A client has a nasopharyngeal tube (NPT) for oxygenation. During the suctioning procedure, the patient says, "I'm experiencing discomfort in my nose.” How should the nurse respond?
"I'll increase the suction pressure for better results.”
"Try to breathe through your mouth; it will help.”
"I'm sorry for the discomfort, but the suctioning is necessary.”
"Let's pause for a moment and reposition the tube to ease the discomfort.”
The Correct Answer is D
Choice D rationale:
The nurse should respond by acknowledging the discomfort and pausing the procedure to reposition the nasopharyngeal tube. Repositioning can help alleviate the discomfort while ensuring the oxygenation needs are still met.
Choice A rationale:
Increasing the suction pressure may exacerbate the discomfort and cause further irritation to the nose and airway.
Choice B rationale:
Instructing the client to breathe through the mouth may not adequately address the discomfort and may not be feasible if the oxygenation is dependent on the nasopharyngeal tube.
Choice C rationale:
Although explaining the necessity of suctioning is important, it does not directly address the client's immediate discomfort. The priority is to address the client's comfort and safety during the procedure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
Choice A rationale:
The nurse should not rotate the catheter between the thumb and forefinger during suctioning. This action could cause trauma to the airway.
Choice B rationale:
Limiting each suction pass to no more than 10 seconds is an essential practice during sterile suctioning. Prolonged suctioning can lead to hypoxia and potential complications.
Choice C rationale:
Rinsing the catheter and tubing with saline after each suction pass helps maintain patency and prevent the accumulation of secretions, ensuring effective suctioning during the procedure.
Choice D rationale:
Applying continuous suction while inserting the catheter is not recommended during sterile suctioning. Intermittent suction is preferred for safety and effectiveness.
Choice E rationale:
Providing encouragement and support to the client throughout the procedure is crucial for their comfort and cooperation. Suctioning can be uncomfortable, and the client may need reassurance during the process.
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.
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