A client has chronic obstructive pulmonary disease (COPD). The nurse has taught the client that pursed-lip breathing helps them by:

Increasing carbon dioxide, which stimulates breathing

Prolonging inspiration and shortening expiration

Liquefying his secretions

Decreasing the amount of air trapping and resistance

Answer and Explanation

The Correct Answer is D

Pursed-lip breathing is a therapeutic maneuver used to manage the mechanical consequences of expiratory airflow limitation. In chronic obstructive pulmonary disease, the loss of elastic recoil leads to the premature collapse of small airways during exhalation. By creating positive back-pressure at the lips, this technique splints the bronchioles open, allowing for a more complete emptying of the alveoli and improving the efficiency of the respiratory cycle.

Rationale for correct answer

4. This technique generates a resistive pressure that prevents the bronchiolar collapse typically seen in obstructive disease. By keeping the airways patent longer, it facilitates the removal of trapped air, thereby reducing residual volume and work of breathing. It is a primary strategy for managing dyspnea in stable and acute phases.

Rationale for incorrect answers

1. The objective of respiratory therapy in this population is to facilitate the clearance of carbon dioxide, not to increase it. Elevated carbon dioxide levels lead to respiratory acidosis and can suppress the neurological drive to breathe in chronic retainers. Inducing hypercapnia would be physiologically detrimental to the patient.

2. The goal of this maneuver is to prolong expiration and shorten the inspiratory phase relative to the total cycle. Extending the expiratory time allows more air to leave the lungs, addressing the hyperinflation characteristic of the disease. Shortening expiration would worsen air trapping and increase respiratory distress.

3. Pursed-lip breathing is a mechanical ventilation strategy and has no chemical or physical effect on the viscosity of mucus. Methods to liquefy secretions include systemic hydration, humidification, and the administration of mucolytic pharmacological agents. It does not assist with the mobilization of thick sputum.

Test-taking strategy

Identify the primary defect: In COPD/Emphysema, the problem is air trapping. The correct answer must address exhalation.
Evaluate pressure mechanics: Pursed lips act like a valve. Think about how back-pressure would help a floppy tube (bronchiole) stay open.
Eliminate harmful options:
- Rule out 1 because increasing CO2 is never the goal for a COPD patient.
- Rule out 2 because you want a longer exhale to get the trapped air out.
Match technique to outcome: Decreasing air trapping (Option 4) is the direct result of keeping those airways open with positive pressure.

Take home points

Pursed-lip breathing should be performed by inhaling through the nose and exhaling through the mouth as if whistling.
The exhalation phase should be at least twice as long as the inhalation phase to maximize air clearance.

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Correct Answer is A

Explanation

Oxygen cylinders are high-pressure vessels containing compressed medicinal gas that require strict regulatory compliance and safety protocols to prevent catastrophic failure or fire. The maintenance of adequate volume is a clinical priority to ensure that oxygen delivery is not interrupted during patient transport or in emergency settings. Proper management involves assessing the pressure gauge to verify that the remaining gas is sufficient for the intended duration of use based on the flow rate.

Rationale for correct answer

1. Verifying the available pressure on the regulator is a fundamental safety action to ensure the cylinder will not run out during use. A full cylinder typically registers 2,000 psi, and the nurse must calculate if the remaining amount is adequate for the patient's needs. This prevents the life-threatening cessation of oxygen therapy during transport.

Rationale for incorrect answers

2. A cylinder containing only 500 psi is generally considered near empty and should not be used for patient transfers. Standard safety protocols require replacing the tank when it reaches 500 psi to provide a safety margin against total depletion. Using such a low-pressure tank increases the risk of the patient losing their oxygen supply mid-transport.

3. Placing an unsecure cylinder directly on a stretcher next to a patient is a significant safety hazard because the tank could fall or the valve could shear. If a pressurized valve is damaged, the cylinder can become a dangerous projectile. Tanks must be secured in a designated rack or the specific holder on the transport vehicle.

4. Turning the key counterclockwise actually opens the valve further rather than closing it. To discontinue flow and secure the cylinder, the key must be turned clockwise until the valve is completely seated. Operating the valve in the wrong direction can lead to rapid gas loss and depletion of the resource.

Test-taking strategy

Identify the priority: In oxygen tank questions, safety and resource availability are the main goals.
Analyze the pressure: Remember the 500 psi rule. In many facilities, 500 psi is the minimum threshold where a tank is replaced. Therefore, starting a transfer with only 500 psi is risky.
Determine mechanical direction: For almost all medical and industrial valves, turning the handle clockwise closes the system. Choice 4 is a technical error.
Select the most reliable step: Choice 1 is the only option that represents a universal, standardized pre-procedure safety check for oxygen administration.

Take home points

Oxygen is an oxidizer and must be kept away from oils, greases, and open flames to prevent combustion.
The duration of flow for a cylinder can be calculated by multiplying the psi by the tank factor and dividing by the flow rate.

A. The client has visible secretions in the airway. B. There is a sawtooth pattern on the client’s EtCO2 monitor. C. The client has clear breath sounds. D. It has been 3 hours since the client was last suctioned. E. The client has excessive coughing.

Correct Answer is ["A","B","E"]

Explanation

Suctioning is a high-risk intervention used to maintain patency in patients with artificial airways who cannot clear secretions independently. Because the procedure can cause hypoxia and mucosal trauma, it should never be performed as a routine or scheduled task. Clinical decisions to suction must be based on a thorough assessment of the patient's respiratory status, including physical signs of obstruction and changes in physiological monitoring.

Rationale for correct answers

1. The presence of visible secretions within the endotracheal or tracheostomy tube is a direct indication that the airway is obstructed. These secretions increase airway resistance and must be removed to ensure adequate tidal volumes and oxygenation. It is one of the most objective signs that suctioning is required.

2. A sawtooth pattern on the capnography (EtCO2) waveform is a specific monitor finding that indicates turbulent airflow caused by secretions in the circuit or airway. This visual indicator allows the nurse to identify the need for suctioning even before audible adventitious sounds are heard. It is a highly sensitive clinical marker.

5. Excessive, unproductive coughing often indicates that secretions are irritating the carina or obstructing the airway lumen, but the patient is unable to move them. Suctioning provides the mechanical assistance needed to clear these irritants and restore comfortable ventilation. It helps prevent patient exhaustion.

Rationale for incorrect answers

3. Clear breath sounds indicate that the lower airways are patent and free of obstructive secretions. Suctioning a patient with clear sounds is unnecessary and exposes the patient to the risks of mucosal trauma and hypoxia without clinical benefit. Assessment findings must justify the intervention.

4. Suctioning should be performed on a PRN (as needed) basis rather than a fixed schedule like “every 3 hours.” Scheduled suctioning increases the frequency of iatrogenic injury to the trachea and increases the risk of introducing pathogens. The nurse should assess frequently but only suction when indications are present.

Test-taking strategy

Identify PRN vs. scheduled: Always rule out scheduled suctioning (Option 4). The correct approach is always based on assessment.
Evaluate clinical signs:
- Clear breath sounds (Option 3) means do nothing.
- Visible secretions (Option 1) and coughing (Option 5) are red flags for obstruction.
Identify advanced monitoring: Recognize that modern monitors provide clues; a sawtooth on EtCO2 (Option 2) is the textbook waveform for secretions.
Select for necessity: In SATAs only choose the options that represent a deficit or an abnormal finding that requires intervention.

Take home points

Indications for suctioning include increased peak inspiratory pressure, decreased oxygen saturation, and audible crackles over the trachea.
Routine saline instillation before suctioning is no longer recommended as it may push bacteria deeper into the lungs.

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A client has chronic obstructive pulmonary disease (COPD). The nurse has taught the client that pursed-lip breathing helps them by:

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer oxygen to a client. Which action does the nurse use to follow safe technique when using a portable oxygen cylinder?

Correct Answer is A

Explanation

The nurse is caring for a client with an artificial airway. Which of the following are reasons to suction the client? Select all that apply

Correct Answer is ["A","B","E"]

Explanation

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