The nurse is caring for a client with a tracheostomy receiving oxygen therapy. Which intervention should the nurse prioritize to prevent infection and ensure proper oxygen delivery?
Regularly suctioning the tracheostomy tube.
Assessing the client's respiratory rate every hour.
Applying a sterile dressing over the tracheostomy site.
Administering humidified oxygen through the tracheostomy tube.
The Correct Answer is C
Answer: c. Applying a sterile dressing over the tracheostomy site.
Explanation: Applying a sterile dressing over the tracheostomy site helps prevent infection by providing a barrier against microorganisms. It also ensures a clean environment for optimal oxygen delivery and promotes wound healing.
Incorrect choices: a. Regularly suctioning the tracheostomy tube is important for maintaining airway patency but may not directly address infection prevention or oxygen delivery.
b. Assessing the client's respiratory rate every hour is important for monitoring respiratory status but does not specifically address infection prevention or oxygen delivery.
d. Administering humidified oxygen through the tracheostomy tube may be necessary to provide moistened air to the client's lungs but does not directly address infection prevention.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Answer: c. "Avoid using electric heating devices in your home."
Explanation: Oxygen supports combustion, and using electric heating devices in the presence of oxygen therapy can pose a significant fire hazard. It is important to educate clients with long-term oxygen therapy about the importance of avoiding open flames and electric heating devices to ensure their safety.
Incorrect choices: a. Ensuring a fire extinguisher is readily available is a good general safety practice but may not directly address the specific risk associated with oxygen therapy.
b. Keeping the oxygen tubing loose may increase the risk of tangling and accidental disconnection. The tubing should be appropriately secured and free from obstructions.
d. Using an oxygen concentrator for outdoor activities may not be necessary for all clients and should be based on individual needs and healthcare provider recommendations.
Correct Answer is C
Explanation
Answer: c. Frequently checking for condensation inside the face tent.
Explanation: Checking for condensation inside the face tent is important to ensure that the oxygen is effectively delivered to the client. Condensation can obstruct the flow ofoxygen and reduce its effectiveness. The nurse should frequently check for condensation and take appropriate measures to maintain proper oxygen delivery.
Incorrect choices: a. Adjusting the face tent to fit snugly around the client's face may cause discomfort and impede proper oxygen delivery. The face tent should be loosely fitted to allow adequate airflow.
b. Ensuring the client breathes through the nose during oxygen therapy is not necessary with a face tent, as it covers both the nose and mouth, allowing the client to breathe through either.
d. Monitoring the client's oxygen saturation every 8 hours is not frequent enough for clients receiving oxygen therapy. Continuous or regular monitoring is typically necessary to assess the effectiveness of oxygen therapy and adjust as needed.
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