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Brandi Sizemore
week 9 Airway management Lesson 1-6
| Question | Answer |
|---|---|
| Ventilation is the exchange of oxygen for carbon dioxide at the cellular level. | False |
| A severely anemic patient may experience tachypnea during routine daily activities | True |
| Inadequate tissue oxygen with adequate blood supply is called hypoxia. | True |
| A patient with a "normal" respiratory rate cannot become hypoxic. | False |
| The appearance of cyanosis around the lips and fingertips of the patient may be the result of chronic respiratory impairment | True |
| An elevated pulse rate is the body's attempt to increase oxygen delivery to the tissues. | True |
| A patient with an acute onset of pneumonia is coughing copious amounts of secretions. The best coughing technique to teach a patient is the huff cough. | False |
| Coughing maintains patency of the airway by removing secretions and/or foreign body materials. | True |
| Assisting a patient, a paraplegic patient with bronchitis, by supporting his abdominal muscles during forced expiration and coughing is an example of huff coughing. | False |
| Patients at risk for airway obstruction should be encouraged to breathe deeply and cough at least once every 4 hours. | False |
| Huff coughing is usually effective only for clearing the central airways. | True |
| Cascade coughing requires that the patient take a deep breath and hold it for 2 seconds before performing a series of forceful coughs. | True |
| Excessive airway secretions can cause airway occlusion. | True |
| A key assessment technique to determine whether a patient's airways are occluded is auscultation of the lungs. | True |
| A patient is able to cough and expectorate but complains of mucus in the back of the throat. You should: | Perform oropharyngeal suctioning. |
| A patient with an endotracheal tube is unable to cough effectively and is acting irritable, and his oxygen saturation is decreasing. What is the correct suctioning technique for this patient? | Perform endotracheal suctioning |
| When teaching patients how to perform oropharyngeal suctioning, instruct them to place the suction setting at the highest level. | False |
| The nurse should direct NAP to avoid touching the back of the patient’s throat with the Yankauer suction catheter. | True |
| This patient is at risk for developing airway obstruction. | True |
| Because this patient may have difficulty communicating, what assessment findings may indicate the patient is currently experiencing hypoxia? (Select all that apply.) | Pulse 110 Pallor Pulse oximetry 88% |
| A patient with a history of a cerebrovascular accident has left-sided weakness and difficulty with thick oral secretions and swallowing. Why would you choose a Yankauer or tonsillar tip suction catheter to perform oropharyngeal suctioning on this patient | It can handle large volumes of secretions. |
| Left Column Encourage the patient to cough during oropharyngeal suctioning because: | It moves secretions into the mouth. |
| Which of the following would indicate that oropharyngeal suctioning was effective? | Normal breath sounds |
| The student nurse correctly obtains a ________ catheter because it can handle large amounts of secretions. | tonsillar tip or Yankauer suction |
| The student nurse sets the vacuum regulator to the appropriate setting and applies ________ gloves. | clean |
| To suction the patient, the student nurse inserts the catheter along the ________ . | gingival border |
| The student nurse identifies the risk of causing ________ the oral mucosa and is careful to gently move the catheter around the mouth until all secretions are cleared. | trauma to |
| Which of the following indicates a need to perform oropharyngeal suctioning? (Select all that apply.) | Excessive drooling Persistent coughing Restlessness |
| Which type of technique is used to perform oropharyngeal suctioning? | Clean technique |
| You are instructing the NAP regarding oropharyngeal suctioning. Which of the following is correct? (Select all that apply.) | "Report to me if the color of the secretions obtained is any color other than clear or white." "Move the suction catheter around the patient's mouth and avoid touching the back of the patient's throat." |
| The NAP reports to you the patient seems to be having more difficulty breathing since oropharyngeal suctioning was performed. Which action should you take first? | Assess the patient’s respiratory status. |
| An endotracheal or tracheostomy tube can become more easily occluded by secretions than a normal airway. | True |
| Airway resistance automatically increases when an artificial airway is inserted. | True |
| As airway resistance increases, so does the work of breathing in order to meet the body's demand for oxygen. | True |
| When providing care of the patient with a newly inserted artificial airway, which of the following may be delegated to NAP? | Oropharyngeal suctioning |
| After listening to the audios, identify the patients who have symptoms that might benefit from nasopharyngeal/nasotracheal suctioning. (Select all that apply.) | Patient 2 Patient 1 |
| Infant (0 to 12 months) Young child (age 2 to 5 years) Adolescent to adult Older child (age 6 to 12 years) | 5 to 6 French 6 to 8 French 10 to 16 French 8 to 10 French |
| A patient has the following baseline vital signs: heart rate 76, respiratory rate 18, SpO2 95%. The nurse just finished performing nasopharyngeal suctioning on the patient. What are the expected positive outcomes of the procedure? (Select all that apply.) | Auscultation reveals less gurgling. The heart rate is 76. |
| An endotracheal tube and ventilator will prevent a patient’s airway from occluding. | False |
| The patient should be on continual pulse oximetry monitoring. | True |
| If the patient becomes anxious and/or restless, the nurse should be concerned about a possible airway occlusion. | True |
| When the patient's oxygen saturation fell to 85%, this was an indication of hypoxia. | True |
| Inserting an endotracheal tube has decreased the patient's airway resistance (made it easier to breathe). | False |
| He is at no risk of airway obstruction because he is still able to cough. | False |
| The fact that he has a history of a chronic respiratory disease places him at greater risk of an airway obstruction. | True |
| His abdominal surgery may result in a decreased ability to breathe deeply and cough effectively after surgery. | True |
| Tenacious (thick) sputum could be an indication that this patient is overhydrated. | False |
| Preoperatively he had the following vital signs: blood pressure 134/72, pulse 84, respirations 14 without audible gurgling or wheezes, and oxygen saturation 98%. Immediately after the operation, his lungs have crackles in both bases that clear with coughi | False |
| Eight hours after surgery, his blood pressure is 130/84, pulse is 104, respirations are 24, and pulse oximetry is 91%. He has received pain medication, is very tired, and is taking long naps. He has audible gurgling on inspiration and expiration that rema | True |
| Prior to suctioning, the nurse should ________ the patient’s oxygen. | increase |
| Prior to suctioning, the nurse should instruct the patient to take ________, deep breaths. | slow |
| The nurse should apply sterile gloves ________ opening the sterile basin. | after |
| The nurse will apply ________ suction for 10 seconds and rotate the catheter as it is being withdrawn. | intermittent |
| The nurse should discontinue suctioning if the patient’s heart rate increases or decreases by ________ beats per minute or if the oxygen saturation falls below 90%, or 5% below baseline. | 20 |
| A nurse is performing endotracheal suctioning (select on the Nurse Names below to refer what each nurse is doing). Which of the nurses is performing the procedure incorrectly? Nurse Alan Nurse Bob Nurse Carol Nurse Don | Nurse Don |
| What happens if the inline suction device is locked? | Nothing; you cannot apply suction. |
| What should you do if your patient's pulse goes from 60 to 100 beats per minute during closed inline suctioning? | Stop suctioning and administer oxygen. |
| You are evaluating the effectiveness of suctioning. The patient's wife asks why you listen to the patient's lungs before and after suctioning. Your correct response is: | "To see if the suctioning was effective in removing mucus from his lungs" |
| You have performed endotracheal suctioning on the patient. Because the patient is unable to speak, how else might you determine the effectiveness of the suctioning and the patient's tolerance of the procedure? (Select all that apply.) | By auscultating the patient's breath sounds By noting the color of the secretions obtained By assessing the pulse oximetry By monitoring the patient's vital signs |
| The student nurse is performing nasotracheal suctioning for the first time on a patient. Which action(s), if made by the student nurse, indicate(s) further instruction is required? (Select all that apply | Inserts catheter during exhalation. Picks up the suction catheter with the nondominant hand and connects it to the suction tubing. |
| If the patient should gag during insertion of the suction catheter, the student nurse should remove the suction catheter and obtain a new sterile catheter. What is the reason for doing this? | The suction catheter is contaminated |
| The student nurse is concerned about correctly performing open artificial airway suctioning. The nursing instructor asks the student to verbally review the procedure before going into the patient's room. The student nurse is correct in stating the followi | "I will select a size 12 French suction catheter for my adult patient." "I will place the patient in high Fowler’s position and apply a pulse oximetry probe." "I will place my sterile basin on the bedside table, being careful not to touch the inside." |
| Providing endotracheal tube care is ________ to delegate to NAP. | inappropriate |
| Nurses may collaborate with ________ to prevent cuff-related problems. | respiratory therapy staff |
| Once an ET is inserted, confirmation of correct placement is achieved by chest X-ray examination or ________ | capnography |
| Your chief concern after an ET is inserted and secured and the cuff is inflated is to maintain ________ of the ET. | patency |
| Properly securing an ET prevents inadvertent ________ from coughing or pulling on the tube. | extubation |
| The nurse auscultates the lung sounds of a patient with an ET and notes decreased breath sounds on the left. The nurse wants to verify that the ET has not moved from its original position. What is the nurse’s best initial action to determine proper tube d | Observe the centimeter marking on the ET at lip or gum line. |
| To prevent ventilator-associated pneumonia, change patient position every 2 hours, perform oral care every 8 hours, and keep the head of the bed flat. | False |
| Signs that endotracheal tube care must be performed include loosening of the tapes, soiled tapes, mobility of the tube, and alteration in skin/tissue integrity. True | True |
| Endotracheal tube care is a sterile procedure. | False |
| The patient should be sedated before endotracheal tube care is begun. | False |
| Your assistant should hold the endotracheal tube firmly in place while you remove the old tapes. | True |
| Extubation is an unwanted and unexpected result of endotracheal tube care. | True |
| You have performed endotracheal tube care. Which of the following lines would be appropriate to include in your documentation regarding evaluation of the procedure? (Select all that apply.) | "Size 7.5-mm endotracheal tube remains with 22-cm marking at lips." "No irritation or skin breakdown noted." "Clear breath sounds bilaterally." |
| The alarm is sounding on a patient’s ventilator. The student nurse goes in to check on the patient and finds that the patient has extubated himself and the endotracheal tube is lying on the bed. What primary risk is associated with this occurrence? | Respiratory arrest. |
| Arrange the sequence options in the correct order by assigning each option a number. | Remain with the patient and call for assistance. 2 Assess for airway patency and spontaneous breathing. 3 Be prepared to assist respirations with Ambu-bag. 4 Be prepared for reintubation. |
| You are assessing the patient. Which of the following is an appropriate action regarding the patient’s endotracheal tube? | You change the tape on an unstable tube. |
| What measures can you take while caring for the patient’s endotracheal tube to prevent further injury or complications? (Select all that apply.) | Use adhesive remover to remove excess adhesive left on the face after tape removal. Note the markings on the tube indicating the depth of tube insertion |
| The pilot balloon allows for inflation and deflation of the cuff of an endotracheal/tracheotomy tube | True |
| The obturator of the inner cannula of the tracheostomy tube must be withdrawn immediately on insertion of the tube to allow for airflow. | True |
| The fenestrations in a tracheostomy tube allow the patient to be able to speak. | True |
| A patient with an endotracheal tube is scheduled to have a tracheotomy with tracheostomy tube placement. A family member asks why the patient just can’t keep the endotracheal tube and avoid the procedure. The nurse is correct to respond: | A patient with an endotracheal tube is scheduled to have a tracheotomy with tracheostomy tube placement. A family member asks why the patient just can’t keep the endotracheal tube and avoid the procedure. The nurse is correct to respond: |
| A purpose of tracheostomy tube care is to: | Prevent complications |
| It is a busy day on your unit and you are trying to determine whether you need to perform routine tracheostomy care on your patient. Choose the options that indicate that tracheostomy care needs to be performed. (Select all that apply.) | The tracheostomy dressing has secretions on it from where the patient has coughed. The tracheostomy ties are allowing the tracheostomy tube to move around. The stoma has purulent drainage. |
| The inner cannula should always be free of obstruction. | true |
| Long-term tracheostomy care can be delegated to the patient, the family, or NAP. | true |
| Frequent coughing indicates that the airway is clear. | false |
| When performing tracheostomy care, the nurse should suction the patient ________ changing the tracheostomy dressing. | before |
| The pilot balloon allows for inflation and deflation of the cuff of an endotracheal/tracheotomy tube. | True |
| A patient with an endotracheal tube is scheduled to have a tracheotomy with tracheostomy tube placement. A family member asks why the patient just can’t keep the endotracheal tube and avoid the procedure. The nurse is correct to respond: | "A tracheostomy tube is placed in patients who require long-term airway management because it is less likely to cause tracheal or laryngeal tissue damage." |
| It is a busy day on your unit and you are trying to determine whether you need to perform routine tracheostomy care on your patient. Choose the options that indicate that tracheostomy care needs to be performed. (Select all that apply.) | The tracheostomy dressing has secretions on it from where the patient has coughed. The tracheostomy ties are allowing the tracheostomy tube to move around. The stoma has purulent drainage. |
| The inner cannula should always be free of obstruction. | True |
| Reusable inner cannula Faceplate and stoma Disposable inner cannula | Place in hydrogen peroxide and allow to soak. Use brush to clean. Cleanse with normal saline soaked cotton tipped applicators and gauze pads. After cleaning area, quickly insert new inner cannula into outer cannula following angle of tracheostomy |
| When performing tracheostomy care, the nurse should suction the patient ________ changing the tracheostomy dressing. | before |
| Following completion of suctioning, the nurse may remove the soiled tracheostomy dressing before removing ________ . | gloves |
| After preparing the equipment, the nurse should apply ________ gloves. | sterile |
| If a reusable cannula is being used, the nurse should remove the ________ cannula. | inner |
| To clean the inner cannula, it should be placed first into the basin of ________ . | normal saline |
| While cleaning the cannula with a brush, the nurse should have the ________ source near the patient’s tracheostomy. | oxygen |
| The nurse should clean the inner cannula with normal saline, replace it, and ________ the locking mechanism. | secure |
| If you are unable to have someone else assist you during tracheostomy care, you should avoid cutting the old tracheostomy ties until the new ties are in place and securely tied. | True |
| A patient with a permanent tracheostomy is to be discharged home to the care of the family. Which of the following should you cover during patient teaching to prepare the patient's family for tracheostomy care evaluation? (Select all that apply.) | To make sure the tracheostomy ties are the right tension To determine the patient's respiratory rate and ease of breathing before and after care To inspect the inner and outer cannula for secretions To observe the stoma for redness, inflammation, drain |
| Increase the frequency of tracheostomy care. Remove the inner cannula and clean or suction it. Support the patient with oxygen or manual ventilation with a self-inflating resuscitation bag. If trained to do it, replace the old tracheostomy tube with a | The stoma is inflamed. The inner cannula remains plugged Respiratory distress occurs Accidental extubation occurs |
| The student nurse is assisting the staff nurse with tracheostomy care. Which of the following actions, if made by the staff nurse, would be inappropriate? (Select all that apply.) | The staff nurse cleans the tracheostomy site with alcohol swabs and pats dry with gauze. Keeping the dominant hand sterile, the staff nurse replaces the inner cannula with a new cannula and locks it into position. |
| Other than when the tracheostomy tube is removed permanently, what parts of a tracheostomy may be removed? (Select all that apply.) | The obturator The inner cannula |
| The patient is well enough to be discharged home with the tracheostomy. Before the patient leaves, you have to verify the competency of the patient’s family caregivers to perform tracheostomy suctioning and tracheostomy tube care. | True |
| The patient and her relatives should have a nonverbal method of communicating. | True |
| Did you notice any errors in practice during the skill performance? | The nurse reaches over the sterile field to put on gloves. |
| What is the potential risk to the patient from the identified error? | The patient is at increased risk for infection. |
| What steps should be taken to correct the error? | Discard supplies and set up a new sterile field. |
| What differences are there between closed (inline) and open artificial airway suctioning? (Select all that apply.) | Closed (inline) suctioning is quicker to perform With open artificial airway suctioning, sterile gloves should be worn |
| A nurse is documenting the suctioning of a patient's endotracheal tube. Select the charts to review the entries. Which of the charts is the most accurate example of a charting entry for this procedure? Chart A Chart B Chart C | Chart B |
Created by:
Brandi Sizemore
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