chapter 14-15

A staff nurse has asked the nursing student to perform an intervention that the nursing student has not been trained to perform? What is the appropriate approach for the nursing student to take?

Consult with your nursing instructor before performing the procedure.

A nurse is preparing to educate a client about self-care after a cataract surgery. Which of the following would the nurse do first?

Determine the client's willingness to follow the regimen.

A nurse is administering metformin to a client who has a new onset of diabetes mellitus type 2. Which of the following steps of nursing process is the nurse using?

Implementation

Which nursing intervention is appropriate for a risk nursing diagnosis? Select all that apply.

Prevent the problem. Reduce or eliminate risk factors. Monitor the client's status.

The nurse participates in a quality assurance program and reviews evaluation data for the previous month. The data indicates a nursing plan was developed within 8 hours of admission for 97% of all admissions. The nurse recognizes this as which type of evaluation?

Process evaluation

While observing a new nurse inserting an indwelling urinary catheter, the preceptor observes a break in sterile technique. What is the preceptor's first action?

Tell the new nurse that a break in sterile technique has occurred and the procedure must be stopped.

A student nurse received a report on his assigned clients for the clinical day. Which client should the student nurse plan to assess first

an asthma client who reports shortness of breath with a respiratory rate of 26 bpm

A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?

asking if the client feels less anxious 30 minutes after administering the medicine

Which nursing action can be categorized as a surveillance or monitoring intervention?

auscultating of bilateral lung sounds

The primary purpose of nursing implementation is to:

help the client achieve optimal levels of health.

A nurse case manager is explaining the role of a case manager to a group of nursing students. One student asks if the case manager misses providing client care. What is the case manager's best response?"I provide indirect care to my clients by coordinating their treatment with other disciplines."

"I provide indirect care to my clients by coordinating their treatment with other disciplines."

An 84-year-old male has been admitted to the hospital several times in the past few months for exacerbations of chronic obstructive pulmonary disease (COPD) and elevated blood glucose. Which statement by the client could help identify the most likely reason for the changes in his health status?

"My wife's been gone for about 7 months now."

What guides professional practice?

ANA Standards of Nursing Practice

Which of the following nursing interventions is most likely to be allowed within the parameters of a protocol or standing order?

Administering a glycerin suppository to a constipated client who has not responded to oral stool softeners

A client requires a change and reapplication of a colostomy bag. The nurse has never changed an ostomy bag before. What is the nurse's best course of action?

Ask a skilled nurse to assist with the procedure.

The surgeon is insisting that a client consent to a hysterectomy. The client says that she will not make a decision without her husband's consent. What is the nurse's best course of action?

Ask the surgeon to wait until the client has had a chance to talk to her husband.

The nurse is caring for a client admitted to the hospital for renal calculi. What is the action to take first?

Assess for bladder distention.

As part of the plan of care, a nurse administers scheduled pain medication to a postoperative client with a pain level of 6 on a 0 to 10 scale. Which action best represents the next step in the nursing process?

Assess pain level in 30 minutes.

One hour after receiving pain medication, a postoperative client reports intense pain. What is the nurse's appropriate first action?

Assess the client to determine the cause of the pain.

The nurse is preparing to administer a blood pressure medication to a client. To ensure the client's safety, what is the priority action for the nurse to take?

Assess the client's blood pressure to determine if the medication is indicated

The nurse has assisted the client to ambulate for the first time. After returning the client to bed, what is the nurse's priority intervention?

Assess the client's response to the ambulation.

The physician has ordered 100 mg of morphine sulfate IM to a client. The nurse knows that the usual dose is 10 mg of morphine sulfate. What is the nurse's most appropriate action?

Call the physician to clarify the order.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome?

Cognitive outcome

Discharge plans for a client with a mental health disorder include living with family members. The nurse learns that the family is no longer willing to allow the client to live with them. What is the nurse's most appropriate action?

Collaborate with other disciplines to revise the discharge plans.

After instituting interventions to increase oxygenation, the client shows no signs of improvement. What is the nurse's priority action?

Communicate with the physician for additional orders.

The nurse is caring for a client who is recovering from a cerebrovascular accident (CVA). When reviewing the client's orders, the nurse notes that one of the physicians wrote orders to ambulate the client while another physician ordered strict bed rest for the client. How would the nurse most appropriately remedy this conflict?

Communicate with the physicians to coordinate their orders.

The mother of a pediatric client being discharged confides to the nurse that her husband is abusive and she is afraid to return home. What is the nurse's most appropriate action?

Coordinate with the case manager to make a safe discharge plan.

The nurse must give instructions before discharge to a 13-year-old in a sickle cell crisis. Three of the client's friends from school are visiting. In order to assure effective instruction, what should the nurse plan to do?

Delay the instruction until the visitors leave.

A client tells the nurse, "My doctor has told me I have to have a blood transfusion, but I am a Jehovah's Witness and I can't take one." What is the nurse's most appropriate intervention?

Discuss possible alternatives to a blood transfusion with the physician.

A client has a nursing diagnosis of Possible Spiritual Distress. What is the most appropriate nursing intervention?

Discuss spirituality with the client.

The nurse is preparing a client for surgery when the client tells the nurse that he no longer wants to have the surgery. How should the nurse most appropriately respond?

Discuss with the client the reasons for declining surgery.

Which of the following actions should the nurse take during the evaluation phase of the nursing process?

Document improved pain after pain medication administered

The client is in a rehabilitation unit after a traumatic brain injury. In order to facilitate the client's recovery, what would be the nurse's most appropriate intervention?

Encourage the client to provide as much self-care as possible

Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called which of the following

Evaluative statement

As the nurse bathes a patient, she notes his skin color and integrity, his ability to respond to simple directions, and his muscle tone. Which statement best explains why such continuing data collection is so important?

It enables the nurse to revise the care plan appropriately

The client reports right knee pain of 6/10 on the pain scale and requests for medication. The nurse assesses and flushes the IV site. Which type of intervention skill is the nurse using

Mechanical skill

The physician has ordered that the client should ambulate 3 times a day. The nurse enters the room to ambulate the client and the client reports pain. What is the nurse's most appropriate action?

Medicate the client and wait to ambulate later.

A client cannot afford the treatment prescribed. Who would be the most appropriate professional for the nurse to involve with the client's care

Nurse case manager

Prior to the first postoperative visit post gastrectomy, the client will have a weight loss of 10 lbs. This is an example of which type of evaluative statement?

Physical changes

The mother brings her infant into the clinic. The infant is two months old and has not been gaining weight appropriately. The outcome statement on the plan of care states "The infant will double birth weight by 6 months of age." This is an example of what type of outcome statement?

Physical changes

A nurse documents the following diagnosis for a hospitalized client: "Risk for Imbalanced Nutrition: More Than Body Requirements." What is the major goal of interventions for a risk diagnosis?

Prevent the problem

After learning about a client's limited financial resources and limited insurance benefits, the home care nurse modifies nursing interventions related to a client's care instructions. The nurse modifies the plan of care based upon which client variable?

Psychosocial background

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?

Quality assurance

A client with hypertension being seen for follow-up care has a blood pressure of 160/100. The client reports following the treatment regimen closely and that blood pressure readings have been elevated for the last 2 weeks. What is the nurse's most appropriate action?

Report the findings to the physician for further plans.

The nurse is discussing diabetes mellitus with the family members of a client recently diagnosed. In order to promote the health of the family members, what would be the most important information for the nurse to include?

Risk factors and prevention of diabetes mellitus

The nurse is caring for a 10-year-old client who is newly diagnosed with a seizure disorder. What variable would alter the nurse's plan for educating the client and parent?

The client has a 12-year-old sister who has been treated for a seizure disorder for 3 years

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)?

bed bath for the newly-admitted client who has multiple skin lesions

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate?

"Demonstrated steps"

A nurse has been doing discharge teaching to a client with diabetes mellitus type 1. Which of the following outcomes indicates that the teaching has been effective?

By a certain date, client will verbalize signs and symptoms of hypoglycemia.

A mother brings her child into the clinic for follow up after beginning treatment for Attention Deficit Hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a one hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child?

"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?"

A mother brings her infant into the clinic for a well baby visit. The mother was concerned when she left the hospital about being able to get the infant to latch on for breast feeding. Which of the following is an appropriate evaluative statement?

8/2/2014.Goal met. Mother reports that breast feeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight."

A nurse suspects that the client with Crohn's disease does not understand the medication regimen or diet modifications required to manage the illness. What is the nurse's most appropriate action

Ask the client to verbalize the medication regimen and diet modifications required.

The nurse has instructed the client in self-catheterization, but the client is unable to perform a return demonstration. What is the nurse's most appropriate plan of action?

Reassess the appropriateness of the method of instruction.

A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on his plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?

Cognitive

A client being treated for myasthenia gravis at home tells the nurse, "This medicine is so expensive. I have only been taking half of what the doctor ordered." How would the nurse most effectively meet this client's need?

Collaborate with other disciplines to determine the best way to meet the client's medication requirements.

The nurse is caring for a vegetarian who is suffering from iron deficiency anemia. The nutritional plan for a client with anemia calls for the client to increase consumption of animal protein. How will the nurse plan to meet this client's nutritional needs?

Collaborate with the nutritionist to modify the nutritional plan.

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a physician's order. The client is agitated and not cooperating. What would be the best initial action of the first nurse in this situation?

Confront the nurse and explain how this could be dangerous for the client.

Which action is appropriate when evaluating a client's responses to a plan of care?

Continue the plan of care if more time is needed to achieve the goals/outcomes.

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care?

Continue the plan of care.

A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment?

Safety

A nurse finds that her client is not achieving the set outcomes for care and reviews the plan. Which actions are appropriate changes for the nurse to make in the plan of care? Select all that apply

Delete or modify the nursing diagnosis. Make the outcome statement more sensible. Adjust the time limits on the outcome statement. Increase the complexity of the outcome statement

Which of the following would a nurse know is a part of an evaluative statement? Select all that apply.

Description of how the patient outcome was met Patient data that supports how the outcome was met

The nurse has prepared to educate a client about caring for a new colostomy. When the nurse begins the instruction, the client states, "I am not ready to deal with this now. I am feeling overwhelmed." What is the nurse's most appropriate action?

Discontinue the education and attempt at another time.

Which purpose of the evaluation phase of the nursing process is a priority during client care?

Examine the client's behavioral response to the care received.

Priority setting is based on the information obtained during reassessment. Priority setting is used to rank nursing diagnoses. Each of the following contributes to priority setting except which of the following?

Finances of the client

A hospital is revising its quality improvement program. The goal of the program is to improve quality in the facility. Which of the following are major premises of the program? (Select all that apply) Empowerment

Focus on the organizational mission Customer orientation Leadership commitment Empowerment

During morning report, the night nurse tells the oncoming nurse that the client has been medicated for pain and is resting comfortably. Thirty minutes later, the client calls and requests pain medication. What is the nurse's appropriate first action?

Go to the client and assess the client's pain.

Nurses perform many independent nursing actions when caring for patients. Which action is considered an independent (nurse-initiated) action?

Helping to allay a patient's fears about surgery

Identifying the kind and amount of nursing services required is a possible solution for:

Inadequate staffing

The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment?

Individualization

The nurse is preparing a client with a bowel obstruction for emergency surgery. Of the following interventions, which has the highest priority?

Inform the client what to expect after the surgery.

A nurse has committed to quality improvement in her nursing care. She knows that quality improvement will require her to do which of the following? (Select all that apply)

Leadership commitment Continuous improvement Focus on data collection Focus on the mission of the organization

The RN is orienting a new nurse who suggests a different way to perform a procedure. What is the RN's most appropriate reaction?

Listen to the new nurse's suggestion and evaluate its usefulness.

The nurse ascertains that a client is failing to follow the plan of care that was collaboratively developed. Further investigation determines that the plan of care is not appropriate for this client. What is the nurse's next step in correcting this problem?

Make changes in the plan of care based upon assessment data.

The nurse is assigned a client who had an uneventful colon resection two days ago and requires a dressing change. To which nursing team member should the nurse avoid delegating the dressing change?

Nursing assistant

The nurse is coordinating care for the client with continuous pulse oximetry who requires pharyngeal suctioning. Which staff member should the nurse avoid delegating the task of suctioning?

Nursing assistant who is a nursing student

The nurse is caring for Mr. M., a 48-year-old man with congestive heart failure. The nurse manager informs the nurse that Mr. M. was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?

Outcome evaluation

Nurses are involved in many types of evaluation. All of the following are activities that are related to evaluation, but which of the following is the priority concern for nurses

Patients and their care

A group of nurses of the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. The nurses know that this program is termed which of the following?

Peer review

A nurse identifies an area where client care has been compromised. Which of the following steps should the nurse take to improve performance? Select all that apply

Plan a strategy using indicators Assess the change Discover a problem Implement a change

The nurse is to delegate certain tasks to unlicensed assistive personnel (UAP). Which of the following tasks can be appropriately assigned to a UAP

Provide client assistance to the bedside commode.

Which is a responsibility of the nurse in the nurse-nurse team relationship?

Provide creative leadership to make the nursing unit a challenging place to work.

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?

Psychomotor

The client demonstrates stair climbing using a quad cane. What type of outcome is this an example of?

Psychomotor outcome

A client recovering after an appendectomy is reporting pain. The nurse administers the ordered pain medication and assists the client to splint the incision. What is the nurse's next step in implementing the plan of care?

Reassess the client to determine the effectiveness of the interventions.

A nurse in the ICU (intensive care unit) has been assigned to care for a client who was seriously injured during a gang rape. The nurse was raped 6 months ago and feels that she will be too upset to care for the client properly. How should the nurse deal with the assignment?

Recognize her limitations and ask for another nurse to be assigned.

The nurse determines that the client is not meeting some of the expected outcomes in the plan of care. The next steps should include which of the following? Select all that apply

Reevaluate each step of the nursing process. Identify contributing factors. Collect additional data. Add or alter nursing diagnoses

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

Review each preceding step of the nursing process.

Nursing interventions for the client after prostate surgery include assisting the client to ambulate to the bathroom. The nurse concludes that the client no longer requires assistance. What is the nurse's best action?

Revise the care plan to allow the client to ambulate to the bathroom independently.

A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?

Revise the plan of care

The nurse is caring for a postoperative client who is receiving morphine sulfate for pain management. The nurse obtains the following vital signs. HR 74 RR 8 BP 114/68. After reviewing the nursing care plan and physician orders, the nurse administers naloxone (Narcan). What would allow the nurse to initiate this action?

Standing orders

Mr. J. is a 56-year-old man status post admission for a myocardial infarction and coronary artery bypass graft. He is preparing to go home tomorrow. Mr. J. expresses that he feels unprepared to cook heart-healthy foods. The nurse sits with Mr. J. and reviews the heart-healthy nutrition plan, asking him to identify which foods would be appropriate for him to eat. What type of nursing intervention is the nurse engaging in?

Supervisory intervention

The nurse is working with Ms. V. today. Ms. V. is having a difficult time accepting her new diagnosis of type 2 diabetes. Thenurse pulls up a chair next to Ms. V.'s bed and holds her hand while listening to her story. What type of nursing intervention is the nurse engaging in?

Supportive intervention

Nurse Mayweather is auscultating lung sounds. She notes crackles in the LLL which were not present at the start of the shift. Nurse Mayweather is engaged in which type of nursing intervention?

Surveillance intervention

A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to take which action based on the client's previous responses to the current plan of care? Select all that apply.

Terminate the plan of care if outcomes have been achieved. Modify the plan of care if difficulty has been encountered with achieving outcomes. Continue the plan of care if more time could result in achievement of outcomes.

Which client outcome is an example of a cognitive outcome?

The client identifies three strategies for minimizing leakage of an ileostomy bag.

A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem?

The client is able to explain when and why he needs to check his blood sugar.

The nurse is planning instruction on wound care to an adult client. What variables would cause the nurse to alter the education plan? Select all that apply.

The client is blind. The client denies the need for education.

The client is having difficulty breathing. The respiratory rate is 44 and the oxygen saturation is 89%. The nurse raises the head of the bed and applies oxygen at 3L/min per nasal cannula. How does the nurse determine the effectiveness of the interventions? Mark all that apply

The client's respiratory rate decreases. The client states, "I can breathe easier now." The client's oxygen saturation level increases.

Which nurse is using criteria to determine expected standards of performance?

The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.

Which nursing action reflects evaluation?

The nurse assesses the client's response to pain medication.

Which of the following nursing actions reflects evaluation?

The nurse assesses urine output following administration of a diuretic

Which of the following is the most important indicator of quality nursing care?

The nurse considers the individual needs of clients.

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

The nurse devises a post-discharge questionnaire to evaluate patient satisfaction

A nurse evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse?

The nurse evaluates the client's goal/outcome achievement.

The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review?

The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

A nurse who is experienced caring only for well babies is assigned to the newborn intensive care nursery (NICU) because of a shortage of nurses in the NICU. The nurse is assigned to an infant on a ventilator who will require blood transfusions during the shift. What is the nurse's most appropriate course of action?

The nurse should inform the charge nurse that she does not have the experience to properly care for this client.

A nurse is caring for a client in the immediate postoperative period and discovers there are factors that are affecting the attainment of client goals. Which of the following is true of factors that influence client responses and outcome achievement? Select all that apply

The nurse will draw on positive factors to deal with other variables in the future. A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. The nurse should understand which factors are helpful to attaining outcome attainment and manipulate them to achieve goals.

Which of the following does a nurse recognize is among the rules suggested by the Institute of Medicine's (IOM) Committee on Quality of Health Care in America to improve health care?

The patient as the source of control Safety as a system priority Anticipation of clients' needs Cooperation among clinicians

Which are essential components for delegating nursing care? Select all that apply.

The task is delegated to a person with sufficient knowledge and skill for completing the task. Instructions have been clearly communicated by the nurse to the unlicensed assistive personnel. The unlicensed assistive personnel can verbalize what information is to be reported to the

When the nurse is administering medication, an older adult client states, "Why does everyone keep asking my name? I've been here for days." How should the nurse respond to the client?

We ask your name to ensure that we are treating the right client."

The nurse in a Burn Intensive Care Unit (BICU) is caring for a 3-year-old boy who was burned with scalding hot water. He has burns covering 75 percent of his body. His condition is critical but stable. At 10 a.m., the nurse reassesses the client and finds that he is agitated and pulling at his endotracheal tube. What would be the nurse's priority?

ensuring that the endotracheal tube is secure

A student nurse is performing a sterile dressing change on a client's abdominal incision. While establishing her sterile field, the nurse drops her forceps on the floor. She is unable to continue with the dressing change because she has no extra supplies in the room, and no one is present to bring new forceps. The student has failed to organize ...

equipment and personnel.

The nurse is assessing the client's self-care capabilities for after discharge from the hospital. Which barrier greatly contributes to the nursing goals being unmet? Select all that apply.

poor communication skills inadequate emotional coping skills debilitating illness family's lack of interest in the plan of care

The terms "criteria" and "standard" are often used interchangeably but actually have distinct, separate definitions. "The levels of performance accepted by, and expected of, nursing staff or other health team members" is known as:

standards.

The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which of the following does the nurse recognize as an example of outcome evaluation?

A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery

The nursing is caring for several clients. Which client can the nurse delegate to the unlicensed assistive personnel?

Bathe a client with stable angina who has a continuous IV infusing.

Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal?

By 8/18/15, client will demonstrate improved motion in left arm.

Nurses implement care for clients in various health care settings. Which activities would typically be carried out during the implementation step of the nursing process? Select all that apply.

Collecting additional client data Modifying the client plan of care

Which statement related to the evaluation of outcome attainment for a client is correct?

Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria.

The nurse reports for a day shift and learns that the unit is understaffed due to several sick calls. The charge nurse has arranged for two unlicensed assistive personnel to be available due to the nursing shortage on this morning. The nurse is aware that this shortage has the potential to affect the nursing care delivered on the unit on this day. What type of variable has the nurse identified as potentially affecting the care delivery?

Healthcare system variable

A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?

Investigate the circumstances that contributed to client falls.

At the beginning of prenatal care, the goal for the client was to gain 25 pounds by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 pound. Which statement(s) would help the nurse most appropriately interpret this data?

The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.

Which client outcome is a cognitive outcome? Select all that apply.

The client lists the side effects of digoxin (Lanoxin). The client describes how to perform progressive muscle relaxation. The client identifies signs and symptoms of hypoglycemia.

One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated?

throughout the client's hospital admission

A registered nurse (RN) and a licensed practical nurse (LPN) are caring for a client who has been admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which nursing actions can the RN delegate to the LPN? Select all that apply.

Obtaining pulse oximetry Auscultating breath sounds Administering nebulizer treatment

What assessment data would indicate to the nurse at the conclusion of an education session that the client education was effective? Mark all that apply.

The client verbalizes understanding of the instructions. The client is able to answer the nurse's questions. The client discusses the specifics of what was taught during the session.

The registered nurse is working with an unlicensed assistive personnel. Which client should the nurse not delegate to the unlicensed assistive personnel

The client with continuous pulse oximetry who requires pharyngeal suctioning