A client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to:

Correct Answer: D

Rationale: The correct instruction for the client when removing secretions above the cuff of a tracheostomy tube is to exhale deeply as the nurse re-inflates the cuff. By having the client exhale deeply during cuff inflation, it helps to prevent aspiration of secretions or air into the lungs. This action also helps in securing an airtight seal around the tracheostomy tube before the normal breathing is resumed. It is crucial to promote the safety and prevent complications in clients with a tracheostomy tube, especially post partial laryngectomy.

Correct Answer: B

Rationale: Rheumatic fever is an inflammatory disease that can develop as a complication of untreated or inadequately treated infections caused by group A beta-hemolytic streptococci. These bacterial infections are usually in the form of strep throat or scarlet fever. Rheumatic fever typically occurs 2-4 weeks after a streptococcal infection. The body's immune response to the streptococcal infection can lead to an autoimmune reaction, resulting in rheumatic fever. It is important to promptly diagnose and treat streptococcal infections to prevent the development of rheumatic fever.

Correct Answer: B

Rationale: Option B, "I told her she is wrong and I explained to her what is right," would require the nurse to give further teaching because it indicates a lack of understanding about how to communicate with a person experiencing hallucinations. People with hallucinations may have a distorted sense of reality, and arguing with them or insisting on what is "right" can be counterproductive. The daughter would benefit from additional education on how to effectively communicate and support her father during episodes of hallucinations.

Correct Answer: C

Rationale: Total protein is a laboratory test that is commonly ordered to assess the nutritional status of an individual. In the case of a child with poor nutritional status and weight loss, assessing the total protein levels can help in diagnosing a negative nitrogen balance. Total protein levels may decrease in individuals with inadequate protein intake, malnutrition, or negative nitrogen balance. Monitoring total protein levels can provide valuable information about the child's nutritional status and help guide further interventions to improve their overall health and well-being.

Correct Answer: C

Rationale: A complete blood count (CBC) is a common blood test that provides important information about the types and numbers of cells in the blood, such as red blood cells, white blood cells, and platelets. The primary purpose of performing a CBC before surgery is to identify any abnormalities in the blood that could affect the patient's ability to undergo the surgical procedure safely. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels indicated by a CBC may suggest anemia, which could impact the patient's ability to tolerate surgery and anesthesia. Anemia can result in decreased oxygen delivery to tissues and organs, leading to potential complications during surgery. Therefore, identifying low HCT and Hb levels through a CBC allows healthcare providers to take appropriate measures to address and manage the condition before proceeding with surgery.