I2N Module Practice Questions: Airway Management

The nurse is caring for a patient who underwent major abdominal surgery 24 hours ago. The 72-year-old male patient is weak and lethargic because of large doses of medication for pain control. After noting audible gurgling on inspiration and expiration, the nurse completes a respiratory assessment. Which assessment parameters indicate the need for oral suction? (Select all that apply.) A. Unusual restlessness. B. Gagging. C. Gurgling and adventitious lung sounds. D. Evidence of emesis in the mouth. E. Persistent coughing that fails to clear airway. F. Persistent complaints of pain. G. Weakness and lethargy accompanied by drooling.

A, B, C, D, E, G- The following signs indicate the need for oropharyngeal suctioning: (1) restlessness, especially if it is new or unusual for the patient; (2) obvious, excessive oral secretions as evidenced by drooling and/or gagging; (3) gurgling and/or audible crackles and wheezes that occur on inspiration and/or expiration; (4) evidence of gastric contents and/or emesis in the mouth; (5) persistent coughing that fails to clear the upper airway; and (6) weakness and lethargy accompanied by drooling and gagging. Persistent complaints of pain are more likely related to the surgery.

You are reviewing the signs, symptoms, and prevention of hypoxia with the family of a patient who requires frequent suctioning at home. Choose the information that you should cover. (Select all that apply.) A. Restlessness and anxiety are indications of hypoxia. B. Confusion, disorientation, and altered consciousness are indications of hypoxia. C. Increases in pulse, respiration, and blood pressure are indications of hypoxia. D. Having difficulty breathing and looking blue are indications of hypoxia. E. Infection and fever are indications of hypoxia. F. Bronchitis and chronic obstructive pulmonary disease are indications of hypoxia.

A, B, C, D- Indications of hypoxia include restlessness, anxiety, confusion, disorientation, altered consciousness as well as increases in pulse rate, respiration rate, and blood pressure. Feeling out of breathe and looking blue also indicate hypoxia.

Which of the following patients may likely require oropharyngeal suctioning? (Select all that apply.) A. A patient who had maxillofacial surgery. B. A patient who had trauma to the mouth. C. A patient with impaired swallowing from neurologic injury. D. A patient who has been diagnosed with lung cancer. E. A patient with an artificial airway who requires oral hygiene. F. A patient who has a nasogastric feeding tube. G. A patient with pneumonia.

A, B, C, E- The Yankauer suction device is useful in the removal of secretions from the mouth in patients after oral and maxillofacial surgery, trauma to the mouth, neurovascular injury and/or cerebrovascular accident causing hemiparesis and drooling, or impaired swallowing. Patients with artificial airways and impaired swallowing ability may require use of the Yankauer suction device to promote oral hygiene. Patients with lung cancer or pneumonia may be able to cough up or swallow secretions on their own.

Which of the following is a potential complication for a patient who is having nasotracheal suctioning? (Select all that apply.) A. A significant drop in oxygen concentration. B. A decrease in heart rate. C. Dysrythmias. D. Coughing during and after suctioning E. Less secretions in the airway.

A, B, C- The patient is at risk for developing hypoxemia at any point from assessment of airway secretions to a short time after the suctioning procedure. The suctioning procedure itself removes oxygen from the airways. A patient may experience bradycardia as a result of vagal stimulation. Dysrhythmias are a potential complication of nasotracheal suctioning. Coughing is an expected outcome of nasotracheal suctioning and will aid in clearing the airways.

Before performing endotracheal suctioning, the nurse presses the sigh mechanism on the mechanical ventilator. Why does the nurse do this? The nurse is: (Select all that apply.) A. preoxygenating the patient. B. offsetting the volume of oxygen lost during the suction procedure. C. compensating for the interruption in mechanical ventilation. D. preventing the development of atelectasis.

A, B, C- The purpose of preoxygenating the patient whether intubated or not, is to compensate for the loss of oxygen during the procedure.

An elderly woman is hospitalized with pneumonia and anemia, and has a history of heart failure. She is weak and has a poor cough effort. Her current vital signs are temperature 100.2 ˚F (37.9 ˚C), pulse 114, respiration 26, blood pressure 106/58. She has oxygen ordered at 2 liters by nasal cannula. Her oxygen saturation measures 88% when on room air, 93% with supplemental oxygen. She develops shortness of breath on any activity and eats little because it is difficult for her to eat and breathe at the same time. Which of the following are risk factors for this patient developing hypoxia? (Select all that apply.) A. Anemia B. Tachycardia C. Increased secretions with weak cough. D. Impaired cardiac function. E. Shortness of breath. F. Pneumonia

A, C, D, F- Hypoxia results when there is inadequate tissue oxygenation at the cellular level. Lowered oxygen-carrying capacity from anemia can lead to hypoxia. A diminished concentration of inspired oxygen, such as with an obstructed airway from secretions, results in lowered oxygen saturation. Impaired cardiac function results in poor tissue perfusion with oxygenated blood. With pneumonia there is decreased diffusion of oxygen from the alveoli to the blood, leading to inadequate tissue oxygenation. An increase in pulse rate is an adaptive response to meet the body's oxygen demand. Shortness of breath (dyspnea) is a symptom of decreased oxygenation.

Which of the following would lead to an increase in oxygen demand? A. A fever. B. Sleep. C. Taking a narcotic. D. Postural drainage.

A- Increased metabolic activity associated with a fever increases tissue oxygen demand. Postural drainage is an intervention used to mobilize secretions and maintain an open airway.

A discussion is taking place on the unit regarding the application of lubricant to the suction catheter before passing it through the nasal passage. Which statement is accurate? A. "Water-soluble lubricant should be used because oil based lubricants increase the risk for aspiration and pneumonia." B. "If the patient's fluid status is sufficient, lubricating the catheter is unnecessary." C. "Petroleum jelly can be used to lubricate the catheter as long as the patient is not on oxygen via nasal cannula." D. "Applying water-soluble lubricant to the suction catheter ensures that it is working properly prior to oropharyngeal or nasotracheal suctioning."

A- Oil-based lubricants increase the risk for aspiration and pneumonia. Water-soluble lubricant is applied to the catheter to ease insertion and prevent tissue trauma. It is unrelated to the patient's fluid status. Suctioning a small amount of sterile normal saline from the basin ensures that the suction system is working correctly. It is unnecessary to lubricate the end of the suction catheter when performing oropharyngeal suctioning.

A 73-year-old patient was admitted with severe respiratory distress secondary to pneumonia. She has a long history of smoking, which she recently stopped. Upon arrival she was placed on continuous pulse oximetry, and an endotracheal tube was inserted for mechanical ventilation. She is heavily sedated. This patient is at risk for airway occlusion. A. True B. False

A- She must constantly be monitored for airway occlusion.

A 73-year-old patient was admitted with severe respiratory distress secondary to pneumonia. She has a long history of smoking, which she recently stopped. Upon arrival she was placed on continuous pulse oximetry, and an endotracheal tube was inserted for mechanical ventilation. She is heavily sedated. This patient's risk factors for respiratory problems include history of smoking, her illness, and her age. A. True B. False

A- She was a smoker for many years, and her age and illness place her at greater risk for respiratory distress.

The nurse is performing routine assessments of the patients on the unit. The nurse notes audible gurgling on inspiration and expiration of the stable postoperative patient. Which of the following tasks can be delegated to competent NAP? A. Performing oral suctioning. B. Assessing the adequacy of respiratory functioning. C. Evaluating the outcome of oral suctioning. D. Performing nasotracheal suctioning.

A- Since the patient is stable, the task of performing oral suctioning may be delegated to NAP. However, the responsibility for assessing the adequacy of respiratory functioning and evaluating the patient outcome of oral suctioning remains with you. Nasotracheal suctioning requires sterile technique and cannot be delegated to NAP.

The nurse performs nasotracheal suctioning. Which of the following is an incorrect sequence for this procedure? A. Apply sterile gloves, pick up the suction catheter with dominant hand, secure the catheter to the tubing, connect the tubing to the suction machine, and turn the suction on. B. Wearing sterile gloves, suction a small amount of sterile normal saline from the basin and lightly coat 6 to 8 cm of the catheter with water-soluble lubricant. C. Using dominant hand, gently but quickly insert the catheter into the patient's nares and intermittently suction and rotate the catheter while withdrawing the catheter. D. Rinse the catheter and connecting tubing with normal saline and allow the patient to rest 1 to 2 minutes between catheter passes. Encourage the patient to cough, and when suctioning is complete, appropriately discard used equipment and perform oral care.

A- The connecting tubing should be attached to the suction machine and turned on before applying sterile gloves.

The nurse is preparing to perform oropharyngeal suctioning. Which of the following steps in the sequence is incorrect? A. Assist the patient into a supine position. Prepare supplies. Turn the suction unit on and set the suction control gauge to high. Connect the suction tubing to the suction machine and to the Yankauer suction catheter. B. Place the suction catheter in the container of water and apply suction. If the patient has an oxygen device, remove it, placing it near the patient's face. Insert the catheter gently into the mouth along the gingival border (gum line). C. Gently move the catheter around the patient's mouth until all of the secretions are cleared. Encourage the patient to cough. Replace the oxygen mask. Suction water from the basin through the catheter until the catheter is cleared of secretions. Reassess the patient's respiratory status and repeat the procedure if necessary. D. Turn off the suction source. Wipe the patient's face. Discard the water into an appropriate receptacle. Discard the Yankauer suction catheter or place it in a nonairtight container to ensure that it remains uncontaminated. Provide oral care. Remove the gloves and perform hand hygiene. Record the procedure.

A- The nurse should place the patient in a Fowler's position, then perform hand hygiene, and finally set the suction control gauge according to manufacturer's directions. A high setting on the suction control gauge could cause damage to the oral mucosa. The other options are correct steps in the sequence for performing oropharyngeal suctioning.

A 73-year-old patient was admitted with severe respiratory distress secondary to pneumonia. She has a long history of smoking, which she recently stopped. Upon arrival she was placed on continuous pulse oximetry, and an endotracheal tube was inserted for mechanical ventilation. She is heavily sedated. She is receiving an intravenous infusion at 100 mL per hour. Intravenous fluids may impact this patient's respiratory status. A. True B. False

A- Too little fluid can cause thickened secretions and too much fluid may add stress to the heart. Monitor input and output closely. IV fluids can also help to keep her secretions thin and mobile.

Which of the following statements regarding nasotracheal suctioning are true? (Select all that apply.) A. This procedure can be delegated to NAP. B. Sterile technique is required. C. Suction should be applied intermittently as the catheter is removed. D. The suction catheter should be rotated as it is withdrawn. E. Clean technique may be used.

B, C, D- Sterile technique is required for nastotracheal suctioning to prevent introducing microorganisms into the trachea. Suction is applied intermittently and the catheter is rotated as it is removed to prevent adherence of the mucosa to the suction catheter and to facilitate removal of secretions. Nasotracheal suctioning should not be delegated to NAP. NAP may perform oropharygeal suctioning where clean technique is used.

The nurse is preparing to perform nasotracheal suctioning on a patient. Which of the following actions would indicate a break in sterile technique? (Select all that apply.) A. The nurse applies a sterile glove to the dominant hand and a nonsterile glove to the nondominant hand. B. As the nurse places the sterile basin on the bedside table, the nurse touches the inside of the basin with the nonsterile glove. C. The nurse uses the same suction catheter to suction the oral cavity followed by the endotracheal tube and then discards the suction catheter inside the gloves into an appropriate receptacle. D. The nurse picks up the catheter with the dominant hand, then picks up the connecting tubing with the nondominant hand and secures the catheter to the tubing.

B, C- The nurse should avoid touching the inside of the sterile basin with the nonsterile glove as this would contaminate the sterile basin. The nurse should not use the same suction catheter to suction the mouth and then the trachea as this would introduce microorganisms into the trachea. The nurse may suction the trachea first, followed by the oral route using the same catheter.

What nursing intervention is appropriate for the patient with a large amount of sputum? A. Perform nasotracheal suctioning every hour. B. Encourage the patient to cough every hour while awake. C. Place the patient on fluid restriction. D. Avoid all milk products.

B- A patient with a large amount of sputum should be encouraged to cough every hour while awake. Adequate fluids should be maintained to help keep secretions thin and easier to expectorate. Although milk has a protein structure similar to sputum, it does not increase sputum production and plays an important role in nutrition. Suctioning should be performed on an as-needed basis.

Which of the following should NOT be delegated to NAP? A. Oropharyngeal suctioning. B. Nasotracheal suctioning. C. Pulse oximetry. D. Oral care.

B- Because sterile technique and critical thinking skills are required, it is inappropriate to delegate nasotracheal suctioning to NAP. The other tasks can be performed by NAP on stable patients.

Which of the following patients would have the greatest potential for an alteration in respiration? A. A 15-year-old male with a migraine headache. B. A 44-year-old female with anemia. C. A 19-year-old female with diarrhea. D. A 32-year-old male with an ear ache.

B- Hemoglobin carries about 97% of oxygen to the tissues. Anemia lowers the oxygen-carrying capacity of the blood and potentially leads to hypoxia.

The nurse is teaching the spouse of a patient how to perform oral suctioning for when they return home. Which of the following statements, if made by the spouse, indicates further instruction is needed? A. "It would be abnormal to obtain bloody secretions." B. "Because oral secretions are thick, suction settings should always be set on high." C. "I should be careful to avoid touching the back of the throat with the tip of the suction catheter." D. "I should encourage fluids to help keep secretions thin."

B- Suction settings should be low to ensure that the oral tissue is uninjured during suctioning. Bloody secretions may be an indication of mucosal damage. The oropharynx should be assessed for any tissue injury, and the frequency of suctioning should be evaluated. Touching the back of the throat can stimulate the gag reflex. Unless contraindicated, fluids should be encouraged to reduce the viscosity of secretions.

For a patient with an endotracheal tube on mechanical ventilation, preoxygenation is unnecessary before suctioning because the ventilator will maintain the patient's oxygen levels. A. True B. False

B- The ventilator should be set to deliver 100% oxygen before suctioning this patient.

Which of the following patients is most likely to experience some difficulty with effective coughing? A. The elderly patient who had outpatient foot surgery. B. The middle-age man who is postoperative for knee arthroplasty. C. The patient who is postoperative for abdominal surgery. D. The patient who preoperatively practiced cascade coughing.

C- Abdominal surgery causes pain and weakness of the abdominal muscles, both of which can result in ineffective airway clearance. Learning coughing techniques preoperatively will aid in postoperative performance of these skills.

The nurse is orienting a new graduate nurse to common procedures performed on the unit. Which statement, if made by the graduate nurse, indicates understanding of nasotracheal suctioning? A. "The maximum duration to suction is 20 seconds." B. "The bacterial count in the nasotracheal pathway is higher, therefore suction the trachea through the mouth." C. "A 1- to 2- minute interval should be allowed between suctioning passes." D. "Intermittent suction is applied during insertion of the catheter."

C- Intermittent suction up to 15 seconds safely removes pharyngeal secretions. The maximum time to suction the trachea is 10 seconds, with a 1- to 2-minute interval in between suctioning passes for reoxygenation. The mouth carries the highest bacterial count. Whenever possible, suction via the nasotracheal route. To avoid tissue damage, intermittent suction is applied as the catheter is being withdrawn.

Which of the following, if exhibited by the patient, is a late sign of hypoxia? A. Restlessness. B. Anxiety. C. Eupnea. D. Cyanosis.

D- Restlessness and anxiety are early indicators of hypoxia. Cyanosis is a late indicator of hypoxia. Eupnea is normal respiration.

The nurse desires to suction the patient's left main stem bronchus. In what position should the patient be placed? A. Keep the patient's head in a neutral position and rotate the catheter counter-clockwise upon insertion. B. Keep the patient's head in a neutral position and rotate the catheter clockwise upon insertion. C. Turn the patient's head to the left. D. Turn the patient's head to the right.

D- To effectively suction the left main stem bronchus, turn the patient's head to the right.

Which of the following patients should be assessed for a worsening clinical situation? A. The chronic obstructive pulmonary disease (COPD) patient whose pulse oximetry remains the same after oropharyngeal suctioning. B. The patient with absence of adventitious lung sounds on inspiration and expiration. C. The patient who demonstrates less drooling after being suctioned. D. The patient with presence of blood in the secretions.

D-Bloody secretions are an unexpected outcome. The cause should be investigated. The removal of secretions helps to improve the oxygen saturation level. In patients with chronic pulmonary diseases such as COPD, the pulse oximetry value may remain the same. The absence of adventitious sounds is an expected finding. An expected outcome of oropharyngeal suctioning is lessened or absence of drooling.