A nurse is planning to perform tracheostomy care for a toddler.
which of the following is an appropriate action for nurse to take?
use clean technique to change the tracheostomy tube.
clean around the stoma with full -strength hydrogen peroxide.
Place the child in Trendelenburg position when performing care.
Have the child flex his head when securing the ties.
The Correct Answer is D
The correct answer is D. Have the child flex his head when securing the ties.
Explanation:
When securing tracheostomy ties, flexing the head helps ensure the ties are snug but not too tight. This minimizes the risk of accidental dislodgement while allowing proper airway support.
Why the other options are incorrect:
-
A. Use clean technique to change the tracheostomy tube – Incorrect. Sterile technique is required when changing the tracheostomy tube to prevent infection, especially in pediatric clients.
-
B. Clean around the stoma with full-strength hydrogen peroxide – Incorrect. Diluted hydrogen peroxide or saline is recommended to avoid tissue irritation. Full-strength hydrogen peroxide can damage delicate skin around the stoma.
-
C. Place the child in Trendelenburg position when performing care – Incorrect. The Trendelenburg position (head down, feet up) is not used for tracheostomy care and can increase the risk of aspiration or breathing difficulties.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A weak pedal pulse distal to the site of a cardiac catheterization procedure could indicate a vascular complication, such as a hematoma or thrombosis, and should be reported to the provider immediately.
Choice B rationale
A blood pressure of 102/58 mm Hg is within the normal range for a toddler and does not need to be reported to the provider.
Choice C rationale
Bilateral cool extremities can be a normal finding in a child who is recovering from anesthesia. However, if coolness is accompanied by other signs of poor perfusion, such as pallor or delayed capillary refill, it should be reported to the provider.
Choice D rationale
A serum glucose level of 90 mg/dL is within the normal range for a toddler and does not need to be reported to the provider.
Correct Answer is B
Explanation
Choice A rationale
Consuming flavored yogurt instead of plain yogurt may not be beneficial for a lactose intolerant individual. Flavored yogurts often contain added sugars and may still contain lactose, which can trigger symptoms in individuals with lactose intolerance.
Choice B rationale
Replacing milk with non-dairy sources of calcium is a common strategy for managing lactose intolerance. Non-dairy sources of calcium include foods like broccoli, oranges, almonds, tofu, and certain fortified products. This can help ensure the individual meets their calcium needs without triggering symptoms of lactose intolerance.
Choice C rationale
Drinking milk on an empty stomach is not typically recommended for individuals with lactose intolerance. Consuming lactose-containing foods or drinks on an empty stomach may increase the likelihood of experiencing symptoms.
Choice D rationale
The tolerance for plain milk versus chocolate milk can vary among individuals with lactose intolerance. However, chocolate milk often contains added sugars and may still contain lactose, which can trigger symptoms.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.