Chapter 38 Oxygenation and Tissue Perfusion

Chapter 38  Oxygenation and Tissue Perfusion

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse finds the patient in cardiopulmonary arrest with no pulse or respirations. Which oxygen delivery device will the nurse use for this patient?
a.
Non-rebreather mask
b.
Bag-valve-mask unit
c.
Continuous positive airway pressure (CPAP)
d.
High-flow nasal cannula

ANS: B
The priority of the nurse is to ventilate the patient manually using an Ambu bag-valve-mask unit. This allows air to be forced into the patient’s lungs when there are no spontaneous respirations. The non-rebreather mask and nasal cannula require the patient to breathe on his own. CPAP is used for patients who are awake, oriented, and in respiratory failure.

DIF: Understanding REF: p. 960 | p. 964
TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Adaptation: Medical Emergencies
NOT: Concepts: Gas Exchange

2. The nurse is caring for a patient who is slow to awaken following general anesthesia. The patient is breathing spontaneously but is minimally responsive and having difficulty maintaining a patent airway. Which intervention is the most appropriate for the patient to improve oxygenation?
a.
Insert an oral airway.
b.
Lower the head of the bed.
c.
Turn the patient’s head to the side.
d.
Monitor the patient’s pulse oximetry.

ANS: A
An oral airway will prevent the patient’s tongue from falling back and occluding the airway. Lowering the head of the bed will only increase airway occlusion and risk of aspiration. Turning the patient’s head to the side will not clear the back of the patient’s tongue from the airway. Monitoring the patient’s pulse oximetry will not improve oxygenation or clear the airway.

DIF: Applying REF: pp. 964-965 TOP: Implementation
MSC: NCLEX Client Needs Category: Reduction of Risk Potential: Potential for Complications from Surgical Procedures NOT: Concepts: Gas Exchange

3. The nurse is caring for a patient with a history of left-sided congestive heart failure who is acutely short of breath. The nurse hears fine crackles throughout both lung fields and notes that the patient’s pulse oximetry is only 88% on 4 L of oxygen. What is the priority intervention of the nurse?
a.
Administer the ordered intravenous diuretic.
b.
Prepare for insertion of a chest tube.
c.
Suction secretions from the patient’s respiratory tract.
d.
Have the patient use the ordered incentive spirometer.

ANS: A
The patient’s respiratory distress is due to pulmonary edema and fluid overload from left-sided congestive heart failure. A diuretic will pull the excess fluid out of the body through the urine and relieve the patient’s distress. A chest tube is not needed as the fluid is within the alveoli rather than between the lung and chest wall. Suctioning and use of an incentive spirometer will not address fluid overload or improve the patient’s symptoms.

DIF: Understanding REF: p. 966 TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Adaptation: Fluid and Electrolyte Imbalances
NOT: Concepts: Fluid and Electrolyte Balance

4. The nurse is caring for a patient who has been intubated with an oral endotracheal tube for several weeks. The physicians predict that the patient will need to remain on a ventilator for at least several more weeks before he will be able to maintain his airway and breathe on his own. What procedure does the nurse anticipate will be planned for the patient to facilitate his recovery?
a.
Placement of a tracheostomy tube
b.
Diagnostic thoracentesis
c.
Pulmonary angiogram
d.
Lung transplantation surgery

ANS: A
Placement of a tracheostomy tube will secure the patient’s airway directly through the trachea, eliminating the need for the endotracheal tube. This will make the patient more comfortable and may allow him to eat while minimizing damage to the oropharynx from the endotracheal tube.

DIF: Understanding REF: p. 965 TOP: Planning
MSC: NCLEX Client Needs Category: Reduction of Risk Potential: Therapeutic Procedures
NOT: Concepts: Gas Exchange

5. The nurse is caring for a patient with a chest tube who was transported to radiology for testing. When the patient returns to the nursing unit, the transporter shows the nurse the patient’s chest tube collection device, which was badly damaged after being caught in the elevator door. What is the priority action of the nurse?
a.
Clamp the chest tube until the collection device is replaced.
b.
Cover the insertion site with a new occlusive dressing.
c.
Ensure that there is gentle bubbling in the water seal chamber.
d.
Check the patient’s lung sounds and pulse oximetry.

ANS: A
The broken collection device may no longer be used to collect chest tube drainage. Clamping the chest tube until the collection device is replaced will prevent air from entering into the lung space until the new collection device is attached.

DIF: Applying REF: p. 980 TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Adaptation: Medical Emergencies
NOT: Concepts: Gas Exchange