Respiratory Nursing

His natural voice will not come back, but he can learn another way to speak.

A total laryngectomy removes the whole larynx, including the vocal cords. The trachea is brought out to a permanent stoma in the neck, so exhaled air no longer reaches the mouth. The nurse sets up a communication method before surgery, such as a writing board. Later he can learn esophageal speech or use an electrolarynx.

• A — "Voice is kept but will sound hoarse and weaker than before": This is a valid description of a partial laryngectomy, but a total laryngectomy leaves no vocal cords to produce a voice.
• Correct answerB — "Natural voice is lost, and a new way of speaking is learned": Removing the larynx ends natural voice, and speech rehabilitation takes its place.
• C — "Voice returns gradually as the swelling in his throat subsides": Swelling explains temporary hoarseness after airway surgery. It cannot restore vocal cords that were removed.
• D — "Voice returns once the tracheostomy tube is capped and removed": Capping restores speech after a temporary tracheostomy. After a laryngectomy the stoma is permanent and the airway no longer connects to the mouth.

Why A is correct

Asthma narrowing is reversible, meaning it often eases on its own or with treatment. It comes and goes, which sets asthma apart from lung diseases whose narrowing stays largely fixed.

Why the other options are wrong

• B — "It stays fixed and worsens steadily over the years": Narrowing that stays largely fixed and worsens steadily is typical of chronic obstructive pulmonary disease, a smoking-related lung disease whose narrowing does not fully reverse. Partly reversible narrowing can occur in long-standing asthma, but the narrowing that marks asthma comes and goes.
• C — "It affects the large airways and spares the small ones": Asthma narrowing is widespread, reaching the small airways as well as the large ones.
• D — "It comes from scarring left by past lung infections": Scarring from past infections is permanent damage, which does not come and go as asthma narrowing does.

Why A is correct

Smoking damages the airway lining that sweeps mucus out of the lungs and weakens the lungs' defenses against germs. Mucus and germs then stay in the airways, where pneumonia can start.

Why the other options are wrong

• B — "Smoking dries the throat so that germs slip down into the lungs": A dry throat is not how smoking raises pneumonia risk; the harm is to the lungs' own cleaning and defense.
• C — "Smoking builds up plaque in the arteries that supply the lungs": Plaque in the arteries is how smoking harms the heart and blood vessels, not how it raises pneumonia risk. It is true that smoking builds up plaque in arteries, but that does not weaken the lungs' defenses against germs.
• D — "Smoke carries germs from the cigarette itself into the lungs": Pneumonia germs usually come from other people in the community, not from the cigarette.

Why C is correct

Leptospirosis is an infection caught from floodwater or soil tainted by infected animals' urine. In its severe form, pulmonary hemorrhage, bleeding into the lungs, and acute respiratory distress syndrome (ARDS) are known complications with high death rates.

Why the other options are wrong

• A — "Pulmonary embolism": Pulmonary embolism, a clot blocking a lung artery, is an important risk in bedbound clients, but lung bleeding is the known complication of severe leptospirosis.
• B — "Pulmonary tuberculosis": Pulmonary tuberculosis, a slow bacterial lung infection, can cause coughed-up blood, but it develops over weeks, not two days into an acute illness.
• D — "Pleural effusion": Pleural effusion, fluid around the lungs, can lower oxygen, but it does not cause coughed-up blood.

Why B is correct

Cor pulmonale is right-sided heart failure caused by lung disease or raised pressure in the lung arteries. Pulmonary hypertension overworks the right ventricle until it fails, and blood backs up into his neck veins, liver, abdomen and legs.

Why the other options are wrong

• A — "Liver cirrhosis": Cirrhosis, liver scarring, can swell the abdomen and liver but does not distend neck veins.
• C — "Constrictive pericarditis": Constrictive pericarditis, a stiff, scarred sac around the heart, can cause this back-up, but his pulmonary hypertension explains it.
• D — "Biventricular heart failure": Left-sided heart disease can occur with pulmonary hypertension, but a failing left side would flood the lungs; his breath sounds are clear.