Answer: I will clean the site under the tracheostomy plate with half strength
hydrogen peroxide at least twice daily.
Rationale: Cleaning the site around the tube and under the plate will help keep secretions
from irritating the skin in and around the stoma. The stoma is allowed to close naturally when
the client is ready for decannulation; it is never sutured closed. Suctioning the trachea should
only be done only when absolutely necessary to prevent tracheal irritation and mucosal
breakdown. The goal for clients discharged with a tracheostomy is to resume activities as
normally as possible.
LO: 5
16. Which individual is most at risk for head and neck cancer?
1. An older female with a history of using snuff
2. An older male with a history of preferring meat and potatoes
3. A young male with a history of smoking for 15 years
4. A young female infected with human papillomavirus
Correct Answer: An older female with a history of using snuff
Rationale: Any client with a history of using smokeless tobacco is 50 times more likely to
experience a cancer of the cheeks, gums, and inner surface of the lips. Decreased intake of
fruits and vegetables, smoking, and human papillomavirus infection all increase the risk, but
not as high as in those using smokeless tobacco.
LO: 6
17. Which individual has the most risk factors for developing head and neck cancer?
1. A Chinese American who drinks one alcoholic beverage every day and has
smoked half a pack of cigarettes daily for the past 20 years
2. An African American who drinks and smokes a cigar when on the town with
friends for their monthly get-together
3. An Italian American who has had a liver transplant in the past 6 months
4. A Japanese American who has a poor diet consisting of mostly rice and meat
Correct Answer: A Chinese American who drinks one alcoholic beverage every day and has
smoked half a pack of cigarettes daily for the past 20 years
Rationale: The risk for cancer is correlated with the length and amount of tobacco smoked or
chewed, and rises even higher when tobacco use is combined with alcohol use. Individuals
who are from an Asian heritage also have an increased risk of nasopharyngeal cancer,
especially if they have a history of eating salt-preserved fish. The other cultural heritages
have no known link to developing head and neck cancer, and the individuals lifestyles place
them at lower risk.
LO: 6
18. After a client has had a surgical resection for a head and neck cancer, which is the priority
nursing diagnosis?
1. Risk for Impaired Gas Exchange related to new tracheotomy
2. Knowledge Deficit related to necessary home care
3. Risk for Injury related to CSF leak
4. Anxiety related to changes in health status
Correct Answer: Risk for Impaired Gas Exchange related to new tracheotomy
Rationale: Nursing diagnoses currently applicable to the clients hospitalization take priority
over those after discharge. Impaired Gas Exchange takes priority because it relates to a basic
physical need for a patent airway and ability to circulate oxygen to the peripheral and central
circulation. Risk for Injury is important but is secondary to airway. Anxiety is important, but
is psychosocial in nature and is therefore secondary to all physical nursing diagnoses.
Nursing Process: Diagnosis
LO: 7
19. Which most accurately describes the priority goal for wound care management in the
client who has undergone surgical resection of a head and neck cancer?
1.
2.
3.
4.
Prevent shifts in electrolyte and fluid balances.

Prevent fistula development in the wound bed.
Prevent decubitus ulcer formation.
Prevent flap failure.
Correct Answer: Prevent shifts in electrolyte and fluid balances.

Rationale: While all four options are important in the postoperative period, the priority is
preventing shifts in fluid and electrolytes through monitoring for bleeding, either from the
carotid artery if at or near the surgical site, and excessive drainage from surgical drains. In
addition, the nurse must observe for a chyle leak from the lymph system. Both of these can
cause life-threatening alterations in potassium, sodium, calcium, and magnesium levels,
having deadly cardiac manifestations.
LO: 7
20. The nurse is discussing discharge instructions with the family of a client going home
after a total laryngectomy. Which statement indicates teaching has been unsuccessful?
1. The laryngectomy will be in place until she can breathe normally again.
2. I should make sure she keeps her head in a neutral position to decrease any
airway obstruction.
3. I should purchase a small spray bottle so she can humidify her airway when
needed.
4. I should clean the stoma about every 8 hours to make sure it stays clean and
free of debris.
Correct Answer: The laryngectomy will be in place until she can breathe normally again.
Rationale: The laryngectomy is the clients only airway and is permanent. A neutral position
helps keep the laryngeal airway open, and the mist from the spray bottle will be necessary
until the airway gets used to unfiltered, unwarmed air. The stoma is cleaned at least every 8
hours to prevent infection and irritation at the site.
LO: 7

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[Osborn] chapter 34

Learning Outcomes [Number and Title ]

1. Which client requires the most immediate intervention by the nurse?

A client with a maxillary fracture who has been swallowing frequently

Notify the healthcare provider immediately.

Correct Answer: Notify the healthcare provider immediately.

Educating the client about proper oral care

Correct Answer: Educating the client about proper oral care

If you experience recurrent hoarseness, come in for a check-up.

The client will be unable to speak.

Prevent shifts in electrolyte and fluid balances.

Correct Answer: Prevent shifts in electrolyte and fluid balances.

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