c. Wheezing d. Bradycardia
e. Rapid respiratory rate
8. What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction?
a. A tracheostomy is safer to perform in an emergency.
b. An ET tube has a higher risk of tracheal pressure necrosis.
c. A tracheostomy tube allows for more comfort and mobility.
d. An ET tube is more likely to lead to lower respiratory tract infection.
9. What are the characteristics of a fenestrated tracheostomy tube (select all that apply)?
a. The cuff passively fills with air.
b. Cuff pressure monitoring is not required.
c. It has two tubings with one opening just above the cuff.
d. Patient can speak with an attached air source with the cuff inflated.
e. Airway obstruction is likely if the exact steps are not followed to produce speech.
f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted.
10. During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. To care for the tracheostomy appropriately, what should the nurse do?
a. Deflate the cuff, then remove and suction the inner cannula.
b. Remove the inner cannula and replace it per institutional guidelines.
c. Remove the inner cannula if the patient shows signs of airway obstruction.
d. Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube.
11. Which actions prevent the dislodgement of a tracheostomy tube in the first 3 days after its placement (select all that apply)?
a. Provide tracheostomy care every 24 hours.
b. Keep the patient in the semi-Fowler's position at all times.
c. Keep a same-size or larger replacement tube at the bedside.
d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure.
e. Suction the tracheostomy tube when there is a moist cough or a decreased SpO2. f. A physician performs the first tracheostomy tube change 2 days after the tracheostomy.
12. Teamwork and Collaboration: In planning the care for a patient with a tracheostomy who has been stable and is to be discharged later in the day, the RN may delegate which interventions to the licensed practical/vocational nurse (LPN/LVN) (select all that apply)?
a. Suction the tracheostomy.
b. Provide tracheostomy care.
c. Determine the need for suctioning.
d. Assess the patient's swallowing ability.
e. Teach the patient about home tracheostomy care.
13. What is included in the nursing care of the patient with a cuffed tracheostomy tube?
a. Change the tube every 3 days.
b. Monitor cuff pressure every 8 hours.
c. Perform mouth care every 12 hours.
d. Assess arterial blood gases every 8 hours.
14. Priority Decision: A patient's tracheostomy tube becomes dislodged with vigorous coughing.
What should be the nurse's first action?
a. Attempt to replace the tube.
b. Notify the health care provider.
c. Place the patient in high Fowler's position.
d. Ventilate the patient with a manual resuscitation bag until the health care provider arrives.
15. When obtaining a health history from a patient with possible cancer of the mouth, what would the nurse expect the patient to report?
a. Long-term denture use
b. Heavy tobacco and/or alcohol use c. Persistent swelling of the neck and face
d. Chronic herpes simplex infections of the mouth and lips
16. The patient has been diagnosed with an early vocal cord malignancy. The nurse explains that usual treatment includes
a. radiation therapy that preserves the quality of the voice.
b. a hemilaryngectomy that prevents the need for a tracheostomy.
c. a radical neck dissection that removes possible sites of metastasis.
d. a total laryngectomy to prevent development of second primary cancers.
17. During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include?
a. The postoperative use of nonverbal communication techniques
b. Techniques that will be used to alleviate a dry mouth and prevent stomatitis c. The need for frequent, vigorous coughing in the first 24 hours postoperatively d. Self-help groups and community resources for patients with cancer of the larynx
18. When assessing the patient on return to the surgical unit following a total laryngectomy and radical neck dissection, what would the nurse expect to find?
a. A closed-wound drainage system b. A nasal endotracheal tube in place
c. A nasogastric tube with orders for tube feedings d. A tracheostomy tube and mechanical ventilation
19. What should the nurse include in discharge teaching for the patient with a total laryngectomy?
a. How to use esophageal speech to communicate b. How to use a mirror to suction the tracheostomy c. The necessity of never covering the laryngectomy stoma d. The need to use baths instead of showers for personal hygiene
20. What is the most normal functioning method of speech restoration for the patient with a total laryngectomy?
a. Esophageal speech
b. A transesophageal puncture c. An electrolarynx held to the neck d. An electrolarynx placed in the mouth
Case Study
Rhinoplasty
(©g-stockstudio/iStock/Thinkstock)
Patient Profile
F.N. is a 28-yr-old male patient who sustained bilateral fractures of the nose, three rib fractures, and a comminuted fracture of the tibia in an automobile crash 5 days ago. An open reduction and internal fixation of the tibia were performed the day of the trauma. F.N. is now scheduled for a rhinoplasty to reestablish an adequate airway and improve cosmetic appearance.
Subjective Data
• Reports facial pain at a level of 6 on a 10-point scale
• Expresses concern about his facial appearance
• Complains of dry mouth Objective Data
• RR 24
• HR 68 bpm
• Bilateral ecchymosis of eyes (raccoon eyes)
• Periorbital and facial edema reduced by about half since second hospital day
• Has been NPO since midnight in preparation for surgery Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. When F.N. was admitted, examination of his nose revealed clear drainage. What is the significance of the drainage? What testing is indicated?
2. What is the reason for delaying repair of F.N.'s nose for several days after the trauma?
3. What measures should be taken to maintain F.N.'s airway before and after surgery?
4. Priority Decision: When F.N. arrives in the postanesthesia care unit (PACU) following surgery, what priority assessments should the nurse make in the immediate postoperative period?
5. Priority Decision: F.N.'s nasal packing is removed in 24 hours, and he is to be discharged.
What priority predischarge teaching should the nurse provide?
6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?