You are setting up a room for your patient that has a new tracheostomy. Select all of the equipment you need bring with to ensure patient is safe should the tracheostomy become dislodged:

Tracheostomy kit setup

Suction equipment

Smaller Tracheostomy Tube and Same size Tracheostomy Tube

Ambu bag

Oxygen

Larger Tracheostomy T

Answer and Explanation

Correct Answer : A,B,C,D,E

A tracheostomy is a surgical procedure that involves creating an opening in the neck to establish a direct airway to the trachea. It is usually done in patients who require long-term mechanical ventilation or have upper airway obstruction. In case the tracheostomy becomes dislodged, the following equipment should be available to ensure the patient's safety:

Tracheostomy kit setup: This includes a new tracheostomy tube, obturator, and other equipment necessary to replace the dislodged tracheostomy tube.

Suction equipment: Dislodgement of the tracheostomy tube can cause airway obstruction due to the presence of secretions. Suction equipment can be used to remove the secretions and prevent airway obstruction.

Smaller Tracheostomy Tube and Same size Tracheostomy Tube: If the dislodged tracheostomy tube cannot be reinserted or is damaged, having smaller and same size tracheostomy tubes available can be helpful in establishing a new airway.

Ambu bag: This is a manual resuscitation device used to provide positive pressure ventilation to the patient. It can be used in case the patient's breathing is compromised due to airway obstruction.

Oxygen: The patient may require supplemental oxygen if their breathing is compromised due to airway obstruction.

Larger Tracheostomy Tube: A larger tracheostomy tube may not be needed immediately and may be contraindicated in some cases as it can cause trauma to the tracheal wall.

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Correct Answer is A

Explanation

A. This is the most appropriate response. Clients with COPD often have chronically elevated carbon dioxide levels, which can lead to a compensatory decrease in the oxygen saturation level. A reading of 91% may be within their normal range.

A. Auscultate bilateral breath sounds. B. Obtain blood culture for tuberculosis. C. Request pulmonary function studies. D. Document the findings.

Correct Answer is A

Explanation

The client's greenish-yellow sputum with a musty odor may indicate an infection, such as pneumonia or bronchitis, which can aﬀect the client's lung function. By auscultating bilateral breath sounds, the nurse can assess for the presence of abnormal lung sounds, such as crackles or wheezing, which may indicate further respiratory compromise.

While obtaining a blood culture for tuberculosis (option b) may be appropriate in certain circumstances, the client's sputum color and odor do not necessarily indicate tuberculosis as the cause of their respiratory symptoms.

Requesting pulmonary function studies (option c) may also be beneficial in assessing the client's lung function, but this is not the priority assessment in this situation.

Finally, while documenting the findings (option d) is an important aspect of nursing care, it is not the priority action when the client is presenting with signs of compromised lung function.

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You are setting up a room for your patient that has a new tracheostomy. Select all of the equipment you need bring with to ensure patient is safe should the tracheostomy become dislodged:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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