A nurse is caring for a patient who has just returned to the unit following a bronchoscopy and requests coffee.

The nurse assesses that it is safe for the patient to resume oral liquids when which of the following behaviors is demonstrated?

Choice A rationale
Implementing ventilator-weaning protocols is a crucial intervention in the care plan for a patient on a ventilator to prevent ventilator-associated pneumonia. These protocols aim to minimize the patient’s exposure to mechanical ventilation, which is a significant risk factor for developing ventilator-associated pneumonia. By systematically reducing the level of ventilatory support, these protocols facilitate the earliest possible liberation from mechanical ventilation, thereby reducing the risk of ventilator-associated pneumonia.
Choice B rationale
Providing frequent oral care is another essential intervention in preventing ventilator- associated pneumonia. Oral health can quickly deteriorate in mechanically ventilated patients, leading to an increased risk of ventilator-associated pneumonia. Regular oral care, including the use of antiseptics, can help reduce the number of potential respiratory pathogens in the oral cavity and prevent their aspiration into the lower respiratory tract.
Choice C rationale
Suctioning the patient every hour is not typically recommended as a standard intervention to prevent ventilator-associated pneumonia. Over-suctioning can lead to trauma and inflammation in the airway, potentially increasing the risk of infection. Suctioning should be performed based on the patient’s needs and clinical signs, rather than on a fixed schedule.
Choice D rationale
Positioning the patient in a semi-upright position (30 to 45 degrees), rather than a prone position, is recommended to prevent ventilator-associated pneumonia. This position helps to reduce the risk of aspiration, which is a major risk factor for ventilator-associated pneumonia.
Choice E rationale
Avoiding suctioning the patient is not a recommended strategy for preventing ventilator- associated pneumonia. Suctioning is necessary to clear secretions from the airway, and its omission could potentially increase the risk of infection. However, as mentioned earlier, suctioning should be performed based on the patient’s needs and clinical signs, rather than on a fixed schedule.

Choice A rationale
A non-productive cough is not a definitive sign of inadequate drug therapy for tuberculosis. It could be a symptom of many other respiratory conditions.
Choice B rationale
Decreased shortness of breath is generally a positive sign indicating improvement in the patient’s condition. It does not necessarily indicate inadequate drug therapy.
Choice C rationale
The presence of positive acid-fast bacilli in the sputum after 2 months of treatment indicates that the tuberculosis bacteria are still present in the patient’s body. This suggests that the triple antibiotic therapy is not effectively eliminating the bacteria, thus indicating inadequate drug therapy.
Choice D rationale
Poor appetite is a common symptom of tuberculosis, but it does not specifically indicate the effectiveness or inadequacy of drug therapy.