MedSurg/Evolve/Oxygen Therapy – Flashcards
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An RN from the orthopedic unit has been floated to the medical unit. Which client assignment for the floated RN is the best? A) The client with a resolving pulmonary embolus who is receiving oxygen at 6 L/min through a nasal cannula B) The client with chronic lung disease who is being evaluated for possible home oxygen use C) The client with a newly placed tracheostomy who is receiving oxygen through a tracheostomy collar D) The client with chronic bronchitis who is receiving oxygen at 60% through a Venturi mask
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A) The client with a resolving pulmonary embolus who is receiving oxygen at 6 L/min through a nasal cannula Rationale: Orthopedic nurses are familiar with pulmonary emboli and with administration of oxygen through nasal cannulas.
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Which value indicates clinical hypoxemia and the need to increase oxygen delivery? A) Hemoglobin of 22 g/dL B) PaCO2 of 30 mm Hg C) PaO2 of 65 mm Hg D) Oxygen saturation of 88%
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C) PaO2 of 65 mm Hg Rationale: Pao2 of 65 mm Hg indicates low levels of oxygen in the arterial blood; this is termed hypoxemia.
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A client with chronic obstructive pulmonary disease has a physician's prescription stating, "Adjust oxygen to keep SpO2 at 90% to 92%." Which nursing action can be delegated to a nursing assistant working under the supervision of an RN? A) Adjust the position of the oxygen tubing. B) Assess for signs and symptoms of hypoventilation. C) Change the O2 flow rate to keep SpO2 as prescribed. D) Choose which O2 delivery device should be used for the client.
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A) Adjust the position of the oxygen tubing. Rationale: The scope of a nursing assistant's work includes positioning of oxygen tubing for client comfort.
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A client who smokes is being discharged home on oxygen. The client states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? A) "You can quit when you are ready." B) "It's never too late to quit." C) "Just turn off your oxygen when you smoke." D) "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous."
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D) "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous." Rationale: This is a great opening for the nurse to educate the client about the dangers of smoking in the presence of oxygen, as well as the benefits of quitting.
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Which client has the most urgent need for frequent nursing assessment? A) An older adult client who was admitted 2 hours ago with emphysema and dyspnea and has a 45-year 2-pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask B) A young client who has had a tracheostomy for 1 week, who is on room air with SpO2 at percents in the upper 90's, who has been receiving antibiotic therapy for 16 hours, and who has foul-smelling drainage on the tracheostomy ties C) An older adult client who is anxious to go home with her new tank of oxygen and supply of nasal cannulas and is being discharged with a new prescription for home oxygen therapy D) A middle-aged client who was admitted yesterday with pneumonia and is receiving oxygen at 2 L/min through a nasal cannula
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A) An older adult client who was admitted 2 hours ago with emphysema and dyspnea and has a 45-year 2-pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask Rationale: An older adult client with a long history of smoking and chronic lung disease who is receiving high-flow oxygen delivery is at elevated risk for respiratory depression owing to the hypoxic drive of respirations countered by high levels of oxygen. This client must be assessed frequently while receiving high-flow oxygen.
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A client has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the nurse use initially? A) Face tent B) Venturi mask C) Nasal cannula D) Non-rebreather mask
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A) Face tent Rationale: A client with smoke inhalation and facial burns who requires high-flow oxygen should initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue.
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A "Do not resuscitate" (DNR) client has a non-rebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? A) Ensures that the tubing is patent and that oxygen flow is high B) Notifies the chaplain and the family member of record C) Calls the Rapid Response Team and prepares to intubate D) Comforts the client and confirms that signed DNR orders are in the chart.
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A) Ensures that the tubing is patent and that oxygen flow is high Rationale: Labored breathing and ultimately suffocation can occur if the reservoir bag kinks, or if the oxygen source disconnects or is not set to high flow levels.
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The client is admitted to the hospital for chronic obstructive pulmonary disease (COPD), and the physician requests a nasal cannula at 2 L/min. Within 30 minutes, the client's color improves. What does the nurse continue to monitor that may require immediate attention? A) Increasing carbon dioxide levels B) Decreasing respiratory rate C) Increasing adventitious breath sounds D) Increased coughing
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B) Decreasing respiratory rate Rationale: Respiratory rate and depth should be monitored closely while the client receives oxygen, because hypoventilation is seen during the first 30 minutes of oxygen therapy in clients with hypoxic drive for respiration. The client's color will improve (from ashen or gray to pink) because of an increase in Pao2 level before apnea or respiratory arrest occurs from loss of the hypoxic drive.
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A client who has experienced a panic attack is being transferred to the medical-surgical ward. The transfer nurse reports that the client is doing much better after receiving bronchodilators via nebulizer and a small dose of oral Valium 4 hours ago in the emergency department. Vital signs are stable with oxygen delivered at 4 L/min via simple facemask. Why is this client at high risk for subsequent respiratory distress? A) The client is not being treated for asthma. B) The client has a mental disorder. C) The client received a dose of Valium. D) The client is receiving oxygen at 4 L/min.
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D) The client is receiving oxygen at 4 L/min. Rationale: A simple facemask must receive oxygen at a rate of at least 5 L/min to prevent inhalation of exhaled breath, which has low levels of oxygen and can eventually suffocate the client.
