174. 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.)
Rinse the catheter to remove secretions.
Don sterile gloves.
Apply suction while rotating the catheter.
Insert the catheter during the client's inspiration.
Turn on the suction and set the pressure.
The Correct Answer is E, B, D,C,A
2. E. Turn on the suction and set the pressure.
1. B. Don sterile gloves.
3. D. Insert the catheter during the client's inspiration.
4. C. Apply suction while rotating the catheter.
5. A. Rinse the catheter to remove secretions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A.Induration after a Mantoux test is a common response and does not necessarily require follow-up care.
B.A potassium level of 3.6 mEq/L is within the normal range (3.5-5.0 mEq/L).
C.Sodium phosphate is commonly used for bowel preparation before procedures like colonoscopy.
D.Correct. An INR of 1.8 for a client on warfarin is below the therapeutic range (usually 2.0- 3.0 for most indications), indicating that the client's blood may not be adequately anticoagulated. This requires follow-up to adjust the warfarin dose.
Correct Answer is D
Explanation
A. Incorrect. Mild swelling under the sutures is a common finding after surgery and may not necessarily require reporting unless it worsens or is associated with other concerning symptoms.
B. Incorrect. Pink-tinged coloration can be a normal part of the healing process, as long as there is no excessive redness, warmth, or signs of infection.
C. Incorrect. Crusting of exudate on the incisional line can occur during the healing process and may not necessarily indicate a problem unless it's accompanied by signs of infection.
D. Correct. Partial separation of the upper part of the incisional line can indicate wound dehiscence, a potential complication that requires immediate attention to prevent infection and further complications.
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