Question 1

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?

Accepted Answer

Petroleum-based gel should not be used around oxygen because it is flammable.If the oxygen flow rate is greater than 4 L/min, humidification should be used.Frequent oral care and sterile nasal saline will help when there is drying of the nasal and oral mucosa.

Question 2

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?

Accepted Answer

In the patient with COPD, high levels of oxygen can extinguish the stimulus to breathe.In the individual with healthy lungs, the chemoreceptors are sensitive to small changes in carbon dioxide levels and effectively regulate ventilation.In patients with COPD who retain carbon dioxide, the chemoreceptors are not sensitive to small changes in carbon dioxide and regulate ventilation poorly.In these patients, it is the change in the oxygen level that stimulates changes in ventilation.Patients with COPD are at risk of retaining carbon dioxide and developing carbon dioxide narcosis induced by administration of high levels of oxygen.Uncontrolled oxygen administration may cause acute hypoventilation and carbon dioxide retention with dire consequences.Arterial oxygen saturation levels should be at 88% to 92% and no higher.Some patients with COPD have normal oxygen levels during the day but oxygen desaturation during sleep.

Question 3

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?

Accepted Answer

The nasal cannula is used with an oxygen flow rate of 1 to 6 L/min.The face tent provides high humidity, and mist is expected.The reservoir of the rebreathing mask remains partially inflated when operating effectively to avoid rebreathing of carbon dioxide.The flow rate for an oxygen hood may be 5 L/min or more to prevent CO₂ narcosis.

Question 4

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?

Accepted Answer

The goal is to keep the balls elevated for as long as possible to ensure maximal sustained inhalation, not to snap the balls to the top of the chamber quickly with a rapid, brief, low-volume breath.Even if very slow inspiration does not elevate the balls, this pattern helps to improve lung expansion.

Question 5

The nurse is caring for a patient on mechanical ventilation.The nurse determines that the endotracheal tube is properly placed by which assessment?

Accepted Answer

Verify placement of the endotracheal tube by auscultating the lungs and assessing chest wall symmetry.This ensures that the tube has not migrated into the right main stem bronchus.Many factors can cause blood pressure fluctuations and fluctuations in respiratory rate.Always assess the patient first.Once the patient is determined to be safe, the settings for the ventilator alarm can be checked as well.

Question 6

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?

Accepted Answer

The low-pressure alarm sounds when the ventilator has no resistance to inflating the lung.The patient may be disconnected from the ventilator, or a leak may have developed in the ventilator circuit.The high-pressure alarm sounds when the ventilator has met resistance to delivery of the tidal volume.This may result from coughing, increased secretions, or biting on the endotracheal tube.The cuff of the endotracheal tube is inflated to create a seal for positive-pressure ventilation.A cuff that is leaking could cause the low-pressure alarm to sound.

Question 7

The nurse is caring for several patients postoperatively following abdominal surgery.Which patient will benefit the least from the use of incentive spirometry?

Accepted Answer

Incentive spirometry (IS) assists the patient in deep breathing.It is used most often following abdominal or thoracic surgery to help reduce the incidence of postoperative pulmonary atelectasis.It is especially beneficial in patients with a history of smoking, pneumonia, chronic respiratory disease, or atelectasis.

Question 8

A patient with COPD has carbon dioxide retention and is ordered oxygen therapy.The nurse anticipates the use of which oxygen delivery system?

Accepted Answer

Oxygen can be delivered via the nasal cannula at flow rates of 1 to 2 L per minute, which deliver 24% to 28% FiO₂ and are useful for patients with chronic lung disease.The face tent is used primarily for humidification and for oxygen only when the patient cannot or will not tolerate a tight-fitting mask.The FiO₂ cannot be controlled, and there is no way to estimate how much oxygen is delivered.The simple face mask is used for short-term oxygen therapy.It fits loosely and delivers oxygen concentrations from 40% to 60%.The mask is contraindicated for patients with carbon dioxide retention because it will make the retention worse.When used as a nonrebreather, the plastic face mask with a reservoir bag delivers 60% to 100% oxygen at appropriate flow rates.This oxygen mask maintains a high-concentration oxygen supply in the reservoir bag.If the bag deflates, the patient breathes in large amounts of exhaled carbon dioxide.

Question 9

A patient is admitted with a diagnosis of COPD and the health care provider orders BiPAP.Which action by the nurse is appropriate?

Accepted Answer

When BiPAP is initiated, especially in patients with underlying COPD, it is important to obtain ABG levels after the first hour and then per agency policy (usually every 2 to 6 hours) during the first day because these patients may retain carbon dioxide.BiPAP initial settings are 10 to 15 cm H?O for inspiratory pressure and 4 to 10 cm H?O for expiratory pressure.It is imperative that the mask have quick-release straps.In the case of an emergency (e.g., vomiting, respiratory arrest), quick-release straps allow the mask to be removed quickly.This system also allows the patient to remove the mask quickly as needed.

Question 10

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.)

Accepted Answer

Cyanosis caused by hypoxia is observed in the oral mucosa, in the conjunctiva of the eye, and around the lips, known as circumoral cyanosis.Nail bed cyanosis may be caused by peripheral vascular disease or cold temperatures.

Question 11

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?

Accepted Answer

A patient on mechanical ventilation ideally has an FiO₂ setting less than 40% to maintain PaO₂ levels greater than 60 mm Hg and SpO₂ levels greater than 90%.

Question 12

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.)

Accepted Answer

Hypoxemia is a deficiency of arterial blood oxygen.Decreased hemoglobin levels reduce the amount of oxygen transported to the cells.Acidemia (decreased blood pH) increases the ability of hemoglobin to release oxygen to the tissues.Alkalemia (increased blood pH) decreases the ability of hemoglobin to release oxygen to the tissues.

Question 13

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?

Accepted Answer

Noninvasive ventilation, including CPAP and BiPAP, is contraindicated in cardiac or respiratory arrest, nonrespiratory organ failure, facial surgery or trauma, inability to protect the airway and/or high risk for aspiration, and inability to clear secretions.A nasal cannula cannot be used with nasal obstruction from a broken nose.

Question 14

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.)

Accepted Answer

Flow rates for a nasal cannula are 1 to 6 L/min, and flow rates for an oxymizer are 1 to 15 L/min, so 2 L/min is appropriate for either device.Flow rates for a simple face mask are 5 to 8 L/min to prevent rebreathing of CO₂.Flow rates for a Venturi mask are 4 to 12 L/min, and a specific rate is necessary to deliver a specific FiO₂.

Question 15

A patient is planning to perform incentive spirometry after abdominal surgery.The nurse should encourage the patient to do which of the following?

Accepted Answer

The patient should hold his breath for at least 3 seconds after inhalation.The patient should be positioned in the most erect position (e.g., high-Fowler's position), if tolerated.This promotes optimal lung expansion during respiratory maneuvers.The patient should exhale completely through the mouth and place the lips around the mouthpiece, and then he should take a slow, deep breath, hold it for at least 3 seconds, and exhale normally.

Question 16

A patient with pneumonia is receiving supplemental oxygen.Which assessment finding(s) by the nurse should be reported as an early indication of hypoxia?

Accepted Answer

Anxiety, confusion, and restlessness are early signs of hypoxia.Cyanosis around the lips and mouth is a sign of hypoxia, but it is a late sign.Decreased level of consciousness, decreased respiratory rate, and decreased blood pressure are also late signs of hypoxia.The respiratory rate will increase as the body attempts to compensate for the decreased level of oxygen.As hypoxia worsens, the respiratory rate may decline.During early stages of hypoxia, blood pressure is elevated unless the condition is caused by shock.

Question 17

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?

Accepted Answer

When used as a nonrebreather, the face mask with a reservoir bag delivers 60% to 90% oxygen at 15 L/min.The simple face mask delivers oxygen concentrations from 40% to 60% when set at 5 to 8 L/min.It is not used at 15 L/min.A Venturi mask delivers oxygen concentrations from 24% to 60% when set at 4 to 12 L/min.It is not used at 15 L/min.An oxygen tent is usually for pediatric use and delivers up to 50% oxygen concentration at 10 to 15 L/min.

Question 18

A patient with a tracheostomy tube has an order for oxygen.Which action by the nurse is appropriate?

Accepted Answer

The T tube connects an oxygen source to an artificial airway such as a tracheostomy tube.Humidification is necessary because the artificial airway bypasses the normal humidification process of the nose and mouth.Clean gloves, not sterile gloves, are used to connect oxygen to the artificial airway.Fluid should be drained from the tubing so that it does not provide a medium for bacterial growth.Hourly ABGs are not the standard for monitoring patients with artificial airways and oxygen.

Question 19

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?

Accepted Answer

BiPAP uses two modes of pressure: one for inspiration and one for expiration.During expiration, BiPAP delivers sufficient pressure to keep the airways open.CPAP maintains a set positive airway pressure during inspiration and expiration.It keeps the airways open and prevents upper airway collapse.

Question 20

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.)

Accepted Answer

Items that create a spark such as an electric razor should not be used while a nasal cannula is in use.Oxygen delivery systems should be at least 5 feet from any heat source.No smoking is allowed on the premises.Oxygen is a medication.Increasing the oxygen liter flow for shortness of breath is similar to doubling heart, asthma, or other medications.

Quiz 23: Oxygen Therapy

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 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?

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?

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?

The nurse is caring for a patient on mechanical ventilation.The nurse determines that the endotracheal tube is properly placed by which assessment?

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?

The nurse is caring for several patients postoperatively following abdominal surgery.Which patient will benefit the least from the use of incentive spirometry?

A patient with COPD has carbon dioxide retention and is ordered oxygen therapy.The nurse anticipates the use of which oxygen delivery system?

A patient is admitted with a diagnosis of COPD and the health care provider orders BiPAP.Which action by the nurse is appropriate?

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 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?

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.)

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 patient is planning to perform incentive spirometry after abdominal surgery.The nurse should encourage the patient to do which of the following?

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 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 patient with a tracheostomy tube has an order for oxygen.Which action by the nurse is appropriate?

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 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.)

Quiz 23: Oxygen Therapy

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 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?

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?

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?

The nurse is caring for a patient on mechanical ventilation.The nurse determines that the endotracheal tube is properly placed by which assessment?

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?

The nurse is caring for several patients postoperatively following abdominal surgery.Which patient will benefit the least from the use of incentive spirometry?

A patient with COPD has carbon dioxide retention and is ordered oxygen therapy.The nurse anticipates the use of which oxygen delivery system?

A patient is admitted with a diagnosis of COPD and the health care provider orders BiPAP.Which action by the nurse is appropriate?

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 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?

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.)

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 patient is planning to perform incentive spirometry after abdominal surgery.The nurse should encourage the patient to do which of the following?

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 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 patient with a tracheostomy tube has an order for oxygen.Which action by the nurse is appropriate?

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 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 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?