A nurse is preparing discharge planning for a client who has a newly placed tracheostomy tube. The nurse should assess the client's need for which of the following supplies to manage the tracheostomy at home? (Select all that apply.)

Obturator

Cotton balls

Oxygen tank

Pipe cleaners

Petroleum jelly

Answer and Explanation

Correct Answer : A,C

Rationale:
A. The obturator is needed in case the tracheostomy tube becomes dislodged, allowing safe reinsertion.
B. Cotton balls should not be used near the tracheostomy because fibers can be inhaled and cause airway obstruction.
C. An oxygen tank may be required to ensure adequate oxygenation at home, especially if the client has respiratory compromise.
D. Pipe cleaners are unsafe for cleaning tracheostomy equipment because they can leave particles or cause trauma. Only sterile, manufacturer-approved cleaning devices should be used.
E. Petroleum jelly is not recommended because it can occlude the airway and increase infection risk; water-based lubricants are preferred if lubrication is necessary.

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Correct Answer is A

Explanation

Rationale:
A. Alcohol-based hand sanitizer is not effective against C. difficile spores. Hands must be washed with soap and water to physically remove the spores, making this action unsafe and requiring intervention.
B. Wearing a mask when caring for a client who has varicella is appropriate for airborne precautions.
C. Closing the door of a client on airborne precautions helps contain infectious particles and is correct.
D. Removing cut flowers from the room of a client in a protective environment is appropriate to reduce the risk of infection.

A. A client who has a scalp laceration and is bleeding heavily B. A client who reports chest pain and is diaphoretic C. A client who has an open humerus fracture D. A client who reports severe itching on the chest

Correct Answer is B

Explanation

Rationale:
A. A scalp laceration with heavy bleeding is urgent, but bleeding can often be controlled quickly; not immediately life-threatening once managed.
B. Chest pain with diaphoresis suggests myocardial infarction (MI) or another life-threatening cardiac condition → emergent priority because it requires immediate intervention to preserve life.
C. An open humerus fracture is urgent, but not typically immediately life-threatening.
D. Severe itching is nonurgent, not life-threatening at all.

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A nurse is preparing discharge planning for a client who has a newly placed tracheostomy tube. The nurse should assess the client's need for which of the following supplies to manage the tracheostomy at home? (Select all that apply.)

Nursing Test Bank

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