After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?

Place the patient in a lateral recovery position for better drainage of the secretions.

Activate the rapid-response team.

Keep monitoring the oxygen saturation and respiratory rate.

Increase the humidification of the patient's oxygen.

Answer and Explanation

The Correct Answer is A

A. Placing the patient in a lateral recovery position is the best immediate action. This position helps facilitate drainage of secretions, especially after a laryngectomy, which can reduce the risk of aspiration and airway obstruction. The blood-tinged mucus may be due to recent surgery and should be monitored for changes.
B. The activation of the rapid-response team may be necessary if the patient’s condition worsens or becomes critical, but there is no indication of an acute life-threatening event based on the blood-tinged mucus alone.
C. Monitoring the oxygen saturation and respiratory rate is important, but it is a secondary concern compared to providing a position that promotes drainage and prevents aspiration.
D. Increasing humidification of the oxygen may help keep the airway moist, but the immediate priority should be ensuring proper positioning to allow secretion drainage and prevent aspiration.

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Correct Answer is C

Explanation

A. Hypotension is not a risk factor for metabolic syndrome; in fact, metabolic syndrome is often associated with hypertension.
B. Hypoglycemia is not a risk factor for metabolic syndrome. It is typically a concern in diabetes, not directly related to metabolic syndrome.
C. A large waist size is a significant risk factor for metabolic syndrome, as it is one of the key components in diagnosing the syndrome. Abdominal obesity (visceral fat) is strongly associated with insulin resistance, high cholesterol, and increased cardiovascular risk.
D. While asthma may affect overall health, it is not a direct risk factor for metabolic syndrome.

A. Polyuria B. Tachycardia C. Blurred vision D. Polydipsia E. Moist, clammy skin

Correct Answer is ["B","C","E"]

Explanation

A. Polyuria is typically a symptom of hyperglycemia (high blood sugar) rather than hypoglycemia. When blood glucose is elevated, the kidneys attempt to excrete the excess glucose, leading to increased urination.
B. Tachycardia (increased heart rate) is a common sign of hypoglycemia due to the body's stress response to low blood sugar. The release of adrenaline (epinephrine) can cause a rapid heart rate.
C. Blurred vision can occur with hypoglycemia because low glucose levels can affect the function of the retina and cause vision changes. This can resolve once the blood glucose level is normalized.
D. Polydipsia (excessive thirst) is more commonly seen in hyperglycemia, as high blood glucose leads to dehydration due to increased urination.
E. Moist, clammy skin is a classic sign of hypoglycemia. When blood sugar drops too low, the body activates the sympathetic nervous system, which can cause sweating and clammy skin.

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After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client to identify risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome?

Correct Answer is C

Explanation

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

Correct Answer is ["B","C","E"]

Explanation

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After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?