Oxygen ( Chap 23) Flashcards
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
ANS: C
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.
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
ANS: B
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.
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
ANS: C
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.
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.
ANS: C
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.
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
ANS: B
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.
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
ANS: B
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.
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.
ANS: C
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.
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
ANS: B 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.
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.”
ANS: C
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.
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.
ANS: C
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.
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.”
ANS: D
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.
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
ANS: D
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.
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.
ANS: B
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 H2O for inspiratory pressure and 4 to 10 cm H2O 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.
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.
ANS: D
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.
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
ANS: A
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.
