Correct answer—D. Rationales: The administration of pain medication, tetanus prophylaxis, and antibiotics are all appropriate interventions because nasal fractures should be treated like open fractures. A topical vasoconstriction is used for the treatment of epistaxis or foreign-body extraction.

Nursing process step: Implementation

Correct answer—A. Rationales: The cheek, nose, and upper lip are all supplied by the infraorbital nerve as it exits through the zygoma. The mandible is supplied by a branch of the facial nerve.

Nursing process step: Assessment

Correct answer—C. Rationales: The Waters’ view requires the client to lie in a prone position with hyperextension of the neck. This client wouldn’t be able to safely assume this position because of the multiple injuries. Supine position with forward flexion of the neck represents a submentovertex view that could be used if cervical spine injury were ruled out. A right lateral position with hyperextension of the neck and a left lateral position with flexion of the neck aren’t positions of either view.

Nursing process step: Assessment

Correct answer—A. Rationales: Dental abscesses, cocaine use, and smoking are all significant predisposing factors to a diagnosis of sinusitis. Other factors include foreign bodies in the nose, allergic rhinitis, use of nasogastric tubes, and air pollution. Dentures, rhinoplasty, and asthma don’t contribute to sinusitis.

Nursing process step: Assessment

Correct answer—C. Rationales: Conjunctivitis, periorbital edema, and opacification to transillumination all indicate sinusitis. Paresthesia of the cheek is present with a zygomatic fracture.

Nursing process step: Assessment

Correct answer—C. Rationales: Decongestants should be used for only about 3 days. If used for an extended period, a rebound occurs and may cause severe nasal congestion when the drug is discontinued. Two sprays are recommended: one to shrink the mucosa so the second spray (dose) can reach the upper turbinate and sinus ostia. Heat treatment is preferred to cold applications. Antibiotics should be taken for the full course of therapy; discontinuing early may cause the infection to return.

Nursing process step: Evaluation

Correct answer—C. Rationales: Neosynephrine on a saturated pledget that’s inserted into the nares assists in epistaxis treatment by constricting blood vessels, thereby decreasing bleeding and improving visualization of the area. Reducing vomiting and anxiety and dilating vessels aren’t effects of neosynephrine.

Nursing process step: Analysis

Correct answer—A. Rationales: Epiglottiditis, an acute bacterial infection, causes swelling of the epiglottis and subsequent airway obstruction. It’s treated with antibiotics, humidified oxygen, intubation, or cricothyrotomy; incision and drainage are unnecessary. Peritonsillar abscess and retropharyngeal abscess are complications of acute suppurative tonsillitis. Symptoms include a septic appearance, fever, drooling, foul breath, and a muffled voice. Clients with these abscesses require close airway monitoring, incisions, and drainage. Ludwig’s angina presents with high fever, dyspnea, and elevation of the tongue and floor of the mouth. It’s caused by streptococcal bacilli and results in a bilateral boardlike swelling of the neck. Sudden airway obstruction can occur; incision and drainage may be required.

Nursing process step: Analysis

Correct answer—D. Rationales: COPD wouldn’t be of concern regarding a nosebleed. Hypertension may be a cause of epistaxis. Arteriosclerotic heart disease may predispose a client to hypertension secondary to decreased compliance of the arterial walls or decreased arterial vessel lumen. Medications used to treat arthritis may increase a client’s hemostatic abnormalities.

Nursing process step: Assessment

Correct answer—C. Rationales: The trigeminal nerve provides facial sensation and jaw movements. These tests assess trigeminal nerve injury: pain, touch, hot and cold sensations, biting, and the ability to open the mouth against resistance. The facial nerve has three branches that deal with facial expression and taste. The zygomatic branch provides the ability to close the eyes tightly; the temporal branch provides the ability to elevate the brows and wrinkle the forehead; and the buccal branch provides the ability to wrinkle the nose, whistle, and elevate the upper lip. The oculomotor and trochlear nerves elicit eyeball movement as well as pupillary response.

Nursing process step: Assessment

Correct answer—C. Rationales: Instilling artificial tears is an appropriate intervention for Bell’s palsy, in which the eyelid can’t close and injury and damage to the eye are potential problems. Trigeminal neuralgia causes severe, intermittent facial pain that can be elicited by stimulating a trigger zone on the face; these clients should avoid cold drinks, cold wind, and swimming in cold water. Gentle washing of the face assists in decreased stimulation of the trigger zone. The client needs to understand that analgesic medications are indicated until the problem resolves.

Nursing process step: Intervention

Correct answer—B. Rationales: Ludwig’s angina refers to cellulitis involving the floor of the mouth. This infection is usually due to Streptococcus or Staphylococcus species in adults. Clients usually present with pain, tenderness, and swelling of the mouth floor. Stroke symptoms don’t include edema of the mouth. Epiglottiditis symptoms are located in the posterior pharynx. An anaphylactic reaction wouldn’t cause fever and would be generalized versus specific to left side of the face.

Nursing process step: Analysis

Correct answer—A. Rationales: To reduce pain and cartilage necrosis, the nurse should support the pinna with gauze in, around, and behind it, thereby decreasing and preventing pressure. Cover the ear with fluffed gauze, and apply a fluff roll bandage or conforming gauze bandage circumferentially. The ear should be protected and well-padded with a bulky dressing. A constrictive dressing causes more damage, and no dressing will leave the ear itself unprotected and increase the risk of bacterial invasion. Taping a dressing won’t keep it in place or provide the needed bulkiness.

Nursing process step: Intervention