When suctioning a client with a tracheostomy which nursing intervention is correct quizlet?
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Terms in this set (32)When preparing to suction a client's tracheostomy, which action by the nurse best helps to prevent the Introduction of microorganisms into the respiratory tract? A. Gently rotating the suction catheter as it is being withdrawn B. Using only the dominant hand to handle and manipulate the catheter Which client is most likely to need administration of pain medication before being suctioned the tracheostomy? A. Client who has a toe amputation C. Client who had abdominal surgery The nurse is preparing to suction a client who has a tracheostomy after cardiac surgery. To help minimize the client's anxiety , which statement made by the nurse is most therapeutic ? A. Once the procedure started we will not interrupt it so that we do not cause additional pain D. If you experience any difficulty squeeze my hand and I will stop to allow you to rest a bit The nurse is preparing to section the tracheostomy of a client. The nurse will place which client in the lateral position facing the nurse? A. Client who is confusing or uncooperative B. Unconscious client after abdominal surgery The nurse is suctioning a client with a tracheostomy using an open system device. Which action will the nurse implement specifically to help prevent trauma to the tracheal tissue? Apply section at 110 to 130 mm Hg from the wall unit The nursing is auctioning a clients tracheostomy using an open system. For which action should the nursing use the gloves, dominant hand? A. Manipulating the suction catheter A. Manipulating the suction catheter Place in order, from first to last, the actions the nurse will perform when preparing to suction an alert client tracheostomy using an open system, Use all options. 1. Adjust the wall suction to the appropriate level. 1. Explain the procedure to the client. The nurse is observing a student nurse suction a client with a tracheostomy using an open system. Which action by the student nurse will require additional instruction by the nurse? The student nurse: A. pauses for 45 seconds between suction attempts and encourages the client to cough. D. uses a manual resuscitation bag to give the client big breaths before beginning. The nurse is inserting the suction catheter into a client's tracheostomy and suddenly meets resistance. Which action would be most appropriate? A. Withdraw the catheter at least 0.5 in (1.25 cm). When suctioning a client with the tracheostomy using an open system, with actions by the nurse would help to prevent hypoxemia during the procedure. Select all that apply Limit suctioning to 10 to 15 seconds each time. Hyperventilating client with 3 to 6 breast before suctioning Pause for 30 to 60 seconds between sectioning attempts The nurse has assessed a client with a tracheostomy and decided that suctioning needed. Which action will the nurse implement to help prevent complications? A. Suction the trachea only after suctioning the oropharynx C. Limit suctioning passes to no more than three per episode. Place in order, from first to last, the actions the nurse will perform when suctioning a client using a closed system suction. Use all options. 1. Explain the procedure to the client. 1. Explain the procedure to the client.
After assessing clients with a tracheostomy, which client will the nurse suction? A. A client who has not been suctioned in more than 4 hours. D. A client with rhonchi in upper airways noted on auscultation.
While suctioning a client, the nurse inserts a closed-system suction catheter into the tracheostomy tube and meets resistance. Which action should the nurse take? A. Withdraw the catheter at least 0.5 (1.25 cm) before applying suction. A. Withdraw the catheter at least 0.5 (1.25 cm) before applying suction. When suctioning the tracheostomy, when would the nurse suction the oral cavity? A. Shortly after suctioning the tracheostomy. A. Shortly after suctioning the tracheostomy. The nurse has just finished suctioning a client with a tracheostomy. Which action should the nurse take next? A. Document the procedure and client tolerance. B. Assess the client's lung sounds. The nurse has just finished replacing a disposable inner cannula of a client's tracheostomy The client begins coughing and dislodges the tracheostomy. Which action should the nurse take first? A. Rinse off the expelled tracheostomy with sterile saline and reinsert it using the obturator. C. Insert the obturator into a new tracheostomy and insert the tracheostomy into the stoma. The preparing to provide tracheostomy care to a client. The client's tracheostomy dressing is soiled, but a commercially prepared tracheostomy dressing is not available. Which action should the nurse perform? A. Apply water-soluble lubricant around the stoma. B. Use two folded gauze sponges on each side of the stoma. The nurse is preparing to provide tracheostomy care to a client with a new tracheostomy Which action should the nurse take before beginning the procedure? A. Apply a topical analgesic around the tracheostomy stoma site. C. Assess the client for pain and administer analgesic as needed. When providing tracheostomy care a client with a disposable Inner cannula, at which point would the nurse put on sterile gloves? A. before opening the
package containing the new cannula C. after removing the old inner cannula The nurse is changing a disposable inner cannula on a tracheostomy client, Place order , from first to last, the actions the nurse will perform. Use all options. 1. Remove and discard clean gloves,
and put on sterile gloves. 1. Open supplies using aseptic technique. The nurse is providing tracheostomy care for a client. When changing the dressing, which action would be most appropriate for cleaning the stoma? A. Use each applicator only oncemoving from the stoma site outward. A. Use each applicator only oncemoving from the stoma site outward. The nurse is providing tracheostomy care to a client and is preparing to change the client's tracheostomy collar. Which action would be most appropriate? A. Hold the tracheostomy tube in place with the nondominant hand while changing the collar with the dominant hand. C. Enlist the help of a second nurse to hold the tracheostomy tube in place while the old collar is removed and the new collar is placed. The nurse if providing tracheostomy care to a client with a nondisposable inner cannula. Which action should the nurse take next after removing the inner cannula? A. Place the inner cannula a sterile alcohol solution to soak. D. Replace the client's oxygen source over the outer cannula. The nurse is providing site care for a client with a tracheostomy using a nandisposable inner cannula, Which step is recommended to release the lock on the device? A. Stabilize the outer cannula and faceplate with the dominant hand. B. Stabilize the outer cannula and faceplate with the nondominant hand. The nurse is providing tracheostomy care for a client and cleans the nondisposable inner cannula with the brush. What should the surse do next? A. Apply a water-based lubricant to the inner cannula. C. Place the inner cannula a basin of sterile saline. While providing care to a client who has a tracheostomy with a nondtsposable inner cannula, the nurse observes secretions that have accumulated in the outer cannula. Which action would the nurse take? A. Suction the outer cannula using strict aseptic technique. A. Suction the outer cannula using strict aseptic technique. The nurse is observing a family caregiver doing a return demonstration of tracheostomy care for a client with a nondisposable cannula action by the family caregiver indicates that additional teaching is required? A. The family caregiver performs hand hygiene, then dons clean gloves and a face shield to begin the
procedure. B. The family caregiver rotates the inner cannula clockwise with the nondominant hand to release the lock. On assessment, the nurse notes significant secretions on the client's tracheostomy dressing. The health care provider's prescription states that tracheostomy site care is to be done once per shift. The nurse has already performed site care once during the current shiftWhat the best action by the nurse? A. Notify the health care provider and request additional prescription. B. Perform site care again and document the procedure. After changing a client's tracheostomy holder, the nurse determines that the collar fits properly when: A. the faceplate is centered. C. the client can flex the neck comfortably. After changing the disposable inner cannula and changing the dressing of a client who has a tracheostomy , a nurse prepares to change the client's tracheostomy collar. Which action would the nurse take first? A. Keep the old collar in place until the new collar secured. B. Enlist the assistance of a second nurse. On assessment, the nurse notes that the tracheostomy ties are grossly soiled and require changing . No one is available to assist at this time. What is the best action by the nurse? A. Wait until
later when someone is available to assist with the change. D. Secure the new tracheostomy ties before removing the old Sets with similar termsATI tracheostomy18 terms cortney_stout Ch. 34 - NCLEX Review Questions21 terms j_lafollette Ch. 7, 8, 38, 3940 terms mitchel_underoath Sets found in the same folderSkills Lab Chp. 1730 terms nallen416 Quiz: Emptying and Changing an Ostomy Appliance17 terms jessicawalden2 Quiz: Irrigating a Nasogastric Tube Connected to S…15 terms jessicawalden2 Unit 7- Administer Meds by IV Bolus or through IV…7 terms summertime4814 Other sets by this creatorAMS Exam 5 Questions66 terms TrinitimulwaPLUS Chapter 6618 terms TrinitimulwaPLUS Community Exam 3- Poverty26 terms TrinitimulwaPLUS Community Exam 3- Evolve Chapters 14; ATI Chapters…15 terms TrinitimulwaPLUS Other Quizlet setsgb 350182 terms aidangallardo25 Exam 1 review265 terms katmiddleton1PLUS Finance Exam 2157 terms aepritch Medical Aspects of Physical Activity Midterm73 terms emilymawson3 Related questionsQUESTION If the pt has a diagnostic arthroscopy and no surgical repair, the perianesthesia care nurse encourages the pt to exercise the leg, including..... 2 answers QUESTION Where do the muscles of mastication insert? 15 answers QUESTION what is the treatment for anorectal abscess or fistula? 13 answers QUESTION what is tamoxifen? what is its risk? 8 answers What do you do when suctioning a patient with a tracheostomy?Utilizing a non-touch technique gently introduce the suction catheter tip into the tracheostomy tube to the pre-measured depth. Apply finger to suction catheter hole & gently rotate the catheter while withdrawing. Each suction should not be any longer than 5-10 seconds.
What are the nursing interventions for a patient with a tracheostomy?When caring for a patient with a tracheostomy, nursing care includes suctioning the patient, cleaning the skin around the stoma, providing oral hygiene, and assessing for complications. Normal functions of the upper airway include warming, filtering, and humidifying inspired air.
Which nursing action is appropriate when suctioning the secretions of a client with a tracheostomy quizlet?Which nursing action is appropriate when suctioning the secretions of a client with a tracheostomy? Initiate suction as the catheter is being withdrawn. A client has a tracheostomy tube attached to a tracheostomy collar for the delivery of humidified oxygen.
What is the primary nursing responsibility for a patient with a tracheostomy?Caring for a patient with tracheostomy requires the nurse to have a thorough understanding of airway management, and maintain an ongoing assessment of the patient's respiratory function. Critical situations would require immediate intervention to ensure that respiratory arrest is avoided.
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