FPCC Unit 2 - PrepU: OXYGENATION

An older resident at a long-term care facility has been placed on oxygen via a partial rebreather mask due to COVID-19. While helping the resident prepare for sleep, the nurse notices the mask is no longer fitting properly. Which question should the nurse prioritize? -"Did you remove your dentures?" -"Did someone take your mask off?" -"Did someone loosen the straps on your mask?" -"Is your mask causing discomfort?"

"Is your mask causing discomfort?"

A client who utilizes a portable oxygen device reports planning to attend an upcoming bonfire on the beach. What is the appropriate nursing response? -"Saltwater can increase the potential for oxygen toxicity." -"When using portable oxygen, you should avoid any fire." -"You should not leave the house with portable oxygen." -"Have an enjoyable time."

"When using portable oxygen, you should avoid any fire."

A nurse assessing a client's respiratory effort notes that the client's breaths are shallow and 8 per minute. Shortly after, the client's respirations cease. Which form of oxygen delivery should the nurse use for this client? -Nasal cannula -Ambu bag -Oxygen mask -Oxygen tent

Ambu bag

While assessing vital signs of a client with a head injury and increased intracranial pressure (IICP), a nurse notes that the client's respiratory rate is 8 breaths/minute. How will the nurse interpret this finding? -This is a normal respiratory rate. -Bradypnea is uncommon in a client with IICP. -IICP most commonly results in tachypnea. -Bradypnea is a response to IICP.

Bradypnea is a response to IICP.

After collecting data from a client with respiratory distress, the nurse prioritizes the client interventions to provide oxygen to the client first. This is an example of which model for organizing data? -Functional Health Patterns -Body Systems Model -Hierarchy of Human Needs -Human Response Patterns

Hierarchy of Human Needs

A client is being admitted from the emergency room reporting shortness of breath, wheezing, and coughing. What would the nurse formulate as an appropriate nursing diagnosis? -Asthma Attack -Acute Dyspnea -Bronchial Pneumonia -Ineffective Airway Clearance

Ineffective Airway Clearance

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency? -Dehydration -Cardiac distress -Wound infection -Respiratory obstruction

Respiratory obstruction

A 33-year-old male client returns to the medical-surgical unit following a thyroidectomy. Which assessment finding requires an immediate intervention by the nurse? -The client reports thirst. -The client reports pain at the surgical site. -The client makes noises when he breathes. -The client is sleepy from the anesthesia.

The client makes noises when he breathes.

The client is having difficulty breathing. The respiratory rate is 44 and the oxygen saturation is 89% (0.89 L). The nurse raises the head of the bed and applies oxygen at 3 L/min per nasal cannula. How does the nurse determine the effectiveness of the interventions? Select all that apply. -The client's respiratory rate decreases. -The client states, "I can breathe easier now." -The client's family asks if the client is going to be okay. -The client's oxygen saturation level increases. -The client is watching television.

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

The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? -They are loud, high-pitched sounds heard primarily over the trachea and larynx. -They are soft, high-pitched discontinuous (intermittent) popping lung sounds. -They are medium-pitched blowing sounds heard over the major bronchi. -They are low-pitched, soft sounds heard over peripheral lung fields.

They are low-pitched, soft sounds heard over peripheral lung fields.

True or False? After insertion of a chest tube, fluctuations in the water-seal chamber that correspond with inspiration and expiration are an expected and normal finding.

True

Clients demonstrating apnea have what? -normal respiratory rate of 20 -increased rate and depth of respirations -decreased rate and depth of respirations -a temporary cessation of breathing

a temporary cessation of breathing

What assessments would a nurse make when auscultating the lungs? -air flow through the respiratory passages -presence of edema -volume of air exhaled or inhaled -abnormal chest structures

air flow through the respiratory passages

The nurse is informed while receiving a nursing report that the client has been hypoxic during the evening shift. Which assessment finding is consistent with hypoxia? -decreased blood pressure -decreased respiratory rate -confusion -hyperactivity

confusion

The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? -normal saline -mineral oil -distilled water -tap water

distilled water

The nurse is caring for a client who has smoked for more than 20 years and is now experiencing labored respirations. The nurse documents the client is experiencing: -stridor. -wheezing. -fremitus. -dyspnea.

dyspnea.

Upon auscultation of a client's lung fields, the nurse hears a continuous high-pitched sound on expiration. These are characteristics of which adventitious breath sound? -wheezes -stertorous breathing -fine crackles -pleural friction rub

wheezes