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. Examining the character of the sputum: While monitoring secretions is important, it does not necessarily indicate the need for immediate suctioning.
B. Monitoring the rate of respirations: An increased respiratory rate can indicate distress but is not a definitive cue for suctioning.
C. Auscultating the breath sounds: This helps identify the presence of secretions or airway obstruction and is a primary indicator for suctioning.
D. Determining the last time the patient was suctioned: Suctioning should be based on clinical need rather than a routine schedule.
Correct Answer is C
Explanation
A) Choose a wool blanket when using oxygen. Wool and synthetic fabrics can generate static electricity, which is a fire hazard in the presence of oxygen.
B) Keep oxygen tanks 4 feet away from an electric stove. Oxygen tanks should be kept at least 8 to 10 feet away from heat sources, including electric stoves.
C) Store oxygen tanks upright. Oxygen tanks should always be stored upright and secured to prevent them from falling and causing injury or damage.
D) Use petroleum-based ointments to moisturize lips. Petroleum-based products are flammable and should be avoided when using oxygen. Water-based moisturizers are safer.
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