A client expresses concern about the suctioning procedure. What is the best response by the nurse?
"You have nothing to worry about; the procedure is entirely safe.".
"Suctioning can be uncomfortable, but it helps maintain clear airways.".
"I understand your concern, but we have no other options to remove secretions.".
"Don't worry; I'll make sure to suction quickly to minimize any discomfort.".
The Correct Answer is B
Choice A rationale:
(Incorrect) Assuring the client that the procedure is entirely safe is not entirely accurate, as suctioning can carry some risks and discomfort.
Choice B rationale:
(Correct) This response acknowledges the client's concern about the suctioning procedure while providing a rationale for its importance, which is to maintain clear airways and prevent complications like airway blockage and respiratory distress.
Choice C rationale:
(Incorrect) Stating that there are no other options to remove secretions may not be true, and it does not address the client's concern effectively.
Choice D rationale:
(Incorrect) Promising to suction quickly may not address the client's worry and might compromise the effectiveness of the procedure, as thorough suctioning is necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
(Correct) After sterile suctioning, it is essential to reposition the patient to a comfortable and safe position, ensuring proper alignment and support to prevent complications.
Choice B rationale:
(Incorrect) While documentation is crucial, ensuring the patient's safety and comfort should be the immediate priority after the procedure.
Choice C rationale:
(Incorrect) The nurse should not remove the catheter and tubing from the artificial airway immediately after suctioning, as it may still be needed for subsequent interventions.
Choice D rationale:
(Incorrect) Assessing the patient's response to suctioning is essential, but ensuring safety and repositioning take precedence immediately after the procedure.
Correct Answer is D
Explanation
Choice D rationale:
Before performing sterile suctioning on a patient with an endotracheal tube (ETT), the nurse should preoxygenate the patient with 100% oxygen. Suctioning can temporarily decrease oxygen levels in the airway, and preoxygenation helps prevent hypoxia during the procedure.
Choice A rationale:
Checking the patient's blood pressure is not directly related to the preparation for sterile suctioning. However, the nurse should monitor vital signs during and after the procedure.
Choice B rationale:
Placing the patient in the supine position is not a specific requirement for sterile suctioning. The nurse should position the patient appropriately for the procedure to ensure optimal access to the airway.
Choice C rationale:
Inserting the catheter without resistance is not a recommended action. The nurse should assess the patient's airway and ensure proper placement of the suctioning catheter to avoid causing injury or damage.
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