A nurse is caring for an adult client with a tracheostomy. After suctioning the tracheostomy, which finding best indicates the procedure was effective?

Rationale:
A. Verifying calculations with another nurse is an important safety step to ensure the correct dose is administered, especially for high-risk medications. However, this action focuses on dosage accuracy rather than whether the medication is appropriate for the client’s medical condition or therapeutic need. Correct calculation alone does not guarantee that the medication is indicated for the client’s current diagnosis.

B. Checking the label against the order ensures the nurse selects the right medication and dose and matches it to the prescription. This step is critical to prevent administration errors, but it does not provide information about whether the medication is indicated for the client’s condition or whether it is safe considering their medical history or concurrent medications.

C. Reviewing the client’s medical history is the most important action to ensure the medication is given for the right indication. By examining the client’s diagnoses, current symptoms, comorbidities, allergies, and other medications, the nurse can confirm that the prescribed medication is appropriate for the client’s needs. This step helps prevent giving a medication that is unnecessary, contraindicated, or potentially harmful. For example, administering a beta-blocker to a client with bradycardia or giving an NSAID to a client with renal impairment could cause serious complications if the indication and client history are not considered.

D. Confirming the name on the prescription ensures the right client receives the medication, which is essential for safety, but it does not verify that the medication is appropriate for the client’s health condition. Administering the correct drug to the wrong client or the correct drug to a client without proper indication can both result in adverse outcomes.

Rationale:

A. Bananas are appropriate for a low-residue diet. A low-residue diet limits fiber and foods that increase stool bulk in order to decrease bowel activity and reduce the amount of undigested material passing through the intestines. Ripe bananas are low in fiber, easy to digest, soft in texture, and produce minimal fecal residue, making them suitable for clients requiring bowel rest.

B. Broccoli is not appropriate because it is high in fiber and increases stool bulk. It may also cause gas and bloating, which can irritate the gastrointestinal tract. High-fiber vegetables are restricted on a low-residue diet.

C. Brown rice is a whole grain and contains significant fiber. Whole grains increase intestinal residue and stimulate bowel movements, which contradicts the purpose of a low-residue diet. Refined grains would be preferred instead.

D. Black bean soup contains legumes, which are high in fiber and known to increase stool bulk and gas production. Beans are avoided on a low-residue diet because they stimulate bowel activity and increase intestinal workload.