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Practice Question

A nurse is caring for an adult client who requires nasopharyngeal suctioning. Which of the following actions should the nurse take?

Answer Choices:

Correct Answer:

Set the suction device to 120 mm Hg.

Rationale:

🌬️ For adult suctioning, safe suction pressure typically ranges around 100–150 mm Hg, and 120 mm Hg is within this recommended range.

🌬️ Using appropriate suction pressure helps remove secretions while minimizing mucosal trauma.

🌬️ Too high pressure can cause bleeding, irritation, and potential damage to the nasopharyngeal tissues.

🌬️ Proper suction setting is a key part of safe airway management.

🌬️ Therefore, setting the device to 120 mm Hg is an appropriate action.

Have the client tuck his chin to his chest during suctioning.

🌬️ Tucking the chin to the chest is more commonly used to protect the airway during swallowing, not for nasopharyngeal suctioning.

🌬️ For suctioning, the client’s head is generally kept in a neutral or slightly extended position to allow easier passage of the catheter.

🌬️ Chin-tucking may actually narrow the airway passage and make catheter insertion more difficult.

🌬️ This position does not enhance the effectiveness of nasopharyngeal suction.

🌬️ Thus, this is not the best action in this context.

Apply a petroleum-based lubricant to the catheter.

🌬️ For suctioning procedures, a water-soluble lubricant should be used, not a petroleum-based product.

🌬️ Petroleum-based lubricants can increase the risk of aspiration-related complications and are not safe for use in the respiratory tract.

🌬️ They may also interfere with certain respiratory equipment and are not recommended in airway procedures.

🌬️ Water-soluble lubricants are safer and easier to clear if small amounts enter the airway.

🌬️ Therefore, applying a petroleum-based lubricant is incorrect.

Apply suction to the catheter during insertion.

🌬️ Suction should never be applied during insertion because it can cause mucosal trauma and hypoxia.

🌬️ Standard practice is to insert the catheter without suction, then apply suction only while withdrawing the catheter, using a rotating motion.

🌬️ Applying suction on the way in can also pull tissue into the catheter opening, increasing injury risk.

🌬️ This also lengthens the time of continuous suction, worsening oxygen desaturation.

🌬️ Thus, applying suction during insertion is unsafe and incorrect.

Want to practice more questions like this?

This question is from RN Fundamentals 2023 EXAM 7 which contains 69 questions.

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From Exam
RN Fundamentals 2023 EXAM 7

69 Questions

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Question Details
  • Category: RN Nursing Exam(s)
  • Subcategory: ATI Exam(s)
  • Domain: RN ATI Fundamentals of Nursing
  • Answer Choices: 4
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