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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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View Related questions

Correct Answer is D

Explanation

Choice A rationale

Determining the neurological baseline prior to the fall is important but not the immediate priority. The client’s current confusion and projectile vomiting suggest a potential acute condition that needs immediate assessment.

Choice B rationale

Determining the client’s last dose of corticosteroids is relevant for managing multiple sclerosis but does not address the immediate concern of confusion and vomiting.

Choice C rationale

Administering a PRN IV antiemetic as prescribed can help manage vomiting but does not address the underlying cause of the symptoms.

Choice D rationale

Completing a head-to-toe neurological assessment is the priority intervention. The client’s confusion and projectile vomiting could indicate increased intracranial pressure or another acute neurological condition that requires immediate attention.

Correct Answer is C

Explanation

Choice A rationale

Auscultating bowel sounds is important for assessing gastrointestinal function, but it is not directly related to the administration of vancomycin for Clostridium difficile infection.

Choice B rationale

Measuring oxygen saturation is important for assessing respiratory function, but it is not directly related to the administration of vancomycin for Clostridium difficile infection.

Choice C rationale

Checking serum creatinine is crucial before administering vancomycin because this medication can be nephrotoxic. Monitoring kidney function helps prevent potential renal damage.

Choice D rationale

Assessing body temperature is important for monitoring infection, but it is not directly related to the administration of vancomycin for Clostridium difficile infection.

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