Adult Critical Care Specialty (ACCS) Practice Exam

When monitoring a patient using a tracheal speaking device, what should the specialist do?

1. Suction through the center of the device as needed

2. Initiate use of the device right after tracheostomy

3. Monitor for adequacy of exhalation

4. Ensure the cuff is inflated

The correct answer is: Monitor for adequacy of exhalation

Monitoring for adequacy of exhalation is essential when using a tracheal speaking device because the device relies on airflow to allow the patient to generate sounds and communicate effectively. Adequate exhalation is necessary to provide the pressure and airflow needed to vibrate vocal cords and produce voice. If the exhalation is insufficient, the ability to speak will be compromised and the effectiveness of the device will be reduced. Suctioning through the center of the device is not typically recommended as this may disrupt airflow and create difficulties in speech. Initiating use of the device immediately after tracheostomy is not ideal; typically, some recovery time is necessary before introducing speech devices. Ensuring the cuff is inflated is also not relevant when using a speaking valve, as the cuff should be deflated to allow airflow through the speaking device for vocalization. Hence, monitoring exhalation adequacy is a critical step in effectively utilizing a tracheal speaking device.