Ok a question on one of my exams asks something like this, "The nurse decides suctioning is appropriate based on which one of the findings?"
Answer A: Crackles heard on auscultation
Answer B: Audible inspiratory wheezes.
The correct answer is A, but I chose B, although I feel like both are good answers. Here is my rationale. (this was sent in a separate email to my prof in attempt to defend my answer).
I know inspiratory wheezes are associated more with bronchoconstriction, but I associated it with mucus. Wheezes are a result of an obstructed airway, which is from mucus (inflammation). Also, audible inspiratory wheezes are more of a red flag for airway compromise, b/c it could (not is) be a sign of impending ARDS. Crackles can lead to ARDS as well, but that wouldn't happen right away. If I heard inspiratory wheezes in real life would I suction right away? Probably not, maybe I would collect other data first, and if anything, give a bronchodilator. But I thought this was a better answer than choosing crackles.
The answer regarding the crackles turned out to be correct, and I had a hard time between the two, but chose the wheezing. I understand that if the nurse hears crackles, there's clearly congestion in the lungs, but the stem didn't specify where s/he heard the crackles. Crackles are usually heard in the bases, so I went with that. With that said, I know you cannot suction past the carina, and usually crackles are at the bases, so even if I decided to suction just because I auscultated crackles, what would suctioning do to decrease the crackles? It wouldn't do a whole lot, and that's something to think about when choosing the right nursing intervention-Is it even going to be effective?.
Also, page 649 in our MS text at the top right corner states,
"Trachael suctioning is performed when adventitious breath sounds are detected or whenever secretions are obviously present" (p.649).
That's all I found about trach's in that volume text. Adventitious breath sounds include crackles and WHEEZES.
I know you said in lecture (and it was in the notes) that if the patient was wheezing that the RN should give a bronchodilator. But between the 2 answer choices, I had to defend the "wheezes" answer choice for the sake of correctly answering, what I thought was, a tricky question. You might think I read too far into the question, but I thought I was critically thinking.
...now that i reflect on all this stuff i wrote, I'm starting to realize why the "crackles"-answer was correct after all. But at the same time, I'm not going back! If i'm wrong, tell me why, and if i'm not, tell me why!-if your reason is different than mine. :)
Thank you everyone!!
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This is a good example of the way NCLEX questions are written. Sometimes you'll find more than one "right" answer. But you must chose the BEST answer.
Or another way to think of it, sometimes, is a "less bad" answer.
Though my experience with the actual NCLEX (as I recall five years out) was that I didn't find poorly worded or ambiguous questions; they were pretty cut and dried.
For the purpose of getting extra points, I thought I would see what other nurses/students would think. And yes, my school gives the most ambiguous questions on exams...very difficult to pass these exams..but apparently if you can pass my exams, you will pass the NCLEX...even though that wasn't the case a few years ago. Hopefully they are right, and I hope you are right about the nclex questions.
Can option B (audible wheezing) be an expected finding for a trached patient. My trached patient had what sounded like expiratory wheezing the other week. But when you listened to his lungs, they were clear. The RT said that his cannula may have been too small and he needed to get a bigger trach.
Specializes in Complex pedi to LTC/SA & now a manager.
That's not wheezing. That's air around the trach. Wheezing does not warrant suctioning. Neither does a wrongly sized trach. Expiratory wheezing/whistling around a mis-sized trach is not pathological.
The correct answer is A, but I chose B, although I feel like both are good answers. Here is my rationale. (this was sent in a separate email to my prof in attempt to defend my answer).
I know inspiratory wheezes are associated more with bronchoconstriction, but I associated it with mucus. Wheezes are a result of an obstructed airway, which is from mucus (inflammation). Also, audible inspiratory wheezes are more of a red flag for airway compromise, b/c it could (not is) be a sign of impending ARDS. Crackles can lead to ARDS as well, but that wouldn't happen right away. If I heard inspiratory wheezes in real life would I suction right away? Probably not, maybe I would collect other data first, and if anything, give a bronchodilator. But I thought this was a better answer than choosing crackles.
The answer regarding the crackles turned out to be correct, and I had a hard time between the two, but chose the wheezing. I understand that if the nurse hears crackles, there's clearly congestion in the lungs, but the stem didn't specify where s/he heard the crackles. Crackles are usually heard in the bases, so I went with that. With that said, I know you cannot suction past the carina, and usually crackles are at the bases, so even if I decided to suction just because I auscultated crackles, what would suctioning do to decrease the crackles? It wouldn't do a whole lot, and that's something to think about when choosing the right nursing intervention-Is it even going to be effective?.
Inflammation and bronchospasm are not the same thing as mucus. You can't suction inflammation and bronchospasm away. Wheezes aren't just "associated with" bronchospasm, they are caused by bronchospasm.
Crackles don't "lead to ARDS," either. Cart before the horse.
Also, just so you know, you don't just "give a bronchodilator." Unless it's prescribed by a physician or ANP as a prn, it's not your call.
Hi Bella, I can't tell you how many times I've written out my rationale for why my answer was the correct answer after a test only to figure it out mid-sentence. I guess that means we are thinking, right?
Snot rocket was my favorite answer. If you've ever been hit by wads of phlegm, you know exactly when you should suction, or duck. :) And I agree with everyone else. Wheezing is associated with constriction of the bronchial passages, what every person with asthma will attest to. Crackles is the moist sound of mucus being rattled around when the patient breathes. A person with a trach most likely can cough up the secretions from the lower airway, but they usually can't clear the secretions from the larger passages, which is where a good suctioning comes in. If it sounds wet in there, and they are having trouble clearing it on their own, suction. If they sound wheezy, they don't need suctioned, they need a respiratory therapist (who presumably has an order for bronchodialators on hand).
B. Crackles indicate the need to suction,while wheezes indicate air,and constriction of the airways in lung diseases e.g asthma,
acute bronchitis,or allergy...in most cases a bronchodilator is used for asthma,acute bronchitis ,and epinephrine in the case of allergy induced Anaphylactic Shock.
um my head is hurting just thinking about this. Suctioning for wheezing and crackles. Sigh this is just rediculous. Nether should be suctioned THE ONLY TIME YOU SUCTION IS WHEN YOU HEAR RONCHI!!!!!!!!
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Or another way to think of it, sometimes, is a "less bad" answer.
Though my experience with the actual NCLEX (as I recall five years out) was that I didn't find poorly worded or ambiguous questions; they were pretty cut and dried.