A nurse is caring for a client who has a tracheostomy.
Based on the Nurses Notes and Diagnostic Results, which of the following is a manifestation in the client?
The client appears restless.
The client’s SaO2 is 92% on 40% humidified oxygen via tracheostomy collar.
The client’s lung fields have scattered rhonchi throughout.
The client’s tracheostomy was suctioned for thin clear secretions.
The Correct Answer is A
Choice A rationale
Restlessness in a client with a tracheostomy could indicate respiratory distress or hypoxia. It’s important for the nurse to further assess the client’s vital signs, oxygen saturation, and overall appearance.
Choice B rationale
A SaO2 of 92% on 40% humidified oxygen via tracheostomy collar is within the acceptable range for a client with a tracheostomy. However, it’s important to consider the client’s baseline SaO2 and any changes in their condition.
Choice C rationale
Scattered rhonchi throughout the lung fields could indicate secretions in the airways. However, this finding alone does not necessarily indicate a problem with the tracheostomy.
Choice D rationale
Suctioning of thin clear secretions from a tracheostomy is a routine part of tracheostomy care. This finding does not necessarily indicate a problem with the tracheostomy.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Written competency exams can assess theoretical knowledge and understanding of procedures, but they may not accurately reflect practical skills or performance under real-life conditions.
Choice B rationale
Insence training, while potentially beneficial for enhancing certain skills, may not be the most effective method for improving confidence and performance in response to a “code”. It lacks the realism and immediacy of a code situation.
Choice C rationale
Simulation-based mock codes provide a safe environment where staff can practice their skills, learn from their mistakes, and improve their performance without risk to patients. They can enhance confidence, competence, and performance in real code situations.
Choice D rationale
Peer-to-peer feedback sessions can provide valuable insights and foster a culture of continuous learning and improvement. However, they may not offer the same level of structured, targeted skill development and performance improvement as simulation-based mock codes.
Correct Answer is A
Explanation
Choice A rationale
Efficiency in healthcare refers to the optimal use of resources to achieve the desired health outcomes. Reducing wait times in the emergency department is an example of improving efficiency, as it involves streamlining processes to provide timely care.
Choice B rationale
Utilizing the CAUTI bundle to prevent urinary tract infections when placing indwelling urinary catheters is more related to the safety and effectiveness domains of healthcare quality.
Choice C rationale
Using an interpreter for patients who do not speak the healthcare provider’s language is related to the equity and patient-centeredness domains of healthcare quality.
Choice D rationale
Opening and utilizing supplies that are necessary for the task is a basic requirement in healthcare, but it does not specifically relate to the efficiency domain of healthcare quality.
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