A nurse is performing nasopharyngeal suctioning for an adult client. Which of the following techniques should the nurse use?

Apply intermittent suction for 30 seconds.

Insert the catheter 10 cm (4 in).

Apply suction while inserting the catheter.

Wait 1 min between suctioning attempts.

Answer and Explanation

The Correct Answer is D

Waiting 1 minute between suctioning attempts allows the client to recover and ensures that the procedure is not overly invasive. It also helps to prevent the client from becoming hypoxic.

The distance that the nasopharyngeal catheter should be inserted varies from person to person and therefore 10 cm is not standard.

During nasopharyngeal suctioning, the nurse should apply suction intermittently while withdrawing the catheter, not during insertion. Applying suction during insertion can cause tissue damage and increase the risk of trauma.

The nurse should also apply intermittent suction for no longer than 15 seconds to prevent hypoxia and damage to the mucosal lining. Suctioning for an extended period can cause discomfort and harm to the client.

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Correct Answer is B

Explanation

This statement demonstrates an understanding of the concept of spacing out immunizations to reduce the number of shots given during a single visit. By making multiple office visits, the parent can ensure that their child receives the recommended immunizations while minimizing the number of injections at each visit.

Lactose intolerance is not a contraindication to receiving immunizations. Most vaccines do not contain lactose, and even if they do, the amount present is typically minimal and not expected to cause an adverse reaction in individuals with lactose intolerance.

The first flu immunization is typically recommended for children starting at 6 months of age, not at 6 years of age.

The human papillomavirus (HPV) vaccine is typically recommended for preteens and adolescents, usually starting between the ages of 11 and 12. It is not typically administered when a child enters kindergarten.

A. "The client reports pain is reduced when he is positioned on his side." B. "The client's mother died 4 years ago from breast cancer." C. "The client's partner visited earlier today for 2 hours." D. "The client received the prescribed antibiotic every 8 hours."

Correct Answer is A

Explanation

This statement should be included in the change-of-shift report because it provides vital information about the patient’s condition and any changes that have occurred to the patient during the shift.

Statement B is wrong because it does not provide relevant information about the patient’s current condition or changes that have occurred during the shift. Statement C is wrong because it does not provide relevant information about the patient’s medical condition. Statement D is wrong because it does not provide new information about changes that have occurred during the shift.

Change-of-shift reports are key to inpatient care because they provide vital information about and responsibility for the patient from the off-going provider to the on-coming provider.

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A nurse is performing nasopharyngeal suctioning for an adult client. Which of the following techniques should the nurse use?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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Correct Answer is A

Explanation

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