Question 1

During the preoperative assessment and teaching for a patient scheduled for otolaryngologic surgery performed using local anesthetic,the perioperative nurse reviews with the patient normal coping mechanisms that are personally effective and supports and encourages the patient during the surgical intervention.The nurse is preparing the patient to anticipate:

Accepted Answer

A)   disturbed sensory perceptions.
B)   tachypnea.
C)   acute pain.
D)   claustrophobia. C

Question 2

The salivary glands produce saliva,which serves to moisten the mouth and initiate:

Accepted Answer

A)   antibacterial activity in the mouth.
B)   carbohydrate digestion.
C)   protein breakdown.
D)   alimentary (gastrointestinal [GI])  tract peristalsis. B

Question 3

The nasal septum is lined with blood vessels and mucus-secreting cells.The proper name of this lining is the:

Accepted Answer

A)   mucoperichondrium.
B)   columella.
C)   nasoseptal mucosa.
D)   cartilaginous vascular bed. A

Question 4

A nasal polypectomy is the removal of polyps from the nasal cavity.Nasal polyps are benign,grapelike clusters of mucous membrane and connective tissue.When the polyps become large,they obstruct the free passage of air,make breathing difficult,and cause a change in speech quality.Nasal polypectomies are typically performed endoscopically with the use of microdebriders,which remove the polyps by their mechanism of _______________.

Accepted Answer

A)   ultrasonic cavitation
B)   morcellation
C)   radiofrequency ablation
D)   laser vaporization

Question 5

A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures.A selection of burrs including assorted sizes of round cutting burrs and diamond polishing burrs should be available.During drill and power saw use,the scrub person keeps irrigation solution on the sterile field to:

Accepted Answer

A)   keep the drill bit or burr cool and prevent breaking.
B)   prevent clogging of the burr and contamination of the area with bone dust.
C)   prevent aerosolized bone dust particles, because they are an occupational hazard.
D)   avoid using a wire brush.

Question 6

Oral malignancies can be linked to specific carcinogens,the most important one being tobacco.Benign or malignant lesions of the tongue,floor of the mouth,alveolar ridge,buccal mucosa,or tonsillar area are excised depending on the extensiveness of disease,involvement of surrounding vessels and nerves,and candidacy for surgery.Benign or small malignant tumors of the oral cavity may be excised without a neck dissection.Which indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors?

Accepted Answer

A)   The patient is a smoker
B)   Suspicious metastatic disease
C)   Presence of undiagnosed skin lesions of the head and neck
D)   Benign growth in the lower jugular region

Question 7

The palatine and lingual tonsils are situated in the oropharynx,while the adenoids are located in the nasopharynx.Both adenoids and tonsils consist of:

Accepted Answer

A)   lymphoid tissue.
B)   glandular tissue.
C)   vascular tissue.
D)   mucosal tissue.

Question 8

Surgical removal of hypertrophic adenoids to relieve upper airway obstruction is often performed to create a patent nasal airway.The highly vascular adenoids are treated by which method(s)of hemostasis to control bleeding?

Accepted Answer

A)   Pharyngeal packing
B)   Cryotherapy
C)   Radiofrequency current
D)   Tannic acid and epinephrine paste

Question 9

Excision of the submandibular gland is performed to remove mixed tumors and calculi associated with extensive chronic inflammation.The submandibular gland lies in close proximity to several important nerves and vessels.Of the following,what is the highest priority perioperative nursing action related to submandibular surgery?

Accepted Answer

A)   Provide the scrub person with a bipolar electrosurgical unit (ESU) .
B)   Provide the scrub person with a nerve stimulator.
C)   Avoid local anesthetics on the sterile field if identification of major nerves will take place.
D)   Provide the anesthesia provider with an intraoperative nerve monitoring system.

Question 10

The external ear,which includes the auricle (or pinna)and external auditory canal,is composed of cartilage covered with skin.The primary function of the auricle is to:

Accepted Answer

A)   gather and direct sound waves toward the inner ear.
B)   concentrate and conduct incoming sound waves into the external auditory canal.
C)   collect and amplify incoming sound waves by facilitating tympanic membrane vibration.
D)   facilitate air conduction of sound waves.

Question 11

Depending on the surgical defect,head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures.The wound may be closed primarily,or local flaps and split-thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects.An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool?

Accepted Answer

A)   Skin-adhering adhesive temperature probe to detect subtle changes in graft perfusion
B)   Light-pressure skin blanch test for return perfusion and viability of graft
C)   Use of intraoperative and postoperative Doppler to detect presence of blood flow
D)   Interval flow cytometry readings of vascular perfusion to the graft

Question 12

Lasers assist in vaporization of scar tissue,granulomas,and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures.Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a:

Accepted Answer

A)   fiberoptic probe.
B)   beam separator.
C)   micromanipulator.
D)   flexible microlaser fiber.

Question 13

The surgical microscope is often used to provide illumination and magnification for complex procedures to the ear,laryngeal surgery,or reconstructive free flap procedures following neck surgery.A common eyepiece magnification for an otologic microscope is ´12.5,and the usual objective (lens)is ______-mm focal length (f).A _______-mm lens is used for laryngeal surgery.

Accepted Answer

A)   250- or 300; 400
B)   400; 150
C)   150; 400
D)   400; 250 or 300

Question 14

Myringotomy is often accompanied by the aspiration of fluid under pressure in the tympanum,and the subsequent placement of small,hollow pressure equalization tubes.It is indicated for acute otitis media (AOM)in the presence of an exudate that has not responded to antibiotic therapy.If left untreated,what is the main concern for a child with chronic otitis media?

Accepted Answer

A)   Impaired language development
B)   Encephalitis
C)   Hearing loss
D)   Impaired language development and hearing loss

Question 15

Microlaryngoscopy facilitates improved diagnosis and allows the laryngologist to view,with relative ease,areas that previously were inaccessible or difficult to visualize.What are the two most common indications for microlaryngoscopy?

Accepted Answer

A)   Chronic hoarseness and cough
B)   Laryngeal polyps and nodules
C)   Epiglottitis and frequent choking
D)   Laryngeal injury and cancer

Question 16

Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain.Conductive hearing loss is caused by an obstruction in the external canal or middle ear,which impedes the passage of sound waves to the inner ear.A common cause of conductive hearing loss would be:

Accepted Answer

A)   AOM.
B)   fluid extravasation in the ear canal.
C)   perforation of the tympanic membrane.
D)   a healed myringotomy.

Question 17

During a stapedotomy or stapedectomy procedure,the perioperative nurse manages and controls the environment of care by maintaining a quiet,warm,and comfortable operating room (OR).Energy modality devices and monitor alarms are turned down to the lowest audible setting for the team to hear without startling the patient.The English-speaking,nonanxious patient sedated using local or monitored anesthesia care (MAC)anesthetics is well prepared by the perioperative nurse for sensory and procedural expectations.Which event occurs near the conclusion of the procedure that predicts patient outcome?

Accepted Answer

A)   The surgeon whispers softly in the patient's operative ear to determine return of hearing.
B)   The surgeon irrigates the middle ear to promote and visualize movement of the ossicles.
C)   The surgeon asks the patient to repeat words as the external ear packing is placed.
D)   The surgeon performs an acoustic reflex test.

Question 18

When laryngoscopy,bronchoscopy,and esophagoscopy are performed in a single session on a patient,the procedure is termed triple endoscopy or panendoscopy.The purpose of triple endoscopy is usually diagnostic.A procedure-specific perioperative nursing intervention is:

Accepted Answer

A)   documenting the procedure in the perioperative record.
B)   identifying, containing, and labeling all specimens accurately.
C)   carefully handling and reprocessing the endoscopes.
D)   providing calm, careful, and comforting nursing measures to reduce the patient's anxiety.

Question 19

When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords,which important postoperative instruction must the nurse give the patient during discharge teaching?

Accepted Answer

A)   Complete voice rest is essential.
B)   Coughing and deep-breathing exercises should be performed.
C)   Clearing the throat to remove secretions is advised.
D)   The patient should use a humidifier.

Question 20

Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes,highlighting specific structures,or tissue densities.Examples of these imaging diagnostics would be:

Accepted Answer

A)   complementary computed tomography (CT)  scan with magnetic resonance imaging (MRI) .
B)   positron emission tomography (PET) .
C)   audiometry scan with photoacoustic spectrometry (PAT) .
D)   tuning-fork conduction scan with electrical capacitance volume tomography (ECVT) .

Exam 19: Otorhinolaryngologic Surgery