When inserting a rectal thermometer, the nurse encounters ...

[kwoodring]

When inserting a rectal thermometer, the nurse encounters resistance. The nurse should:
 
  a. apply mild pressure to advance.
  b. ask the patient to take deep breaths.
  c. remove the thermometer immediately.
  d. remove the thermometer and reinsert it gently.

Question 2

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?
 
  a. Use manual ventilation to hyperoxygenate the patient with 100 oxygen via Ambu bag.
  b. Push the catheter and slide the plastic sleeve back when the patient exhales.
  c. Push the catheter in until resistance is felt or the patient coughs.
  d. Apply suction for no longer than 30 seconds as you remove the catheter.

[shoemake]

Answer to Question 1

C
If resistance is felt during insertion, withdraw the thermometer immediately. Never force the thermometer. This prevents trauma to the mucosa. With the nondominant hand, separate the patient's buttocks to expose the anus. Ask the patient to breathe slowly and relax. This fully exposes the anus for thermometer insertion and relaxes the anal sphincter for easier thermometer insertion.

Answer to Question 2

C
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 FiO2 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.

[kwoodring]

Gracias!

[jackie]

TYSM