A nurse is caring for a client who requires nasotracheal suctioning. Identify the sequence the nurse should follow to perform suctioning. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Don sterile gloves.

Turn on the suction and set the pressure.

Insert the catheter during the client's inspiration.

Apply suction while rotating the catheter.

Rinse the catheter to remove secretions.

Answer and Explanation

The Correct Answer is B,A,C,D,E

B.   The nurse first prepares the equipment and ensures the suction pressure is set appropriately.
A.   Sterile gloves are then applied to maintain sterile technique during airway suctioning.
C.   The catheter should be inserted during the client’s inspiration to minimize discomfort and maximize
effectiveness.
D.   Suction should be applied while rotating the catheter to prevent tissue damage and to clear secretions effectively.
E.   After suctioning, the catheter should be rinsed to remove any remaining secretions.

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Correct Answer is B

Explanation

A. Submerging feet in ice water may cause hypothermia and is not an appropriate method for cooling down.
B. Initiating seizure precautions is important due to the risk of seizures associated with elevated body temperature.
C. Acetaminophen is not effective for reducing body temperature in cases of hyperthermia and may mask important symptoms.
D. A thermal blanket can increase the temperature and should be avoided for hyperthermia management.

A. Offer small amounts of clear liquids 6 hr following surgery. B. Administer analgesics on a scheduled basis for the first 24 hr. C. Apply a warm compress to the operative site once daily. D. Give cromolyn nebulized solution every 8 hr.

Correct Answer is B

Explanation

A. Offering clear liquids should typically occur 6 hours or later postoperatively; in the first few hours, the focus is on monitoring and pain management.
B. Administering analgesics on a scheduled basis ensures consistent pain control and helps prevent unnecessary discomfort.
C. Applying a warm compress is not appropriate in the early postoperative period and may risk increased bleeding.
D. Giving cromolyn nebulized solution is unrelated to appendectomy recovery and is not part of standard postoperative care.

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A nurse is caring for a client who requires nasotracheal suctioning. Identify the sequence the nurse should follow to perform suctioning. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Nursing Test Bank

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