The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [400]
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Multiple choice questions
1 What should be included in your initial assessment of your patient’s respiratory status?
a Review the patient’s notes and charts, to obtain the patient’s history.
b Review the results of routine investigations.
c Observe the patient’s breathing for ease and comfort, rate and pattern.
d Perform a systematic examination and ask the relatives for the patient’s history.
2 What should be included in a prescription for oxygen therapy?
a You don’t need a prescription for oxygen unless in an emergency.
b The date it should commence, the doctor’s signature and bleep number.
c The type of oxygen delivery system, inspired oxygen percentage and duration of the therapy.
d You only need a prescription if the patient is going to have home oxygen.
3 You are caring for a patient with a tracheostomy in situ who requires frequent suctioning. How long should you suction for?
a If you preoxygenate the patient, you can insert the catheter for 45 seconds.
a Never insert the catheter for longer than 10–15 seconds.
a Monitor the patient’s oxygen saturations and suction for 30 seconds.
a Suction for 50 seconds and send a specimen to the laboratory if the secretions are purulent.
4 You are caring for a patient with a history of COAD who is requiring 70% humidified oxygen via a facemask. You are monitoring his response to therapy by observing his colour, degree of respiratory distress and respiratory rate. The patient’s oxygen saturations have been between 95% and 98%. In addition, the doctor has been taking arterial blood gases. What is the reason for this?
a Oximeters may be unreliable under certain circumstances, e.g. if tissue perfusion is poor, if the environment is cold and if the patient’s nails are covered with nail polish.
b Arterial blood gases should be sampled if the patient is receiving >60% oxygen.
c Pulse oximeters provide excellent evidence of oxygenation, but they do not measure the adequacy of ventilation.
d Arterial blood gases measure both oxygen and carbon dioxide levels and therefore give an indication of both ventilation and oxygenation.
5 When using nasal cannulae, the maximum oxygen flow rate that should be used is 6 litres/min. Why?
a Nasal cannulae are only capable of delivering an inspired oxygen concentration between 24% and 40%.
b For any given flow rate, the inspired oxygen concentration will vary between breaths, as it depends upon the rate and depth of the patient’s breath and the inspiratory flow rate.
c Higher rates can cause nasal mucosal drying and may lead to epistaxis.
d If oxygen is administered at greater than 40% it should be humidified. You cannot humidify oxygen via nasal cannulae.
6 You are currently on placement in the emergency department (ED). A 55-year-old city worker is bluelighted into the ED having had a cardiorespiratory arrest at work. The paramedics have been resuscitating him for 3 minutes. On arrival, he is in ventricular fibrillation.