Week 2 Clinical Skills

Question 1

How can the nurse best minimize a patient’s risk for infection during tracheostomy care?

A. Adhere to sterile technique when appropriate.
B. Frequently assess for signs of local or systemic infection.
C. Monitor for indications that tracheostomy care is needed.
D. Instruct nursing assistive personnel (NAP) to report any changes in color or odor of tracheal drainage

Answer 1

A. Adhere to sterile technique when appropriate.

Question 2

Which nursing action shows the most effective planning for emergency care of a patient with a tracheostomy?

A. Having a spare oxygen mask at the patient’s bedside
B. Keeping an obturator and a tracheostomy tube at the patient’s bedside
C. Reviewing the agency’s policy regarding tracheostomy care
D. Instructing the family to call immediately if the patient has difficulty breathing

Answer 2

B. Keeping an obturator and a tracheostomy tube at the patient’s bedside

Question 3

Which intervention reduces the risk for skin breakdown in a patient with a new tracheostomy?

A. Cleaning the stoma with hydrogen peroxide and drying thoroughly
B. Cleaning and assessing the skin around the stoma
C. Assessing temperature and reporting skin breakdown immediately
D. Allowing the patient to re-oxygenate after each tracheal suctioning

Answer 3

B. Cleaning and assessing the skin around the stoma

Question 4

Which action may be delegated to nursing assistive personnel (NAP) regarding the care of a patient with a tracheostomy?

A. Performing tracheostomy care for a patient whose tracheostomy was placed 1 week ago
B. Removing the outer cannula and placing the obturator
C. Holding the tracheostomy tube while the nurse changes the neck ties
D. Monitoring oxygen saturation levels and placing oxygen if needed

Answer 4

C. Holding the tracheostomy tube while the nurse changes the neck ties

Question 5

Which technique would the nurse use to change a patient’s tracheostomy ties?

A. Use a slipknot.
B. Ensure that two fingers fit snugly under the tie.
C. Knot the ends of the tie in the eyelets on the faceplate.
D. Ask the patient to hold his or her breath while the ties are changed.

Answer 5

B. Ensure that two fingers fit snugly under the tie.

Question 6

Why is it important for the nurse to set the correct flow rate for a patient to whom oxygen is prescribed?

A. To provide the correct amount of oxygen to the patient
B. To ensure the therapeutic effects of oxygen therapy
C. To prevent any adverse reaction to the prescribed oxygen therapy
D. To minimize the risk of combustion during oxygen delivery

Answer 6

A. To provide the correct amount of oxygen to the patient

Question 7

What would be the nurse’s priority in order to minimize a patient’s risk for injury during oxygen therapy?

A. Advising the patient to call for assistance before getting out of bed.
B. Instructing nursing assistive personnel (NAP) to immediately correct the flow rate if the oxygen regulator is not set as prescribed.
C. Observing the six rights of medication administration.
D. Monitoring the patient for signs of hypoxia.

Question 8

What can the nurse do to evaluate a patient’s response to continuous oxygen therapy delivered at 4 L/min by nasal cannula?

A. Regularly measure and trend the patient’s pulse oximetry (SpO2) values.
B. Evaluate venous blood levels every morning.
C. Monitor the patient’s arterial blood gas (ABG) levels hourly.
D. Assess the patient for compliance with the prescribed therapy.

Answer 8

A. Regularly measure and trend the patient’s pulse oximetry (SpO2) values.

Question 9

What should the nurse do when a patient is ordered to receive 4 L/min oxygen by nasal cannula?

A. Encourage oral fluids.
B. Restrict fluids.
C. Ensure that humidification is present.
D. Measure blood pressure every hour.

Answer 9

C. Ensure that humidification is present.

Question 10

What would the nurse monitor frequently to ensure that the prescribed amount of oxygen is being delivered to a patient?

A. Arterial blood gas (ABG) levels
B. Oxygen flow meter setting
C. Respiratory rate
D. Temperature

Answer 10

B. Oxygen flow meter setting

Question 11

A nurse is preparing to help a patient administer a bronchodilator using a nebulizer. What will the nurse do first in order to evaluate the medication’s effectiveness?

A. Assess the patient’s respiratory status before administration.
B. Demonstrate use of the nebulizer.
C. Discuss the medication side effects.
D. Verify the patient’s identification according to agency policy

Answer 11

A. Assess the patient’s respiratory status before administration.

Question 12

What should the nurse do first if the patient or family express concerns about the accuracy of a nebulized medication?

A. Do not give the medication.
B. Explore the patient’s concerns.
C. Notify the healthcare practitioner.
D. Verify the medication order.

Answer 12

A. Do not give the medication.

Question 13

The nurse needs to administer a nebulized medication to an older adult who is too weak hold the nebulizer mouthpiece. Which intervention should the nurse implement?

A. The nurse should ask a family member or NAP to assist with holding the nebulizer mouthpiece.
B. The nurse should delay treatment until the patient is stronger.
C. The nurse should hold the mouthpiece for the patient while the medication is being nebulized.
D. The nurse should use an aerosol facemask to administer the nebulized medication.

Answer 13

D. The nurse should use an aerosol facemask to administer the nebulized medication.

Question 14

Why should the nurse tap the nebulizer medication cup during and near the end of the treatment?

A. To make the mist form
B. To improve the patient’s pulmonary function
C. To provide control of airway hyperactivity and constriction
D. To release droplets that are clinging to the side of the cup

Answer 14

D. To release droplets that are clinging to the side of the cup

Question 15

Severe bronchospasm occurs during nebulizer treatment. What action should the nurse take?

A. The nurse continues to deliver the needed treatment so the patient will not be deprived of a necessary therapy.
B. The nurse discontinues the medication and notifies the practitioner immediately.
C. The nurse discontinues the medication for 15 to 20 minutes and then restarts the treatment if bronchospasm resolves.
D. The nurse switches to an aerosol facemask to administer the nebulized medication.

Answer 15

C. The nurse discontinues the medication for 15 to 20 minutes and then restarts the treatment if bronchospasm resolves.

Question 16

The nurse is preparing to help a patient use a dry powder inhaler. What will the nurse do first in order to evaluate the medication’s effectiveness?

A. Assess the patient’s respiratory status.
B. Warn the patient against overuse of the inhaler.
C. Discuss the side effects of the particular drug.
D. Verify the patient’s identity according to agency policy.

Answer 16

A. Assess the patient’s respiratory status.

Question 17

To make sure the drug is delivered properly, what discharge instructions might the nurse give a patient who is being discharged with a dry powder inhaler (DPI)?

A. Rinse your mouth out with water after using the inhaler.
B. Use the inhaler while sitting up in bed.
C. Keep track of the dosage using the counter on the inhaler.
D. After inhaling the medication, hold your breath for at least 10 seconds before exhaling.

Answer 17

D. After inhaling the medication, hold your breath for at least 10 seconds before exhaling.

Question 18

Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the use of a dry powder inhaler (DPI)?

A. “Be sure to let me know if the patient starts coughing again.”
B. “Did you shake the inhaler well before giving it to the patient?”
C. “Do you think the patient is capable of using the inhaler independently?”
D. “Please tell the patient that the inhaler is to be used only when she is having trouble breathing.”

Answer 18

A. “Be sure to let me know if the patient starts coughing again.”

Question 19

Before discharge, the nurse shows a patient how to use a dry powder inhaler (DPI). What should the nurse now assess?

A. Patient’s understanding of the purpose of the medication
B. Patient’s ability to handle, manipulate, and activate the DPI
C. Adequacy of the patient’s planned daily medication schedule
D. Patient’s awareness of the signs of an allergic reaction to the medication

Answer 19

B. Patient’s ability to handle, manipulate, and activate the DPI

Question 20

When instructing a patient in the use of a dry powder inhaler (DPI), which statement is accurate?

A. It is important to shake the DPI before administering the medication.
B. It is important to exhale while the lips are still around mouthpiece.
C. It is important to read the manufacturer’s instructions to determine how quickly to inhale the medication.
D. It is important for the patient to hold his or her breath for at least 60 seconds after inhaling the medication.

Answer 20

C. It is important to read the manufacturer’s instructions to determine how quickly to inhale the medication.

Question 21

A nurse is preparing to help a patient administer a mucolytic agent using a pressurized metered-dose inhaler (pMDI). What will the nurse do first in order to evaluate the medication’s effectiveness?

A. Assess the patient’s respiratory status before administration.
B. Warn against overuse of the inhaler.
C. Discuss the side effects of the particular drug.
D. Verify the patient’s identification according to agency policy.

Answer 21

A. Assess the patient’s respiratory status before administration.

Question 22

Which discharge instruction would help to ensure that the patient achieves maximum therapeutic delivery of the medication when using a pressurized metered-dose inhaler (pMDI)?

A. Make sure to report any adverse effects after using your inhaler.
B. Prime the inhaler if it is new or has not been used for several days.
C. Hold your breath for 60 seconds after the medication is delivered.
D. Use the inhaler while sitting up in a chair at 90-degree angle.

Answer 22

B. Prime the inhaler if it is new or has not been used for several days.

Question 23

Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the use of a metered-dose inhaler?

A. “Be sure to let me know if she starts coughing again.”
B. “Show the patient how to clean the spacer chamber after she’s finished with the inhaler.”
C. “Offer the patient her inhaler if it looks like she’s short of breath.”
D. “Please tell her the inhaler is to be used no more than three times per day.”

Answer 23

A. “Be sure to let me know if she starts coughing again.”

Question 24

A patient has been prescribed a pressurized metered-dose inhaler (pMDI) containing 200 doses of a bronchodilator. The patient has been instructed to take two puffs of the medication three times daily. At this dosage, how long will the MDI last?

A. 100 days
B. 50 days
C. 66 days
D. 33 days

Answer 24

D. 33 days

Question 25

The nurse is instructing a patient who is to receive both a bronchodilator and a steroid medication delivered by means of a pressurized metered-dose inhaler (pMDI). Which instruction is necessary for the safe administration of both agents?

A. “Make sure to use the steroid medication before the bronchodilator.”
B. “Make sure to use the bronchodilator before the steroid medication.”
C. “Rinse your mouth with warm water before using the pMDI to administer either medication.”
D. “Make sure you wait at least 30 seconds between administering the bronchodilator and administering the steroid medication.”

Answer 25

B. “Make sure to use the bronchodilator before the steroid medication.”