A nurse is caring for a patient who is using a partial rebreather mask for oxygen therapy. The patient reports feeling short of breath. What is the nurse's priority action?
Increase the flow rate of oxygen to improve oxygenation.
Assess the mask bag to ensure it remains inflated during inspiration and expiration.
Switch the patient to a non-rebreather mask for higher oxygen delivery.
Reassure the patient that shortness of breath is common with this type of mask.
The Correct Answer is B
Choice A rationale:
Increasing the flow rate of oxygen may not be the priority action because the patient's shortness of breath could be due to a problem with the mask itself, rather than the amount of oxygen being delivered. Before making any adjustments to the oxygen flow rate, it is essential to assess the equipment's integrity.
Choice B rationale:
This is the priority action because a partial rebreather mask relies on the patient's exhaled breath to partially fill the reservoir bag. If the mask bag does not remain inflated during both inspiration and expiration, the patient may not be receiving the appropriate oxygen concentration, leading to increased shortness of breath. Checking the mask bag ensures that the mask is functioning correctly and delivering the intended oxygen concentration.
Choice C rationale:
Switching the patient to a non-rebreather mask for higher oxygen delivery is not the priority action in this scenario. The non-rebreather mask is used when high oxygen concentrations are required, such as in emergencies or when a patient's condition requires immediate intervention. However, the priority at this moment is to assess the current equipment's effectiveness before considering a change in oxygen delivery method.
Choice D rationale:
Reassuring the patient that shortness of breath is common with this type of mask is not appropriate without first addressing the issue at hand. The nurse should first assess the mask's functionality to ensure it is working correctly and providing the appropriate oxygen concentration before addressing the patient's concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
The correct answers are choices A, C, and E.
Choice A rationale:
A Venturi mask is designed to deliver a precise concentration of oxygen and is often used in COPD, where it is important not to over-oxygenate the patient. It allows for the adjustment of oxygen concentration by changing the color-coded entrainment adapters.
Choice B rationale:
A non-rebreather mask is not typically used for clients who require a precise concentration of oxygen because it is designed to deliver high concentrations of oxygen, but without a way to precisely control the amount.
Choice C rationale:
An aerosol mask can be used with a nebulizer system to deliver specific concentrations of oxygen along with medication, which is beneficial for COPD patients who may need bronchodilators or steroids in addition to oxygen therapy.
Choice D rationale:
A simple face mask is not suitable for delivering a precise concentration of oxygen as it does not allow for the fine control needed for COPD patients. It is generally used for short-term oxygen therapy and for patients who require a moderate amount of oxygen.
Choice E rationale:
A tracheostomy collar can provide a specific concentration of oxygen when used with a tracheostomized patient and is suitable for long-term use in COPD patients who have a tracheostomy.
In summary, for a client with COPD who requires a precise concentration of oxygen, the Venturi mask, aerosol mask, and tracheostomy collar are appropriate choices as they allow for the delivery of a specific and controlled amount of oxygen.
Correct Answer is D
Explanation
Choice D rationale:
The nurse should connect the nasal cannula to a humidifier first. Dry and irritated nares are common side effects of oxygen therapy via nasal cannula, and using a humidifier adds moisture to the oxygen, reducing irritation and discomfort for the patient.
Choice A rationale:
Applying petroleum jelly to the nares is not the first action to take. It might provide temporary relief, but it is essential to address the root cause of dryness, which is the lack of moisture in the oxygen delivered.
Choice B rationale:
Increasing the flow rate of oxygen is not the first step because it may not address the dryness issue. It can lead to a higher concentration of oxygen, but it won't solve the problem of dry and irritated nares.
Choice C rationale:
Changing the nasal cannula to a face mask is not necessary to address the dryness. Face masks may not be well-tolerated by some patients, and it's better to try less invasive interventions first.
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