Clinical Chapter 23: Oxygen Therapy

The nurse is caring for a patient on mechanical ventilation. The nurse determines that the endotracheal tube is properly placed by which assessment? a. Auscultating both lungs and watching the rise and fall of both sides of the chest b. Monitoring and comparing the blood pressure in both arms c. Observing and measuring inspiratory and expiratory rates d. Checking the settings on the ventilator and the low-pressure and high-pressure alarm settings

A

The nurse is assessing a patient for hypoxia and observes a bluish discoloration in the following areas. Which areas indicate hypoxia? (Select all that apply.) a. Oral mucosa b. Conjunctiva of the eye c. Around the lips d. On the nail beds

ABC

The patient is placed on mechanical ventilation. After the initial settings have been applied, the nurse should watch for which of the following complications? (Select all that apply.) a. Signs of decreased cardiac output b. Tension pneumothorax c. Pneumonia d. Failure to wean

ABC

The nurse is caring for several patients who require oxygen therapy. The nurse anticipates an order for noninvasive positive-pressure ventilation (NIPPV) for the patients with which diagnoses? (Select all that apply.) a. Pulmonary edema b. Obstructive sleep apnea c. Stroke with dysphagia d. Congestive heart failure

ABD

A patient in respiratory distress enters the emergency department. The patient denies a history of COPD. The nurse anticipates an order for oxygen delivered by which method to achieve the highest possible concentration of oxygen? a. Simple face mask at 15 L/min b. Nonrebreathing face mask at 15 L/min c. Venturi mask at 15 L/min d. Oxygen tent at 15 L/min

B

A patient is admitted with a diagnosis of COPD and the health care provider orders BiPAP. Which action by the nurse is appropriate? a. Set the initial BiPAP settings at 4 to 8 cm H2O for inspiration and expiration. b. Draw arterial blood gas (ABG) levels after the first hour. c. Make sure the mask does not have quick-release straps. d. Set the initial BiPAP settings at 4 to 10 cm H2O for inspiration and at 10 to 15 cm H2O for expiration.

B

A patient with a nasal cannula at 5 L/min has skin irritation around the nares and complains of a dry mouth and nose. Which action by the student nurse should be questioned by the nursing instructor? a. Using humidification b. Applying petroleum-based gel to the nares c. Providing frequent oral care d. Asking the physician for an order for sterile nasal saline

B

A patient with pneumonia is receiving supplemental oxygen. Which assessment finding(s) by the nurse should be reported as an early indication of hypoxia? a. Cyanosis around the lips and oral mucosa b. Anxiety and restlessness c. Decrease in the level of consciousness d. Decreased blood pressure and respiratory rate

B

The nurse is caring for several patients postoperatively following abdominal surgery. Which patient will benefit the least from the use of incentive spirometry? a. Middle-aged male with a history of smoking since high school b. Elderly female with type 2 diabetes c. Middle-aged female with a history of chronic respiratory disease d. Adolescent female with atelectasis

B

The nurse is reviewing lab results for a patient with hypoxemia. The nurse is aware that which of the following results may worsen the patient's hypoxemia? (Select all that apply.) a. Low sodium levels b. Low hemoglobin levels c. Increased blood pH d. Decreased blood pH

BC

The patient is on mechanical ventilation. Which actions by the nurse are appropriate? (Select all that apply.) a. Keep the patient in a supine position. b. Note and mark the level of the endotracheal (ET) tube at the lips or nares. c. Have suction equipment available for immediate use. d. Perform mouth care at least twice daily.

BC

The nurse is checking the oxygen flow rate on several patients. All flow meters are set at 2 L/min. The nurse should question this flow rate for which delivery system(s)? (Select all that apply.) a. Nasal cannula b. Simple face mask c. Oxymizer d. Venturi mask

BD

A patient diagnosed with chronic obstructive pulmonary disease (COPD) is on oxygen therapy at 3 L per nasal cannula. Which assessment finding should alert the nurse to a potential problem with this patient? a. Respiratory rate of 26 b. Low carbon dioxide levels c. Arterial oxygen saturation level of 99% d. Lower oxygen saturation levels at night than during the day

C

A patient is planning to perform incentive spirometry after abdominal surgery. The nurse should encourage the patient to do which of the following? a. Get comfortable in a semi-reclined position. b. Inhale as deeply as possible and then exhale into the incentive spirometry device. c. Hold the breath for at least 3 seconds before exhaling. d. Exhale as quickly as possible.

C

A patient on mechanical ventilation has an FiO2 setting of 38%. The nurse is reviewing arterial blood gas results and pulse oximetry readings. The nurse is aware that the desired level of oxygen is which of the following? a. PaO2 greater than 90 mm Hg b. SpO2 greater than 60% c. PaO2 greater than 60 mmHg d. SpO2 greater than 95%

C

A patient with COPD has carbon dioxide retention and is ordered oxygen therapy. The nurse anticipates the use of which oxygen delivery system? a. Face tent b. Face mask c. Nasal cannula d. Nonrebreathing mask

C

A patient with a tracheostomy tube has an order for oxygen. Which action by the nurse is appropriate? a. Apply sterile gloves to connect the oxygen to the tracheostomy tube. b. Check the oxygen tubing frequently to make sure water is present in the tubing. c. Attach the T tube to a humidified oxygen source. d. Monitor the response to oxygen with hourly arterial blood gas levels.

C

The nurse is caring for several patients receiving oxygen by various delivery systems. Which assessment finding by the nurse indicates proper use of the oxygen device? a. No mist is noted in a face tent. b. The reservoir of the rebreathing mask collapses on inhalation. c. The flow rate is between 1 and 6 L/min for a nasal cannula. d. The flow rate for an oxygen hood is set at 3 L/min.

C

The nurse is teaching a patient how to use a flow-oriented incentive spirometer (IS) the night before abdominal surgery. Which statement by the patient indicates an understanding of the procedure? a. "I need to get the balls to the top as quickly as possible." b. "Quick rapid breaths are the most effective when the incentive spirometer is used." c. "I need to keep the balls elevated as long as possible." d. "The balls must be elevated to be effective."

C

A patient will be using a nasal cannula continuously to deliver oxygen at home, and the nurse is instructing the patient and family about important safety guidelines. Which of the following should be included in the teaching plan? (Select all that apply.) a. Smoking is allowed if it is not done in the same room in which the oxygen device is placed. b. If you feel short of breath, increase your oxygen by 2 to 3 L per minute. c. Avoid using an electric razor. d. Keep the oxygen tank at least 5 feet away from the stove.

CD

The nurse is teaching a patient with asthma how to measure peak expiratory flow rate (PEFR). What should be included in the teaching plan? (Select all that apply.) a. Assume a recumbent position before measuring PEFR. b. Take a deep breath in, exhale, then place the mouthpiece in the mouth and form a firm seal with the lips. c. After placing the mouthpiece in the mouth, blow out as hard and as fast as possible through the mouth in only one single breath. d. Measure PEFR 3 times and record the highest number.

CD

A patient has been using continuous positive airway pressure (CPAP), and now the health care provider is recommending bi-level positive airway pressure (BiPAP). The patient is asking the nurse to explain the difference again. Which response is appropriate? a. "CPAP maintains a set positive airway pressure during inspiration only." b. "CPAP opens the airways during inspiration and allows them to close during expiration." c. "BiPAP maintains a set pressure that is the same for inspiration and expiration." d. "BiPAP delivers sufficient expiratory pressure to keep the airways open."

D

A patient is admitted to the emergency department following a motor vehicle accident. The patient is unconscious and has a broken jaw, a broken nose, and facial lacerations. The patient's breath sounds are diminished, and the health care provider suspects atelectasis. Frequent suctioning is required to clear the airway. Oxygen saturation levels range from 70% to 75%. The nurse recognizes that this patient most likely will have which type of ventilatory device ordered? a. CPAP b. BiPAP c. Nasal cannula d. Mechanical ventilation

D

The nurse is caring for a patient on a mechanical ventilator and the low-pressure alarm sounds. Which action by the nurse is most appropriate? a. Assess for secretions in the airway and suction the patient. b. Administer a sedative to the patient to prevent coughing. c. Assess the endotracheal tube cuff to make sure it is deflated. d. Check the ventilator tubing and reconnect if disconnected.

D

The ________, also called a Briggs adaptor, connects an oxygen source to an artificial airway such as an endotracheal tube.

T tube

A condition in which oxygen is insufficient to meet the metabolic demands of the tissues and cells is known as __________________.

hypoxia

In noninvasive ventilation, ________________ keeps the terminal airways (alveoli) partially inflated, reducing the risk for atelectasis.

positive airway pressure

The amount of air inspired and expired with each breath while a patient is on mechanical ventilation is known as the ________________.

tidal volume

A curved oxygen delivery device with an adjustable strap that fits around the patient's neck is known as a _______________.

tracheostomy collar