Question 1

The nurse is caring for a client being weaned from the ventilator,and wants to improve the client's ability to communicate.Which item will the nurse request an order for from the health care provider?&#10;A)Cuffed tracheostomy tube&#10;B)Uncuffed tracheostomy tube&#10;C)Fenestrated tracheostomy tube&#10;D)Obturator&#10;

Accepted Answer

A fenestrated tracheostomy tube has a small opening or window on its anterior surface, and is designed to allow for improved airflow through the tracheostomy. This can facilitate speech, as air is able to pass through the vocal cords and be articulated into speech sounds. A cuffed or uncuffed tracheostomy tube may be necessary for other reasons, such as preventing aspiration, but they would not directly improve the client's ability to communicate. An obturator is typically used during the initial placement of a tracheostomy tube, and would not be necessary once the tube is in place.

Question 2

Which task could the nurse safely delegate to the unlicensed assistive personnel (UAP)?&#10;A)Capping a tracheostomy tube&#10;B)Performing tracheostomy care&#10;C)Increasing oxygen concentration delivered to the client&#10;D)Providing routine client care&#10;

Accepted Answer

Routine client care tasks, such as bathing, dressing, and feeding, can be safely delegated to unlicensed assistive personnel (UAP) as they do not require the clinical judgment and skill of a licensed nurse. Tasks like capping a tracheostomy tube, performing tracheostomy care, and adjusting oxygen concentrations require specific clinical skills and knowledge, making them inappropriate to delegate to UAP.

Question 3

When performing tracheostomy care,which action by the nurse is not appropriate?&#10;A)Unlocking and removing the inner cannula&#10;B)Rinsing the cannula in normal saline&#10;C)Using a pipe cleaner to dry the inside and outside of the cannula&#10;D)Cleaning the incision site and flange using sterile applicators or gauze dressings moistened with normal saline&#10;

Accepted Answer

Using a pipe cleaner to dry the inside and outside of the cannula is not an appropriate action during tracheostomy care. Instead, a sterile cotton-tipped applicator or gauze dressing moistened with normal saline should be used.

Question 4

The nurse is caring for a client with a longstanding permanent tracheostomy that has been in place for several years in order to provide mechanical ventilation.Which type of tracheostomy does the nurse anticipate this client may have based on the health history?

A)Uncuffed tracheostomy
B)Cuffed tracheostomy
C)Fenestrated tracheostomy
D)Uncuffed or fenestrated tracheostomy

Accepted Answer

A longstanding permanent tracheostomy that has been in place for several years in order to provide mechanical ventilation would most likely be a cuffed tracheostomy. A cuffed tracheostomy provides a better seal to prevent air from leaking around the tracheostomy site and to facilitate positive pressure ventilation. Uncuffed and fenestrated tracheostomies are typically used in clients who do not require mechanical ventilation or who are weaning off mechanical ventilation.

Question 5

The nurse is performing tracheostomy care.Which portion of the trach will the nurse use when tying the new trach ties?&#10;A)Inner cannula&#10;B)Outer cannula&#10;C)Obturator&#10;D)Flange&#10;

Accepted Answer

The flange is the portion of the trach that rests against the patient's neck and has holes for the trach ties to be threaded through and tied in order to secure the trach in place. The inner and outer cannula and obturator do not have any function in tying trach ties.

Question 6

When capping the client's tracheostomy tube with a speaking valve,the nurse assesses the client's breath sounds around the tube and hears no air leak.Which nursing action is the most appropriate based on this assessment finding?

A)Allowing the cap to remain in place as long as the client tolerates it
B)Documenting the placement of the cap and relevant data regarding client assessment
C)Removing the valve and notifying the health care provider
D)Assisting the client out of bed

Accepted Answer

When there is no air leak around the tracheostomy tube with a speaking valve in place, it may indicate that the airway is obstructed. This can prevent the client from breathing adequately. Therefore, the most appropriate action is to remove the valve and notify the health care provider to ensure the client's airway is assessed and managed properly.

Question 7

The nurse is working in the pediatric intensive care unit,and is caring for a toddler-age client with a tracheostomy.Which type of tracheostomy does the nurse anticipate this client will have?&#10;A)Uncuffed tube&#10;B)Cuffed tube&#10;C)Tube with an inner cannula&#10;D)Tube with a low-pressure cuff&#10;

Accepted Answer

Uncuffed tubes are typically used for pediatric patients, including toddlers, to minimize the risk of tracheal damage and because positive pressure ventilation can usually be achieved without the need for a cuff.

Question 8

When preparing to cap the client's tracheostomy tube with a speaking valve,which nursing action is not appropriate before placing the valve?&#10;A)Suctioning the oropharynx if there are any secretions present&#10;B)Asking the client to cough&#10;C)Suctioning the tracheostomy tube&#10;D)Deflating the cuffed tracheostomy tube&#10;

Accepted Answer

Suctioning the tracheostomy tube should not be done immediately before placing a speaking valve as this can cause irritation and inflammation, making it uncomfortable for the client to speak. The other options are appropriate actions to prepare the client for the speaking valve.

Question 9

Which item is not included for all tracheostomy tubes?&#10;A)Outer cannula&#10;B)Inner cannula&#10;C)Flange&#10;D)Obturator&#10;

Accepted Answer

The inner cannula is not included with all tracheostomy tubes. Some tracheostomy tubes are designed without an inner cannula; they are a single tube that serves the purpose of maintaining an open airway. The outer cannula, flange, and obturator are standard components of a tracheostomy tube. The outer cannula is the main part of the tube that is inserted into the trachea, the flange is the part that rests against the neck and allows the tube to be secured in place, and the obturator is used to guide the outer cannula during insertion, making the process smoother and reducing the risk of tissue damage.

Question 10

The nurse is caring for a client with a longstanding permanent tracheostomy that has been in place for several years in order to provide mechanical ventilation.Which type of tracheostomy does the nurse anticipate this client may have based on the health history?

A)Uncuffed tracheostomy
B)Cuffed tracheostomy
C)Fenestrated tracheostomy
D)Uncuffed or fenestrated tracheostomy

Accepted Answer

Using a fenestrated tracheostomy tube is not appropriate when facilitating communication because it allows air to escape from the trachea and may result in the inability to sustain ventilation. The appropriate strategies for communication with a client with a tracheostomy tube include using writing materials, a communication board, or a Passy-Muir valve which helps redirect air flow to allow for speech.

Deck 27: Caring for the Client With a Tracheostomy