Nursing and Mrs. Newman
Mrs. Newman has been experiencing hoarseness and a change in her voice, but she did not seek medical help until she began to have difficulty swallowing. After being seen by her healthcare provider, she is scheduled for outpatient surgery for a direct laryngoscope to obtain a culture and take a biopsy. Mrs. Newman arrives at the outpatient surgical department at 6:30 am and is escorted to her room. The admitting nurse begins her assessment; 1. Which question is most important for the nurse to ask Mrs. Newman? A) Have you had anything to eat or drink since midnight?
B) Are you taking any medications? C) Have you smoked any cigarettes in the last 24 hours? D) When was the last time you drank any alcohol? The admission nurse completes the admission assessment and starts an IV. Mrs. Newman is taken to the operating room for the biopsy. Sifter the procedure, Mrs. Newman is admitted into the PACU. 2. Which intervention will the PACU nurse implant first? A) Check the healthcare provider’s prescriptions B) Monitors Mrs. Newman’s pulse OX C) Contain Mrs. Newman’s vital signs D) Assess Mrs. Newman’s gag reflex After 2 days Mrs.
Newman calls the oncologist and reluctantly agrees to a total laryngectomy. Mrs. Newman comes to the oncology office to meet with the oncology nurse specializations to discuss the preoperative and postoperative care. Mrs. Newman tells them that she is very scared about having this surgery. She says that she has no questions about the medical aspects of the procedure, but states she is concerned about how her life will change. She tells the nurse she realizes she need to have the surgery but is ambivalent and doesn’t know is she will be able to go through with it after all. . Which nursing intervention is most helpful to mars Newman? A) Refer mars Newman to a psychologist to discuss her fears about having this surgery B) Give Mrs. Newman literature provided by the American cancer society C) Ask Mrs. Newman if she would like to talk to someone who has had this surgery D) Tell Mrs. Newman iota is OK to be scared and hold her hands Mrs. Newman is concerned about singing in the country and western club and asks the ONS “how long do you think it will be before I can sing with my band again” 4. How should the ONS RESPOND?
A) Request that the oncologist visit with Mrs. Newman and explain the procedure to her again B) Explain that her vocal cords will be removed, and that she will not be able to sing C) Reassure her that she will be able to sing with the band, but her voice may be different D) Ask Mrs. Newman if she understands what a total laryngectomy is The ONS has given verbal and written information to Mrs Newman answered any questions and is completing the physical assessment 5. Which question is important for the nurse to ask Mrs. Newman?
A) When did you first notice any hoarseness in your voice? B) How long did you say have you been singing w/the band? C) How much alcohol do u drink a week? D) What foods are difficult for you to wallow? Mrs. Newman reports that she drinks occasionally, mainly on the weekends with friends. The nurse is more concerned that Ms Newman smokes one pack of cigarettes a day. She discusses this issue with mars Newman, who says “Don’t worry about my smoking. I will never smoke another cigarette again” 6. How should the nurse respond to help Mrs.
Newman in her attempt to stop smoking? A) I know it will be hard and I am very proud of u B) You will kit be able to smoke after urn surgery C) anyone else in urn household smoke D) What steps is u going to take to stop smoking? Mrs. Newman discusses the surgery with her family and a woman from a laryngectomy support group. Mrs. Newman decides to go ahead and he a total larygectomy. 7. A referral to which member of the indiciplinary team will be most important for mars Newman prior to surgery: A) Case manger
B) Social worker C) Physical therapist D) Speech therapist The speech therapist discusses with mars Newman alternative tech inquest for restoring her speech after surgery. Selection of the best techniques varies from person to person depending on their age and personal preferences. Esophageal speech is popular among laryngectomies because it costs less and can provide a more normal sounding voice than some of the other options. 8. Which statement describes esophageal speech?
A) Generator held to the neck creates vibrations those form words when the client speaks B) Swallowed air used to create around and words in a controlled belch C) Vibration and sound are used to form words by occluding a valve over the stoma D) A handheld device delivers tone via a plastic tube that is inserted into the mouth After discussing her options with a speech therapist mars Newman demonstrates her ability to use esophageal speech she comments” I used to hear my son and his friends rack like this. Won’t he be surprised? Two days later, mars Newman is admitted to the hospital accompanied by her husband and her two grown children.
She is in the preoperative holding area. 9. Which interventions will the nurse implement? A) ask mars Newman if she has any concerns about the upcoming surgery B) Notify the surgeon that mars Newman has been admitted to the hospital C) Reassure mars Newman that her family can stay with her until surgery D) Retrained if mars Newman has any problems hearing or writing Mrs. Newman shares with the nurse that she is scared that no one will help her if she needs help and that she will not be able to talk anymore. 10. Which intervention should the nurse implement? A) Assure Mrs.
Newman that someone will be with her at all times B) Provide a bell that she can ring as another means of communication C) Show her how to work the nurses call light and have her perform a return demonstration D) Tell her that whiles her fears are justified; she should not try to worry. Following a seven –hour surgery mars Newman was first placed in the PACU, before being transferred to the intensive care unit. 11. Which nursing intervention should the ICU nurse implement? A) Discourage coughing for the first 24 hrs B) Notify the healthcare provider during rounds
C) Determine when mars Newman received her last antibiotic D) Assist mars Newman to gargle w/warm salty water The nurse is completing the shift assessment and notes that Mrs. Newman has white and dark brown patchy areas on her tongue and oral mucosa. 12. Which action should the nurse implement? A) Document this finding and take no action B) Notify the health care provider during rounds C) Determine when Mrs. Newman received her last antibiotic D) Assist Mrs. Newman to gargle with warm water, salty water Because of the cancer mars Newman is at risk for potential complications, such as neck would fistula and carotid arty blowout 13.
When anticipating these possible complications, the nurse should place which equipment at miss newness bedside? A) Several packages of sterile 4×4 gauze B) Two non sterile hemostats C) A syringe filled w/calcium glaciate D) The intensive care unit crash cart While assessing mars Newman, the nurse notices that Mrs. Newman’s blood pressure is 92/60 and her pulse is 112. Mrs. Newman reports feeling very tired. 14 What action should the nurse implement first? A) Check mars Newman’s pervious vital signs B) Suction mars Newman tracheotomy C) Administer oxygen via nasal cannula D) Slip a gloved hand under the client’s neck
The nurse also calls the nurses’ station and requests a CBC stat 15 which laboratory result consistent w/blood loss through hemorrhaging A) A hematocrit 40 % B) Erythrocyte sedimentation rate 8 mm/hr C) Red blood cell count 5. 2 million/mm^3 D) Hemoglobin 11. 3g/dl. Mrs. Newman’s gag reflex has returned and she is preparing to eat her first meal. 16 which action should the nurse implement A) Place cold packs around the clients neck prior to eating B) Remind her to place the food on the front of the tongue and flex her head backward to swallow C) Ensure the client has a variety of thin liquids to drink D) Provide Mrs.
Newman with soft foods when eating for the first time after surgery 17. What action should the nurse take regarding Mrs. Newman’s concern? A) Explain to the client that this is normal following this type of surgery B) He the client smell a variety of aromas to ensure that the client cannot smell C) Reassure he client that these senses will return after post-operative edema subsides D) Notify the healthcare provider about these findings when making rounds Mrs.
Newman has a tracheotomy that has an inner canola. The nurse is performing routine tracheotomy care 18 Which action should the nurse implement first? A) wash the flange of the outer cannula with normal saline B) Pour hydrogen peroxide and normal saline into separate containers C) Cleanse the inner cannula using a small pipe brush D) Remove the tracheotomy dressing with clean disposable gloves What should the nurse do before inserting the inner canola? A) Tap or shake inner cannula to remove excess moisture
B) Dry the outside of the inner cannula with non sterile gauze C) Remove the outer cannula, reinsert the inner cannula, then place back into stoma D) Clean it w/hydrogen peroxide An unlicensed assistive personnel UAP is assisting the surgical floor nurse w/morning care for mars Newman 20. Which task should the nurse delegate to the UAP? A) Empty the Foley and record the output B) Clean Mrs. Newman’s bathroom C) Change the intravenous bag on the pump D) Perform the routine tracheotomy care
The charge nurse notices that the primary nurse caring for mars Newman is cutting 4×4 gauze to use as a tracheotomy dressing 21. What action should the charge nurse implant? A) Praise the primary nurse for using a cost saving technique B) Instruct the primary nurse not to cut gauze for the tracheotomy dressing C) Take no action since Mrs. Newman is the primary nurse’s responsibility D) Determine why commercially prepared dressings aren’t being used The night nurse is preparing to administer the 12:00 midnight dose of gentamicin, an intravenous amino glycoside antibiotic that was started when Mrs.
Newman was in the PACU. The nurse notices the empty IV antibiotic bag that was administered during the day shift is labeled ampicilllin. The nurse checks the medication administration record and realizes client does not have a prescription for ampicillin. 22. Which action should the night nurse implement? A) Notify the pharmacist about the medication error B) Complete a medication error report c) Call the day nurse to determine what occurred D) Asses Mrs. Newman’s white blood cell count WBC The next time the nurse enters Mrs. Newman room Mrs.
Newman writes on the communication inboard is there something wrong? I heard someone in the hall say something about me receiving the wrong medication? 23. How should the nurse respond? A) Please don’t worry about anything. I am sorry you overheard that conversation B) No Mrs. Newman you did not receive the wrong medication C) C) You are concerned that you might have received the wrong medication D) you were supposed to receive gentamcin but you received ampicillin 24. Which intervention should the nurse provide to Mrs. Newman?
A) Insert a suction tube into the stoma while applying suction, the remove while twisting the tube B) Take a deep breath, occlude the tracheotomy with urn finger cough and remove your finger C) Insert a small amount of sterile normal saline into the stoma and cough in a normal manner D) Take a deep broth in through the nose, cough and expel the secretions through the tracheostomy The nurse is discussing activities of daily living with Mrs. Newman. Which instruction should the nurse include? A) Caution Mrs. Newman to take only tub baths B) Encourage Mrs.
Newman to use aerosol deodorants C) Advise Mrs. Newman not to wear any types of perfumes D) Explain the need to wear a plastic bib when showing 26. Which intervention has highest priority to discharge? A) encourage the client to wear attractive coverings over stoma B) Ensure that Mrs. Newman carries a special identification card C) Stress the importance of returning to as normal a lifestyle as possible D) Discuss the importance of attending support group meetings Mrs. Newman is being discharged home today after five days in the hospital.
Mr. Newman stops the nurse in the hallway and says that he is really scared about taking his wife home 27 what is the best response by the nurse? A) Have you discussed your fears w/ur wife B) It sounds like you can’t take care of her C) I know this must be very scary but u and ur wife are strong D) Let’s sit down and discuss what u are worried about Mr. Newman hesitantly shares with the nurse that he is afraid to touch his wife How should the nurse respond? A) Would u like to talk to your wife’s doctor, I can call him for u?
B) You can touch ur wife all u want, u will not hurt her C) You are worried about touching ur wife but she needs ur support right now D) Tell me more about what you mean by touching ur wife A home healthcare nurse has been assigned to care for Mrs. Newman and is making the initial visit. After completing the admission assessment the home healthcare nurse develops a nursing care plan for Mrs. Newman 29 of the nursing diagnosis included in Mrs. Newman’s careplan, which one has the highest priority? A) Deficient of knowledge B) Anticipatory grieving
C) Ineffective airway clearance D) Impaired verbal communication Then home healthcare nurse is discussing the plan of care with Mrs. Newman and her husband, she instructs them to keep the rooms humidified at all times. Mr. Newman asks why this is important. 30. Which explanation should the nurse provide? A) It will decrease the amt of foreign material that enters the stoma B) Humidified air decreases the need for oral fluids C) Humidified air will keep mucous membranes and secretions moist D) The lower airway responsible for humidification was removed during surgery