Question 1

The student nurse is preparing to perform nasotracheal suctioning on an adult patient wearing a face mask.Which action by the student should the nursing instructor question?

Accepted Answer

The suction catheter should not be inserted during swallowing because it will most likely enter the esophagus.Insert during inhalation because the epiglottis is open.The patient should be hyperoxygenated before suctioning.The oxygen flow rate can be increased on the face mask,and the patient can deep-breathe slowly to accomplish this.The catheter should be inserted along the natural course of the nares-slightly slanted downward.In adults,the catheter is inserted about 20 cm (8 inches).

Question 2

The nurse is assessing a patient who is intubated and on a ventilator.When listening above the sternal notch with a stethoscope,the nurse notes a minimal amount of air leak at the end of inspiration.Which action by the nurse is appropriate?

Accepted Answer

The cuff should be inflated to minimal leak.If the air leak is audible with the ear,it is too large.A properly inflated cuff should have a minimal air leak that is heard only with a stethoscope.The air should not be removed,the health care provider does not need to be notified,and the patient does not need to be suctioned because the cuff is properly inflated.

Question 3

The nurse is preparing to suction an infant with a tracheostomy tube.Which action by the nurse follows appropriate procedure?

Accepted Answer

Suction catheters for pediatrics should be half the diameter of the child's tracheostomy tube.The distance suctioned should be no greater than 0.5 cm (0.2 inches)beyond the tip of the artificial airway.To determine distance,the catheter is placed near a sample artificial airway.Hyperoxygenate with 100% oxygen in pediatric patients.Negative pressure for suctioning should not exceed 100 mm Hg.

Question 4

The student nurse is providing tracheostomy care to a patient who has intratracheal secretions and a damp tracheostomy dressing and ties.Which action by the student should the nursing instructor question?

Accepted Answer

Do not use scissors to cut gauze pads as they may shed fibers that could be inhaled by the patient.Use a manufactured pad with a slit.Suctioning the tube removes secretions to avoid occluding the outer cannula while the inner cannula is removed.Usually a supine or semi-Fowler's position is used to promote patient comfort and prevent muscle strain for the nurse.If changing ties without an assistant,the old ties are not cut until the new ties are securely in place.

Question 5

A patient with head trauma following a motor vehicle accident is on mechanical ventilation with an endotracheal tube.Which action by the nurse will reduce the risk for elevations in intracranial pressure during suctioning?

Accepted Answer

Suctioning can cause elevations in intracranial pressure in patients with head injury.To reduce the risk,the nurse should hyperoxygenate the patient before suctioning and should suction only twice with each suctioning procedure.The catheter is inserted past the end of the endotracheal tube until resistance is met to adequately remove secretions from the airway.Suction should be applied while the catheter is removed.

Question 6

After oropharyngeal suctioning of a patient,the nurse notes bloody secretions in the suction catheter and tubing.What should the nurse do next?

Accepted Answer

Observe the catheter tip for nicks,which can cause mucosal trauma.The nurse should assess the oral cavity for trauma or lesions,reduce the amount of suction pressure used,provide supplemental oxygen only if respiratory distress occurs,and increase the frequency of oral hygiene.

Question 7

A patient with a tracheostomy tube is accidentally extubated.What should the nurse do immediately?

Accepted Answer

Replace the old tracheostomy tube with a new tube.Some experienced nurses or respiratory therapists may be able to quickly reinsert the tracheostomy tube.A spare tracheostomy tube of the same size and kind should be kept at the bedside in the event of emergency replacement.Notify the health care provider after reestablishing the airway.Be prepared to manually ventilate the patient with an Ambu bag if respiratory distress develops until the tracheostomy is replaced.An endotracheal tube of the same size can be inserted in the stoma in an emergency.

Question 8

The nurse is performing nasotracheal suctioning on a patient.The nurse should discontinue the suctioning if which of the following occurs?

Accepted Answer

If the patient's pulse drops by more than 20 beats per minute,suctioning should be discontinued.The patient should cough,and this is expected.If the patient's pulse increases by more than 40 beats per minute or pulse oximetry falls below 90% or 5% from baseline,suctioning should be discontinued.

Question 9

The nurse is caring for an infant who has been vomiting and is having difficulty breathing.What actions by the nurse are appropriate for suctioning the infant?

Accepted Answer

Position infants with breathing problems or excessive vomitus in a supine or side-lying position.Airways of infants and children are smaller than those of an adult;even small amounts of mucus can cause airway obstruction.Suction should be completed for only 5 seconds with 30 to 60 seconds in between for the patient to reoxygenate.Compress the bulb syringe before insertion to prevent forcing secretions into the infant's bronchi.

Question 10

The nurse is assessing several patients who have returned from surgery.Which finding most likely indicates a need for suctioning?

Accepted Answer

When a patient's oxygen saturation falls below 90%,this is a good indicator of the need for suctioning.Pain with breathing is probably related to the surgery.If a cough is productive,suctioning is not necessary.Drowsiness and a decreased respiratory rate may be due to administration of pain medications such as opioids.

Question 11

The nurse is providing care to a patient with a tracheostomy tube that has an inner cannula.Which intervention by the nurse follows proper procedure for tracheostomy tube care?

Accepted Answer

After the inner cannula is thoroughly cleaned,it is rinsed with normal saline.The inner cannula is removed and is placed in a basin of normal saline to loosen secretions.It is scrubbed and then rinsed with normal saline.The outer cannula is not cleaned on the inside.The exposed outer cannula surfaces at the stoma are dried with a 4×4 gauze to prevent a moist environment and prohibit microorganism growth and skin excoriation.

Question 12

The nurse is performing nasotracheal suctioning for a patient.Which action by the nurse is appropriate?

Accepted Answer

Suction should be applied for 15 seconds or less to avoid cardiopulmonary compromise from hypoxemia or vagal overload.Continuous suction and back and forth rotation of the catheter are now recommended because studies show that tracheal damage from intermittent and continuous suctioning was similar.The catheter should be rotated back and forth,not pushed in and out.At least 1 minute should be allowed between suction passes for ventilation and oxygenation.

Question 13

A patient on mechanical ventilation with an endotracheal tube requires suctioning.A closed in-line catheter is in place.Which action by the nurse is appropriate?

Accepted Answer

The catheter is pushed in while the plastic sleeve is slid back between the thumb and forefinger until resistance is felt or the patient coughs.Hyperoxygenation is done by adjusting the FiO? setting on the ventilator.Manual ventilation is not recommended.The catheter is pushed in when the patient inhales.Suction is applied for no longer than 15 seconds.

Question 14

The nurse has completed suctioning a patient's airway.Which action should the nurse take first?

Accepted Answer

When suctioning is completed,disconnect the catheter from the connecting tubing.Roll the catheter around the fingers of the dominant hand.Pull the glove off inside out so that the catheter remains coiled in the glove.Pull off the other glove over the first glove in the same way.Discard in an appropriate receptacle.The suction device should be turned off when suctioning is complete.There is no further need for suction.Remove the face shield and discard into an appropriate receptacle.Apply clean gloves to give personal care.

Question 15

The nurse is providing nasotracheal suctioning for a 13-year-old patient with secretions in the throat and trachea.Which action by the nurse demonstrates proper technique?

Accepted Answer

In older children,the suction catheter is inserted about 16 to 20 cm (6 to 8 inches).The catheter is always inserted during inspiration.The catheter should be lubricated with water-soluble lubricant to avoid lipid aspiration pneumonia from a petroleum-based gel.The procedure requires sterile gloves,at least on one hand.The trachea should be suctioned before the pharynx because the mouth and the pharynx contain more bacteria than the trachea.

Question 16

A patient using a nasal cannula has gurgling on inspiration.The nurse notes a productive cough but the inability to clear the secretions from the mouth.Which action should the nurse take first to prepare for oropharyngeal suctioning?

Accepted Answer

Perform hand hygiene and apply clean gloves.Apply a mask or face shield if splashing is likely.Insert the device into the mouth along the gum line to the pharynx.Remove the patient's oxygen mask,if present.A nasal cannula may remain in place.Connect one end of the connecting tubing to the suction machine and the other to a Yankauer suction catheter.

Question 17

A patient has been on mechanical ventilation with an endotracheal tube for 1 week.Which intervention by the nurse will help prevent ventilator-associated pneumonia (VAP)?

Accepted Answer

Subglottal secretions should be removed every 4 to 6 hours or before position changes.Oral care should be provided with a chlorhexidine swab or toothbrush (if chlorhexidine is contraindicated)every 8 hours.The ventilator circuits should be changed every 48 hours because of potential bacteria within the tubing condensation.The endotracheal cuff pressures should be maintained at 20 cm H?O to decrease movement of secretions into the lower airways.

Question 18

The nurse is suctioning a patient with an endotracheal tube.Which action should the nurse take when the patient develops respiratory distress?

Accepted Answer

If the patient develops respiratory distress during suctioning,the catheter should be immediately withdrawn and supplemental oxygen and breaths supplied as needed.In an emergency,disconnect suction and attach oxygen at the prescribed flow rate through the catheter.

Question 19

A patient with a tracheostomy tube has thick,tenacious mucus that is difficult to remove.The nurse should choose which technique to suction the airway?

Accepted Answer

Normal saline instillation (NSI)into artificial airways is no longer recommended as standard practice.Clinical studies show that suctioning with or without NSI produces similar amounts of secretions and significant decreases in oxygen saturation.Potential side effects include increases in heart rate for 4 to 5 minutes after suctioning using NSI as opposed to dry suctioning.NSI has the potential to increase ventilator-associated pneumonia because bacteria from the upper airway can be dislodged to the lower airway.

Question 20

The nurse is caring for a patient with an oral endotracheal tube in place.Which intervention by the nurse demonstrates proper procedure when providing endotracheal tube care?

Accepted Answer

The endotracheal tube should be repositioned to the opposite side or at the center of the mouth every 24 to 48 hours to prevent formation of pressure sores at the sides of the mouth.The proper depth of the endotracheal tube is determined by noting the centimeter mark at the lip or gum line.This line is marked on the tube and is recorded in the patient's record at the time of intubation.The tube should not be held away from the lips because this allows too much "play" in the tube and increases the risk for tube movement and accidental extubation.The oral airway should not be removed if the patient is actively biting down until tape partially or completely secures the tube.

Quiz 25: Airway Management