A nurse is performing sterile suctioning on a patient with an artificial airway. What is the purpose of sterile suctioning?
To administer medications.
To promote comfort.
To assess lung sounds.
To monitor vital signs.
The Correct Answer is C
To assess lung sounds.
Choice A rationale:
Sterile suctioning is not performed to administer medications. Its primary purpose is to remove secretions and maintain a patent airway.
Choice B rationale:
Sterile suctioning is not done solely for promoting comfort. Its main goal is to clear the airway and prevent respiratory complications.
Choice C rationale:
The purpose of sterile suctioning is to assess lung sounds by removing excess secretions and mucus that may obstruct the airway. This helps in evaluating the patient's respiratory status and identifying any abnormal lung sounds.
Choice D rationale:
Sterile suctioning is not performed to monitor vital signs. Although vital signs may be monitored during the procedure, it is not the primary purpose of suctioning.
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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 C
Explanation
"I have been coughing up blood.”.
Choice A rationale:
Mild nasal congestion may be a common finding in many patients and does not necessarily contraindicate suctioning unless it significantly obstructs the airway.
Choice B rationale:
A sore throat may indicate local irritation, but it does not directly contraindicate suctioning unless there are other underlying complications.
Choice C rationale:
A history of coughing up blood (hemoptysis) suggests an ongoing bleeding disorder. Suctioning could exacerbate the bleeding, leading to further complications. The procedure should be avoided until the cause of hemoptysis is properly assessed and managed.
Choice D rationale:
Feeling lightheaded may be a common sensation during and after suctioning due to the stimulation of the gag reflex, but it does not necessarily contraindicate the procedure. It is essential to ensure adequate oxygenation and provide proper support during the procedure to minimize this discomfort.
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