A nurse is preparing to perform nasotracheal suctioning for a client. Which of the following is an appropriate action for the nurse to take?
Apply intermittent suction for 20 to 30 seconds.
Place the catheter in a location that is clean and dry for later use.
Hold the suction catheter with the clean, nondominant hand.
Use surgical asepsis when performing the procedure.
The Correct Answer is D
A. "Apply intermittent suction for 20 to 30 seconds." –
Suctioning should be applied intermittently for no more than 10 to 15 seconds to prevent hypoxia and mucosal damage.
B. "Place the catheter in a location that is clean and dry for later use." –
A suction catheter should not be reused once it has been used; it should be discarded after a single use to prevent infection.
C. "Hold the suction catheter with the clean, nondominant hand." –
The dominant hand should remain sterile and be used to control the suction catheter, while the nondominant hand is used to handle nonsterile equipment.
D. "Use surgical asepsis when performing the procedure." –
Nasotracheal suctioning is a sterile procedure because it involves direct access to the lower airway, requiring surgical asepsis to reduce the risk of infection.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Consult the social worker to speak with the client about support groups. While a social worker can be a valuable resource, advocacy involves the nurse directly supporting the client rather than referring them to another professional as the primary action.
B. Help the client make decisions about their treatment by providing them with your opinions. Advocacy means ensuring the client has accurate, unbiased information to make informed decisions, not influencing them with personal opinions.
C. Provide the client with a computer to look up questions they have about their diagnosis. While access to information is important, the nurse should provide evidence-based resources and ensure the client receives accurate, professional guidance.
D. Avoid discussing alternative treatments that may have the potential to harm the client. Advocacy includes ensuring the client is aware of safe and effective treatment options while protecting them from misinformation or potentially harmful alternatives.
Correct Answer is A
Explanation
A. "Use IV tube ports when injecting medications." Latex-free IV ports should be used instead of rubber stoppers found in some IV bags and vials.
B. "Remove medication from multi-dose vials with the stopper in place." Many vial stoppers contain latex, so the nurse should use single-dose vials or vials labeled as latex-free.
C. "Secure loose cords in stockinette with tape." Stockinettes are sometimes made with latex, posing a risk to the client. Non-latex materials should be used instead.
D. "Schedule the client's surgery as the last procedure of the day." Clients with latex allergies should be scheduled first to minimize exposure to airborne latex particles from gloves and equipment used earlier in the day.
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