Chapter 25 Respiratory Care Modalities

Multiple Choice

1. The nurse is caring for a patient with chronic obstructive pulmonary disease. The patient has been receiving oxygen therapy for an extended time. What symptoms would the patient exhibit if he was experiencing oxygen toxicity?
A) Bradycardia and frontal headache

B) Dyspnea and substernal pain C) Anger and restlessness
D) Poor personal hygiene

Ans: B
Chapter: 25
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Page and Header: 637, Noninvasive Respiratory Therapies

Feedback: Oxygen toxicity can occur when patients receive too high a concentration of oxygen for an extended period. Symptoms of oxygen toxicity include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia, frontal headache, anger,

and poor personal hygiene are not symptoms of oxygen toxicity.

2. The nurse, caring for a patient with an endotracheal tube, recognizes that there are several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes?
A) Mobility is limited.

B) The patient is unable to speak.
C) The patient requires oxygen support. D) The cough reflex is depressed.

Ans: D
Chapter: 25
Client Needs: D-3
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 3
Page and Header: 646, Airway Management

Feedback: There are several disadvantages of an endotracheal tube. Disadvantages include suppression of the patient’s cough reflex, thickening of secretions, and depressed swallowing reflexes. With an endotracheal tube in place it is true that mobility is limited and the patient is unable to speak; however, from a nursing standpoint, these are not considered disadvantages of an endotracheal tube. Requiring oxygen is also not a disadvantage of endotracheal tubes.

3. What would the critical care nurse recognize as a condition that may indicate the patient’s need to have a tracheostomy?
A) A patient with a respiratory rate of 10 breaths per minute
B) A patient who requires permanent ventilation

C) A patient who exhibits symptoms of dyspnea D) A patient with respiratory acidosis

Ans: B
Chapter: 25
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 5
Page and Header: 648, Airway Management

Feedback: A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed patient. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.

4. The nursing instructor is teaching her clinical group about the care of an adult patient requiring mechanical ventilation. What would the instructor teach the students?
A) Keep the patient in a low Fowler’s position.
B) Perform tracheostomy care at least every 12 hours.

C) Keep the patient on bed rest continually. D) Monitor cuff pressure every 8 hours.

Ans: D
Chapter: 25
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 5
Page and Header: 649, Airway Management

Feedback: It is important to perform tracheostomy care at least every 8 hours because of the risk of infection. The use of antacids can contribute to nosocomial infections. The patient should be encouraged to ambulate, if possible. The cuff pressure should be monitored every 8 hours.

5. You are the nurse caring for a patient who is scheduled to have a thoracotomy. You are planning to provide preoperative teaching and know to share what information with the patient? A) How to milk the chest tubing
B) How to splint the incision when coughing
C) How to care for the wound
D) How to recognize signs of respiratory distress

Ans: B
Chapter: 25
Client Needs: D-4
Cognitive Level: Application Difficulty: Easy
Integrated Process: Teaching/Learning Objective: 7

Page and Header: 666, The Patient Undergoing Thoracic Surgery

Feedback: Preoperative teaching for a patient who will undergo a thoracotomy includes the use of incentive spirometry, turning, coughing, deep breathing, and splinting the incision. Wound care, endotracheal suctioning, and signs of respiratory distress are not a part of the preoperative teaching.