A nurse is nasopharyngeal suctioning an adult patient to remove thick secretions. The nurse will:
use a 14-Fr catheter
use suction pressure between 120 and 160 mm Hg
use an 8-Fr catheter
use the catheter to suction the mouth and nasopharynx
The Correct Answer is A
A. Use a 14-Fr catheter: This is the appropriate size for suctioning an adult to effectively remove thick secretions.
B. Use suction pressure between 120 and 160 mm Hg: This pressure is too high and may cause mucosal damage; 100 to 120 mm Hg is recommended for adults.
C. Use an 8-Fr catheter: This size is too small for effectively suctioning thick secretions in adults.
D. Use the catheter to suction the mouth and nasopharynx: Suctioning the mouth first contaminates the catheter, increasing the risk of infection in the nasopharynx.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Be monitored for respiratory rate: Important for ongoing assessment but not directly related to the deflation process.
B. Have the cuff pressure checked: Necessary during care but not immediately before deflation.
C. Have the pharynx suctioned: Suctioning clears secretions that could be aspirated when the cuff is deflated.
D. Be administered extra oxygen: Beneficial but not a direct prerequisite for cuff deflation.
Correct Answer is A
Explanation
A. Oxygen diffuses across the alveolar membrane into the blood: This is the primary function of the respiratory system, ensuring oxygenation of blood.
B. The alveoli have cilia that help remove foreign particles: Cilia are present in the respiratory tract, but not in the alveoli.
C. The diaphragm controls respiration: The diaphragm assists with breathing but does not "control" respiration, which is regulated by the brainstem.
D. The bronchioles contain macrophages that phagocytize inhaled bacteria: Macrophages are found in alveoli, not the bronchioles.
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