Chapter 23 Oxygen Therapy

Chapter 23  Oxygen Therapy

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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.

DIF: Cognitive Level: Analyzing REF: Text reference: p. 588
OBJ: Discuss indications for oxygen therapy.
TOP: Carbon Dioxide Retention and Oxygen Drive
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

2. 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.

DIF: Cognitive Level: Applying REF: Text reference: p. 588
OBJ: Discuss indications for oxygen therapy. TOP: Early Signs of Hypoxia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. 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.

DIF: Cognitive Level: Analyzing REF: Text reference: pp. 590-591
OBJ: Demonstrate applying a nasal cannula and an oxygen mask.
TOP: Nasal Cannulas KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

4. 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.

DIF: Cognitive Level: Knowledge REF: Text reference: pp. 590-591
OBJ: Demonstrate applying a nasal cannula and an oxygen mask.
TOP: Nasal Cannulas KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

5. 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.

DIF: Cognitive Level: Analyzing REF: Text reference: pp. 590-591
OBJ: Discuss methods for administering oxygen therapy. TOP: Oxygen Mask
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity