A nurse is preparing to discharge a client who is a status post-operative laryngectomy. The nurse should recognize which of the following discharge teaching is the highest priority?

Use of Passy Muir speaking valve

Phone number of healthcare provider to report complications

Emergency personal identification that client is unable to speak

Ability to perform tracheostomy care

Answer and Explanation

The Correct Answer is C

A. Use of Passy Muir speaking valve: While this is an important aspect of communication for a client who has undergone a laryngectomy, it is not the highest priority at the time of discharge. The use of the speaking valve can be addressed after ensuring that the client is equipped to handle immediate safety concerns and emergencies related to their condition.
B. Phone number of healthcare provider to report complications: Providing the client with contact information for their healthcare provider is essential for ongoing support and to address any concerns that may arise after discharge. However, this information is secondary to ensuring the client can effectively communicate their condition and limitations, particularly in an emergency situation.
C. Emergency personal identification that client is unable to speak: This is the highest priority for discharge teaching because it directly addresses the client’s safety. Having emergency identification is crucial for informing healthcare providers and first responders about the client's inability to speak, especially in situations where communication may be vital for receiving appropriate care. Ensuring that the client can communicate their condition in emergencies takes precedence over other aspects of post-operative care.
D. Ability to perform tracheostomy care: While it is important for the client to be educated on tracheostomy care to ensure ongoing health and safety, this teaching can be considered after addressing immediate safety needs. The ability to care for the tracheostomy is vital but does not take priority over having emergency identification that communicates the client’s needs to others who may not be aware of their condition.

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Correct Answer is A

Explanation

A. Set ground rules: This step involves establishing guidelines for the discussion to ensure that all participants feel respected and heard. By inviting each staff member to speak in turn and asking them to listen respectfully without making personal or professional remarks, the nurse manager is creating a safe and structured environment for open communication. Setting ground rules is crucial for facilitating a productive dialogue and minimizing conflict during negotiations.
B. Perform an opening move: This refers to the initial statement or action taken to start the negotiation process. While the nurse manager is initiating the meeting, the emphasis on respectful communication and turn-taking indicates that the focus is more on establishing an effective communication framework rather than simply making an opening statement.
C. Continue the negotiation: This step implies that the negotiation is already underway and is focused on maintaining momentum in the discussion. However, the scenario describes the nurse manager taking proactive steps to set the stage for the negotiation rather than continuing an existing conversation.
D. Clarify the problem: While it is important to identify and clarify the staffing issues and tardiness, the nurse manager's actions are more about creating an environment for discussion rather than explicitly defining the problem at this stage. Setting ground rules is a foundational step that supports problem clarification by fostering respectful dialogue among participants.

A. pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L B. pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L C. pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L D. pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L

Correct Answer is B

Explanation

A. pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L: This ABG finding indicates respiratory alkalosis, as evidenced by the elevated pH and decreased PaCO2. In progressive COPD, clients typically retain carbon dioxide rather than blow it off, so this finding would not be expected in a patient with chronic respiratory issues.
B. pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L: This is the most consistent finding for a client with progressive COPD. The low pH indicates acidosis, and the elevated PaCO2 suggests respiratory acidosis due to carbon dioxide retention, a common problem in COPD. The elevated HCO3 indicates a compensatory metabolic response, as the body attempts to retain bicarbonate to buffer the acidosis.
C. pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L: These values indicate a normal ABG, which would not be expected in a client with progressive COPD. Patients with chronic lung disease typically present with acid-base imbalances due to respiratory failure, so this finding suggests the client is not exhibiting the expected complications of COPD.
D. pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L: Although these findings show mild acidosis, the PaCO2 is within normal limits, indicating that this patient may not be experiencing significant respiratory failure. In advanced COPD, one would expect to see a higher PaCO2 and more pronounced acidosis, making this option less characteristic of a patient with progressive COPD compared to option B.

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A nurse is preparing to discharge a client who is a status post-operative laryngectomy. The nurse should recognize which of the following discharge teaching is the highest priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

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Correct Answer is B

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