Ch. 14 Oxygenation
The daughter of a client who is being treated for pneumonia has told the nurse that her father had his blood checked for its oxygen level during a previous bout with pneumonia. What disadvantage of arterial blood gas measurement should the client's nurse be aware of? A) The procedure is invasive and painful. B) ABGs are less accurate than pulse oximetry. C) ABGs are not accurate if the client has been receiving supplementary oxygen. D) The procedure is normally conducted on an outpatient basis.
Ans: A Feedback: Having ABG's drawn is invasive and painful. ABG's are more accurate than pulse oximetry and are not invalidated by the use of supplementary oxygen. ABG's are usually performed on acutely ill clients on an inpatient basis.
A nurse uses an oxygen analyzer to measure the percentage of oxygen delivered to a client. When checking the percentage of oxygen in the room air, what should the reading of the analyzer be if there is a normal mixture of oxygen and other gases in the environment? A) 0.21 B) 0.23 C) 0.25 D) 0.27
Ans: A Feedback: If there is a normal mixture of oxygen and other gases in the environment, the oxygen analyzer will indicate 0.21 (21%). An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine whether the client is receiving the amount prescribed by the physician. The nurse or respiratory therapist first checks the percentage of oxygen in the room air with the analyzer. If there is a normal mixture of oxygen and other gases in the environment, the analyzer indicates 0.21 (21%). When the analyzer is positioned near or within the device used to deliver oxygen, the reading should register at the prescribed amount (>0.21).
During oxygen administration to the client, which of the following pieces of equipment would enable the nurse to regulate the quantity of oxygen delivered from the wall-mounted oxygen supply? A) Flowmeter B) Oxygen analyzer C) Humidifier D) Nasal cannula
Ans: A Feedback: In order to regulate the amount of oxygen delivered to the client, the nurse should use a flowmeter. A flowmeter is attached to the source of oxygen. An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine whether the client is receiving the amount prescribed by the physician. A humidifier is a device that produces small water droplets and may be used during oxygen administration because oxygen dries the mucous membranes. A nasal cannula is a hollow tube with half-inch prongs placed into the client's nostrils. It provides a means for administering a low concentration of oxygen.
During the physical assessment of a client who has been inactive due to a leg injury, the nurse notes that the client tends to breathe very shallowly. What technique should the nurse teach the client in order to breathe more efficiently? A) Deep breathing B) Pursed-lip breathing C) Diaphragmatic breathing D) Incentive spirometry
Ans: A Feedback: The nurse should teach deep breathing techniques to the client who tends to breathe shallowly in order to help the client breathe more efficiently. Deep breathing is a technique for maximizing ventilation. Taking in a large volume of air fills alveoli to a greater capacity, thus improving gas exchange. Pursed-lip breathing is a form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing, which helps clients to eliminate more than the usual carbon dioxide from the lungs. It is used to increase the volume of air exchanged during inspiration and expiration. Incentive spirometry, a technique for deep breathing using a calibrated device, encourages clients to reach a goal-directed volume of inspired air. It prevents respiratory complications of immobility but does not directly increase the efficiency of breathing. Diaphragmatic breathing is breathing that promotes the use of the diaphragm rather than the upper chest muscles. It is used to increase the volume of air exchanged during inspiration and expiration.
The nurse is caring for a client who requires long-term oxygen therapy. However, the client is adequately oxygenated at a lower flow. What type of device may be best suited to this client's needs? A) Transtracheal oxygen B) CPAP mask C) Oxygen tent D) Nonrebreather mask
Ans: A Feedback: The nurse should use a transtracheal oxygen device for a client who requires long-term oxygen therapy and who is adequately oxygenated at a lower flow. A transtracheal catheter is a hollow tube inserted within the trachea to deliver oxygen. A CPAP mask is used for clients with sleep apnea; oxygen tents are used to care for active toddlers. A nonrebreather mask is used for acutely ill clients.
A nurse uses a simple mask to administer oxygen to a client with nasal trauma who breathes through the mouth. What is the minimum amount of oxygen delivered to the client using a simple mask? A) 5 L/min B) 4 L/min C) 3 L/min D) 2 L/min
Ans: A Feedback: When a simple mask is used for a client with nasal trauma who breathes through the mouth, oxygen is delivered at no less than 5 L/min. A simple mask, like other types of masks, allows the administration of higher levels of oxygen than are possible with a cannula. A simple mask is sometimes substituted for a cannula when a client has nasal trauma or breathes through the mouth. When a simple mask is used, oxygen is delivered at no less than 5 L/min.
Which of the following is a disadvantage of using a face tent to administer oxygen to a client with facial trauma? A) Delivers an inconsistent amount of oxygen B) Creates a risk of suffocation C) Dries nasal mucosa at a higher flow D) Permits condensation to form in the tubing
Ans: A Feedback: When using a face tent to administer oxygen to a client with facial trauma, the nurse should remember that the amount of oxygen the client actually receives may be inconsistent with what is prescribed because of environmental losses. A partial rebreather mask creates a risk of suffocation. A nasal cannula dries the nasal mucosa at a higher flow. A venturi mask permits condensation to form in tubing, which diminishes the flow of oxygen.
A nurse uses a nasal cannula to deliver oxygen to a client who has been diagnosed with chronic lung disease. What is an important thing to remember when using a nasal cannula? A) It can cause the nasal mucosa to dry in case of high flow. B) It can cause anxiety in clients who are claustrophobic. C) It can create a risk of suffocation. D) It can result in an inconsistent amount of oxygen.
Ans: A Feedback: When using a nasal cannula to deliver oxygen to a client, the nurse should remember that the nasal cannula can cause the nasal mucosa to dry in case of high oxygen flow. A simple mask can cause anxiety in clients who are claustrophobic. Clients using a partial rebreather mask are at risk of suffocation. A face tent may deliver an inconsistent amount of oxygen, depending on environmental loss.
A nurse is conducting a focused respiratory assessment of a 21-year-old man who has been admitted to the hospital with a pneumothorax (collapsed lung). The nurse is aware that this client's diagnosis affects multiple aspects of his respiratory function, including external respiration. In what anatomical location does the external respiration take place? A) The bronchi B) The alveoli C) The surface of red blood cells D) Arterial vessel walls
Ans: B Feedback: External respiration takes place at the most distal point in the airway between the alveolar capillary membranes. Internal respiration occurs at the cellular level by means of hemoglobin and body cells.
A client with a diagnosis of vascular dementia is unable to communicate clearly because of his cognitive deficit. The client has developed influenza with extensive respiratory involvement. What sign of inadequate oxygenation should the nurse at the facility where the client resides assess for? A) Flushed skin B) Uncharacteristic restlessness C) Wincing, grimacing, or guarding D) Decreased respiratory rate
Ans: B Feedback: Restlessness can be a sign of inadequate oxygenation. Pallor and increased respirations also accompany the problem, not flushed skin and decreased respiratory rate. Impaired oxygenation does not normally result in wincing, grimacing, or guarding.
A nurse is caring for an asthmatic client who requires a low flow and low concentration of oxygen. Which of the following delivery devices should the nurse use in order to administer oxygen to the client? A) Simple mask B) Nasal cannula C) Face tent D) Nonrebreather mask
Ans: B Feedback: The nurse should use a nasal cannula to administer oxygen to an asthmatic client who requires a low concentration of oxygen. A nasal cannula is a hollow tube with half-inch prongs placed into the client's nostrils. It is used for administering a low concentration of oxygen to clients who are not extremely hypoxic and are diagnosed with chronic lung disease. A simple mask allows the administration of higher levels of oxygen than a cannula. A face tent is used for clients with facial trauma and burns. Nonrebreather masks are used for clients requiring a high concentration of oxygen and are critically ill.
A physician prescribes the use of water-seal chest tube drainage for a client with a severe pleural effusion. What should the nurse ensure when using the water-seal chest tube drainage? A) Filters need to be cleaned regularly to avoid unpleasant taste or smell. B) The chest tube should not be separated from the drainage system unless clamped. C) A nasal cannula should be used to administer oxygen when cleaning the opening. D) A secondary source of oxygen should be available in case of power failure.
Ans: B Feedback: When using water-seal chest tube drainage, the nurse should never separate the chest tube from the drainage system unless clamped. Even then, the tube should be clamped only briefly. When using an oxygen concentrator as a source of oxygen, the nurse should clean the filter regularly to avoid an unpleasant taste or smell. A secondary source of oxygen should also be available in case of a power failure. When cleaning a transtracheal catheter, oxygen needs to be administered with a nasal cannula.
A physician has ordered an arterial blood gas test for a client with a respiratory disorder. What is the most common role of the nurse in the arterial blood gas test? A) Measure the partial pressure of the oxygen dissolved in plasma. B) Independently perform the arterial puncture to obtain the specimen. C) Implement measures to prevent complications after arterial puncture. D) Measure the percentage of hemoglobin saturated with oxygen.
Ans: C Feedback: During the arterial blood gas test, the nurse should implement measures to prevent complications after the arterial puncture. The nurse would not be involved in measuring the partial pressure of oxygen dissolved in plasma or the percentage of hemoglobin saturated with oxygen. In most cases, collection of the sample is not performed independently by the nurse.
A nurse is conducting a morning assessment of an elderly client who is being rehabilitated after orthopedic surgery. In addition to vital signs, the nurse assesses the client's oxygenation by pulse oximetry. At what SpO2 reading should the nurse begin to consider additional respiratory assessments and interventions? A) SpO2 96% B) SpO2 93% C) SpO2 89% D) SpO2 86%
Ans: C Feedback: In general, the nurse should consider additional assessments and interventions if a client's oxygen level is below 90%. The normal range is 95% to 100%.
A nurse is caring for a client who is being treated for several intractable wounds. The client has been put on hyperbaric oxygen therapy (HBOT). How could the nurse avoid oxygen toxicity for this client? A) By delivering 100% oxygen at two times normal atmospheric pressure B) By reducing the treatment time from 90 minutes to 30 minutes C) By providing brief periods of breathing room air D) By performing the therapy once every 2 weeks
Ans: C Feedback: The nurse can prevent oxygen toxicity from occurring in a client on HBOT by providing the client with brief periods of breathing room air. HBOT consists of the delivery of 100% oxygen at three times the normal atmospheric pressure within an airtight chamber. Treatments, which last ~90 minutes are repeated over days, weeks, or months of therapy. Reducing the amount of time oxygen is delivered over the atmospheric pressure, reducing the treatment time, or performing the therapy once in 2 weeks would not help to prevent oxygen toxicity in a client.
A 65-year-old client visits a health care facility for a scheduled physical assessment. During the assessment, the client states that he experiences occasional shortness of breath. What suggestion could the nurse make to improve the client's respiratory function in this case? A) Avoid strenuous exercises. B) Use a nasal strip. C) Drink liberal amounts of fluids. D) Avoid excessive use of over-the-counter medications.
Ans: C Feedback: The nurse could suggest liberal fluid intake for the client in order to improve respiratory function. Older adults need encouragement to maintain liberal fluid intake, which keeps the mucous membranes moist. Unless contraindicated, the nurse should encourage the client to engage in regular exercise to maintain optimal respiratory function. A nasal strip reduces airflow resistance by widening the nasal breathing passageway, thus promoting easier breathing. An older adult may or may not use a nasal strip to improve respiratory function. OTC medications do not normally affect respiratory function.
A nurse is assisting the respiratory therapist with a physical assessment of a client who is being treated for pleural effusion at a health care facility. The therapist needs the client to exhale additional air in order to determine the client's expiratory reserve volume. What instruction should the nurse give the client? A) Expand the thoracic cavity. B) Relax the respiratory muscles. C) Contract the abdominal muscles. D) Elevate the ribs and sternum.
Ans: C Feedback: The nurse should instruct the client to contract the abdominal muscles to exhale additional air. A person can forcibly exhale additional air by contracting abdominal muscles such as the rectus abdominis, transverse abdominis, and external and internal obliques. The client elevates the ribs and sternum and expands the thoracic cavity during inspiration. The client relaxes the respiratory muscles during normal expiration.
A nurse is caring for a client who is being administered oxygen through a transtracheal catheter. Which of the following devices should the nurse use to administer oxygen when cleaning the opening and the tube? A) Simple mask B) Face tent C) Nasal cannula D) Venturi mask
Ans: C Feedback: The nurse should use a nasal cannula to administer oxygen when cleaning the opening and the tube of the transtracheal catheter. A transtracheal catheter, which is a hollow tube inserted within the trachea to deliver oxygen, is used to administer oxygen to a client who requires long-term oxygen therapy. During the cleaning of the catheter, the client takes in oxygen through a nasal cannula. The nurse may not use a simple mask, face tent, or a venturi mask to administer oxygen to the client.
A nurse is caring for a client with severe influenza who requires an external source of oxygen in order to breathe efficiently. In which of the following situations is oxygen humidified? A) When more than 2 L/min of oxygen is administered for an extended period B) When more than 2 L/min but less than 3 L/min oxygen is administered C) When more than 4 L/min of oxygen is administered for an extended period D) When more than 5 L/min of oxygen is administered intermittently
Ans: C Feedback: When administering oxygen to a client using an external source of oxygen, the nurse should remember that oxygen is humidified when more than 4 L/min of oxygen is administered for an extended period. Oxygen need not be humidified if less than 4 L/min of oxygen has been administered to the client. Oxygen administered over an extended period of time, not intermittently, is humidified.
When caring for older adults with respiratory ailments, why is it imperative that the nurse carefully assess a client who demonstrates restlessness or confusion? A) To determine whether the ailment is causing respiratory acidosis B) To perform appropriate client education and health promotion C) To calculate the amount of oxygen that needs to be administered D) To differentiate signs of inadequate oxygenation from early signs of delirium
Ans: D Feedback: In elderly clients, the signs of inadequate oxygenation, such as restlessness or confusion, can resemble the early signs of delirium. Therefore, it is important for the nurse to carefully assess clients demonstrating these symptoms. Determining the cause of inadequate oxygenation, selecting an oxygenation technique, and calculating the amount of oxygen that needs to be administered are of secondary importance.
A hospital client has illuminated her call light and told the nurse, ìI can't quite seem to catch my breath.î The client appears to be in no visible distress. What is the first intervention that the nurse should perform? A) Place the client in the recovery position, side-lying with one knee bent. B) Apply oxygen at 8 L/min by nasal cannula. C) Apply supplementary oxygen using a Venturi mask. D) Raise the head of the client's bed and put her in the high Fowler's position.
Ans: D Feedback: Repositioning in a high Fowler's position can facilitate oxygenation in clients who are experiencing shortness of breath. A Venturi mask is used to deliver a precise mixture of oxygen and air to an acutely ill client. Oxygen by nasal cannula should not exceed 6 L/min. A side-lying position does not facilitate oxygenation.
A nurse is caring for a client who is being administered oxygen through a liquid oxygen unit. What is the most common potential problem the nurse may face when using a liquid oxygen unit to administer oxygen? A) It increases the client's electric bill. B) It produces an unpleasant odor. C) It requires a secondary source of oxygen. D) It leaks during warm weather.
Ans: D Feedback: The most common potential problem that the nurse may face when administering oxygen using a liquid oxygen unit is that the unit may leak during warm weather. An oxygen concentrator increases the client's electric bill and produces an unpleasant odor or taste if the filter is not cleaned weekly. An oxygen concentrator also requires a secondary oxygen device in case of a power failure.
A nurse is caring for a client who has just been diagnosed with sleep apnea. Which of the following devices would be of most use to this client? A) Nasal catheter B) Oxygen tent C) Transtracheal oxygen D) CPAP mask
Ans: D Feedback: The nurse should use a CPAP mask for a client with complaints of sleep apnea. A CPAP mask maintains positive pressure within the airway throughout the respiratory cycle. Clients generally wear this type of mask at night to maintain oxygenation when they experience sleep apnea. A nasal catheter is a tube for delivering oxygen that is inserted through the nose into the posterior nasal pharynx. It is used for clients who tend to breathe through the mouth or experience claustrophobia when a mask covers their face. An oxygen tent is a clear plastic enclosure that provides cooled, humidified oxygen, which is used for active toddlers. Transtracheal oxygen is a hollow tube inserted within the trachea to deliver oxygen to clients who require long-term oxygen therapy.
A nurse is caring for a client who is unable to breathe efficiently by himself. The physician has directed the nurse to put the client on oxygen therapy. The client is receiving a high concentration of oxygen. At what level should a nurse consider using a humidifier for the client? A) 1 L/min B) 2 L/min C) 3 L/min D) 4 L/min
Ans: D Feedback: The nurse should use a humidifier when the client has been receiving more than 4 L/min of oxygen over an extended period. A humidifier is a device that produces small water droplets and may be used during oxygen administration because oxygen dries the mucous membranes. In most cases, oxygen is humidified only when more than 4 L/min is administered for an extended period. When humidification is desired, a bottle is filled with distilled water and attached to the flowmeter.
A nurse is caring for a critically ill client who is receiving oxygen through a nonrebreather mask. The nurse should remember that the client becomes at risk of oxygen toxicity at what concentration and length of administration? A) Oxygen concentration of more than 25% given for longer than 24 hours B) Oxygen concentration of more than 30% given for longer than 48 hours C) Oxygen concentration of more than 25% given for longer than 36 hours D) Oxygen concentration of more than 50% given for longer than 48 hours
Ans: D Feedback: When administering oxygen to a critically ill client using a nonrebreather mask, the nurse should remember that an oxygen concentration of more than 50% given for longer than 48 hours can cause oxygen toxicity in the client. Oxygen toxicity means lung damage that develops when oxygen concentrations of more than 50% are administered for longer than 48 to 72 hours. The best way to prevent oxygen toxicity is to administer the lowest FiO2 possible for the shortest amount of time.