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A client who has had a laryngectomy and tracheostomy frequently expectorates copious amounts of purulent secretions. When changing the ties of the tracheostomy tube, which action is most important for the nurse to take?

A.

Secure tracheostomy ties by making knots close to the tube.

B.

Remove ties to secure a disposable, soft foam collar with hook and loop fastener.

C.

Leave the old ties in place until the new ones are secure.

D.

Place knots of the ties laterally to prevent irritation and pressure.

Answer and Explanation

The Correct Answer is C

Choice A rationale

 

Securing tracheostomy ties by making knots close to the tube can cause irritation and pressure on the skin.

 

Choice B rationale

 

Removing ties to secure a disposable, soft foam collar with hook and loop fastener is not the most important action when changing the ties of the tracheostomy tube.

 

Choice C rationale

 

Leaving the old ties in place until the new ones are secure is the most important action to prevent accidental dislodgement of the tracheostomy tube.

 

Choice D rationale

 

Placing knots of the ties laterally to prevent irritation and pressure is important but not the most critical action when changing the ties of the tracheostomy tube.


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Correct Answer is D

Explanation

Choice A rationale

Flatulence is not a specific indicator of a serious complication related to a gallstone lodged in the common bile duct.

Choice B rationale

Amber urine is normal and does not indicate a serious complication.

Choice C rationale

Belching is not a specific indicator of a serious complication related to a gallstone lodged in the common bile duct.

Choice D rationale

Yellow sclera indicates jaundice, which is a sign of bile duct obstruction and requires immediate medical attention.

Correct Answer is D

Explanation

Choice A rationale

Storing the medication at room temperature is appropriate for ipratropium inhalers. This ensures the medication remains effective and safe for use.

Choice B rationale

Attaching a spacer device to the inhaler is recommended for patients using ipratropium inhalers. A spacer helps deliver the medication more effectively to the lungs and reduces the risk of side effects.

Choice C rationale

Rinsing the mouth after each use of the inhaler is a good practice to prevent oral thrush and other side effects. It is a recommended step in the proper use of inhalers.

Choice D rationale

Priming the inhaler with 7 pumps is excessive. Typically, inhalers need to be primed with 2-4 pumps before first use or if they haven’t been used for a while. Over-priming can waste medication and indicate a need for additional teaching.

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