Pulmonary Part 1
The nurse notes that the patient's tracheostomy cuff requires increasing amounts of air to maintain the seal and observes food particles in the tracheal secretions. Which tracheal complication would the nurse suspect? 1 Dilation 2 Infection 3 Stenosis 4 Obstruction
A
Which action would the nurse include in the procedure for suctioning a tracheostomy? 1 Preoxygenate for 30 seconds to 3 minutes before suctioning. 2 Suction for at least 30 seconds to maximize secretion removal. 3 Apply suction during catheter insertion and withdrawal. 4 Tell the patient not to cough during suctioning.
A
Which action would the nurse plan to include in the care of a patient with a recently placed tracheostomy who is on a mechanical ventilator? 1 The pilot balloon should remain inflated. 2 A cuffed tube protects against aspiration. 3 A noncuffed tracheostomy tube is used. 4 The inner cannula is left out of the tube.
A
Which action would the nurse take if a patient develops bradycardia during tracheal suctioning? 1 Administer 100% oxygen by bag-valve-mask. 2 Continue suctioning as quickly as possible. 3 Ask the patient to hold his or her breath and then cough. 4 Administer a bronchodilator using a small particle nebulizer.
A
patient has just arrived in the postanesthesia care unit (PACU) after a successful tracheostomy procedure. Which action would the nurse take first? 1 Suction as needed. 2 Listen to lung sounds. 3 Change the tracheostomy dressing as needed. 4 Clean the tracheostomy inner cannula and stoma.
B
Which finding indicates tube obstruction in a patient with tracheostomy? 1 Quiet respirations 2 Thick, wet secretions 3 Difficulty breathing 4 Lower peak pressures
C
Which goal is a purpose of oxygen therapy? 1 To cure the condition 2 To stop the disease process 3 To provide an acceptable blood oxygen level 4 To use the highest fraction of inspired oxygen
C
Which factor is a sign of tracheoesophageal fistula (TEF)? 1 Increased coughing and choking while eating 2 Clear and thin tracheal secretions 3 Receiving the set tidal volume on the ventilator 4 Decreasing air in the cuff needed to achieve a seal
A
The nurse is caring for a patient the day after tracheostomy placement and notes new swelling around the tube. When gently palpating the area, the nurse feels a crackling sensation. Which action would the nurse take? 1 Notify the health care provider immediately. 2 Apply an occlusive pressure dressing around the tube. 3 Re-evaluate in 2 hours because this is normal after surgery. 4 Ensure that the tracheostomy tube is well-secured without tension.
A
The nurse is teaching a patient with a tracheostomy who is to be discharged about home tracheostomy management. Which statement by the patient indicates that further instruction may be needed? 1 "I should sleep in a room with a dehumidifier." 2 "I should not lie down within 30 minutes after eating." 3 "If I notice white spots in my mouth, I should call my health care provider." 4 "I will change the tracheostomy holder at least once daily."
A
A chest x-ray is prescribed for an ambulatory patient receiving nasal oxygen. Which action would the nurse take when personnel arrive to transport the patient? 1 Ensure that portable oxygen is in place before the patient leaves for radiology. 2 Turn the oxygen rate up briefly before disconnecting it during the transport. 3 Call radiology and request that a portable chest x-ray be done at the bedside. 4 Turn the oxygen off and then resume it immediately upon the patient's return.
A
A patient admitted to the emergency department with facial burns and smoke inhalation requires high-flow oxygen therapy. Which oxygen delivery device would the nurse apply? 1 Face tent 2 Venturi mask 3 Nasal cannula 4 Nonrebreather mask
A
A patient has a pulse oximetry level of 96% and a respiratory rate of 14 breaths/min. Oxygen is being delivered via a simple facemask at a flow rate of 4 L/min. Which action would the nurse take? Correct1 Increase the oxygen flow rate to 5 L/min and review the health care provider's orders. 2 Assess the patient at 30- to 60-minute intervals for evaluation of oxygenation status. 3 Suggest that the patient sit up straight and take several deep, slow breaths. Incorrect4 Request an order to decrease the mask flow rate to wean the patient from oxygen.
A
After surgical placement of a tracheostomy tube, which method is recommended to verify correct placement? 1 Chest x-ray 2 Bronchoscopy 3 Symmetrical chest expansion 4 Auscultation of bilateral lung sounds
A
Which mode of oxygen delivery is recommended for a patient with facial burns? 1 Face tent 2 Venturi mask 3 Nasal cannula 4 Simple facemask
A
Which outcome is the purpose of removing the inner cannula from a fenestrated tracheostomy tube? 1 The patient will be able to speak. 2 The patient is able to swallow small sips of water. 3 The patient's full neck range of motion will be restored. 4 The patient will be weaned from the tracheostomy.
A
Which technique or action would the nurse use to prevent a tracheoesophageal fistula (TEF) in a patient after a tracheostomy has been performed? 1 Maintain proper cuff pressure. 2 Manually administer oxygen by mask. 3 Prevent pulling or tugging on the tube. 4 Apply direct pressure to the stoma site.
A
Which value indicates clinical hypoxemia? 1 Partial pressure of arterial oxygen (Pao2) of 50 mm Hg 2 Partial pressure of arterial carbon dioxide (PaCo2) of 30 mm Hg 3 Hemoglobin of 22 g/dL 4 Oxygen saturation of 90%
A
Which concern would be included in the plan of care after a patient returns from surgery with a new tracheostomy? Select all that apply. One, some, or all responses may be correct. 1 Tube obstruction 2 Tube dislodgement 3 Accidental decannulation 4 Securing the endotracheal tube 5 Plugging the tube for communication
A, B, C
Which condition may result from vagal stimulation during tracheal suctioning? Select all that apply. One, some, or all responses may be correct. 1 Asystole 2 Heart block 3 Bradycardia 4 Hypertension 5 Mucosal injury
A, B, C
Which information would the nurse include when teaching a patient about home care after a tracheostomy? Select all that apply. One, some, or all responses may be correct. 1 "Clean the stoma regularly." 2 "Wear a shower shield." 3 "Wear a medical alert bracelet." 4 "Maintain low humidity in the home." 5 "Avoid covering the opening of the stoma."
A, B, C
Which respiratory device can be used to provide a patient with an 80% fraction of inspired oxygen (Fio2)? Select all that apply. One, some, or all responses may be correct. 1 Face tent 2 Aerosol mask 3 T-piece 4 Venturi mask 5 Simple mask
A, B, C
Which information would the nurse include when instructing a patient about safe practice for home oxygen therapy? Select all that apply. One, some, or all responses may be correct. 1 Exercising safety precautions 2 Maintaining equipment 3 Explaining the equipment needed 4 Cleaning the oxygen device 5 Traveling outside the home
A, B, C, D, E
Which action helps to prevent tracheostomy decannulation during tie replacement? Select all that apply. One, some, or all responses may be correct. 1 Always have a co-worker assist with the procedure. 2 Do not remove the old ties until the new ones are in place. 3 Give the patient a cough suppressant to prevent coughing. 4 Hold the tracheostomy tube in place with one hand during the process. 5 Know the tracheostomy tube size and type if replacement is necessary.
A, B, D
Which statement by a student nurse demonstrates understanding about how to use a simple facemask for oxygen delivery? Select all that apply. One, some, or all responses may be correct. 1 "Monitor the patient closely for aspiration." 2 "Provide skin care to the area covered by the mask." 3 "The mask should fit loosely near the nose and mouth." 4 "Patients with claustrophobia may need emotional support to tolerate the device." 5 "I can ask the provider to prescribe a nasal cannula for use during meals."
A, B, D, E
Which criterion does Medicare use to cover the cost of home oxygen therapy for a patient? Select all that apply. One, some, or all responses may be correct. 1 Arterial oxygen saturation of less than 88% on room air 2 Arterial oxygen saturation of less than 90% during exercise 3 Partial pressure of arterial oxygen level of less than 55 mm Hg 4 Partial pressure of arterial oxygen level of less than 65 mm Hg when nonpulmonary problems cause the hypoxemia 5 Arterial oxygen saturation of less than 90% when oxygen is needed only during the night
A, C
Which finding may indicate that a tracheostomy tube is obstructed? Select all that apply. One, some, or all responses may be correct. 1 Dyspnea 2 Bradypnea 3 Noisy respirations 4 Edema around the stoma 5 Asymmetrical chest movement 6 Difficulty inserting a suction catheter
A, C, F
Which factor may cause hypoxia in a patient with tracheostomy? Select all that apply. One, some, or all responses may be correct. 1 Frequent suctioning 2 Use of 14 Fr catheter 3 Limited suctioning time 4 Excessive suction pressure 5 Ineffective oxygenation before suctioning
A, D, E
A patient has a fenestrated tracheostomy tube in place. Which multidisciplinary team member would be involved in the discharge planning process, specific to the tracheostomy? 1 Physical therapist 2 Speech therapist 3 Occupational therapist 4 Patient care assistant
B
A patient with respiratory failure who has been intubated and placed on a ventilator requires 100% oxygen delivery to maintain adequate oxygenation. Twenty-four hours later, the nurse notes new-onset crackles and decreased breath sounds, and the most recent arterial blood gases (ABGs) show a partial pressure of arterial oxygen (PaO2) level of 95 mm Hg. Which conclusion would the nurse reach? 1 The patient has oxygen toxicity. 2 The patient has absorption atelectasis. 3 The patient needs an increased percentage of oxygen. 4 The patient is ready for extubation.
B
A patient's heart rate increases to 98 beats/min and oxygen saturation decreases to 88% during tracheostomy suctioning. Which action would the nurse take? 1 Continue suctioning to fully clear the airway of secretions. 2 Reoxygenate the patient with a 100% oxygen delivery system. 3 Instill normal saline into the tracheostomy before resuming suctioning. 4 Ask the patient to take three or four deep breaths before resuming suctioning.
B
For which reason would the nurse use caution in providing supplemental oxygen for the patient with hypercarbia? 1 Higher levels of arterial oxygen impair cellular gas exchange. 2 A lower arterial oxygen level provides the stimulus to breathe. 3 Carbon dioxide has a greater affinity to bind with hemoglobin than oxygen. 4 The patient with hypercarbia is no longer sensitive to changing levels of arterial oxygen.
B
Immediately after having a tracheostomy tube removed by the health care provider, the patient begins to cough and has difficulty breathing, talking, and clearing secretions. Which procedure would the nurse anticipate being performed? 1 Reintubation 2 Tracheal dilation 3 Insertion of an oral airway 4 Placement of a nasogastric tube
B
The nurse is discharging a patient with a prescription for continuous oxygen therapy via nasal cannula at home. Which information would the nurse include in the discharge teaching? 1 Complete mouth care daily. 2 Pad the tubing behind the ears. 3 No family members may smoke within 3 feet of the patient. 4 Petroleum jelly may be applied to dry nostrils and chapped lips.
B
The older-adult patient with degenerative arthritis is admitted for tracheostomy surgery. Which communication method would the nurse recommend for this patient during the postoperative period? 1 Magic Slate 2 Picture board 3 Pen and paper 4 Computer keyboard
B
Which action would the nurse take when suctioning a tracheostomy or endotracheal tube? Select all that apply. One, some, or all responses may be correct. 1 Not suctioning longer than 20 seconds 2 If needed, repeating suctioning up to three passes 3 When suctioning, using a gentle twirling motion of the catheter 4 Adjusting the pressure dial on the suction source to 140 to 160 mm Hg 5 Applying suction while quickly inserting the catheter and slowly removing it 6 Preoxygenating the patient with 100% oxygen before suctioning
B, C, F
Which laboratory test would the nurse monitor to determine a patient's ability to oxygenate? Select all that apply. One, some, or all responses may be correct. 1 Serum magnesium 2 Arterial blood gases 3 White blood cell count 4 Hemoglobin and hematocrit 5 Partial thromboplastin time (PTT)
B, D
A patient is to receive oxygen therapy at home by nasal cannula. Which information would the nurse provide to the patient? Select all that apply. One, some, or all responses may be correct. 1 Complete mouth care daily. 2 Lubricate the nostrils with water-soluble jelly. 3 Cleanse the skin under the tubing and straps daily. 4 Do not smoke or use lit candles or matches in the immediate area. 5 Cleanse the cannula by rinsing with clear warm water.
B, D, E
Which factor would the nurse consider when determining the type of oxygen delivery system for a patient? Select all that apply. One, some, or all responses may be correct. 1 Patient mobility 2 Need for humidification 3 Patient body temperature 4 Oxygen concentration required by the patient 5 Oxygen concentration achieved by a delivery system
B, D, E
The nurse is performing stoma care on a tracheostomy placed 24 hours ago. While replacing the ties, the patient becomes agitated and moves unexpectedly, causing the tube to come out. Which action would the nurse take? Select all that apply. One, some, or all responses may be correct. 1 Insert a nasal airway. 2 Call the Rapid Response Team. 3 Provide 100% oxygen via a nonrebreather mask. 4 Attempt to place the tracheostomy tube back into the surgical stoma. 5 Ventilate the patient using a manual resuscitation bag with facemask.
B, E
Which factor would be considered when determining the type of oxygen that a patient will require for home oxygen therapy? Select all that apply. One, some, or all responses may be correct. 1 There are young children living in the home with the patient. 2 Liquid oxygen is available in lightweight, easy-to-carry containers. 3 There are smokers in the family living in the house with the patient. 4 An oxygen concentrator is noisy and big and requires refilling for use. 5 Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks.
B, E
A patient has been receiving 60% oxygen by simple facemask since admission 3 days ago. Which finding alerts the nurse to an early stage of oxygen toxicity? Select all that apply. One, some, or all responses may be correct. 1 Hemoptysis 2 Chest pain 3 Bradycardia 4 High-grade fever 5 Nonproductive cough 6 GI upset
B, E, F
A patient is wearing a nonrebreather mask prescribed to deliver 95% fraction of inspired oxygen (Fio2). Which condition must be met to ensure that this concentration is delivered? Select all that apply. One, some, or all responses may be correct. 1 Oxygen flow rate should be set at 6 to 11 L/min. 2 Oxygen flow rate should be set at 10 to 15 L/min. 3 The reservoir bag should deflate completely during inhalation. 4 Flaps should be removed to allow exhaled air to mix in the reservoir. 5 Dial on the adapter is on the highest setting to deliver the prescribed Fio2. 6 A one-way valve between the mask and reservoir should open during inhalation.
B, F
A patient has developed subcutaneous emphysema after surgery for a tracheostomy. Which situation explains why the nurse would notify the health care provider immediately? 1 Bleeding has occurred related to the surgical incision; hemoglobin is low. 2 Ventilator pressures are too high, forcing air into tissue, and must be lowered. 3 An opening or tear in the trachea is allowing air leakage into the tissues. 4 The patient has a pneumothorax and will require a chest tube for decompression.
C
A patient is scheduled to undergo insertion of a catheter for transtracheal oxygen (TTO) therapy. Which statement by the patient indicates a need for further teaching about the procedure? 1 "I may be able to use less oxygen with this device." 2 "I will have local anesthesia for this procedure." 3 "I can use this method only when I am at home." 4 "I'll need to adjust the flow rate for rest and activity.
C
A patient who has a do-not-resuscitate (DNR) order is using a nonrebreather oxygen mask, and breathing appears to be labored. Which action would the nurse take first? 1 Notify the chaplain and the family member of record. 2 Auscultate the patient's lungs. 3 Ensure that the tubing is patent and that oxygen flow is high. 4 Confirm that signed DNR orders are in the chart.
C
A patient who has a long-term tracheostomy tube in place communicates frustration to the nurse about not being able to talk. Which response would the nurse provide? 1 "You may never be able to speak again." 2 "Cuffed tracheostomy tubes are necessary." 3 "A fenestrated tube can be used to facilitate talking." 4 "Until the tube is out, you will not be able to speak."
C
A patient who has thick, sticky respiratory secretions requires high-flow, humidified oxygen delivery. Which oxygen delivery equipment would the nurse use for this patient? 1 Face tent 2 Venturi mask 3 Aerosol mask 4 Nonrebreather mask
C
Which information about oxygen administration would the nurse explain to a patient who has severe heart failure? 1 Oxygen levels are dangerously low because heart failure causes hypercarbia. 2 Oxygen will not cure heart failure; therefore oxygen is not indicated. 3 Oxygen administration will decrease the work of the heart to deliver oxygen to vital organs. 4 Oxygen administration is not needed; the body can adapt with an increase in red blood cells.
C
Which device is used in a low-flow oxygen delivery system? Select all that apply. One, some, or all responses may be correct. 1 Venturi mask 2 Aerosol mask 3 Simple facemask 4 T-piece apparatus 5 Nonrebreather mask
C, E
A patient who has experienced a panic attack is being transferred to the medical-surgical ward. The transfer nurse reports that the patient is doing much better after receiving a small dose of oral diazepam 4 hours ago in the emergency department. Vital signs are stable with oxygen delivered at 2 L/min via simple facemask. Which information explains why this patient is at high risk for subsequent respiratory distress? 1 The patient has a mental health disorder. 2 The patient received a dose of diazepam. 3 The patient is not being treated for asthma. 4 The patient is receiving oxygen at 2 L/min.
D
A patient who is concerned about getting a tracheostomy says, "I will be ugly with a hole in my neck." Which response would the nurse make? 1 "It won't take you long to learn to manage." 2 "But you know you need this to breathe, right?" 3 "Your family and friends probably won't even care." 4 "Could you place a scarf or a loose collar over it?"
D
Which condition would the nurse suspect is developing if a patient's tracheostomy tube is pulsating in synchrony with the heartbeat? 1 Tracheomalacia 2 Tracheal stenosis 3 Tracheoesophageal fistula (TEF) 4 Trachea-innominate artery fistula
D
While performing care for a patient who had a tracheostomy placed 24 hours ago, the tube is accidentally dislodged. Which action would the nurse take? 1 Attempt to replace the tube. 2 Assess vital signs including respiratory rate. 3 Assess for bilateral breath sounds. 4 Ventilate with a resuscitation bag and mask.
D
Which patient condition indicates a need for low-flow oxygen delivery? 1 Acute hypoxia 2 Chronic hypoxia 3 Acute hypercarbia 4 Chronic hypercarbia
D
A patient with a cuffed fenestrated tracheostomy tube has been speaking well when the decannulation cap is in place. While visiting, the family alerts the nurse that the patient is having difficulty breathing. Which action would the nurse take first? 1 Verifying the cuff is deflated 2 Removing the decannulation cap 3 Calling the health care provider 4 Auscultating the breath sounds
A
A patient with pneumonia who has been receiving oxygen 60% for 2 days has had dyspnea when getting to a chair and a nonproductive cough. The patient now reports chest pain below the sternum and GI upset. Which initial action would the nurse take? 1 Request an order for arterial blood gases. 2 Increase the oxygen to 70%. 3 Contact the health care provider to report the findings. 4 Notify the Rapid Response Team immediately.
C
A patient with a tracheostomy experiences increased coughing and choking while receiving feedings via a nasogastric tube. The tracheostomy cuff requires increasing amounts of air to maintain the seal and food particles are present in the suctioned tracheal secretions. After notifying the health care provider of these observations, which procedure would the nurse anticipate will be performed? 1 Placement of a jejunostomy tube 2 Tracheal dilatation in the operating room 3 Insertion of a fenestrated tracheostomy tube 4 Reintubation with a larger tracheostomy tube
A
In which instance is treatment with continuous positive airway pressure (CPAP) considered less effective? 1 Atelectasis after surgery 2 Cardiac-induced pulmonary edema 3 Respiratory failure after extubation 4 Chronic obstructive pulmonary disease (COPD)
C
A patient with a tracheostomy has been weaned from the mechanical ventilator and now has a decannulation cap over the end of the tracheostomy tube. Which finding would the nurse expect when assessing the patient? 1 The pilot balloon is flat. 2 The tracheostomy cuff is inflated. 3 A tracheostomy collar is providing humidified oxygen. 4 Tracheostomy ties have been removed.
A
A patient with a new tracheostomy has a soiled dressing. What action would the nurse take? 1 Reinforce the dressing with sterile 4 × 4 gauze. 2 Replace the dressing with clean, folded 4 × 4 gauze. 3 Replace the dressing with sterile, folded 4 × 4 gauze. 4 Cut sterile 4 × 4 gauze to fit around the tracheostomy tube
C
A patient with an endotracheal tube airway is receiving oxygen. The nurse notes that a humidifier bottle between the oxygen source and the patient is half-full of sterile water and that the water is bubbling. Which action would the nurse take? 1 Change the humidification device to a heated nebulizer. 2 Add water to the humidifier bottle until the water stops bubbling. 3 Remove the humidification device to minimize the risk for infection. 4 Increase the oxygen flow to ensure adequate humidification.
A
A sedated patient with a new tracheostomy has noisy respirations and the ventilator alarms indicate high peak pressures. Which action would the nurse take? 1 Suction the patient. 2 Increase oxygenation. 3 Humidify the oxygen source. 4 Remove the inner cannula.
A
An older-adult patient is being discharged home with a tracheostomy. Which task could the nurse delegate to an experienced licensed practical nurse/licensed vocational nurse (LPN/LVN)? 1 Suction the tracheostomy using sterile technique. 2 Complete the referral form for a home health agency. 3 Teach the patient and spouse about tracheostomy care. 4 Consult with the health care provider about using a fenestrated tube.
A
Which oral hygiene product would the nurse recommend for a patient with a tracheostomy? 1 Glycerin swabs 2 Normal saline rinses 3 Hydrogen peroxide solutions 4 Mouthwash containing alcohol
B
A patient with chronic obstructive pulmonary disorder (COPD) who has been receiving oxygen via nasal cannula is becoming increasingly dyspneic with increased use of accessory muscles to breathe. The nurse auscultates markedly diminished breath sounds in all lung fields. Which oxygen delivery method would the nurse recommend that the provider prescribe? 1 Venturi mask 2 Transtracheal oxygen catheter 3 Noninvasive positive-pressure ventilation (NPPV) 4 Face tent
C
Which intervention would the nurse include in the plan of care for a patient receiving oxygen at 5 L/min per nasal cannula? 1 Clean the nasal cannula every 4 hours. 2 Elevate the head of the bed 45 degrees. 3 Continuously monitor O2 saturation with a pulse oximeter. 4 Ensure that oxygen bubbles through the water in the humidifier.
D
A patient is being discharged home with a tracheostomy. Which statement by the patient indicates the need for further teaching about correct tracheostomy care? 1 "I can take baths but no showers." 2 "I will have to learn to suction myself." 3 "I should put cotton cloth or foam over the tracheostomy hole." 4 "I can put normal saline in my tracheostomy to liquefy the secretions."
A
Which action would the nurse plan to use when preparing to suction a patient who is intubated on a mechanical ventilator? Select all that apply. One, some, or all responses may be correct. 1 Wear protective eyewear. 2 Maintain Standard Precautions. 3 Preoxygenate the patient with 100% oxygen. 4 Quickly insert the catheter while activating the suction. 5 Never suction longer than 10 to 15 seconds. 6 Repeat suctioning passes the tube until no secretions are obtained.
A, B, C, E
Which intervention would the nurse use to prevent hypoxia during suctioning in the patient with a tracheostomy? Select all that apply. One, some, or all responses may be correct. 1 Monitoring the heart rate 2 Monitoring the temperature 3 Monitoring the respiratory rate 4 Hyperoxygenating the patient with 100% oxygen 5 Having the patient take deep breaths before suctioning
A, D, E
When planning the care of a patient with a tracheostomy, which intervention would the nurse include? Select all that apply. One, some, or all responses may be correct. 1 Encourage ambulation and out-of-bed activities. 2 Use lemon glycerin swabs to provide oral hygiene. 3 If the patient is bedridden, turn and reposition every 4 to 6 hours. 4 Mix equal parts of hydrogen peroxide and water to use as a mouthwash. 5 Use a sponge tooth cleaner or soft toothbrush moistened in water for oral hygiene.
A, E
Which principle would the nurse apply to planning care for a patient receiving supplemental oxygen? Select all that apply. One, some, or all responses may be correct. 1 Nitrogen helps prevent alveolar collapse because it does not cross over capillary membranes. 2 When a patient experiences air hunger, increasing the partial pressure of arterial carbon dioxide (PaCo2) improves the balance. 3 It is important to keep the patient's partial pressure of arterial oxygen (Pao2) above 90 mm Hg for optimal outcomes. 4 Oxygen is harmless; it is part of what we breathe normally, and toxicity is not possible. 5 High levels of oxygen dilute the nitrogen in the lungs and lead to alveolar collapse.
A, E
The nurse is assisting a patient with a tracheostomy to eat. Which action would the nurse take to help the patient avoid aspiration? 1 Offer fluids using a straw and avoid giving thickened fluids. 2 Elevate the head of the bed for at least 30 minutes after eating. 3 Encourage the patient to avoid swallowing between bites of food. 4 Increase the pressure in the tracheostomy cuff to block food particles.
B
Which action would the nurse plan when caring for a patient who is using a nonrebreather mask? 1 Assessment of the patency of both of the nostrils 2 Frequent verification that the oxygen source is functioning 3 Close monitoring to assess for patient feelings of claustrophobia 4 Regular tightening of the mask for a secure fit over the nose and mouth
B
Which action would the nurse take when providing wound care for a patient during the first few days after tracheostomy placement? 1 Applying Steri-Strips to secure the tube 2 Folding standard gauze 4 × 4s to fit around the tube 3 Cutting a slit in standard gauze 4 × 4s for ease of placement around tube 4 Assessing the stoma site every 24 hours for drainage, redness, and swelling
B
Which condition increases oxygen demand? 1 Anemia 2 Fever 3 Heart failure 4 Poisoning
B
Which information would the nurse include when teaching the patient with a new tracheostomy about preventing aspiration? 1 Raise the head of the bed 30 degrees when eating. 2 Thicken liquids, including water. 3 When swallowing, raise the chin as though looking at the ceiling. 4 If not already inflated, inflate the tube cuff when eating or drinking.
B
Which patient would the nurse plan to assess most frequently? 1 A middle-age patient who was admitted yesterday with pneumonia and is receiving oxygen at 2 L/min through a nasal cannula 2 An older-adult patient admitted 2 hours ago with emphysema and dyspnea who has a 45-year smoking history and is receiving 50% oxygen through a Venturi mask 3 A young patient who has had a tracheostomy for 1 week is on room air with saturated peripheral oxygen O2 (Spo2) at 98%, and has been receiving antibiotic therapy for 24 hours 4 An older-adult patient anxious to go home with a new tank of oxygen and supply of nasal cannulas and is being discharged with a new prescription for home oxygen therapy
B
Which prescription for oxygen delivery would the nurse question? 1 36% O2 by Venturi mask 2 48% O2 by nasal cannula 3 50% O2 by simple facemask 4 100% O2 by nonrebreather mask
B
Which principle should guide the nurse's decision regarding oral care for a patient with a tracheostomy during the first 24 hours postoperative? 1 Providing oral care may damage the tracheostomy stoma. 2 Oral care is indicated to decrease the accumulation of organisms. 3 If the patient is not taking oral nutrition, it is not a concern at this time. 4 Oral care is not indicated if the patient is being suctioned on a regular basis.
B
hich patient statement about an oxygen concentrator indicates teaching has been effective? 1 "It provides a flow of 100% oxygen." 2 "It does not require refilling with liquid oxygen." 3 "It is more portable than the compressed gas tank." 4 "It is safe around candles and other open flames."
B
Which mechanism would the nurse expect to be prescribed for a patient who has sleep apnea? 1 Venturi mask 2 Tracheostomy collar 3 Transtracheal oxygen therapy 4 Noninvasive positive-pressure ventilation
D
Which intervention would the nurse include when providing low-flow oxygen to a hospitalized patient through a nasal cannula? Select all that apply. One, some, or all responses may be correct. 1 Teach how to change oxygen tanks. 2 Assess the patency of the nostrils. 3 Ensure secure fitting of the prongs. 4 Apply water-soluble jelly to nares. 5 Verify the setting on the oxygen regulator.
B, C, D, E
A patient with sleep apnea has a new prescription for a bilevel positive airway pressure (BiPAP) device to be worn at night. Which information would the nurse include in teaching this patient? Select all that apply. One, some, or all responses may be correct. 1 The BiPAP device delivers only room air. 2 The mask must fit tightly to form a proper seal. 3 BiPAP provides the same pressure during inhalation and exhalation. 4 BiPAP provides positive pressure during inhalation and exhalation to keep alveoli open. 5 BiPAP improves airflow during sleep and reduces dyspnea.
B, D, E
A registered nurse is educating students about precautions to prevent aspiration during swallowing in patients with tracheostomy tubes. Which nursing student statement indicates a need for further teaching? Select all that apply. One, some, or all responses may be correct. 1 "I'll avoid giving fruit to the patient." 2 "I'll give water and other 'thin' liquids to the patient." 3 "I'll provide smaller and more frequent meals for the patient." 4 "I'll position the patient in the most relaxed position possible." 5 "I'll avoid serving meals to the patient when the patient is fatigued." 6 "I'll assist the patient in turning in bed at regular intervals."
B, D, E
Which nursing intervention will reduce the risk for aspiration in a patient with a tracheostomy? Select all that apply. One, some, or all responses may be correct. 1 Encourage water with meals. 2 Provide small, frequent meals. 3 Encourage frequent sipping from a cup. 4 Inflate the tracheostomy cuff during meals. 5 Maintain the patient upright for 30 minutes after eating. 6 Teach the patient to "tuck" the chin down in the forward position to swallow.
B, E, F
Which medical emergency can lead to a life-threatening situation? 1 Tracheomalacia 2 Tracheal stenosis 3 Tracheoesophageal fistula (TEF) 4 Trachea-innominate artery fistula
D
The health team plans to wean a patient from a tracheostomy. Several hours after capping the tracheostomy tube, the nurse assesses the patient and observes a heart rate of 90 beats/min, respirations of 22 breaths/min, and an oxygen saturation of 94%. The patient has a productive cough and expresses anxiety about weaning. Which action would the nurse take? 1 Suction the patient and recap the tube. 2 Recap the tube and reassess the patient in 15 minutes. 3 Reassure the patient that everything is normal. 4 Notify the health care provider that the patient is not ready to wean.
C
The patient with a tracheostomy who is using a T-piece mask reports a feeling of suffocation to the nurse. Which action would the nurse complete first to provide relief to the patient? 1 Empty condensation from the tubing. 2 Make sure that the humidifier creates enough mist. 3 Check that the exhalation port is open and uncovered. 4 Position the T-piece so that it does not pull on the tracheostomy.
C
When providing suctioning through an endotracheal or tracheostomy tube, which finding would alert the nurse to stop suctioning? 1 The patient's heart rate increases from 72 to 78 beats/min. 2 The patient coughs uncontrollably during suctioning. 3 Oxygen saturation by pulse oximetry is less than 90%. 4 Secretions are thick and occluding the suction catheter.
C
Which action would the nurse plan to take for an older patient with a tracheostomy who is receiving mechanical ventilation? 1 Provide warm, humidified air, and suction the tube hourly. 2 Cut 4 × 4 gauze pads to place around the stoma site. 3 Keep the pressure on the tracheal tube cuff between 14 and 20 mm Hg. 4 Change the tracheostomy tube dressing and reposition the tube every 4 hours.
C
Which action would the nurse suggest to a patient with a tracheostomy to prevent aspiration? 1 Hold the head high when swallowing. 2 Consume consecutive swallows of liquids. 3 Thicken all liquids to increase consistency. 4 Include moisture-producing fruits in the diet.
C
Which action would the nurse take to prevent accidental decannulation when performing tracheostomy care? 1 Assessing for skin breakdown 2 Replacing the disposable cannula 3 Securing new ties before removing the old ones 4 Cleaning the stoma with half-strength hydrogen peroxide
C
Which device is an example of a low-flow oxygen delivery system used for long-term therapy? 1 T-piece 2 Face tent 3 A nasal cannula 4 Simple facemask
C
Which factor increases the risk for aspiration with a tracheostomy tube in place? 1 Capping the tracheostomy tube for speaking 2 Amount of xerostomia experienced by the patient 3 The balloon interfering with food passage in the esophagus 4 Increased length of time tracheostomy tube has been in place
C
Which information helps evaluate the adequacy of a patient's oxygenation? 1 Fraction of inspired oxygen (Fio2) 2 Positive end-expiratory pressure (PEEP) 3 Partial pressure of arterial oxygen (Pao2) 4 The patient's acceptance of the continuous positive airway pressure (CPAP) machine
C
Which information would the nurse include in the discharge teaching of a patient with a laryngectomy and tracheostomy? 1 Cover the airway loosely with plastic wrap when showering. 2 Use a dehumidifier in the home if secretions become excessive. 3 Wear a loose-fitting scarf or decorative collar if you would like to minimize the appearance of the tube. 4 When coughing, place a finger over the tracheostomy to expectorate secretions through the mouth.
C
Which oxygen delivery equipment could provide a fraction of inspired oxygen (Fio2) greater than 80%? 1 Simple facemask 2 Venturi mask 3 Nonrebreather mask 4 Partial rebreather mask
C
Which tracheostomy cuff pressure would the nurse maintain to prevent mucosal ischemia or air leakage? 1 0 to 6 mm Hg 2 8 to 12 mm Hg 3 14 to 20 mm Hg 4 22 to 28 mm Hg
C
Which oxygen device is also likely to increase ventilation? 1 Nasal cannula 2 Simple facemask 3 Partial rebreather mask 4 Continuous positive airway pressure mask (CPAP)
D
A patient receiving oxygen via nasal cannula at a rate of 4 L/min reports irritation of the nose, and the nurse notes dry, reddened nostrils. Which action would the nurse take? 1 Lower the oxygen flow rate to 2 L/min. 2 Change the nasal cannula to a facemask. 3 Apply petrolatum ointment to the patient's nostrils. 4 Notify the respiratory therapist to add humidification.
D
A patient who smokes cigarettes is being discharged home on oxygen. The patient states, "My lungs are already damaged, so I'm not going to quit smoking." Which response would the nurse provide? 1 "It's never too late to quit." 2 "You can quit when you are ready." 3 "Just turn off your oxygen when you smoke." 4 "Let's talk about why smoking around oxygen is dangerous."
D
A patient with chronic obstructive pulmonary disease (COPD) is exhibiting increasing air hunger while receiving oxygen via nasal cannula at a flow rate of 2 L/min. Which treatment option would the nurse discuss with the provider? 1 Aerosol facemask 2 Venturi mask with oxygen at 4 L/min 3 Intubation and mechanical ventilation 4 Noninvasive positive-pressure ventilation
D
A patient's family is asking about the comparative risks of a ventilator versus noninvasive positive-pressure ventilation (NPPV). Which principle would the nurse consider before responding? 1 A ventilator is always preferred; it will be required if the problem is dyspnea. 2 The positive pressure aspect of NPPV may provide for the patient's current oxygenation needs. 3 The patient may require positive end-expiratory pressure (PEEP) and would need a ventilator to provide that. 4 NPPV should be used only in patients alert enough to protect their airway.
D
A patient's tracheostomy tube has an audible air leak with a cuff pressure of 20 mm Hg. Which action would the nurse take? 1 Inflate the tracheostomy tube cuff to a pressure of 20 to 30 mm Hg. 2 Secure the outer cannula of the tracheostomy with tape. 3 Suction the patient more often to prevent frequent coughing. 4 Contact the health care provider to discuss a larger-diameter tracheostomy tube.
D
The nurse assesses a patient who is receiving oxygen using a partial rebreather facemask at a flow rate of 11 L/min. The patient's oxygen saturation level is 89%. Which action would the nurse take? 1 Obtain arterial blood gases immediately. 2 Notify the Rapid Response Team. 3 Increase the oxygen flow rate to 15 L/min. 4 Ask the provider about prescribing a nonrebreather mask.
D
The nurse is preparing to change a cuffed tube tracheostomy to a fenestrated tracheostomy tube. Which action would the nurse take before cuff deflation? 1 Ask the patient to perform the Valsalva maneuver. 2 Insert an oral airway to prevent airway obstruction. 3 Teach the patient how to use an incentive spirometer. 4 Suction the patient's oropharynx before deflating the cuff.
D
The nurse is suctioning a patient who has a tracheostomy and notes a pulse oximetry reading of 90% during the procedure. Which action would the nurse take? 1 Administer oxygen by simple facemask while suctioning the patient. 2 Change to a larger-diameter tube to facilitate removal of secretions. 3 Encourage the patient to cough to assist with clearance of secretions. 4 Use a manual resuscitation bag to deliver 100% oxygen before resuming.
D
The patient coughs and expels the tracheostomy tube. The nurse inserts a new tracheostomy tube and auscultates the lungs but cannot hear breath sounds. Which action would the nurse take? 1 Apply oxygen via simple facemask. 2 Order a chest x-ray to assess for pneumothorax. 3 Assess for air under the skin around the tracheostomy. 4 Ventilate with a bag-valve-mask and call for the Rapid Response Team.
D
The spouse of a patient who is scheduled for a tracheostomy is expressing concern regarding the surgery's effect on their quality of life. Which action would the nurse focus on preoperatively? 1 Providing information about how to perform emergency resuscitation 2 Emphasizing just getting through the surgery and postoperative period 3 Teaching about the techniques explained previously for tracheostomy care 4 Discussing approaches for the patient to use for communicating
D
