CH 28 - Care of Patients Requiring Oxygen Therapy or Tracheostomy

Which complication is the result of constant pressure exerted by a tracheostomy cuff causing tracheal dilation and erosion of cartilage? a. Tracheomalacia b. Tracheal stenosis c. Tracheoesophageal fistula d. Trachea-innominate artery fistula

a. Tracheomalacia

A patient requires long-term airway maintenance following surgery for cancer of the neck. The nurse is using a piece of equipment to explain the procedure and mechanism that are associated with this long-term therapy. Which piece of equipment is the nurse most likely use for this patient teaching session? a. Tracheostomy tube b. Nasal trumpet c. Endotracheal tube d. Nasal cannula

a. Tracheostomy tube

The nurse is assessing a patient after surgery for placement of a tracheostomy tube and notes these findings: difficulty breathing; noisy respirations; difficulty inserting a suction catheter; and thick, dry secretions. Which complication of a tracheostomy does the nurse suspect? a. Tube obstruction b. Tube dislodgement c. Accidental decannulation d. Pneumothorax

a. Tube obstruction

What must the nurse include for discharge education for a client who is newly prescribed to use oxygen therapy at home? Select all that apply. A. The consequences of smoking while using oxygen B. The need to limit potted plants in the home C. The types of oxygen delivery devices available for home use D. The use of oxygen when performing ADLs E. The need to travel only in specially designated cars F. Performing proper skin care under the device and its straps

A C D F

To prevent accidental decannulation of a tracheostomy tube, what does the nurse do? a. Obtain an order for continuous upper extremity restraints. b. Secure the tube in place using ties or fabric fasteners. c. Allow some flexibility in motion of the tube while coughing. d. Instruct the patient to hold the tube with a tissue while coughing.

b. Secure the tube in place using ties or fabric fasteners.

The nurse is caring for several patients on a general medical-surgical unit. The nurse would question the need for oxygen therapy for a patient with which condition? a. Pulmonary edema with decreased arterial Po2 levels b. Valve replacement with increased cardiac output c. Anemia with a decreased hemoglobin and hematocrit d. Sustained fever with an increased metabolic demand

b. Valve replacement with increased cardiac output

For which possible complication of tracheostomy tube dislodgment does the nurse remain alert in a client during the first 72 hours after placement? A. Oxygen toxicity B. Increased secretions C. Movement of the tube into a "false passage" D. Increased risk for aspiration during swallowing

C. Movement of the tube into a "false passage"

The nurse notes that a client with a history of chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy at 2 L/min and had an oxygen saturation of 88% 1 hour ago now has dyspnea and an oxygen saturation of 80%. Should the nurse increase the FiO2? A. No; increasing the FiO2 will severely depress the respiratory rate by blunting the hypoxic drive. B. No; an oxygen saturation of 80% is acceptable for a client with COPD. C. Yes; hypoxia must be treated despite the risk for oxygen-induced hypercapnia. D. Yes; the expected outcome for any client with hypoxia is to achieve a saturation of at least 97%.

C. Yes; hypoxia must be treated despite the risk for oxygen-induced hypercapnia.

The nurse is monitoring a patient receiving oxygen therapy. On auscultation the nurse notes that the patient developed new onset of crackles and decreased breath sounds. Which condition does the nurse recognize? a. Oxygen toxicity b. Hypoxemia c. Hypercarbia d. Absorptive atelectasis

d. Absorptive atelectasis

Patients with a tracheostomy or endotracheal tube need suctioning. Which nursing interventions apply to proper suctioning technique? Select all that apply. a. Preoxygenate the patient for at least 30 seconds before suctioning. b. Instruct the patient that he or she is going to be suctioned. c. Quickly insert the suction catheter until resistance is met. d. Suction the patient for at least 30 seconds to remove secretions. e. Repeat suctioning as needed for four to five total suction passes. f. Apply suction only when withdrawing the suction catheter.

a,b,c,f

The patient is prescribed home oxygen. Which criteria are important when choosing the oxygen delivery system? Select all that apply. a. Oxygen concentration required by the patient b. Importance of accuracy and control of the oxygen concentration c. Importance of humidity d. Need to teach patient to suction self e. Patient pain medication administration f. Patient mobility

a,b,c,f

Which parameters does the nurse monitor to ensure that a patient's response to oxygen therapy gas exchange is adequate? Select all that apply. a. Level of consciousness b. Respiratory pattern c. Oxygen flow rate d. Pulse oximetry e. Respiratory rate f. Blood pressure

a, b, d, e

A patient with a tracheostomy who receives unnecessary suctioning can experience which complications? Select all that apply. a. Bronchospasm b. Mucosal damage c. Impaired gag reflex d. Bronchodilation e. Bleeding f. Tracheostomy obstruction

a, b, e

A patient requires oxygen therapy with a nasal cannula. Which interventions will the nurse teach the student nurse providing care for this patient? Select all that apply. a. "Make sure that the prongs on the nasal cannula are properly positioned in the nares." b. "Apply a water-soluble gel to the nares as needed." c. "Adjust the flow rate between 1 and 8 liters/minute based on how the patient is feeling." d. "Be sure to assess the patency of both nares." e. "Assess the patient for any changes in respiratory rate and pattern." f. "Nasal cannula can provide a patient with between 24% and 50% oxygen flow."

a,b,d,e

A patient is at risk for aspiration. Which instructions must the nurse provide to the unlicensed assistive personnel (UAP) prior to feeding the patient? Select all that apply. a. Position the patient in the most upright position possible b. Provide adequate time; do not "hurry" the patient. c. Provide sips of water or milk between bites of food to help with swallowing. d. Encourage the patient to "tuck" his or her chin down and move the forehead forward while swallowing. e. If the patient coughs, stop the feeding until he or she indicates that the airway has been cleared. f. Allow the patient to indicate when he or she is ready for the next bite.

a,b,d,e,f

A patient was intubated for acute respiratory failure, and there is an endotracheal tube in place. Which nursing interventions are appropriate for this patient? Select all that apply. a. Ensure that the oxygen is warmed and humidified. b. Suction the airway and then the mouth, and give oral care. c. Suction the airway with the oral suction equipment. d. Position the tubing so it does not pull on the airway. e. Apply suction only when withdrawing the suction catheter. f. Keep a resuscitation bag at the bedside at all times.

a,b,d,e,f

A patient has a recent tracheostomy. What necessary equipment does the nurse ensure is kept at the bedside? Select all that apply. a. Resuscitation bag b. Pair of wire cutters c. Oxygen tubing d. Suction equipment e. Tracheostomy tube with obturator f. Endotracheal (ET) tube

a,c,d,e

The nurse is caring for a patient with a tracheostomy. Which interventions for bronchial and oral hygiene should the nurse delegate to the unlicensed assistive personnel (UAP)? Select all that apply. a. Turn and reposition the patient every 2 hours. b. Teach the patient to cough and deep- breathe. c. Elevate the head of the bed for mouth care. d. Assist the patient to the bathroom as needed. e. Help the patient rise mouth with saline every 4 hours while awake. f. Keep glycerin swabs at the bedside for oral care as needed.

a,c,d,e

In what situations is oxygen therapy needed for a patient? Select all that apply. a. To treat hypoxia b. To treat hypothermia c. To treat hypoxemia d. When the normal 35% oxygen level in the air is inadequate e. When the normal 21% oxygen level in the air is inadequate f. To treat acute and chronic respiratory illnesses

a,c,d,e,f

What are possible complications that can occur with suctioning from an artificial airway? Select all that apply. a. Infection b. Coughing c. Hypoxia d. Tissue (mucosa) trauma e. Vagal stimulation f. Bronchospasm

a,c,d,e,f

Increased risk for oxygen toxicity is related to which factors? Select all that apply. a. Continuous delivery of oxygen at greater than 50% concentration b. Family members smoking while patient is receiving oxygen therapy c. The severity and extent of lung disease d. Neglecting to monitor the patient's status and reducing oxygen concentration as soon as possible e. Adding continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) f. Delivery of a high concentration of oxygen over 24-48 hours

a,c,d,f

Which patients could benefit from the use of noninvasive positive-pressure ventilation (NPPV)? Select all that apply. a. Patient with acute exacerbation of COPD b. Patient with acute pneumothorax c. Patient with cardiogenic pulmonary edema d. Patient with cardiopulmonary arrest e. Patient with an acute asthma attack f. Patient with sleep apnea

a,c,e,f

What are the hazards of administering oxygen therapy? Select all that apply. a. Oxygen supports and enhances combustion. b. Oxygen itself can burn. c. Each electrical outlet in the room must be covered if not in use. d. All electrical equipment in the room must be grounded to prevent fires. e. Solutions with high concentrations of alcohol or oil cannot be used in the room. f. Alcohol-based hand rubs should be removed from rooms with oxygen therapy.

a,d,e

An older adult patient is at risk for aspirating food or fluids. Which are the most appropriate nursing actions to prevent this problem? Select all that apply. a. Provide close supervision when the patient is self-feeding. b. Instruct the patient to tilt the head back when swallowing. c. Obtain an order for a clear liquid diet and offer small, frequent amounts. d. Instruct the patient to tuck the chin down when swallowing. e. Place the patient in an upright position. f. Keep emergency suctioning equipment at hand and turned on.

a,d,e,f

The provider orders transtracheal oxygen therapy for a patient with respiratory difficulty. What does the nurse tell the patient's family about the purpose of this type of oxygen delivery system? a. Delivers oxygen directly into the lungs b. Keeps the small air sacs open to improve gas exchange c. Prevents the need for an endotracheal tube d. Provides high humidity with oxygen delivery

a. Delivers oxygen directly into the lungs

A patient required emergency intubation and currently has an artificial airway in place. Oxygen is being administered directly from the wall source. Why would warmed and humidified oxygen be a more appropriate choice for this patient? a. Helps prevent drying damage to mucous membranes b. Promotes thick secretions, which are easier to suction c. Is more comfortable for the patient d. Is less likely to cause oxygen toxicity

a. Helps prevent drying damage to mucous membranes

The nurse is caring for a patient receiving humidified oxygen. Which precaution does the nurse take to prevent bacterial contamination and infection? a. Never drain fluid from the water trap back into the nebulizer. b. Always wear gloves when cleaning the patient's nasal cannula. c. Do not allow live or cut flowers into the patient's room. d. Administer ordered antibiotic therapy.

a. Never drain fluid from the water trap back into the nebulizer.

A patient is receiving preoperative teaching for a partial laryngectomy and will have a tracheostomy postoperatively. How does the nurse define a tracheostomy to the patient? a. Opening in the trachea that enables breathing b. Temporary procedure that will be reversed at a later date c. Technique using positive pressure to improve gas exchange d. Procedure that holds open the upper airways

a. Opening in the trachea that enables breathing

A patient has a temporary tracheostomy following surgery to the neck area to remove a benign tumor. Which nursing intervention is performed to prevent obstruction of the tracheostomy tube? a. Provide tracheal suctioning when there are noisy respirations. b. Provide oxygenation to maintain pulse oximeter readings. c. Inflate the cuff to maximum pressure and check it once per shift. d. Suction regularly and as needed (PRN) with an oral suction device.

a. Provide tracheal suctioning when there are noisy respirations.

The nurse is caring for a patient with a tracheostomy who has recently been transferred from the intensive care unit (ICU), where he has had no unusual occurrences related to the tracheostomy or his oxygenation status. What does the routine care for this patient include? a. Thorough respiratory assessment at least every 2 hours b. Maintaining the cuff pressure between 50 and 100 mm Hg c. Suctioning as needed; maximum suction time of 20 seconds d. Changing the tracheostomy dressing four times a day

a. Thorough respiratory assessment at least every 2 hours

A patient is receiving warmed and humidified oxygen. In discarding the moisture formed by condensation, why does the nurse minimize the time that the tubing is disconnected? a. To prevent the patient from desaturating b. To reduce the patient's risk of infection c. To minimize the disturbance to the patient d. To facilitate overall time management

a. To prevent the patient from desaturating

A patient requires home oxygen therapy. When the home health nurse enters the patient's home for the initial visit, the nurse observes several issues that are safety hazards related to the patient's oxygen therapy. What hazards do these include? Select all that apply. a. Bottle of wine in the kitchen area b. Package of cigarettes on the coffee table c. Several decorative candles on the mantelpiece d. Grounded outlet with a green dot on the plate e. Electric fan with a frayed cord in the bathroom f. Computer with a three-pronged plug

b, c, e

To improve a patient's oxygenation to a normal level, the amount of oxygen administered is based on which factors? Select all that apply. a. Symptom management only b. Pulse oximetry reading c. Respiratory assessment d. The patient's subjective complaints e. Arterial blood gas results f. Presence of chronic hypercarbia

b,c,e,f

Which conditions will increase the body's need for more oxygen? Select all that apply. a. Hypothyroid state b. Infection in the blood c. Diabetes mellitus d. Body temperature of 101°F e. Hemoglobin level of 8.7 g/dL f. Heart failure

b,d,e,f

A patient with a tracheostomy is unable to speak. He is not in acute distress but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach in this situation? a. Rely on the family to interpret for the patient. b. Ask questions that can be answered with a "yes" or "no" response. c. Obtain an immediate consult with the speech therapist. d. Encourage the patient to rest rather than struggle with communication.

b. Ask questions that can be answered with a "yes" or "no" response.

A patient with a tracheostomy tube is currently alert and cooperative but is coughing more frequently and producing more secretions than usual. The nurse determines that there is a need for suctioning. Which nursing intervention does the nurse use to prevent hypoxia for this patient? a. Allow the patient to breathe room air prior to suctioning. b. Avoid prolonged suctioning time. c. Suction frequently when the patient is coughing. d. Use the largest available catheter.

b. Avoid prolonged suctioning time.

The home health nurse has been caring for a patient with a chronic respiratory disorder. Today the patient seems confused when she is normally alert and oriented × 3. What is the priority nursing action? a. Notify the provider about the mental status change. b. Check the pulse oximeter reading. c. Ask the patient's family when this behavior started. d. Perform a mental status examination.

b. Check the pulse oximeter reading.

What is the best description of the nurse's role in the delivery of oxygen therapy? a. Receiving the therapy report from the respiratory therapist b. Evaluating the patient's response to oxygen therapy c. Contacting respiratory therapy for the devices d. Being familiar with the devices and techniques used in order to provide proper care

b. Evaluating the patient's response to oxygen therapy

The patient is receiving oxygen at 5 L/min by nasal cannula. What priority intervention must the nurse use at this time? a. Switch to a mask delivery system. b. Humidify the oxygen with sterile water. c. Monitor for manifestations of oxygen toxicity. d. Add extension tubing for patient mobility.

b. Humidify the oxygen with sterile water.

A patient has an endotracheal tube and requires frequent suctioning for copious secretions. Which is a major complication of tracheal suctioning? a. Atelectasis b. Hypoxia c. Hypercarbia d. Bronchodilation

b. Hypoxia

A patient sustained a serious crush injury to the neck and had a tracheostomy tube placed 3 days ago. As the nurse is performing tracheostomy care, the patient suddenly sneezes very forcefully and the tracheostomy tube falls out onto the bed linens. What does the nurse do? a. Ventilate the patient with 100% oxygen and notify the provider. b. Quickly and gently replace the tube with a clean cannula kept at the bedside. c. Quickly rinse the tube with sterile solution and gently replace it. d. Give the patient oxygen; call for assistance and a new tracheostomy kit.

b. Quickly and gently replace the tube with a clean cannula kept at the bedside.

A patient who is breathing on his own has a fenestrated tracheostomy tube with a cuff. Which precaution must the nurse instruct the student about when caring for this patient? a. Always keep the cuff inflated to prevent secretions from entering the lungs. b. Suction the patient every 30-60 minutes. c. Always deflate the cuff before capping the tube with the decannulation cap. d. To reduce the risk for tracheal damage, keep the cuff pressure between 22 and 30 mm Hg.

c. Always deflate the cuff before capping the tube with the decannulation cap.

A patient is receiving warmed and humidified oxygen. The respiratory therapist informs the nurse that several other patients on other units have developed hospital-acquired infections and Pseudomonas aeruginosa has been identified as the organism. What does the nurse do? a. Place the patient in respiratory isolation. b. Obtain an order for a sputum culture. c. Change the humidifier every 24 hours. d. Obtain an order to discontinue the humidifier

c. Change the humidifier every 24 hours.

An older adult patient sustained a stroke several weeks ago and is having difficulty swallowing. To prevent aspiration during mealtimes, what does the nurse do? a. Hyperextend the head to allow food to enter the stomach and not the lungs. b. Give thin liquids after each bite of food to help "wash the food down." c. Encourage "dry swallowing" after each bite to clear residue from the throat. d. Maintain a low Fowler's position during eating and for 2 hours afterwards.

c. Encourage "dry swallowing" after each bite to clear residue from the throat.

A patient is receiving oxygen therapy through a nonrebreather mask. What is the correct nursing intervention? a. Maintain oxygen liter flow so that the reservoir bag is up to one-half full. b. Maintain 60%-75% Fio2 at 6-11 L/min. c. Ensure that valves and rubber flaps are patent, functional, and not stuck. d. Assess for effectiveness and switch to partial rebreather mask for more precise Fio2.

c. Ensure that valves and rubber flaps are patent, functional, and not stuck.

A patient returns from the operating room and the nurse assesses for subcutaneous emphysema, a potential complication associated with tracheostomy. How does the nurse assess for this complication? a. Checking the volume of the pilot balloon b. Listening for airflow through the tube c. Inspecting and palpating for air under the skin d. Assessing the tube for patency

c. Inspecting and palpating for air under the skin

The nurse is administering oxygen to a patient who is hypoxic and has chronic high levels of carbon dioxide. Which oxygen therapy prevents a respiratory complication for this patient? a. Fio2 higher than the usual 2-4 L/min per nasal cannula b. Venturi mask of 40% for the delivery of oxygen c. Lower concentration of oxygen (1-2 L/min) per nasal cannula d. Variable Fio2 via partial rebreather mask

c. Lower concentration of oxygen (1-2 L/min) per nasal cannula

A patient is receiving a high concentration of oxygen as a temporary emergency measure. Which nursing action is the most appropriate to prevent complications associated with high-flow oxygen? a. Auscultate the lungs every 4 hours for oxygen toxicity. b. Increase the oxygen if the Pao2 level is less than 93 mm Hg. c. Monitor the prescribed oxygen level and length of therapy. d. Decrease the oxygen if the patient's condition does not improve.

c. Monitor the prescribed oxygen level and length of therapy.

A patient receiving oxygen via a face mask at 5 L/min is able to eat. Which nursing intervention is performed at mealtimes? a. Change the mask to a nasal cannula of 6 L/min or more. b. Have the patient work around the face mask as best as possible. c. Obtain a provider order for a nasal cannula at 5 L/min. d. Obtain a provider order to remove the mask at meals.

c. Obtain a provider order for a nasal cannula at 5 L/min.

The patient has been on oxygen therapy at 70% for over 48 hours. For which complication must the nurse monitor? a. Oxygen-induced hypoventilation b. Hypercarbia c. Oxygen toxicity d. Absorptive atelectasis

c. Oxygen toxicity

The nurse is suctioning the secretions from a patient's endotracheal tube. The patient demonstrates a vagal response by a drop in heart rate to 54/min and a drop in blood pressure to 90/50 mm Hg. After stopping suctioning, what is the nurse's priority action? a. Allow the patient to rest for at least 10 minutes. b. Monitor the patient and call the Rapid Response Team. c. Oxygenate with 100% oxygen and monitor the patient. d. Administer atropine according to standing orders.

c. Oxygenate with 100% oxygen and monitor the patient.

Which clinical finding in a patient with a recent tracheostomy is the most serious and requires immediate intervention? a. Increased cough and difficulty expectorating secretions b. Food particles in the tracheal secretions c. Pulsating tracheostomy tube in synchrony with the heartbeat d. Set tidal volume on the ventilator not being received by the patient

c. Pulsating tracheostomy tube in synchrony with the heartbeat

A patient returns from the operating room after having a tracheostomy. While assessing the patient, which observation made by the nurse warrants immediate notification of the health care provider? a. Patient is alert but unable to speak and has difficulty communicating his needs. b. There is a small amount of bleeding present at the incision. c. Skin is puffy at the neck area with a crackling sensation. d. Respirations are audible and noisy with an increased respiratory rate.

c. Skin is puffy at the neck area with a crackling sensation.

What is the most important interrelated medical-surgical concept for nursing care of patients requiring oxygen therapy? a. Gas exchange b. Perfusion c. Tissue integrity d. Cellular regulation

c. Tissue integrity

When a patient is requiring oxygen therapy, what is important for the nurse to know? a. Patients require 1-10 L/min by nasal cannula in order for oxygen to be effective. b. Oxygen-induced hypoventilation is the priority when Paco2 levels are unknown. c. Why the patient is receiving oxygen, expected outcomes, and complications. d. The goal is the highest Fio2 possible for the particular device being used.

c. Why the patient is receiving oxygen, expected outcomes, and complications.

Which statement by the nursing student indicates an understanding of the purpose of administering oxygen by nasal cannula? a. "With a nasal cannula, a wide range of oxygen flow rates and concentrations can be delivered." b. "A minimum flow rate of 5 L/min is needed to prevent the rebreathing of exhaled air." c. "It works by pulling in a proportional amount of room air for each liter flow of oxygen." d. "It is often used for chronic lung disease and for any patient needing long-term oxygen therapy."

d. "It is often used for chronic lung disease and for any patient needing long-term oxygen therapy."

A patient has a cuffed tracheostomy tube with- out a pressure relief valve. To prevent tissue damage of the tracheal mucosa, what does the nurse do? a. Deflate the cuff every 2-4 hours and maintain as needed. b. Change the tracheostomy tube every 3 days or per hospital policy. c. Assess and record cuff pressures each shift using the occlusive technique. d. Assess and record cuff pressures each shift using minimal leak technique.

d. Assess and record cuff pressures each shift using minimal leak technique.

While the nursing student changes a patient's tracheostomy dressing, the nurse observes the student using a pair of scissors to cut a 44 gauze pad to make a split dressing that will fit around the tracheostomy tube. What is the nurse's best action? a. Give the student positive reinforcement for use of materials and technique. b. Report the student to the instructor for remediation of the skill. c. Change the dressing immediately after the student has left the room. d. Direct the student in the correct use of materials and explain the rationale.

d. Direct the student in the correct use of materials and explain the rationale.

A patient with a tracheostomy is being dis- charged to home. In patient teaching, what does the nurse instruct the patient to do? a. Use sterile technique when suctioning. b. Instill tap water into the artificial airway. c. Clean the tracheostomy tube with soap and water. d. Increase the humidity in the home.

d. Increase the humidity in the home.

A patient with a permanent tracheostomy is interested in developing an exercise regimen. Which activity does the nurse advise the patient to avoid? a. Aerobics b. Tennis c. Golf d. Swimming

d. Swimming

A patient with a tracheostomy stoma in place develops increased coughing, inability to expectorate secretions, and difficulty breathing. What are these assessment findings related to? a. Over inflation of the pilot balloon b. Tracheoesophageal fistula c. Cuff leak and rupture d. Tracheal stenosis

d. Tracheal stenosis

A patient with an endotracheal tube in place has dry mucous membranes of the mouth and lips related to the tube and the partial open mouth position. What technique does the nurse use to provide this patient with frequent oral care? a. Cleanses the mouth with glycerin swabs b. Provides alcohol-based mouth rinse and oral suction c. Cleanses with a mixture of hydrogen peroxide and water d. Uses oral swabs or a soft-bristled brush moistened in water

d. Uses oral swabs or a soft-bristled brush moistened in water

Which high flow oxygen delivery system delivers the most accurate concentration of oxygen without intubation? a. Partial rebreather mask b. Nonrebreather mask c. High flow nasal cannula d. Venturi mask

d. Venturi mask