Chapter 21 Respiratory Care Modalities Review Book Exam 2

The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does in-line suction have for the patient? (Select all that apply.)

- Decreases hypoxemia - Decreases patient anxiety - Sustains positive end expiratory pressure (PEEP)

The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.)

- Hold the breath at the end of inspiration for a few seconds - Cough frequently - Frequently evaluate progress

A patient is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes that the cuff pressure is 25 mm Hg. The nurse is aware of what complications that can be caused by this pressure? (Select all that apply.)

- Tracheal ischemia - Tracheal bleeding - Pressure necrosis

The sigh mechanism on an assist-control ventilator needs to be adjusted to provide _________ sigh(s) per hour at a rate that is 1.5 times the tidal volume.

1-3

A patient has a dry suction water seal connected to a chest tube. When the water seal rises above _______ level, intrathoracic pressure increases.

2 cm

The oxygen flow rate for a nasal cannula should not exceed ______

6 L/min.

Oxygen toxicity may occur when oxygen concentration at greater than 50% is given for __________ (length of time).

>48 hours

A patient with COPD requires oxygen administration. What method of delivery does the nurse know would produce optimal results for this patient?

A Venturi mask

Hypoxemia

A decrease in the arterial oxygen tension in the blood

A patient with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?

A lung volume reduction

A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration?

A partial rebreathing mask

A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor this patient for?

Anemic hypoxia

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned?

Auscultate the lung for adventitious sounds

In many patients with _____________, the stimulus for respiration is a decrease in blood oxygen rather than an elevation in carbon dioxide levels.

COPD

The nurse assesses a patient with a heart rate of 42 bpm and a blood pressure of 70/46 mm HG. What type of hypoxia does the nurse determine this patient is displaying?

Circulatory hypoxia

A patient is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this patient?

Continuous positive airway pressure

The nurse is transporting a patient with chest tubes to a treatment room. The chest tube becomes disconnected and falls between the bed rail. What is the priority action by the nurse?

Cut the contaminated tip of the tube and insert a sterile connector and reattach

Hypoxia

Decrease in oxygen supply to the tissues

For a patient with chronic obstructive pulmonary disease (COPD), what is the stimulus for respiration?

Decreased blood oxygen rather than elevated carbon dioxide levels.

histotoxic

Decreased gas exchange at the cellular level resulting from a toxic substance

Hypoxemic hypoxia

Decreased oxygen level in the blood

The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined?

Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved

List three goals of chest physiotherapy

Dislodge mucus and remove bronchial secretions, improve ventilation, increase the efficiency of the respiratory muscles

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education?

Encourage the patient to take approximately 10 breaths per hour, while awake

The nurse is educating a patient with COPD about the technique for performing pursed lip breathing. What does the nurse inform the patient is the importance of using this technique?

It prolongs exhalation

It is important when a patient is on oxygen to post a __________ to prevent the danger of fire.

No Smoking sign

The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber?

Notify the healthcare provider

A patient with emphysema is placed on continuous oxygen at 2 L/min at home. Why is it important for the nurse to educate the patient and family that they must have No Smoking signs placed on the doors?

Oxygen supports combustion

A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the patient reports tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What condition should the nurse suspect?

Oxygen toxicity

The nurse is admitting a patient with chronic obstructive pulmonary disorder (COPD). The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?

PaO2

Anemic hypoxia

Result of decreased effective hemoglobin concentration

Circulatory hypoxia

Results from inadequate capillary circulation

A patient in the process of being weaned from the ventilator will have a ________ connected to the endotracheal tube.

T-piece

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient?

The patient is hypoxic from suctioning

A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the healthcare provider will take now that the patient has been intubated for this length of time?

The patient will have an insertion of a tracheostomy tube

Histotoxic hypoxia

Toxic substance interferes with the ability of tissues to use oxygen.

A patient will require a ____________, which is the most reliable and accurate method of delivery, when a precise concentration of oxygen is required.

Venturi mask

Oxygen transport to the tissues is dependent on four factors:

cardiac output, arterial oxygen content, hemoglobin concentration, metabolic requirements

Hypoxemia usually leads to _______, a decrease in oxygen supply to the tissues.

hypoxia

Positive pressure ventilators work by

inflate the lungs by exerting pressure on the airway, pushing air in, forcing the alveoli to expand during inspiration

A ____________ is used when a patient requires a low to medium concentration of oxygen for which precise accuracy is not essential.

nasal cannula

pneumonectomy

thoracic surgery in which an entire lung is removed

Antioxidants such as ____________________________ may help defend against oxygen-free radicals.

vitamin E, vitamin C and beta carotene