LIPPINCOT EXERCISE 1

Tracheostomy cuff inflation and deflation: Results What information should you include when documenting tracheostomy care?

	Family member present during the procedure
	Stoma and skin condition
	Number of staff members on duty
	Number of tracheostomy sets used

Rationale: You should include the patient's stoma and skin condition in your documentation.

Which complication may result from removing a blocked tracheostomy tube?

	Increased infection
	Fever
	Airway closure
	Decreased carbon dioxide levels

Rationale: If a patient's tracheostomy becomes blocked for any reason (such as secretions that can't be suctioned), don't remove the tracheostomy tube entirely because doing so may allow the airway to completely close.

How should you position a patient to inflate a tracheostomy cuff?

	Prone
	Semi-Fowler's position
	Side-lying
	Lithotomy

Rationale: Position a patient in semi-Fowler's or supine position with the head of the bed elevated as tolerated when inflating a tracheostomy cuff.

When can you begin to perform clean tracheostomy care?

	When the patient has a stable complete blood count
	When the stoma has healed
	When the doctor approves it
	When the patient is discharged from the hospital

Rationale: Whichever tube is used, tracheostomy care should be performed using sterile technique until the patient's stoma has healed to prevent infection.

The purpose of an uncuffed, fenestrated tube is to:

	permit better suctioning.
	cause a more aesthetic appearance.
	permit mechanical ventilation.
	allow speech.

Rationale: A plastic fenestrated tube permits speech through the upper airway when the external opening is capped and the cuff is deflated.

Which complication may occur from replacing an expelled tracheostomy tube?

	Trauma to the airway
	Hypoxia
	Patient discomfort
	Infection

Rationale: Use extreme caution when attempting to reinsert an expelled tracheostomy tube because of the risk of tracheal trauma, perforation, compression, and asphyxiation. Reassure the patient until the doctor arrives.

For which complication should you monitor a patient with a tracheostomy?

	Poor patient compliance
	Improved oxygenation
	Decreased secretions in the airway
	Tracheal necrosis

Rationale: The presence of the tube or excessive cuff pressure can produce tracheal erosion and necrosis.

The primary benefit of using an uncuffed tracheostomy tube is that it:

	blocks air completely from moving through the trachea.
	reduces the risk of tracheal tube damage.
	works well in patients who are unconscious.
	can be used for patients receiving mechanical ventilation.

Rationale: An uncuffed tracheostomy tube, which may be plastic or metal, allows air to flow freely around the tracheostomy tube and through the larynx, reducing the risk of tracheal damage.

In which situation should you suspect a tracheal cuff leak?

	If respiratory pressures are adequate
	If the patient can't speak while the cuff is inflated
	If the cuff pressure exceeds previously documented pressures
	If the cuff won't deflate

Rationale: Suspect a leak if the injection of air fails to inflate the cuff or increase cuff pressure, if you can't inject the amount of air you withdrew, if the patient can speak, if ventilation fails to maintain adequate respiratory movement with pressures or volumes previously considered adequate, or if air escapes during the ventilator's inspiratory cycle.

Documentation: Results

 Which documentation system is considered useful in acute care or long-term care settings only?

	Problem-intervention-evaluation
	FOCUS
	Narrative
	Problem-oriented medical record

Rationale: FOCUS is considered useful in acute care or long-term care settings only.

Which type of documentation system is considered useful in an acute care setting only?

	Problem-intervention-evaluation
	Problem-oriented medical record
	FOCUS
	Narrative

Rationale: The problem-intervention-evaluation system is considered useful in acute care settings only.

Which documentation system uses evaluative statements, expected outcomes, and learning outcomes as the format for progress notes?

	Computerized
	Core
	Flow sheet, assessment, concise, timely
	Charting by exception

Rationale: The computerized system uses evaluative statements, expected outcomes, and learning outcomes as the format for progress notes.

Which type of documentation system doesn't use a separate care plan and instead includes it in the progress notes?

	Problem-intervention-evaluation
	FOCUS
	Problem-oriented medical record
	Narrative

Rationale: The problem-intervention-evaluation system doesn't include a separate care plan; it's included in the progress notes.

Which documentation system uses a database and care plan for the assessment?

	Narrative
	FOCUS
	Problem-intervention-evaluation
	Problem-oriented medical record

Rationale: The problem-oriented medical record uses a database and care plan for the assessment.

Which type of documentation system uses SOAP, SOAPIE, and SOAPIER as the format for progress notes?

	Narrative
	Problem-oriented medical record
	Problem-intervention-evaluation
	FOCUS

Rationale: The problem-oriented medical record uses SOAP, SOAPIE, and SOAPIER as the format for progress notes.

Which type of documentation system includes discharge summaries with progress notes?

	Narrative
	Problem-intervention-evaluation
	FOCUS
	Problem-oriented medical record

Rationale: The narrative documentation system includes discharge summaries along with progress notes.

Which type of documentation system uses a care plan based on the problem list?

	Narrative
	Problem-oriented medical record
	Problem-intervention-evaluation
	FOCUS

Rationale: The problem-oriented medical record uses a nursing care plan based on a problem list.

Which type of documentation system uses the "data, action, response" format for progress notes?

	Problem-oriented medical record
	Problem-intervention-evaluation
	FOCUS
	Narrative

Rationale: FOCUS uses the data, action, and response format for progress notes.

Which documentation system uses a database assessment sheet for the initial assessment?

	Core
	Charting by exception
	Flow sheet, assessment, concise, timely
	Computerized

Rationale: Charting by exception uses a database assessment sheet for the initial assessment.

Code management: Results

 You should avoid placing defibrillation pads on:

	a patient's bony prominence.
	a patient's abdomen.
	the back of a patient.
	the front of a patient.

Rationale: Conduction will decrease over bony prominences. Avoid placing defibrillation pads over a patient's bony prominences and hairy areas.

If a patient doesn't have an IV access, you may administer someadvanced cardiac life support (ACLS) drugs:

	orally.
	intramuscularly.
	intraosseously.
	sublingually.

Rationale: ACLS drugs may be given intraosseously as an alternative to an IV.

Epinephrine acts to:

	increase coronary perfusion pressure during cardiopulmonary resuscitation.
	raise the fibrillation threshold.
	decrease myocardial contractility without raising oxygen demand.
	shorten the duration of atrial action potential during supraventricular tachycardia.

Rationale: Through its alpha-adrenergic affects, epinephrine can increase coronary perfusion and cerebral perfusion during cardiopulmonary resuscitation.

When a patient is orally intubated, you should:

	date the tape.
	help ventilate the patient.
	mark the endotracheal tube at the level of the patient's lips.
	ask a respiratory therapist to check the tube's position.

Rationale: Marking the endotracheal tube at the level of the patient's lips will serve as a reference point for checking placement.

A patient with ventricular fibrillation will most likely receive which medication first?

	Atropine
	Dobutamine
	Epinephrine
	Adenocard

Rationale: According to the advanced cardiac life support (ACLS) algorithm, epinephrine is the drug of choice when treating ventricular fibrillation.

Which drug should you be prepared to administer when treating a patient with supraventricular tachycardia?

	Epinephrine
	Magnesium
	Adenosine
	Atropine

Rationale: Adenosine slows conduction through the atrioventricular node and is effective in treating supraventricular tachycardia.

The typical adult dosage for atropine in symptomatic bradycardia is:

	2 mg.
	3 mg.
	1 mg.
	0.5 mg.

Rationale: Atropine accelerates the atrioventricular conduction and heart rate by blocking the vagal nerve. For symptomatic bradycardia, give 0.5 mg IV push.

What size peripheral IV catheters are preferred in a code situation?

	14G and 22G
	14G and 18G
	16G and 20G
	20G and 22G

Rationale: Large-gauge catheters, such as 14G and 18G, are preferred in a code situation because large volumes of IV fluid can be delivered through them quickly.

In a code situation, who usually provides the first resuscitative measures?

	Advanced cardiac life support (ACLS) nurse
	Basic life support (BLS) nurse
	Nurse
	Doctor

Rationale: An ACLS-trained nurse can direct advanced cardiac measures (until the doctor arrives) and usually initiates the first resuscitative measures.

When giving drugs through the endotracheal (ET) tube, you should dilute the drugs with:

	20 mL normal saline solution.
	10 mL 0.45 normal saline.
	10 mL dextrose 5% in water.
	5 to 10 mL normal saline solution.

Rationale: Drugs given through an ET tube should be diluted with 5 to 10 mL normal saline solution to improve absorption in the lungs.

Which treatment best increases a patient's chance of survival in a code situation?

	Defibrillation and cardiopulmonary resuscitation
	Cardiopulmonary resuscitation and drugs
	Drugs and defibrillation
	Defibrillation

Rationale: A person usually has ventricular fibrillation when in a code situation. Defibrillation and cardiopulmonary resuscitation are the most important resuscitative measures.

How does dobutamine work?

	Accelerates atrioventricular conduction
	Increases heart rate and peripheral resistance
	Produces a chronotropic effect
	Improves myocardial contractility

Rationale: Dobutamine acts to increase myocardial contractility without raising oxygen consumption.

Admission: Results

  One goal of effective admission procedures is to:

	determine the patient's religious beliefs.
	make the patient as comfortable as possible.
	complete the admission process quickly.
	verify the patient's insurance information.

Rationale: Effective admission procedures should accomplish the following goals: Verify the patient's identity using two patient identifiers according to the facility's policy; assess his clinical status; make him as comfortable as possible; introduce him to roommates and staff; orient him to the environment and routine; and provide supplies and special equipment needed for daily care.

If a patient brings medications from home:

	put them with the hospital-dispensed medications to be administered to the patient, as long the patient's name is on the label.
	send authorized medications to the pharmacy for identification and relabeling.
	flush them down the patient's toilet, so he can observe that they were discarded.
	place them in a bag and store them with the patient's clothing and other personal belongings.

Rationale: If a patient brings medications from home, send authorized medications to the pharmacy for identification and relabeling. Send other medications home with a responsible family member, or store them in the designated area outside the patient's room until he's discharged. Use of unauthorized medication may interfere with treatment or cause an overdose.

Before greeting the patient, you should:

	review visiting hours and any restrictions.
	introduce the patient to all the unit staff.
	review the admission form and the doctor's orders.
	orient the patient to the environment and unit routine.

Rationale: Quickly review the admission form and the doctor's orders. Note the reason for admission, any restrictions on activity or diet, and any orders for diagnostic tests requiring specimen collection.

When a patient arrives on the nursing unit after emergency department treatment:

	ask the patient what was done to him in the emergency department.
	receive hand-off communication from the nurse who cared for the patient in the emergency department.
	ask the patient why he's being admitted to the facility.
	remove his temporary identification bracelet.

Rationale: When a patient arrives on the nursing unit from emergency department treatment, receive hand-off communication from the nurse who cared for the patient in the emergency department to ensure continuity of care.

When should you prepare any necessary emergency or special equipment, such as oxygen or suction?

	Immediately after the patient arrives on the unit
	Before the patient arrives on the unit
	After you've finished an assessment of the patient's clinical status
	When the patient begins to show signs of distress

Rationale: Before the patient arrives on the unit, prepare any emergency or special equipment, such as oxygen or suction.

Care reminders placed at the head of the patient's bed should include such information as:

	allergies and dietary and fluid restrictions.
	the patient's diagnosis if he has a communicable disease.
	scheduled surgical procedures.
	the patient's name, age, and date of birth.

Rationale: Care reminders placed at the head of the patient's bed should include such information as allergies; dietary and fluid restrictions; and special instructions, including turning schedules and activity restrictions to notify unit staff.

Your initial assessment should include height and weight measurements to:

	determine where to place footboards on the bed.
	determine the patient's body mass index.
	calculate medication and anesthetic dosages.
	start the patient on a weight-reduction diet if necessary.

Rationale: Knowing the patient's height and weight is important for planning treatment and diet and for calculating medication and anesthetic dosages.

After obtaining the patient's history, complete a physical assessment with an emphasis on the patient's:

	reflexes.
	emotional state.
	level of fatigue.
	complaints.

Rationale: After obtaining the patient's history, complete a physical assessment with an emphasis on the patient's complaints.

An efficient admission routine can:

	ease the patient's anxiety and promote cooperation.
	aggravate the patient's symptoms.
	impair the patient's response to treatment.
	heighten the patient's anxiety and reduce cooperation.

Rationale: Admission routines that are efficient can ease the patient's anxiety and promote cooperation and receptivity to treatment.