NR 324 ADULT HEALTH 1 EXAM 1
QUESTIONS AND ANSWERS 2026
- 2027
What is an obturator?
Rounded tip tube placed inside the outer cannula with its rounded tip
protruding from the end of the tube to ease insertion. After insertion,
the obturator must be immediately removed so air can flow through
the tube.
When caring for a patient with a tracheostomy what is important
to always keep at the bedside?
An obturator in case of accidental decannulation
Tracheostomy nursing management for a bedside insertion
•Record vital signs
•Ensure existing IV is patent
•Assess bedside suction
•Position patient supine
•Administer analgesia and/or sedation
**. Emergency resuscitation equipment, including a bag-valve-mask
(BVM), should be readily available
Tracheostomy nursing management for post procedure care
•Obturator removed, kept
•Cuff (balloon) is inflated
•Auscultate for air entry
•Tracheostomy sutured in place and secured
,After a tracheostomy is performed what is important to
immediately do?
after insertion immediately remove the obturator so air can flow
through the tube
Tracheostomy care
Position patient in semi-fowlers position
Cleansing inner cannula
•Gather equipment, position patient, don PPE, set up equipment
•Don sterile gloves and goggles
•Unlock and remove inner cannula; place in sterile saline, cleanse,
rinse, reinsert
Cleanse stoma
**repeat care 3x day
Changing tracheostomy ties
Change tapes after the first 24 hrs
•A, A slit is cut about 1 inch (2.5 cm) from the end. The slit end is put
into the opening of the cannula. B, A loop is made with the other end
of the tape. C, The tapes are tied together with a double knot on the
side of the neck. D, A tracheostomy tube holder can be used in place
of twill ties to make tracheostomy tube stabilization more secure.
Decannulation of a tracheostomy
-Suction patient prior to decannulation
-clear mouth of any secretions
-loosen/cut trach tapes
-endure trach cuff is deflated
-pull tube out in one smooth motion
,Removal of trach is possible when the primary condition causing
the patient to receive one has been resolved, in addition the
patient needs too...
(1) be hemodynamically stable;
(2) have a stable, intact respiratory drive; and (3) be able to
adequately exchange air and expectorate secretions.
Tracheostomy suctioning
1. Assess need for suctioning q2hr (coarse crackles or rhonchi over
large airways, moist cough, increase in peak inspiratory pressure on
mechanical ventilator, and restlessness or agitation if accompanied by
decrease in SpO2 or PaO2) Do not suction routinely or if patient is
able to clear secretions with cough.
2. If suctioning is indicated, explain procedure to patient.
3. Collect necessary sterile equipment: suction catheter (no larger than
half the lumen of the tracheostomy tube), gloves, sterile water, cup,
and drape.
4. Check suction source and regulator. −120 to −150 mm Hg pressure
with tubing occluded.
5. Assess SpO2 and HR and rhythm to provide baseline for detecting
change during suctioning.
6. Wash hands and put on goggles.
7. Use sterile technique to open package, fill cup with sterile water,
sterile gloves, and connect catheter to suction tubing. Designate one
hand as contaminated for (1) connecting and disconnecting tubing at
the suction catheter, (2) using the resuscitation bag, and (3) operating
the suction control. Suction sterile water through the catheter to test
the system.
8. Provide preoxygenation min of 30 seconds by (1) adjusting
ventilator to deliver 100% O2, (2) using a reservoir-equipped manual
, resuscitation bag (MRB) connected to 100% oxygen, or (3) asking the
patient to take 5-6 deep breaths while administering oxygen.
9. Gently insert catheter without suction to minimize amount of
oxygen removed from lungs. Insert catheter to point where the patient
coughs, resistance is met, or 0.5-1.0 cm beyond the length of the
artificial airway.
10. Apply suction intermittently, while withdrawing catheter in
rotating manner. If secretion volume is large, apply suction
continuously.
11. Limit suction time to 10 seconds. Discontinue suctioning if heart
rate decreases by 20 beats/min, increases by 40 beats/min, a
dysrhythmia occurs, or SpO2 decreases to less than 90%.
12. After each suction pass, oxygenate for at least 30 seconds with 5-6
breaths by ventilator, MRB, or deep breaths with oxygen.
13. Rinse catheter with sterile water between suction passes.
14. Repeat procedure until airway is clear. If airway is not clear after
3 suction passes, allow patient to rest before additional suctioning.
15. Return oxygen concentration to prior setting.
16. Rinse catheter and suction the oropharynx or use mouth suction.
17. Discard equipment in proper waste container.
18. Auscultate lung sounds. Record time, amount, and character of
secretions and response to suctioning.
Client education for a tracheostomy
Instruct the patient to splint the stoma with the fingers when
coughing, swallowing, or speaking.
Complications of a tracheostomy
QUESTIONS AND ANSWERS 2026
- 2027
What is an obturator?
Rounded tip tube placed inside the outer cannula with its rounded tip
protruding from the end of the tube to ease insertion. After insertion,
the obturator must be immediately removed so air can flow through
the tube.
When caring for a patient with a tracheostomy what is important
to always keep at the bedside?
An obturator in case of accidental decannulation
Tracheostomy nursing management for a bedside insertion
•Record vital signs
•Ensure existing IV is patent
•Assess bedside suction
•Position patient supine
•Administer analgesia and/or sedation
**. Emergency resuscitation equipment, including a bag-valve-mask
(BVM), should be readily available
Tracheostomy nursing management for post procedure care
•Obturator removed, kept
•Cuff (balloon) is inflated
•Auscultate for air entry
•Tracheostomy sutured in place and secured
,After a tracheostomy is performed what is important to
immediately do?
after insertion immediately remove the obturator so air can flow
through the tube
Tracheostomy care
Position patient in semi-fowlers position
Cleansing inner cannula
•Gather equipment, position patient, don PPE, set up equipment
•Don sterile gloves and goggles
•Unlock and remove inner cannula; place in sterile saline, cleanse,
rinse, reinsert
Cleanse stoma
**repeat care 3x day
Changing tracheostomy ties
Change tapes after the first 24 hrs
•A, A slit is cut about 1 inch (2.5 cm) from the end. The slit end is put
into the opening of the cannula. B, A loop is made with the other end
of the tape. C, The tapes are tied together with a double knot on the
side of the neck. D, A tracheostomy tube holder can be used in place
of twill ties to make tracheostomy tube stabilization more secure.
Decannulation of a tracheostomy
-Suction patient prior to decannulation
-clear mouth of any secretions
-loosen/cut trach tapes
-endure trach cuff is deflated
-pull tube out in one smooth motion
,Removal of trach is possible when the primary condition causing
the patient to receive one has been resolved, in addition the
patient needs too...
(1) be hemodynamically stable;
(2) have a stable, intact respiratory drive; and (3) be able to
adequately exchange air and expectorate secretions.
Tracheostomy suctioning
1. Assess need for suctioning q2hr (coarse crackles or rhonchi over
large airways, moist cough, increase in peak inspiratory pressure on
mechanical ventilator, and restlessness or agitation if accompanied by
decrease in SpO2 or PaO2) Do not suction routinely or if patient is
able to clear secretions with cough.
2. If suctioning is indicated, explain procedure to patient.
3. Collect necessary sterile equipment: suction catheter (no larger than
half the lumen of the tracheostomy tube), gloves, sterile water, cup,
and drape.
4. Check suction source and regulator. −120 to −150 mm Hg pressure
with tubing occluded.
5. Assess SpO2 and HR and rhythm to provide baseline for detecting
change during suctioning.
6. Wash hands and put on goggles.
7. Use sterile technique to open package, fill cup with sterile water,
sterile gloves, and connect catheter to suction tubing. Designate one
hand as contaminated for (1) connecting and disconnecting tubing at
the suction catheter, (2) using the resuscitation bag, and (3) operating
the suction control. Suction sterile water through the catheter to test
the system.
8. Provide preoxygenation min of 30 seconds by (1) adjusting
ventilator to deliver 100% O2, (2) using a reservoir-equipped manual
, resuscitation bag (MRB) connected to 100% oxygen, or (3) asking the
patient to take 5-6 deep breaths while administering oxygen.
9. Gently insert catheter without suction to minimize amount of
oxygen removed from lungs. Insert catheter to point where the patient
coughs, resistance is met, or 0.5-1.0 cm beyond the length of the
artificial airway.
10. Apply suction intermittently, while withdrawing catheter in
rotating manner. If secretion volume is large, apply suction
continuously.
11. Limit suction time to 10 seconds. Discontinue suctioning if heart
rate decreases by 20 beats/min, increases by 40 beats/min, a
dysrhythmia occurs, or SpO2 decreases to less than 90%.
12. After each suction pass, oxygenate for at least 30 seconds with 5-6
breaths by ventilator, MRB, or deep breaths with oxygen.
13. Rinse catheter with sterile water between suction passes.
14. Repeat procedure until airway is clear. If airway is not clear after
3 suction passes, allow patient to rest before additional suctioning.
15. Return oxygen concentration to prior setting.
16. Rinse catheter and suction the oropharynx or use mouth suction.
17. Discard equipment in proper waste container.
18. Auscultate lung sounds. Record time, amount, and character of
secretions and response to suctioning.
Client education for a tracheostomy
Instruct the patient to splint the stoma with the fingers when
coughing, swallowing, or speaking.
Complications of a tracheostomy
