A nurse caring for a patient with a tracheostomy should determine whether the patient needs suctioning by:
examining the character of the sputum
monitoring the rate of respirations.
auscultating the breath sounds
determining the last time the patient was suctioned
The Correct Answer is C
A. Examining the character of the sputum: While monitoring secretions is important, it does not necessarily indicate the need for immediate suctioning.
B. Monitoring the rate of respirations: An increased respiratory rate can indicate distress but is not a definitive cue for suctioning.
C. Auscultating the breath sounds: This helps identify the presence of secretions or airway obstruction and is a primary indicator for suctioning.
D. Determining the last time the patient was suctioned: Suctioning should be based on clinical need rather than a routine schedule.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Examining the character of the sputum: While monitoring secretions is important, it does not necessarily indicate the need for immediate suctioning.
B. Monitoring the rate of respirations: An increased respiratory rate can indicate distress but is not a definitive cue for suctioning.
C. Auscultating the breath sounds: This helps identify the presence of secretions or airway obstruction and is a primary indicator for suctioning.
D. Determining the last time the patient was suctioned: Suctioning should be based on clinical need rather than a routine schedule.
Correct Answer is C
Explanation
A. Be monitored for respiratory rate: Important for ongoing assessment but not directly related to the deflation process.
B. Have the cuff pressure checked: Necessary during care but not immediately before deflation.
C. Have the pharynx suctioned: Suctioning clears secretions that could be aspirated when the cuff is deflated.
D. Be administered extra oxygen: Beneficial but not a direct prerequisite for cuff deflation.
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