what is the priority nursing intervention for a patient with a new tracheostomy what is the priority nursing intervention for a patient with a new tracheostomy
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Nursing Elites

ATI RN

ATI Capstone Comprehensive Assessment B

1. What is the priority nursing intervention for a patient with a new tracheostomy?

Correct answer: A

Rationale: The correct answer is to suction the tracheostomy as needed to maintain a patent airway. After a tracheostomy procedure, the immediate concern is airway patency to prevent respiratory compromise. Suctioning helps clear secretions and maintains a clear airway, reducing the risk of respiratory distress. Monitoring the patient's oxygen saturation (choice B) is important but not the priority compared to ensuring a clear airway. Providing humidified air (choice C) and administering pain medication (choice D) are also essential aspects of care for a patient with a tracheostomy, but they are not the priority when immediate airway management is required.

2. A client has been diagnosed with dependent personality disorder. Which of the following behaviors should the nurse expect?

Correct answer: A

Rationale: Individuals with dependent personality disorder typically struggle with making decisions independently and rely heavily on others for guidance and reassurance. This can manifest as difficulty in initiating or making choices without the input of others. Clients with this disorder often display clingy, submissive behaviors and fear being alone, which aligns with the characteristic of difficulty making decisions seen in option A. Choices B, C, and D are not typically associated with dependent personality disorder. Preoccupation with orderliness may be seen in obsessive-compulsive personality disorder, attention-seeking behavior in histrionic personality disorder, and aggression in other disorders such as antisocial personality disorder.

3. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?

Correct answer: A

Rationale: Clients are often overwhelmed by a sudden cancer diagnosis; therefore, it is best for the nurse to call the client at home the next day to review teaching. This approach allows the client time to process the information before the surgery. Choice B may be beneficial but is not the priority at this time. Providing written instructions (Choice C) is helpful but does not offer the personalized interaction needed. Reassuring the client (Choice D) is important but does not address the educational aspect of preoperative preparation.

4. What is the main purpose of conducting a SWOT analysis in healthcare?

Correct answer: C

Rationale: The main purpose of conducting a SWOT analysis in healthcare is to assess external opportunities along with identifying strengths, weaknesses, and threats. While identifying strengths and weaknesses is a part of the analysis, the primary goal is to evaluate external opportunities and threats to develop strategic goals. Option A is incorrect as the analysis encompasses more than just strengths and weaknesses. Option B is incorrect as developing strategic goals is a result of the analysis, not the main purpose. Option D is incorrect as streamlining healthcare processes is not the primary focus of a SWOT analysis.

5. What is an example of a client’s primary defense to infection?

Correct answer: Intact skin

Rationale:

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