A client who is being mechanically ventilated has copious amounts of secretions ranging from thick and tenacious to frothy. In preparing to suction this client, the nurse should take which action?
1. Hyperventilate the client using the settings on the mechanical ventilator.
2. Hyperventilate the client using a manual resuscitator.
3. Avoid hyperventilation, but instill normal saline into the endotracheal tube.
4. Avoid hyperventilation and increase the oxygen to 100% for several breaths.
Correct Answer: 4
Rationale 1: Hyperventilating the client will likely serve to force secretions back into the respiratory tract.
Rationale 2: Hyperventilating the client will likely serve to force secretions back into the respiratory tract.
Rationale 3: There is no need to instill normal saline into the tube of a client with copious frothy secretions.
Rationale 4: The nurse should avoid hyperventilation and should increase the oxygen to 100% for several breaths prior to initiating suction. Hyperventilating a client who has copious secretions can force the secretions deeper into the respiratory tract.
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