A client underwent a total laryngectomy. Which of the following is the priority observation in the client's care?

Correct Answer: D

Rationale: The correct answer is D: Need for suctioning. After a laryngectomy, maintaining a clear airway is crucial to prevent aspiration and ensure proper oxygenation. Suctioning helps remove secretions and maintain airway patency. Monitoring for signs of respiratory distress is essential. A: Patency of the intravenous line is important but not the priority over airway management. B: Level of pain is important but not as critical as ensuring a clear airway. C: Integrity of the dressing is important for wound healing but does not directly impact airway patency.

Correct Answer: B

Rationale: The correct answer is B: Continuous bubbling in the water-seal chamber. Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can lead to lung collapse. The water-seal chamber should have intermittent bubbling during exhalation but should not bubble continuously. Constant bubbling in the suction-control chamber (A) is expected and indicates proper suction is being applied. Bloody drainage in the collection chamber (C) is common in the immediate postoperative period. Fluid-level fluctuations in the water-seal chamber (D) can be normal due to changes in intrathoracic pressure.

Correct Answer: C

Rationale: The correct answer is C: Tuberculosis. Healthcare workers should wear an N95 respirator mask when caring for clients with airborne infectious diseases like tuberculosis. The N95 mask is designed to filter out at least 95% of airborne particles, including those that may carry the tuberculosis bacteria. This level of protection is necessary to prevent the healthcare worker from inhaling the infectious agent. Pertussis (A), Mycoplasma pneumonia (B), and Respiratory syncytial virus (D) are not typically transmitted through the air and therefore do not require the use of an N95 respirator mask for standard care. These diseases are usually spread through respiratory droplets or direct contact, so standard precautions such as wearing a surgical mask and gloves are sufficient.

Correct Answer: C

Rationale: The correct answer is C: Smoking cessation. Chronic bronchitis is often caused by smoking. By quitting smoking, individuals can significantly reduce their risk of developing chronic bronchitis. This is the most effective prevention strategy. A: Maintenance of ideal weight may have some benefits for overall health but is not directly linked to preventing chronic bronchitis. B: Annual influenza immunization is important for preventing the flu, but it does not directly prevent chronic bronchitis. D: Regular moderate exercise is beneficial for overall health, but it is not as directly related to preventing chronic bronchitis as smoking cessation.

Correct Answer: A

Rationale: The correct answer is A: Fluctuation of the fluid level within the water seal chamber. This indicates proper chest tube function as it shows that the system is maintaining the desired pressure and allowing for adequate drainage without obstruction. When the patient breathes in and out, the fluid level fluctuates due to changes in intrathoracic pressure. Explanation of other choices: B: Absence of fluid in the drainage tubing - This would indicate a problem with drainage, possibly due to a blockage in the tubing. C: Continuous bubbling within the water seal chamber - This would suggest an air leak in the system, which is not ideal as it can lead to lung collapse. D: Equal amounts of fluid drainage in each collection chamber - While equal drainage is good, it does not specifically indicate proper chest tube function like the fluctuation of the fluid level does.