The nurse is preparing to suction a patient with an endotracheal tube. What should be the nurse's first step in the suctioning process?
A) Explain the suctioning procedure to the patient and reposition the patient.
B) Turn on suction source at a pressure not exceeding 120 mm Hg.
C) Assess the patient's lung sounds and SAO2 via pulse oximeter.
D) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask.
Ans: C
Feedback:
Assessment data indicate the need for suctioning and allow the nurse to monitor the effect of suction on the patient's level of oxygenation. Explaining the procedure would be the second step; performing hand hygiene is the third step, and turning on the suction source is the fourth step.
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