A nurse is caring for a child who has a tracheostomy. After suctioning the tracheostomy, which of the following findings should the nurse use to determine that the procedure was effective?

Decreased respiratory rate

Stable oxygen saturation

Clear breath sounds

Pink capillary refill

Answer and Explanation

The Correct Answer is C

Choice A reason: Decreased respiratory rate is not a finding that indicates the effectiveness of suctioning the tracheostomy. A decreased respiratory rate could be a sign of respiratory depression, fatigue, or hypoxia.

Choice B reason: Stable oxygen saturation is not a finding that indicates the effectiveness of suctioning the tracheostomy. A stable oxygen saturation could be maintained even if the tracheostomy is obstructed or infected.

Choice C reason: Clear breath sounds is a finding that indicates the effectiveness of suctioning the tracheostomy. Clear breath sounds mean that the airway is patent and free of secretions, mucus, or blood.

Choice D reason: Pink capillary refill is not a finding that indicates the effectiveness of suctioning the tracheostomy. Pink capillary refill is a sign of adequate perfusion and circulation, but it does not reflect the status of the airway.

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Correct Answer is A

Explanation

Choice A reason: Barley contains gluten, a protein that triggers an immune reaction in people with celiac disease. This reaction damages the lining of the small intestine and prevents it from absorbing nutrients. Therefore, barley should be avoided by people with celiac disease.

Choice B reason: Wheat also contains gluten and should be avoided by people with celiac disease for the same reason as barley.

Choice C reason: Rice is a gluten-free grain and can be safely consumed by people with celiac disease. Rice is a good source of carbohydrates, fiber, and vitamins.

Choice D reason: Potatoes are also gluten-free and can be safely consumed by people with celiac disease. Potatoes are a good source of potassium, vitamin C, and starch.

A. "We will restrict the amount of salt in our child's food." B. "I'll limit my child's fluid intake." C. "We will give our child pancreatic enzymes with snacks and meals." D. "We'll prepare low-fat meals with limited protein for my child."

Correct Answer is C

Explanation

Choice A reason: Restricting salt in a child with CF is not advised because these children can lose excessive amounts of salt when they sweat. Maintaining adequate salt intake is important to prevent electrolyte imbalances.

Choice B reason: Limiting fluid intake is not recommended for children with CF. Adequate hydration helps to thin mucus secretions, making them easier to clear from the lungs.

Choice C reason:This is the correct choice. Pancreatic enzyme replacement therapy is essential for children with CF because it helps them digest and absorb nutrients from their food, which is critical due to the malabsorption issues associated with CF.

Choice D reason: Preparing low-fat meals with limited protein is not recommended for children with CF. They require a high-calorie diet with sufficient protein to meet their nutritional needs due to their increased metabolic rate and malabsorption issues.

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A nurse is caring for a child who has a tracheostomy. After suctioning the tracheostomy, which of the following findings should the nurse use to determine that the procedure was effective?

Nursing Test Bank

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