A nurse is caring for a client who is postoperative following a tracheostomy and has copious and tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin this client's secretions?
Provide humidified oxygen.
Prelubricate the suction catheter tip with sterile saline when suctioning the airway.
Perform chest physiotherapy prior to suctioning.
Hyperventilate the client with 100% oxygen before suctioning the airway.
The Correct Answer is A
a. Provide humidified oxygen: Humidification helps prevent the drying of mucous membranes, making secretions more manageable and less tenacious. This is an acceptable method to thin
secretions in a client with a tracheostomy.
b. Prelubricate the suction catheter tip with sterile saline when suctioning the airway: While lubrication with sterile saline is a common practice during suctioning to reduce trauma to the airway, it does not directly address the tenacity of secretions.
c. Perform chest physiotherapy prior to suctioning: Chest physiotherapy is a technique used to mobilize respiratory secretions, but it may not directly address the tenacity of secretions.
d. Hyperventilate the client with 100% oxygen before suctioning the airway: Hyperventilation with 100% oxygen is not a routine practice and may lead to respiratory alkalosis. Providing
humidified oxygen is a more appropriate approach.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. “Managing my cholesterol will reduce my chances of having a stroke.”: High cholesterol is a risk factor for stroke, and managing it can help reduce the risk.
b. “My blood pressure needs to stay a little elevated for good blood flow to my brain.”:
Maintaining normal blood pressure is essential for preventing stroke, and elevated blood pressure is a risk factor for stroke.
c. “Using oral contraceptives provides me with protection from a stroke.”: Oral contraceptives, especially in the presence of other risk factors, can increase the risk of stroke.
d. “I can safely have up to 3 alcoholic drinks a day.”: Excessive alcohol consumption is a risk factor for stroke, and moderation is advised to reduce the risk.
Correct Answer is B
Explanation
a. C-reactive protein: This is a marker of inflammation and is not specific to renal function. It is more commonly used to assess inflammation in various conditions.
b. Serum creatinine: Elevated levels of serum creatinine are indicative of impaired renal
function. Creatinine is a waste product that is normally filtered by the kidneys. Increased levels suggest decreased renal filtration.
c. Antinuclear antibody: This test is used to diagnose autoimmune diseases like SLE but does not directly measure renal function.
d. Erythrocyte sedimentation rate: This is a nonspecific marker of inflammation and is not directly related to renal function.
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