Review Practice Exercise 2

Acute Respiratory Disorders > Adult Health

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Practice Exercise 2

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Total Questions : 3

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Question 1:

A nurse in a clinic is assessing a client with sinusitis. Which technique should the nurse use to identify clinical manifestations of this disorder?

A. Percussion of the posterior lobes of the lungs B. Auscultation of the trachea C. Inspection of the conjunctiva D. Palpation of the orbital areas

Answer and Explanation

Choice A:

Percussion of the posterior lobes of the lungs. Percussion of the lungs is used to assess for consolidation, fluid accumulation, or hyperinflation within the pulmonary tissue. Sinusitis affects the paranasal cavities rather than the lower respiratory tract, so percussion of the lungs would not reveal relevant clinical manifestations. Relying on this technique could lead to a missed or delayed diagnosis, as it does not evaluate the site of pathology.

Choice B:

Auscultation of the trachea. Tracheal auscultation is intended to assess airflow, airway obstruction, or abnormal breath sounds such as stridor or wheezing. Since sinusitis is limited to the upper airway and sinus cavities, auscultation of the trachea provides no information regarding sinus inflammation or tenderness. Using this technique could misdirect the assessment and delay identification of sinus-specific symptoms.

Choice C:

Inspection of the conjunctiva. Visual inspection of the conjunctiva can detect injection or pallor, which may occur in some systemic or ocular conditions. Sinusitis generally does not produce consistent changes in the conjunctiva, so this inspection is not diagnostic. Relying on conjunctival findings alone could lead to underrecognition of sinus inflammation and inappropriate management.

Choice D:

Palpation of the orbital areas. Palpating the frontal and maxillary sinus regions allows the nurse to identify tenderness and discomfort that arise from inflamed sinus mucosa. This technique helps distinguish sinus pain from other types of facial or headache pain by localizing the discomfort to the affected sinus. Additionally, palpation can reveal asymmetry or swelling, which supports the clinical diagnosis and helps guide further evaluation or imaging if needed.

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Question 2:

A nurse is assessing a client with suspected acute bacterial sinusitis. Which finding most strongly supports this diagnosis?

A. Clear nasal discharge lasting 3 days. B. Facial pain that worsens when bending forward. C. Sneezing with nasal itching. D. Low-grade fever resolved within 24 hours.

Answer and Explanation

Choice A:

Clear nasal discharge lasting 3 days. Short-term, clear rhinorrhea is typical of viral upper respiratory infections or early allergic reactions, not bacterial sinusitis. Bacterial infections usually produce purulent or thick nasal drainage that persists beyond 10 days or worsens after an initial improvement. This symptom alone is insufficient to confirm bacterial etiology.

Choice B:

Facial pain that worsens when bending forward. Bacterial sinus infections cause accumulation of mucus and inflammatory exudate, which increases pressure within the sinuses. This pressure produces localized pain that intensifies with movement or bending, particularly in the maxillary and frontal sinuses. The persistence of severe facial pain, unlike viral sinusitis which is usually milder, strongly supports acute bacterial involvement rather than a viral or allergic cause.

Choice C:

Sneezing with nasal itching. Sneezing and nasal itching are classic features of allergic rhinitis due to IgE-mediated hypersensitivity. These symptoms reflect histamine release and mucosal irritation but are not typical of bacterial sinus infections, which primarily cause congestion, pressure, and purulent drainage.

Choice D:

Low-grade fever resolved within 24 hours. Bacterial sinusitis often causes persistent or escalating fever along with localized pain and purulent discharge. A brief, low-grade fever that resolves quickly is more consistent with a viral infection rather than bacterial sinus involvement.

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Question 3:

A nurse is providing discharge teaching to a client with acute sinusitis. Which interventions should the nurse recommend to promote sinus drainage and symptom relief? Select all that apply

A. Increase oral fluid intake. B. Apply warm, moist compresses to the face. C. Use topical nasal decongestants for longer than 7 days. D. Perform saline nasal irrigation. E. Sleep with the head elevated.

Answer and Explanation

Choice A:

Increase oral fluid intake. Adequate hydration thins mucus secretions, which improves sinus drainage and reduces the risk of mucus stasis. Thinner secretions are less likely to obstruct the sinus ostia, facilitating resolution of infection and symptom relief. Increased fluid intake also supports overall immune function and recovery from infection.

Choice B:

Apply warm, moist compresses to the face. Local heat applied to the frontal and maxillary sinus areas promotes vasodilation and increases blood flow, which can reduce congestion and alleviate pressure. Warm compresses also help soften thick secretions, enhancing their movement through the sinus passages. This intervention provides both symptomatic relief and aids mechanical drainage of the inflamed sinuses.

Choice C:

Use topical nasal decongestants for longer than 7 days. Prolonged use of topical decongestants can cause rebound congestion (rhinitis medicamentosa), worsening nasal obstruction over time. These medications are intended for short-term symptom relief, typically no longer than 3–7 days. Extended use does not improve sinus drainage and can delay recovery from sinusitis.

Choice D:

Perform saline nasal irrigation. Saline irrigation flushes mucus, allergens, and pathogens from the nasal passages and sinus ostia. This mechanical clearance decreases mucosal swelling, reduces bacterial load, and improves ventilation of the sinuses. Regular irrigation supports mucociliary function and shortens the duration of sinusitis symptoms.

Choice E:

Sleep with the head elevated. Elevating the head during sleep decreases venous congestion in the nasal and sinus mucosa. This position reduces sinus pressure, promotes drainage, and minimizes nocturnal nasal obstruction. Proper positioning supports comfort and facilitates effective sinus clearance while resting.

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Practice Exercise 2

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