A nurse is caring for a client who is postoperative following a tracheostomy and has copious and tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin this client's secretions?
Provide humidified oxygen.
Prelubricate the suction catheter tip with sterile saline when suctioning the airway.
Perform chest physiotherapy prior to suctioning.
Hyperventilate the client with 100% oxygen before suctioning the airway.
The Correct Answer is A
a. Provide humidified oxygen: Humidification helps prevent the drying of mucous membranes, making secretions more manageable and less tenacious. This is an acceptable method to thin
secretions in a client with a tracheostomy.
b. Prelubricate the suction catheter tip with sterile saline when suctioning the airway: While lubrication with sterile saline is a common practice during suctioning to reduce trauma to the airway, it does not directly address the tenacity of secretions.
c. Perform chest physiotherapy prior to suctioning: Chest physiotherapy is a technique used to mobilize respiratory secretions, but it may not directly address the tenacity of secretions.
d. Hyperventilate the client with 100% oxygen before suctioning the airway: Hyperventilation with 100% oxygen is not a routine practice and may lead to respiratory alkalosis. Providing
humidified oxygen is a more appropriate approach.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a. "The pain radiates down to my lower back." This statement is not typical of peptic ulcer
disease. Radiation of pain to the lower back may suggest other abdominal or musculoskeletal issues.
b. "I feel so much better after eating." Relief of pain after eating is more indicative of gastric ulcer rather than peptic ulcer disease. Peptic ulcers are often associated with pain that worsens after eating.
c. "My pain is relieved by having a bowel movement." Relief of pain with bowel movements is
not a characteristic finding of peptic ulcer disease. This may suggest other gastrointestinal issues.
d. "The pain is worse after I eat a meal high in fat." This statement is consistent with peptic ulcer disease. High-fat meals stimulate gastric acid secretion, potentially exacerbating the pain
associated with peptic ulcers.
Correct Answer is D
Explanation
a. Eating dinner early in the evening: Eating dinner early can actually be a positive factor in preventing heartburn by allowing more time for digestion before lying down.
b. Sleeping on a large wedge-style pillow: Elevating the upper body can help prevent acid reflux, so sleeping on a wedge-style pillow may be a helpful strategy.
c. Consuming low-fat meats: Low-fat meats are less likely to contribute to heartburn compared to high-fat meats.
d. Drinking orange juice regularly: Orange juice is acidic and can contribute to heartburn,
especially if consumed regularly. The acid content can irritate the esophagus and worsen GERD symptoms.
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