NUR2243 Module 2 EAQs| Questions and Answers| Latest Update 100%
Verified| Grade A+ Content
The nurse is educating a patient and the caregivers at the time of discharge about home care
after a tracheostomy. Which teachings would be beneficial for the patient? Select all that apply.
"Perform airway care."
"Wear a shower shield."
"Wear a medical alert bracelet."
An older adult patient is being discharged home with a tracheostomy. Which nursing action is
an acceptable assignment for an experienced LPN/LVN? Suction the tracheostomy using
sterile technique.
During shift report, the nurse learns the assigned patient with chronic lung disease is receiving
oxygen at 4 L/min per nasal cannula. When entering the patient's room, what is the nurse's
initial action? Assess oxygen saturation with a pulse oximeter.
In caring for a patient during the first few days after tracheostomy placement, what nursing
action is included in wound care? Folding standard gauze 4 × 4s to fit around the tube
Which action does the nurse take if a patient develops bradycardia during nasopharyngeal
suctioning? Administer 100% oxygen by bag-valve-mask.
The nurse is assisting a patient with a tracheostomy to eat. Which is an important nursing
action to help the patient swallow and avoid aspiration? Elevate the head of the bed for at
least 30 minutes after eating.
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen with a Venturi
mask at a rate of 3 L/min. Prior to initiating oxygen therapy, the patient appeared anxious with
gray skin, a respiratory rate of 24 breaths/min, and an oxygen saturation of 87%. After 15
minutes of oxygen therapy, the nurse observes the patient resting with closed eyes, pink
coloration, a respiratory rate of 12 breaths/min, and an oxygen saturation of 95%. Which action
by the nurse is correct? Decrease the oxygen to 2 L/min to improve respiratory rate.
, The nurse assesses a patient who has begun receiving oxygen therapy of 40% via Venturi mask
and notes pink lips and nail beds and a pulse oximetry value of 98%. The patient is sleeping and
has a heart rate of 76 beats per minute, a respiratory rate of 6 breaths per minute, and breaths
are nonlabored and shallow. What is the nurse's correct initial response? Notify the provider
of the patient's respiratory rate and breathing pattern.
The health care provider has suggested placing a patient with chronic obstructive pulmonary
disease (COPD) on noninvasive positive-pressure ventilation (NPPV) to improve gas exchange.
What information is important to discuss with the patient before starting NPPV? Select all that
apply. Tight-fitting masks can lead to skin breakdown.
Mask leaks can cause pressure around the eyes.
NPPV may require nasal gastric tube placement.
There is a risk of aspiration due to gastric inflation.
A patient with sleep apnea has a new prescription for a BiPAP device to be worn at night. What
does the nurse include in the teaching for this assistive device? Select all that apply. The
mask must fit tightly to form a proper seal.
BiPAP provides positive pressure during inhalation and exhalation to keep alveoli open.
BiPAP improves airflow during sleep and promotes comfort by reducing dyspnea.
When providing suctioning through an endotracheal or tracheostomy tube, what alerts the
nurse to stop suctioning? Oxygen saturation by pulse oximetry is less than 90%.
The nurse is suctioning a patient who has a tracheostomy and notes a pulse oximetry reading of
90% during the procedure. Which action does the nurse take? Use a manual resuscitation
bag to deliver 100% oxygen before resuming.
When suctioning a tracheostomy or endotracheal tube, what nursing actions ensure safe and
effective practice? Select all that apply. If needed, repeating suctioning up to three passes
When suctioning, using a gentle twirling motion of the catheter
Verified| Grade A+ Content
The nurse is educating a patient and the caregivers at the time of discharge about home care
after a tracheostomy. Which teachings would be beneficial for the patient? Select all that apply.
"Perform airway care."
"Wear a shower shield."
"Wear a medical alert bracelet."
An older adult patient is being discharged home with a tracheostomy. Which nursing action is
an acceptable assignment for an experienced LPN/LVN? Suction the tracheostomy using
sterile technique.
During shift report, the nurse learns the assigned patient with chronic lung disease is receiving
oxygen at 4 L/min per nasal cannula. When entering the patient's room, what is the nurse's
initial action? Assess oxygen saturation with a pulse oximeter.
In caring for a patient during the first few days after tracheostomy placement, what nursing
action is included in wound care? Folding standard gauze 4 × 4s to fit around the tube
Which action does the nurse take if a patient develops bradycardia during nasopharyngeal
suctioning? Administer 100% oxygen by bag-valve-mask.
The nurse is assisting a patient with a tracheostomy to eat. Which is an important nursing
action to help the patient swallow and avoid aspiration? Elevate the head of the bed for at
least 30 minutes after eating.
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen with a Venturi
mask at a rate of 3 L/min. Prior to initiating oxygen therapy, the patient appeared anxious with
gray skin, a respiratory rate of 24 breaths/min, and an oxygen saturation of 87%. After 15
minutes of oxygen therapy, the nurse observes the patient resting with closed eyes, pink
coloration, a respiratory rate of 12 breaths/min, and an oxygen saturation of 95%. Which action
by the nurse is correct? Decrease the oxygen to 2 L/min to improve respiratory rate.
, The nurse assesses a patient who has begun receiving oxygen therapy of 40% via Venturi mask
and notes pink lips and nail beds and a pulse oximetry value of 98%. The patient is sleeping and
has a heart rate of 76 beats per minute, a respiratory rate of 6 breaths per minute, and breaths
are nonlabored and shallow. What is the nurse's correct initial response? Notify the provider
of the patient's respiratory rate and breathing pattern.
The health care provider has suggested placing a patient with chronic obstructive pulmonary
disease (COPD) on noninvasive positive-pressure ventilation (NPPV) to improve gas exchange.
What information is important to discuss with the patient before starting NPPV? Select all that
apply. Tight-fitting masks can lead to skin breakdown.
Mask leaks can cause pressure around the eyes.
NPPV may require nasal gastric tube placement.
There is a risk of aspiration due to gastric inflation.
A patient with sleep apnea has a new prescription for a BiPAP device to be worn at night. What
does the nurse include in the teaching for this assistive device? Select all that apply. The
mask must fit tightly to form a proper seal.
BiPAP provides positive pressure during inhalation and exhalation to keep alveoli open.
BiPAP improves airflow during sleep and promotes comfort by reducing dyspnea.
When providing suctioning through an endotracheal or tracheostomy tube, what alerts the
nurse to stop suctioning? Oxygen saturation by pulse oximetry is less than 90%.
The nurse is suctioning a patient who has a tracheostomy and notes a pulse oximetry reading of
90% during the procedure. Which action does the nurse take? Use a manual resuscitation
bag to deliver 100% oxygen before resuming.
When suctioning a tracheostomy or endotracheal tube, what nursing actions ensure safe and
effective practice? Select all that apply. If needed, repeating suctioning up to three passes
When suctioning, using a gentle twirling motion of the catheter
