Block 2 Taylor's Skills Quizzes: Administering O2 by Mask and Nasal Cannula

A nurse is educating a client on the use of continuous oxygen. The nurse asks the client, "What is the advantage of using an oxygen mask versus a nasal cannula?" The nurse confirms that the education has been effective if the client states:

"I will have a greater concentration of oxygen delivered." Rationale:The greatest advantage of using an oxygen mask is the ability to deliver a more concentrated form of oxygen for clients who are not getting optimal results from a nasal cannula. With both systems, the air can be humidified prior to delivery. There is a greater chance of skin breakdown with the mask. The use of the mask does not damage nasal passages less than a nasal cannula.

The nurse is setting up the equipment needed to deliver oxygen to a postsurgical client via a nasal cannula. After connecting the nasal cannula to the oxygen source and flow meter, what is the next action the nurse should perform?

Adjust the flow rate to the prescribed amount. Rationale:After connecting the nasal cannula to the oxygen source and flow meter, the nurse would adjust the flow rate to the prescribed amount. The nurse would then check the flow, insert the nasal cannula into the client's nostrils, and instruct the client to breathe through the nose with the mouth closed to achieve optimal oxygen delivery. The respiratory rate and effort would be assessed prior to setting up the nasal cannula equipment and flow meter.

As prescribed by the health care provider, the nurse has set up an oxygen mask with a reservoir to deliver oxygen to a client with pneumonia. What would the nurse do, prior to putting the mask on the client?

Allow the reservoir bag to fill up with oxygen. Rationale: After connecting the face mask to the oxygen source, the nurse would adjust the flow rate to the prescribed amount and allow the bag to fill up with oxygen prior to placing the mask on the client. Because the reservoir bag supplies the oxygen administered to the client, it must be inflated with oxygen before application. The straps of the mask would be adjusted after placement on the client's face. Powder should not be used under the mask.

A nurse is caring for a client receiving oxygen at 2 liters per minute via nasal cannula. During the morning assessment, the nurse notes reddened areas at the top of the ears and neck. What actions should the nurse take? Select all that apply.

Apply padding to the tubing that goes over the ears and loosen neck tubing. Rationale:The nurse should ensure that reddened areas are adequately padded and that tubing is not pulled too tight, which can cause reddening. If available, a skin care team may be able to suggest methods to prevent further skin breakdown. It is not necessary to cushion the entire length of the cannula tubing, only the areas causing skin breakdown. A nonrebreather mask is not needed for a client who achieves adequate oxygenation receiving 2 liters per minute.

The nurse is caring for five clients on a busy medical floor. Which tasks can the nurse delegate to unlicensed assistive personnel (UAP)? Select all that apply.

Bathing and shaving of a client on continuous oxygen at 2 liters per minute via nasal cannula., Ambulating in the hall a client who always uses portable oxygen via nasal cannula., Reapplying the nasal cannula after the client dislodges it during repositioning. Rationale:If the nasal cannula is removed or dislodged during nursing care activities, such as bathing, shaving, or repositioning, reapplication of the nasal cannula may be performed by UAP. A UAP may ambulate a client that uses portable oxygen, unless the client is unstable. The administration of oxygen by nasal cannula is not delegated to UAP, because assessment by a registered nurse is required.

The health care provider prescribes oxygen to be administered to a client via a mask with an oxygen flow rate of 10 liters per minute. To accommodate meals, what would the nurse do?

Deliver oxygen via nasal cannula during meals, replacing the mask after the client eats. Rationale:The client cannot eat with an oxygen mask on; therefore, the nurse should secure a prescription for oxygen administration via a nasal cannula during meals. Since the flow rate is not as great with a nasal cannula, the mask should be replaced as soon as the client is finished eating. It would not be appropriate to remove the oxygen during meals without applying the nasal cannula, because the client would become hypoxic while eating. Replacing the mask as soon as the client is finished eating is not sufficient, because the client would become hypoxic before finishing eating. Loosening the mask while the client is eating would allow too much oxygen to escape during the meal and risks hypoxia. There is no need to change the client's diet.

The nurse is inserting a nasal cannula into the client's nostrils to improve oxygenation. To correctly insert the curved prongs of the cannula, what would the nurse do?

Follow the angle of the nose with the prongs pointed downward. Rationale:When inserting the prongs of the cannula, the nurse would follow the natural angle of the nose and point the prongs downward. Correct placement of the prongs and fastener facilitates oxygen administration and client comfort; pointing the prongs upward or placing them outside of the nostrils would hinder optimal oxygenation for the client. It is not necessary to adjust airflow for one nostril at a time.

A nurse is caring for a client who has spontaneous respirations and needs to have oxygen administered at a FiO2 of 100%. Which oxygen delivery system should the nurse use?

Nonrebreather mask Rationale:A nonrebreather mask is the only device that can deliver an FiO2 of 100% to a client without a controlled airway. A Venturi mask delivers a maximum FiO2 of 55%. A nasal cannula delivers a maximum FiO2 of 44%. A simple mask delivers a maximum FiO2 of 60%.

A nurse must deliver oxygen at a concentration of 85% to an infant. Which delivery device would be most appropriate for an infant?

Oxygen hood Rationale:An oxygen hood is a delivery device for infants that can deliver oxygen concentrations up to 80% to 90%. None of the other devices listed can deliver oxygen at the concentration needed.

The nurse is applying an oxygen mask prescribed for a client with bronchial pneumonia. What would the nurse do to prevent skin breakdown in the area where the mask is placed?

Place gauze pads under the elastic strap at pressure points. Rationale:If skin irritation or redness is noted, the nurse would use gauze pads under the elastic strap at pressure points to reduce pressure and protect the skin. The mask should fit snugly around the mouth and nose, so cotton balls and powder would not be placed beneath the edges of the mask. The straps should be adjusted to fit snugly, but comfortably, on the face.

The nurse is caring for a client receiving oxygen at a rate of 8 liters per minute via face mask. While monitoring the client for skin irritation, what is the best action by the nurse?

Remove the mask and dry the skin every 2 to 3 hours. Rationale:The nurse would remove the face mask, dry the skin under the mask, and assess for skin breakdown every 2 to 3 hours. Skin integrity can be compromised due to mask pressure and moisture under the mask. Changing the oxygen delivery system would not be an appropriate nursing action. Lifting the mask to dry the skin every 4 to 5 hours would not be often enough to prevent skin compromise. Continuing to monitor is necessary, but it is not the best action, because simply monitoring does not prevent skin breakdown or eliminate the moisture from the skin.

The nurse is caring for a client who is receiving continuous oxygen at 3 L/minute via nasal cannula. The client's oxygen saturation has consistently been 94% to 96%, but suddenly drops to 86% as the nurse palpates the client's abdomen. The client denies respiratory difficulty or other distress. Which is a likely reason for the client's decreasing oxygen saturation?

The nurse has inadvertently stepped on the client's oxygen tubing, occluding the flow of oxygen. Rationale:A sudden drop in oxygen saturation without clinical signs or symptoms may be caused by disruption of oxygen flow. The information in the question does not support a pulmonary embolism, the client holding his or her breath, or an appendix rupturing.

A health care provider prescribes oxygen for a client at 4 liters per minute via a nasal cannula after an initial pulse oximeter reading of 88% on room air. Which is the priority client assessment that the nurse should make prior to administering the oxygen?

respiratory rate and effort Rationale:Prior to administering oxygen to a client, the nurse should make an assessment of the client's respiratory status, including respiratory rate, effort, and lung sounds. The nurse would note any signs of respiratory distress, such as tachypnea, nasal flaring, use of accessory muscles, or dyspnea. The nurse should also assess the client's oxygen saturation to provide a baseline for evaluating the effectiveness of oxygen therapy. It is not necessary to assess blood pressure or pulse, apical heart rate or rhythm, or skin alterations and edema prior to administering oxygen via a nasal cannula, although these may need assessment after the nasal cannula is applied.