Saturday, September 15, 2007

Oxygenation quiz

The following ten questions come from the book “Test Success” (Nugent/Vitale). See if you can answer them, then check for the answer key and rationales in the comments section of this post.

1. To prevent aspiration while administering physical hygiene to a patient receiving a nasogastric feeding tube, the nurse should:
a.) Lower the height of the bag
b.) Seek additional assistance
c.) Slow the rate of flow
d.) Shut off the feeding

2. A patient walking in the hall complains of sudden chest pain. The initial intervention by the nurse should be to:
a.) Take the patient's vital signs
b.) Perform a detailed pain assessment
c.) Walk the patient back to bed slowly
d.) Get a chair so the patient can sit and rest

3. When oxygen therapy via nasal cannula is ordered for a patient, the first action by the nurse is to:
a.) Post an “oxygen in use” sign on the door to the room
b.) Adjust the oxygen level before applying the cannula
c.) Explain the rules of fire safety and oxygen use
d.) Lubricate the nares with water-soluble jelly

4. To prevent aspiration after meals by a patient who has difficulty swallowing, the nurse should first:
a.) Position the patient in the low-Fowler's position
b.) Provide a pitcher of water at the bedside
c.) Encourage mouth care when necessary
d.) Inspect the mouth for pocketed food

5. What should the nurse do first when a patient chokes on food and is unable to speak?:
a.) Initiate the abdominal thrust maneuver
b.) Clap between the scapulae several times
c.) Instruct the patient to swallow forcefully
d.) Wait to see if the patient can cough up the obstruction

6. A patient with a history of chronic respiratory disease begins to have difficulty breathing. The adaptations that are the most serious would be:
a.) Orthostatic hypotension when rising and the need to sit in the orthopneic position.
b.) The need to sit in the orthopneic position and wheezing sounds on inspiration.
c.) Wheezing sounds on inspiration and mucus tinged with frank red streaks.
d.) Mucus tinged with frank red streaks and chest pain.

7. The adequacy of tissue oxygenation is most accurately measured by:
a.) Hematocrit values
b.) Hemoglobin levels
c.) Arterial blood gases
d.) Pulmonary function tests

8. The nurse assesses that the patient understands diaphragmatic breathing when the patient says, “I should:
a.) Feel my abdomen flatten on inspiration.”
b.) Raise my shoulders and chest when I breathe.”
c.) Hold my breath for 3 seconds at the height of inspiration.”
d.) Use my hands to put pressure against my abdomen when I inhale.”

9. When do wheezing breath sounds occur?
a.) When fluid is in the lung
b.) When sitting in the orthopneic position
c.) When air moves through a narrowed airway
d.) When the pleural sack rubs against the lung surface

10. Which is most effective for maintaining a patent airway?
a.) Active coughing
b.) Incentive spirometry
c.) Nebulizer treatments
d.) Abdominal breathing

2 comments:

Sue said...

ANSWER KEY/RATIONALES:

1. d
Shutting off the feeding reduces the risk of aspiration by temporarily halting the administration of an additional volume of feeding.

2. d
Reducing activity decreases the oxygen demand on the heart; this in turn reduces the pain. After the activity is interrupted, the nurse should obtain the vital signs and conduct a thorough pain assessment.

3. c
Safety is a priority; patients must understand the rules related to oxygen use and that oxygen supports combustion.

4. d
Patients who have difficulty swallowing do not recognize that food can become trapped in the buccal cavity and eventually be aspirated.

5. a
The abdominal thrust maneuver pushes trapped air out of the lungs, forcing out the obstructing food.

6. d
Mucus tinged with frank streaks is a common response to chronic respiratory disease and chest pain may indicate a pneumothorax; these should be reported immediately.

7. c
Arterial blood gases include the levels of oxygen, carbon dioxide, bicarbonate, and pH. Blood gases determine the adequacy of alveolar gas exchange and the ability of the lungs and kidneys to maintain the acid-base balance of body fluids.

8. c
Diaphragmatic breathing involves a pattern of a slow deep inhalation followed by a slow exhalation with a tightening of the abdominal muscles to aid exhalation; the patient should hold the breath for 2 to 3 seconds at the height of inhalation, just before exhalation.

9. c
Wheezes occur as air passes through airways narrowed by secretions, edema, or tumors; these high-pitched squeaky musical sounds are best heard on expiration and are not usually changed by coughing.

10. a
A cough forcefully expels air from the lungs and is an effective self-protective reflex to clear the trachea and bronchi of secretions.

Kamo R said...

It feels so nice to find somebody with some original thought on this subject. Really helpful to you for starting this MCAT questions.