On Entering the Room of the Patient Who Has Just

question 4

Multiple Choice

On entering the room of the patient who has just returned from surgery for a total laryngectomy and radical neck dissection,the nurse recognizes a need for intervention upon making which one of the following observations?

• A) The gastrostomy tube is clamped.
• B) The patient is coughing blood-tinged secretions from the tracheostomy.
• C) The patient is positioned in a lateral position with the head of the bed flat.
• D) There are 200 mL of serosanguineous drainage in the patient's portable drainage device.

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