After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?

Place the patient in a lateral recovery position for better drainage of the secretions.

Activate the rapid-response team.

Keep monitoring the oxygen saturation and respiratory rate.

Increase the humidification of the patient's oxygen.

Answer and Explanation

The Correct Answer is A

A. Placing the patient in a lateral recovery position is the best immediate action. This position helps facilitate drainage of secretions, especially after a laryngectomy, which can reduce the risk of aspiration and airway obstruction. The blood-tinged mucus may be due to recent surgery and should be monitored for changes.
B. The activation of the rapid-response team may be necessary if the patient’s condition worsens or becomes critical, but there is no indication of an acute life-threatening event based on the blood-tinged mucus alone.
C. Monitoring the oxygen saturation and respiratory rate is important, but it is a secondary concern compared to providing a position that promotes drainage and prevents aspiration.
D. Increasing humidification of the oxygen may help keep the airway moist, but the immediate priority should be ensuring proper positioning to allow secretion drainage and prevent aspiration.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

A. Hyperaldosteronism causes sodium retention and potassium excretion, leading to elevated serum sodium levels and low potassium levels. A serum potassium level of 2.5 mmol/L is indicative of hypokalemia, which is a classic finding in hyperaldosteronism.
B. This serum electrolyte pattern (normal sodium and potassium) is not suggestive of hyperaldosteronism.
C. In hyperaldosteronism, the serum sodium is typically elevated, but the potassium level is very low, not elevated as seen in this option.
D. While low potassium is indicative of hyperaldosteronism, the sodium level is abnormally low in this case, which is not typical for this condition. Hyperaldosteronism typically presents with elevated sodium.

A. An increase in the secretion of both bile and pancreatic enzymes B. A decrease in the secretion of insulin caused by carbohydrates C. When the passage of food into the small intestine occurs too rapidly D. The inability to digest high-fat foods

Correct Answer is C

Explanation

A. Dumping syndrome is not related to the increased secretion of bile and pancreatic enzymes; it occurs when food passes too quickly from the stomach into the small intestine.
B. Dumping syndrome is not caused by a decrease in insulin secretion, but rather by rapid gastric emptying that can result in fluctuating blood sugar levels.
C. Dumping syndrome occurs when food moves too quickly from the stomach into the small intestine, causing a sudden release of insulin and other gastrointestinal symptoms, such as nausea, diarrhea, and dizziness.
D. While high-fat foods can be problematic for some gastric bypass patients, dumping syndrome is specifically related to rapid gastric emptying and not the inability to digest fat.

View Question and Answer

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

After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which serum electrolyte value alerts the nurse to the possibility of hyperaldosteronism?

Correct Answer is A

Explanation

A patient who is scheduled for gastric bypass surgery asks for information about dumping syndrome. How does the nurse explain dumping syndrome?

Correct Answer is C

Explanation

In reviewing admission orders for a patient admitted with SIADH, the nurse should question which order?

After observing blood-tinged mucous when suctioning a patient who has just arrived on the medical-surgical unit after a laryngectomy, which action by the nurse is best?

Which safety measure is most important for the nurse to institute for a patient who has Cushing Syndrome?

A nurse is teaching a client who has a new diagnosis of asthma. Which of the following medications should the nurse instruct the client to use to abort an acute asthma attack?

A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which of the following laboratory findings indicate a therapeutic effect of the medication?

A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?

A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.)