The answer to this is D. The nurse uses suctioning in order to get rid of the secretions that have caused breathing to become hard to do. When the nurse hears D, this means that the suctioning is a success. When the patient only breathes 28 times for every minute, this may be a sign that there are still some obstructions or secretions that need to be suctioned.
If the heart rate becomes higher, there may be some problems being experienced by the patient because of the suctioning. Letter C is not related to suctioning at all. If this is observed with the patient, the attending physician should be informed immediately as it may indicate cardiovascular issues.
Clear breath sounds.-rationale: clear breath sounds, which indicate that secretions have been removed, indicate effective suctioning. an above-normal respiratory rate, such as a rate of 28 breaths/minute, may indicate that the airway isnt clear of secretions and the clients respiratory rate has increased to compensate. a slightly increased heart rate, such as a rate of 104 beats/minute, may indicate health concerns unrelated to suctioning. brisk capillary refill indicates adequate cardiovascular function and is unrelated to suctioning.client needs category: physiological integrityclient needs subcategory: physiological adaptationcognitive level: comprehensionreference: taylor, c., et al. fundamentals of nursing: the art and science of nursing care, 6th ed. philadelphia: lippincott williams & wilkins, 2008, p. 1649.