A nurse is preparing to perform tracheostomy care for a client. In which order should the nurse take the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Ensure a method to communicate during the procedure.
Wear clean gloves to remove the tracheostomy dressing.
Clean the inner cannula using a small brush.
Explain the procedure to the client.
Apply clean tracheostomy ties.
The Correct Answer is D, A, B, C, E
D. Explain the procedure to the client. Before starting any procedure, explaining it to the client helps reduce anxiety and ensures cooperation. A. Ensure a method to communicate during the procedure. Since the client may have difficulty speaking, establishing a method of communication (such as hand signals or a writing board) is essential to ensure their comfort and safety during the procedure. B. Wear clean gloves to remove the tracheostomy dressing. Putting on clean gloves is important before touching the site and removing the dressing to prevent infection. C. Clean the inner cannula using a small brush. Cleaning the inner cannula is critical to prevent the buildup of secretions and ensure the airway remains clear. E. Apply clean tracheostomy ties. Once the site is cleaned and the cannula is secured, applying new, clean ties will ensure the tracheostomy tube remains in place and secure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Place on airborne precautions. This is incorrect. Tinea corporis isn't transmitted through the air. Airborne precautions are specific infection control measures for diseases transmitted through airborne particles, like tuberculosis or measles, which are caused by specific bacteria or viruses.
Choice B Reason:
Avoid direct contact is correct. Direct contact is a crucial precaution to prevent the spread of tinea corporis. It's a contagious infection, often transmitted through skin-to-skin contact or by sharing contaminated items such as clothing, towels, or bedding. Encouraging precautions like not sharing personal items and avoiding direct skin contact helps prevent the spread of the infection to others.
Choice C Reason:
Isolate for 24 hr. after lesions appear is incorrect. While it's essential to take precautions to prevent spread, isolating for only 24 hours after lesions appear might not be sufficient. The infection can remain contagious until it's effectively treated and lesions have resolved. More extended isolation or precautions might be necessary until the infection is no longer transmissible.
Choice D Reason:
Administer a broad-spectrum antibiotic is incorrect. Tinea corporis is a fungal infection, not a bacterial one, so antibiotics would not be effective against it. Antifungal medications, such as topical or oral antifungals, are the primary treatment for tinea corporis. Using an antibiotic would not treat the fungal infection and might lead to inappropriate medication use.
Correct Answer is A, B, C, D, E
Explanation
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