Nursing Elites

1. When performing tracheostomy care, which intervention should the nurse implement?

• A. Use aseptic technique.
• B. Clean the inner cannula with mild soap and water.
• C. Secure new tracheostomy ties before removing old ones.
• D. Apply suction when inserting the catheter.

Correct answer: C

Rationale: When caring for a client with a tracheostomy, it is essential to ensure that the airway is maintained and secured at all times. Securing new tracheostomy ties before removing the old ones helps prevent accidental decannulation and ensures continuous airway patency. Aseptic technique is crucial to prevent infections but is not directly related to securing the tracheostomy ties. Cleaning the inner cannula with mild soap and water is important for maintaining hygiene but does not address the immediate need for securing the airway. Applying suction when inserting the catheter is not a standard practice during tracheostomy care.

2. A client is wearing a Venturi mask to receive oxygen, and the dinner tray has arrived. What action by the nurse is best?

• A. Assess the client's oxygen saturation and, if normal, turn off the oxygen.
• B. Determine if the client can switch to a nasal cannula during the meal.
• C. Have the client lift the mask off the face when taking bites of food.
• D. Turn off the oxygen while the client eats the meal and then restart it.

Correct answer: B

Rationale: In this scenario, the nurse should determine if the client can safely switch to a nasal cannula during meals. It is crucial to ensure that the provider has approved this change. Oxygen is considered a medication and should be delivered continuously. Turning off the oxygen or lifting the mask while eating can lead to a decrease in the FiO2 delivered, potentially compromising the client's oxygenation status. Therefore, the best course of action is to ascertain if transitioning to a nasal cannula is appropriate for the client during the meal.

3. A client with asthma is being taught about peak flow meter use. Which statement by the client indicates understanding of the teaching?

• A. I will use my peak flow meter every morning.
• B. I will use my peak flow meter when I feel short of breath.
• C. I will use my peak flow meter before using my inhaler.
• D. I will use my peak flow meter after using my inhaler.

Correct answer: A

Rationale: The correct answer is A. Using the peak flow meter every morning is crucial for monitoring asthma control and making timely treatment adjustments. While using the meter when feeling short of breath or before using an inhaler can also be beneficial, the daily morning routine helps in consistent management of asthma symptoms.

4. A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. Which finding does the nurse expect?

• A. Increased anteroposterior (AP) chest diameter
• B. Decreased respiratory rate
• C. Weight gain
• D. Productive cough with yellow sputum

Correct answer: A

Rationale: Clients with COPD commonly develop a barrel chest, characterized by an increased anteroposterior diameter of the chest. This change is due to chronic air trapping and hyperinflation of the lungs. A decreased respiratory rate, weight gain, and productive cough with yellow sputum are not typical findings in COPD. Instead, COPD patients often present with an increased respiratory rate, weight loss, and a chronic cough with sputum production.

5. A client is planning to perform nasotracheal suction for a client who has COPD and an artificial airway. Which of the following actions should the nurse take?

• A. Perform suctioning for up to four passes.
• B. Apply suction to the catheter when advancing it into the trachea.
• C. Preoxygenate the client with 100% oxygen for up to 3 min.
• D. Limit each suction pass to 25 seconds.

Correct answer: C

Rationale:

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