The nurse is teaching a group of staff nurses about complications associated with a tracheostomy. Which of the following conditions would the nurse include? Select all that apply

Laryngeal nerve damage

Coronary artery occlusion

Subcutaneous emphysema

Pneumothorax

Gastric bleeding

Answer and Explanation

Correct Answer : A,C,D

A. Tracheostomy placement can injure the recurrent laryngeal nerve, leading to hoarseness, vocal cord paralysis, or difficulty speaking. This is a recognized complication, especially with high tracheal incisions or improper surgical technique.

B. Coronary artery occlusion is a cardiac event unrelated to tracheostomy. Tracheostomy procedures do not directly affect the coronary arteries.

C. Air can escape from the trachea into surrounding tissue if there is improper tube placement, cuff leak, or airway trauma, causing subcutaneous emphysema. This is a known complication and requires monitoring.

D. Accidental puncture of the pleura during tracheostomy insertion can lead to pneumothorax, especially in patients with underlying lung disease or difficult anatomy. Immediate recognition and intervention are critical.

E. Gastric bleeding is not a direct complication of a tracheostomy. While critically ill patients may be at risk for stress-related mucosal damage, this is not caused by the tracheostomy itself.

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Correct Answer is B,A,D,C

Explanation

B. Blood cultures x 2, taken 5 minutes apart – First Priority:Blood cultures must be obtained before administering antibioticsto accurately identify the causative organism. In a patient showing signs of sepsis—hypotension, tachycardia, tachypnea, fever, and purulent wound drainage—early culture collection is critical to guide effective therapy.

A. Tylenol 650 mg PO prn q6h for a temperature above 101°F – Second:Fever management improves patient comfort and reduces metabolic demand but is not immediately life-saving. It is appropriate to administer after cultures are drawn.

D. Vancomycin 750 mg IVPB over 1 hour every 24 hours – Third:Broad-spectrum IV antibiotics should be started immediately after cultures are obtained.Early administration is essential to treat sepsis and prevent progression to septic shock, while still ensuring culture results are accurate.

C. C&S of abdominal wound drainage – Fourth:Wound culture helps tailor ongoing antibiotic therapy but is secondaryto the urgent need to obtain blood cultures and start empiric antibiotic therapy.

A. Oxygen saturation remains unchanged. B. Core body temperature has increased to 99°F (37.2°C). C. The client correctly states the month and year. D. Serum lactate and serum potassium levels are declining.

Correct Answer is D

Explanation

A. While maintaining oxygen saturation is important, an unchanged SpO2 does not necessarily indicate that tissue perfusion and organ function are improving, which is the primary goal in treating hypovolemic shock.

B. A mild increase in temperature is not a reliable indicator of improved perfusionor effectiveness of interventions in hypovolemic shock. Temperature can fluctuate for many reasons and is not specific to hemodynamic improvement.

C. Improvement in mental status is a positive sign, but it may lag behind biochemical and hemodynamic recoveryand alone does not provide the most objective evidence that interventions are working.

D. Serum lactate is a key marker of tissue hypoxia and poor perfusion. In hypovolemic shock, lactate rises due to anaerobic metabolism. Declining lactate indicates that tissue oxygen delivery is improvingand perfusion is being restored. Similarly, correcting hypovolemia often stabilizes electrolyte imbalances, including potassium. Objective improvements in laboratory values provide clear evidence that fluid resuscitation, oxygen therapy, and other interventions are effective.

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The nurse is teaching a group of staff nurses about complications associated with a tracheostomy. Which of the following conditions would the nurse include? Select all that apply

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Naxlex Comprehensive Predictor Exams

Exhibits In what order will the nurse implement these interventions?

Correct Answer is B,A,D,C

Explanation

The nurse is caring for a client with hypovolemic shock. Which new assessment finding indicates to the nurse that interventions are currently effective?

Correct Answer is D

Explanation

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