A nurse is preparing to perform nasotracheal suctioning for a client. Which of the following is an appropriate action for the nurse to take?
Apply intermittent suction for 20 to 30 seconds.
Place the catheter in a location that is clean and dry for later use.
Hold the suction catheter with the clean, nondominant hand.
Use surgical asepsis when performing the procedure.
The Correct Answer is D
A. "Apply intermittent suction for 20 to 30 seconds." –
Suctioning should be applied intermittently for no more than 10 to 15 seconds to prevent hypoxia and mucosal damage.
B. "Place the catheter in a location that is clean and dry for later use." –
A suction catheter should not be reused once it has been used; it should be discarded after a single use to prevent infection.
C. "Hold the suction catheter with the clean, nondominant hand." –
The dominant hand should remain sterile and be used to control the suction catheter, while the nondominant hand is used to handle nonsterile equipment.
D. "Use surgical asepsis when performing the procedure." –
Nasotracheal suctioning is a sterile procedure because it involves direct access to the lower airway, requiring surgical asepsis to reduce the risk of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Consult the social worker to speak with the client about support groups. While a social worker can be a valuable resource, advocacy involves the nurse directly supporting the client rather than referring them to another professional as the primary action.
B. Help the client make decisions about their treatment by providing them with your opinions. Advocacy means ensuring the client has accurate, unbiased information to make informed decisions, not influencing them with personal opinions.
C. Provide the client with a computer to look up questions they have about their diagnosis. While access to information is important, the nurse should provide evidence-based resources and ensure the client receives accurate, professional guidance.
D. Avoid discussing alternative treatments that may have the potential to harm the client. Advocacy includes ensuring the client is aware of safe and effective treatment options while protecting them from misinformation or potentially harmful alternatives.
Correct Answer is C
Explanation
A. Place multiple smoke detectors in the same area of the home. Smoke detectors should be placed in different areas, especially near bedrooms, in hallways, and on every level of the home, rather than clustering them in one area.
B. Change the batteries in smoke detectors every 2 years. Batteries should be changed at least once a year, and the smoke detector should be tested monthly to ensure functionality.
C. Cover the nose and mouth with a damp cloth before exiting a smoke-filled area. Using a damp cloth helps filter out some smoke and toxic fumes, reducing inhalation of harmful particles.
D. Open a window to let smoke out before leaving the home. Opening a window can increase oxygen flow, which may intensify the fire rather than help in an evacuation. Instead, the priority should be to evacuate immediately and call emergency services.
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