Airway and Oxygenation

Question 1

This is the most effective position for promoting lung expansion and reducing pressure on the diaphragm from the abdomen.

Answer 1

45-degree Semi-Fowler’s position

Question 2

This breathing exercise is ideal for those who have had thoracic or abdominal surgery

Answer 2

Diaphragmatic Breathing

Question 3

Most commonly used type of oxygen delivery, delivers oxygen at 1-6 L/in and is easily tolerated by the patient.

Answer 3

Nasal cannula

Question 4

An important nursing intervention for patients receiving oxygen via nasal cannula is?

Answer 4

Assessing the nasal mucosa for irritation from drying effect of oxygen, especially at high flow rates.

Question 5

This type of oxygen delivery is used for short term oxygen therapy or to deliver oxygen in an emergency.

Answer 5

Simple face mask

Question 6

This used for clients at risk of experiencing acute respiratory failure.

Answer 6

Venturi Mask
This delivers 4-10 L/min oxygen flow and delivers exact desired selected concentrations of oxygen (very precise).

Question 7

Most frequently used method of oxygen delivery for clients with a deteriorating respiratory status who might require intubation.

Answer 7

Nonrebreather Mask

Question 8

For partial and nonrebreather masks with reservoir bag, an important nursing consideration is to:

Answer 8

Adjust the flow rate to keep the reservoir bag 2/3 full during inspiration, and making sure the reservoir bag does not twist, kink, or deflate. Deflation of the bag results in decrease oxygen delivered.

Question 9

How would you determine the length of the nasopharyngeal airway to be inserted in a patient?

Answer 9

Measure the distance from the tip of the nose to the tip of the ear.

Question 10

How would you determine the length of an oropharyngeal airway to be inserted in a patient?

Answer 10

Measure the distance from the corner of the mouth to the angle of the jaw or earlobe.

Question 11

How would you insert an oropharyngeal tube?

Answer 11

The tube is inserted upside down with the bevel pointing towards the roof of the mouth. When the flange reaches the lips, rotate the OPA 90 degrees so that the curvature of the OPA fits the natural curvature of the upper airway.

Question 12

This is the part of the ET tube that, when inflated, produces a seal between the trachea and the cuff to prevent aspiration and ensure delivery of a set tidal volume.

Answer 12

Cuff

Question 13

What is the best and final confirmation of ET tube placement?

Answer 13

Chest X-ray

Question 14

Where is the correct placement of an ET tube?

Answer 14

1 to 2 cm above the carina

Question 15

What symptoms would you watch out for if you suspect esophageal instead of endotracheal intubation?

Answer 15

Perform auscultation over the stomach to rule out esophageal intubation. If tube is in the stomach, breath sounds will be louder in the stomach than the chest, and abdominal distention may be present.

Question 16

if a patient has an ET tube, what needs to be at bedside at all times?

Answer 16

An Ambubag.

Question 17

When removing an ET tube, the nurse should do which three things first?

Answer 17

Hyperoxygenate the client
Suction the ET tube and oral cavity
Position the client in a semi-Fowler’s position

Question 18

This rests against the patient’s neck and keep the tracheostomy tube in place.

Answer 18

Flange or Faceplate

Question 19

This is the part of the tracheostomy tube that fits into the stoma and keeps the airway open.

Answer 19

Outer cannula

Question 20

This is used to facilitate insertion of a tracheostomy tube and MUST be kept at bedside in case of accidental decannulation.

Answer 20

Obturator

Question 21

Which equipment should always be kept at bedside for patients with a tracheostomy?

Answer 21

START
Suction equipment
Tracheostomy tube (same size and one size smaller)
Ambu bag
Resuscitation equipment
Tracheostomy care supplies i.e. dressings and tapes

Question 22

What signs and symptoms would you look out for because they indicate possible tube dislodgement?

Answer 22

Suction catheter cannot pass beyond length of the tube
Subcutaneous emphysema near incision or stoma
Signs of respiratory disress
Gap between faceplate and neck
Patient unable to speak around the tracheostomy tube

Question 23

This is a type of mechanical ventilation which pushes air into the lungs until a specific airway pressure is reached.

Answer 23

Pressure-cycled

Question 24

In mechanical ventilators, this is the volume of air that the client receives with each breath.

Answer 24

Tidal volume

Question 25

This mechanical ventilator setting keeps the alveoli open during inspiration and prevents alveolar collapse.

Answer 25

Continuous positive airway pressure

Question 26

This is exerted during the expiratory phase of ventilation, which improves oxygenation by enhancing gas exchange and preventing atelectasis.

Answer 26

Positive end-expiratory pressure (PEEP). The need for PEEP indicates a severe gas exchange disturbance.

Question 27

High or Low Pressure Mechanical Ventilator Alarm? Increased secretions in the artificial airway or the client's own airway.

Answer 27

High-Pressure

Question 28

High or Low Pressure Mechanical Ventilator Alarm? Obstruction caused by water or kinks

Answer 28

High-Pressure

Question 29

High or Low Pressure Mechanical Ventilator Alarm? Disconnection or leak in the ventilator or client's airway cuff

Answer 29

Low-Pressure

Question 30

How would you position a patient for chest tube insertion?

Answer 30

Head of bed elevated up to 45 degrees, with arm raised above the head on the affected side

Question 31

The correct chest tube insertion site is in:

Answer 31

Fourth or fifth intercostal space, mid-axillary line

Question 32

Give the purpose of the three compartments of a chest drainage system.

Answer 32

Collection chamber - receives fluid and air from the pleural space Water-seal chamber - receives air and acts as 1-way valve to prevent the backflow of incoming air. Suction chamber - applies suction to the chest drainage unit

Question 33

What type of movement would you expect to see in the water-seal chamber of a chest tube under normal circumstances?

Answer 33

Up and down movement of water with the patient's breathing

Question 34

There has been no movement in the water seal chamber of a chest tube for a while now. What should a nurse do?

Answer 34

Assess the chest immediately as this could indicate an occluded tube

Question 35

What is the normal amount of drainage from a chest tube?

Answer 35

Less than 70 ml/hour. Drainage of more than 70 to 100 ml/hour or drainage that becomes bright red or increases suddenly indicates rapid removal of fluid and or blood which can cause pulmonary edema or systematic hypotension.

Question 36

True or False: The drainage system should be maintained at the level of the chest.

Answer 36

False. The drainage system should be kept below the level of the chest to prevent backflow of fluid to the lungs.

Question 37

If a patient has a chest tube, what should always be kept at bedside?

Answer 37

Clamp and sterile occlusive dressing

Question 38

What should a nurse do if a chest tube drainage system suddenly cracks or breaks?

Answer 38

Insert the chest tube into a bottle of sterile water

Question 39

What should a nurse do if a chest tube is accidentally pulled out?

Answer 39

Pinch the skin opening together and apply an occlusive sterile dressing

Question 40

What should be done before suctioning to ensure equipment is functioning properly and to lubricate the internal catheter and tubing?

Answer 40

Place tip of catheter into sterile basin and suction small amount of normal saline solution from basin.

Question 41

What should be done in order to prevent transmission of microorganisms during suctioning?

Answer 41

Rinse catheter with water or normal saline to clear tubing of secretions after each suction pass

Question 42

What should be done before nasopharyngeal or nasotracheal suctioning?

Answer 42

Ask patient to take deep breaths or increase oxygen flow rate as prescribed.

Question 43

How would you measure the length of suction catheter insertion during nasopharyngeal suctioning?

Answer 43

Insert catheter distance from tip of nose or mouth to angle of mandible

Question 44

How long should you apply suction during a suctioning procedure?

Answer 44

Intermittent suction should be applied for no more than10 to 15 seconds to prevent suction-induced hypoxemia and injury to the tracheal mucosa.

Question 45

How far would you advance a catheter for nasotracheal suctioning?

Answer 45

16 to 20 cm or 6-8 inches in adults, then pull back 1-2 cm once the patient begins to cough, before applying suction.

Question 46

How far would you advance a catheter when suctioning a client with an artificial airway?

Answer 46

Advance catheter until patient coughs, which is usually .5 to 1cm below the level of the tube. Pull back 1 cm before applying suction.