BCC Respiratory (Oxygenation & Perfusion)

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A nurse is delivering 3 L/min oxygen to a patient via nasal cannula. What percentage of delivered oxygen is the patient receiving?

32%

A nurse is caring for a client who breathes very shallowly and has been reporting severe back pain. What suggestion could the nurse make to help the client breathe efficiently?

Encourage the client to take deep breaths.

A nurse is caring for a client who suddenly begins to have respiratory difficulty. In what position would the nurse place the client to facilitate respirations?

High-Fowler's

To determine the quality of oxygenation, the nurse performs the physical assessment, the arterial blood gas test, and pulse oximetry. What is the purpose of the pulse oximetry test?

Monitor the amount of oxygen saturation in the blood.

What does pulse oximetry measure?

Arterial oxygen saturation

Upon auscultation of the client's lungs, the nurse hears loud, high-pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound?

Bronchial

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as:

crackles.

A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client?

Flow meter

When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing

Poor tissue perfusion

Which statements about pulse oximetry are true? Select all that apply.

- Once the oximetry probe is correctly placed, a beam of red and infrared light travels through the tissue and blood vessels. -Sensors are available for use on the finger, toe, foot, earlobe, forehead, and bridge of the nose

A nurse is caring for older adults in a nursing home. Which age-related changes may affect the respiratory functioning of the clients living there? Select all that apply.

-Less air exchange, more secretions in lungs. -Greater risk for aspiration due to slower gastric motility.

What structural changes to the respiratory system should a nurse observe when caring for older adults?

respiratory muscles become weaker

A nurse is teaching a home care client and the family about using prescribed oxygen. What is a critical factor that must be included in teaching?

the safety measures necessary to prevent a fire

A client requires low-flow oxygen. How will the oxygen be administered? Select all that apply.

- Nasal cannula - Simple oxygen mask - Partial rebreather mask

The nurse is caring for a postoperative adult client who has developed pneumonia. The nurse should assess the client frequently for symptoms of:

atelectasis

Oxygen and carbon dioxide move between the alveoli and the blood by

diffusion.

A client with no prior history of respiratory illness has been admitted to a postoperative unit following foot surgery. What intervention should the nurse prioritize in an effort to prevent postoperative pneumonia and atelectasis during this time of reduced mobility following surgery?

educating the client on the use of incentive spirometry

The nurse is caring for a client who is diagnosed with impaired gas exchange. While performing a physical assessment of the client, which data is the nurse likely to find, keeping in mind the client's diagnosis?

high respiratory rate

A client suffering from chronic obstructive pulmonary disease (COPD) reports that it is hard to cough up secretions and they are thick and sticky. The nurse should instruct the client to

increase her fluid intake to thin secretions.

Which oxygen delivery system is most commonly used because it does not impede eating or speaking?

Nasal cannula


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