Med-Surg 1 Next
Gen Questions
for Respiratory
0/5
, Med-Surg 1 Next Gen Questions for Respiratory
1. What actions will the nurse include when doing tracheostomy care?: The nurse will use sterile technique when cleaning the
inner cannula to avoid transmitting microorganisms to the lungs.
Sterile gloves are worn when removing the inner cannula.
It is important to completely dry the inside of the inner cannula prior to replacing it.
The client may be preoxygenated before removing the inner cannula with high flow oxygen via tracheal mask, but provision of
oxygen via nasal cannula during suction would not be beneficial to the client.
A brush is used to clean the inner cannula.
Hydrogen peroxide is used to clean secretions from the inner cannula, the cannula is rinsed with normal saline. Because
hydrogen peroxide can be irritating to tissue, normal saline is used to clean the skin around the tracheostomy stoma.
It is inappropriate with tracheal care to use a cut 4x4 gauze pad as a drain sponge, the small loose fibers can become
detached and inhaled.
The nurse will ensure the dominant, not non-dominant hand, remains sterile throughout the procedure.
2. What actions will the nurse take when caring for a client with a chest tube in
place after a thoracotomy?: Because the intrapleural space has many sensory nerves, the chest tube will be uncomfortable,
and the nurse will administer prescribed analgesics as needed.
Crepitus around the chest tube insertion indicates air leakage into the subcutaneous tissue and will be monitored.
Fluid in the suction control chamber may evaporate; the fluid level controls the amount of negative pressure applied to the
intrapleural space and must be kept at the prescribed level.
The water-seal chamber is assessed for bubbling, which indicates that air is exiting the pleural space.
Clamping the chest tube is avoided unless there is damage to the drainage system that requires attachment of a new chest
drainage system.
There is not an associated need for a high-potassium diet with having a chest-tube in place.
A stripping action of milking of the chest tubes is avoided because it can cause increased negative intrapleural pressure that
may lead to pleural trauma and bleeding. Instead, a hand-over-hand milking action may be used if necessary.
Tidaling, or a rise and fall, of water in chamber two with breathing is normal and does not need to be reported.
3. Which action will the nurse take after noticing bibasilar crackles in a client who had an open cholecystectomy on the previous day?
This client likely has postoperative atelectasis and requires frequent breath sounds assessment because of the presence o
bibasilar crackles.
Also, the client should turn, cough, and deep breathe to improve ventilation and resolve atelectasis.
Following a surgery that results in an abdominal incision, such as an open cholecystectomy, the client may be hesitant to
cough or deep breathe due to pain. Splinting of the incision site using either a pillow or a folded blanket reduces respiration
related pain.
1/5
Gen Questions
for Respiratory
0/5
, Med-Surg 1 Next Gen Questions for Respiratory
1. What actions will the nurse include when doing tracheostomy care?: The nurse will use sterile technique when cleaning the
inner cannula to avoid transmitting microorganisms to the lungs.
Sterile gloves are worn when removing the inner cannula.
It is important to completely dry the inside of the inner cannula prior to replacing it.
The client may be preoxygenated before removing the inner cannula with high flow oxygen via tracheal mask, but provision of
oxygen via nasal cannula during suction would not be beneficial to the client.
A brush is used to clean the inner cannula.
Hydrogen peroxide is used to clean secretions from the inner cannula, the cannula is rinsed with normal saline. Because
hydrogen peroxide can be irritating to tissue, normal saline is used to clean the skin around the tracheostomy stoma.
It is inappropriate with tracheal care to use a cut 4x4 gauze pad as a drain sponge, the small loose fibers can become
detached and inhaled.
The nurse will ensure the dominant, not non-dominant hand, remains sterile throughout the procedure.
2. What actions will the nurse take when caring for a client with a chest tube in
place after a thoracotomy?: Because the intrapleural space has many sensory nerves, the chest tube will be uncomfortable,
and the nurse will administer prescribed analgesics as needed.
Crepitus around the chest tube insertion indicates air leakage into the subcutaneous tissue and will be monitored.
Fluid in the suction control chamber may evaporate; the fluid level controls the amount of negative pressure applied to the
intrapleural space and must be kept at the prescribed level.
The water-seal chamber is assessed for bubbling, which indicates that air is exiting the pleural space.
Clamping the chest tube is avoided unless there is damage to the drainage system that requires attachment of a new chest
drainage system.
There is not an associated need for a high-potassium diet with having a chest-tube in place.
A stripping action of milking of the chest tubes is avoided because it can cause increased negative intrapleural pressure that
may lead to pleural trauma and bleeding. Instead, a hand-over-hand milking action may be used if necessary.
Tidaling, or a rise and fall, of water in chamber two with breathing is normal and does not need to be reported.
3. Which action will the nurse take after noticing bibasilar crackles in a client who had an open cholecystectomy on the previous day?
This client likely has postoperative atelectasis and requires frequent breath sounds assessment because of the presence o
bibasilar crackles.
Also, the client should turn, cough, and deep breathe to improve ventilation and resolve atelectasis.
Following a surgery that results in an abdominal incision, such as an open cholecystectomy, the client may be hesitant to
cough or deep breathe due to pain. Splinting of the incision site using either a pillow or a folded blanket reduces respiration
related pain.
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