ATI Tracheostomy Care Comprehensive Nursing Study Guide:
Advanced Airway Management Principles, Tracheostomy
Assessment, Suctioning Techniques, Stoma Care Procedures,
Oxygenation Support, Emergency Interventions, Infection
Prevention Strategies, Patient Safety Measures, Nursing
Priorities, and Critical Care Preparation for ATI Exams and
Clinical Practice
1. A tracheostomy is performed primarily to:
A. Prevent infection of the lungs
B. Provide a patent airway
C. Improve the patient's ability to speak
D. Allow for oral feeding
Answer: B
Rationale: The primary purpose of a tracheostomy is to establish and maintain a
patent airway, bypassing an upper airway obstruction, or to facilitate long-term
mechanical ventilation.
2. A nurse is caring for a client who requires long-term ventilatory support. The
nurse should recognize that a tracheostomy tube is preferred over an
endotracheal tube for which of the following reasons?
A. Endotracheal tubes are more comfortable for awake patients
B. Endotracheal tubes can cause pressure sores and mucosal damage to the lips
and mouth
C. Endotracheal tubes are easier to clean
D. Endotracheal tubes do not impede oral hygiene
Answer: B
Rationale: Endotracheal tubes can cause pressure sores, mucosal damage, and
impede oral hygiene, making tracheostomy tubes preferred for long-term
ventilation.
3. Which of the following patients does NOT have a clear indication for a
tracheostomy?
A. A stroke patient with a decreased level of consciousness
,B. A patient with pneumonia who has excessive retained secretions
C. A post-op hernia repair patient who is expected to be on a ventilator for 5 days
D. A patient who has a foreign body lodged in the upper airway
Answer: C
Rationale: A patient expected to be on a ventilator for only 5 days is more
appropriately managed with an endotracheal tube. Tracheostomy is indicated for
prolonged ventilation, upper airway obstruction, or inability to manage
secretions.
4. What is the function of an obturator?
A. Communicates with the tracheal cuff to indicate pressure
B. Provides a smooth tip for easier insertion into the trachea
C. Prevents the tube from being advanced too far
D. A removable sleeve to facilitate cleaning
Answer: B
Rationale: The obturator is used during insertion of the tracheostomy tube to
provide a smooth, rounded tip that guides the tube through the stoma and into
the trachea with minimal trauma.
5. A nurse is caring for a client who sustained trauma to the head and neck and
will require long-term airway support. Which piece of equipment will be
required for home care?
A. Nasopharyngeal airway
B. Oropharyngeal airway
C. Endotracheal tube
D. Tracheostomy tube
Answer: D
Rationale: A tracheostomy tube provides a stable, long-term airway and is
appropriate for home care. Endotracheal tubes are for short-term use in acute
settings.
6. A nurse is assessing a client for potential tracheostomy placement. Which
condition is a common indication?
A. Severe constipation
B. Prolonged intubation
,C. Mild hypertension
D. Skin infection
Answer: B
Rationale: Prolonged intubation is a common reason for a tracheostomy, as it
allows for long-term mechanical ventilation and reduces the complications
associated with extended endotracheal intubation.
7. The nurse is teaching a client about the parts of a tracheostomy tube. The
client asks about the function of the cuff. Which response is correct?
A. "The cuff secures the tube to the skin."
B. "The cuff is inflated to prevent aspiration and provide a seal for mechanical
ventilation."
C. "The cuff helps the patient speak."
D. "The cuff is used to clean the inner cannula."
Answer: B
Rationale: The cuff, when inflated, seals the airway, allowing for mechanical
ventilation and reducing the risk of aspiration.
8. The primary purpose of inflating the tracheostomy cuff is to:
A. Prevent aspiration
B. Enhance patient comfort
C. Warm inhaled air
D. Prevent infection
Answer: A
Rationale: The primary purpose of an inflated cuff is to prevent aspiration of oral
or gastric contents and to ensure adequate ventilation by creating a seal within
the trachea.
Section 2: Tracheostomy Care Procedure (Questions 9-25)
9. During tracheostomy care, which of the following should the nurse place
underneath the flange of the outer cannula?
A. Commercially prepared transparent dressing
B. Cotton-filled gauze square
, C. Commercially prepared fenestrated dressing
D. Twill tape
Answer: C
Rationale: A commercially prepared fenestrated (split) tracheostomy dressing is
designed to fit around the tracheostomy tube under the flanges without
unraveling or leaving fibers that could be aspirated.
10. How should the nurse clean around the stoma during tracheostomy care?
A. With alcohol and gauze
B. With plain water and cotton balls
C. With sterile saline and gauze
D. With hydrogen peroxide and tape
Answer: C
Rationale: The nurse should clean around the stoma using sterile technique with
sterile normal saline and gauze, moving from the stoma outward to prevent
introducing contaminants.
11. A client has a tracheostomy tube with an inner cannula. Which supplies
should the nurse use to dry the inner cannula after cleaning?
A. Paper towels
B. Cotton-tipped applicators
C. Folded pipe cleaners
D. Facial tissues
Answer: C
Rationale: Pipe cleaners are used to dry the inner cannula because they remain
intact without leaving particulate matter that the client could aspirate.
12. A nurse is providing discharge teaching to a client who has a temporary
tracheostomy. Which statement by the client indicates an understanding?
A. "I should dip a cotton-tip applicator into full-strength hydrogen peroxide to
cleanse around my stoma."
B. "I should cut a 4-inch gauze dressing and place it around my tracheostomy
tube."
C. "I should remove the old twill ties after new ties are in place."
Advanced Airway Management Principles, Tracheostomy
Assessment, Suctioning Techniques, Stoma Care Procedures,
Oxygenation Support, Emergency Interventions, Infection
Prevention Strategies, Patient Safety Measures, Nursing
Priorities, and Critical Care Preparation for ATI Exams and
Clinical Practice
1. A tracheostomy is performed primarily to:
A. Prevent infection of the lungs
B. Provide a patent airway
C. Improve the patient's ability to speak
D. Allow for oral feeding
Answer: B
Rationale: The primary purpose of a tracheostomy is to establish and maintain a
patent airway, bypassing an upper airway obstruction, or to facilitate long-term
mechanical ventilation.
2. A nurse is caring for a client who requires long-term ventilatory support. The
nurse should recognize that a tracheostomy tube is preferred over an
endotracheal tube for which of the following reasons?
A. Endotracheal tubes are more comfortable for awake patients
B. Endotracheal tubes can cause pressure sores and mucosal damage to the lips
and mouth
C. Endotracheal tubes are easier to clean
D. Endotracheal tubes do not impede oral hygiene
Answer: B
Rationale: Endotracheal tubes can cause pressure sores, mucosal damage, and
impede oral hygiene, making tracheostomy tubes preferred for long-term
ventilation.
3. Which of the following patients does NOT have a clear indication for a
tracheostomy?
A. A stroke patient with a decreased level of consciousness
,B. A patient with pneumonia who has excessive retained secretions
C. A post-op hernia repair patient who is expected to be on a ventilator for 5 days
D. A patient who has a foreign body lodged in the upper airway
Answer: C
Rationale: A patient expected to be on a ventilator for only 5 days is more
appropriately managed with an endotracheal tube. Tracheostomy is indicated for
prolonged ventilation, upper airway obstruction, or inability to manage
secretions.
4. What is the function of an obturator?
A. Communicates with the tracheal cuff to indicate pressure
B. Provides a smooth tip for easier insertion into the trachea
C. Prevents the tube from being advanced too far
D. A removable sleeve to facilitate cleaning
Answer: B
Rationale: The obturator is used during insertion of the tracheostomy tube to
provide a smooth, rounded tip that guides the tube through the stoma and into
the trachea with minimal trauma.
5. A nurse is caring for a client who sustained trauma to the head and neck and
will require long-term airway support. Which piece of equipment will be
required for home care?
A. Nasopharyngeal airway
B. Oropharyngeal airway
C. Endotracheal tube
D. Tracheostomy tube
Answer: D
Rationale: A tracheostomy tube provides a stable, long-term airway and is
appropriate for home care. Endotracheal tubes are for short-term use in acute
settings.
6. A nurse is assessing a client for potential tracheostomy placement. Which
condition is a common indication?
A. Severe constipation
B. Prolonged intubation
,C. Mild hypertension
D. Skin infection
Answer: B
Rationale: Prolonged intubation is a common reason for a tracheostomy, as it
allows for long-term mechanical ventilation and reduces the complications
associated with extended endotracheal intubation.
7. The nurse is teaching a client about the parts of a tracheostomy tube. The
client asks about the function of the cuff. Which response is correct?
A. "The cuff secures the tube to the skin."
B. "The cuff is inflated to prevent aspiration and provide a seal for mechanical
ventilation."
C. "The cuff helps the patient speak."
D. "The cuff is used to clean the inner cannula."
Answer: B
Rationale: The cuff, when inflated, seals the airway, allowing for mechanical
ventilation and reducing the risk of aspiration.
8. The primary purpose of inflating the tracheostomy cuff is to:
A. Prevent aspiration
B. Enhance patient comfort
C. Warm inhaled air
D. Prevent infection
Answer: A
Rationale: The primary purpose of an inflated cuff is to prevent aspiration of oral
or gastric contents and to ensure adequate ventilation by creating a seal within
the trachea.
Section 2: Tracheostomy Care Procedure (Questions 9-25)
9. During tracheostomy care, which of the following should the nurse place
underneath the flange of the outer cannula?
A. Commercially prepared transparent dressing
B. Cotton-filled gauze square
, C. Commercially prepared fenestrated dressing
D. Twill tape
Answer: C
Rationale: A commercially prepared fenestrated (split) tracheostomy dressing is
designed to fit around the tracheostomy tube under the flanges without
unraveling or leaving fibers that could be aspirated.
10. How should the nurse clean around the stoma during tracheostomy care?
A. With alcohol and gauze
B. With plain water and cotton balls
C. With sterile saline and gauze
D. With hydrogen peroxide and tape
Answer: C
Rationale: The nurse should clean around the stoma using sterile technique with
sterile normal saline and gauze, moving from the stoma outward to prevent
introducing contaminants.
11. A client has a tracheostomy tube with an inner cannula. Which supplies
should the nurse use to dry the inner cannula after cleaning?
A. Paper towels
B. Cotton-tipped applicators
C. Folded pipe cleaners
D. Facial tissues
Answer: C
Rationale: Pipe cleaners are used to dry the inner cannula because they remain
intact without leaving particulate matter that the client could aspirate.
12. A nurse is providing discharge teaching to a client who has a temporary
tracheostomy. Which statement by the client indicates an understanding?
A. "I should dip a cotton-tip applicator into full-strength hydrogen peroxide to
cleanse around my stoma."
B. "I should cut a 4-inch gauze dressing and place it around my tracheostomy
tube."
C. "I should remove the old twill ties after new ties are in place."
