A nurse is reinforcing teaching with a client's family about home oxygen use via nasal cannula. Which of the following statements by a family member indicates an understanding of the teaching?
"We will frequently check the top of his ears for sores."
"We can turn the oxygen up to 10 when he has trouble breathing."
"We can use petroleum jelly to keep his nares moist."
"We will need to remove the nasal cannula when he is eating."
The Correct Answer is A
A. Frequently checking the top of the ears for sores is correct. The nasal cannula tubing can cause pressure injuries behind the ears over time. The family should check for redness or sores and use protective padding or adjust the tubing as needed.
B. Turning the oxygen up to 10 when the client has trouble breathing is incorrect. Oxygen flow rates should be adjusted only as prescribed by the provider. Increasing the flow rate without guidance can lead to complications, such as oxygen toxicity in clients with chronic respiratory conditions.
C. Using petroleum jelly to keep the nares moist is incorrect. Petroleum-based products are flammable and should not be used with oxygen therapy. Instead, a water-based lubricant should be used to prevent nasal dryness.
D. Removing the nasal cannula when eating is incorrect. Clients using a nasal cannula can continue wearing it while eating, as it allows them to receive oxygen continuously. If needed, a healthcare provider can recommend adjustments to oxygen flow during meals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
A. Keep track of how long it takes to complete certain tasks is correct. Tracking the time it takes to complete tasks can help the nurse identify areas for improvement and prioritize tasks accordingly.
B. Delegate collection of vital signs to the assistive personnel on the team is correct. Delegating tasks such as vital sign monitoring to assistive personnel allows the nurse to focus on higher-level clinical duties and improves time management.
C. Make a priority to-do list at the beginning of the shift is correct. Creating a to-do list helps the nurse organize tasks based on urgency, improving overall time management and ensuring critical tasks are addressed.
D. Plan a time at the end of the shift to document nursing interventions is incorrect. Documentation should be done throughout the shift as interventions are performed, not solely at the end. Delaying documentation can lead to errors and missed information.
E. Complete activities with one client before moving to another client is correct. Focusing on one client at a time helps ensure each task is completed thoroughly and reduces the risk of neglecting important care steps.
Correct Answer is A
Explanation
A. Wipe any excess medication from the inner canthus outward: This is the correct approach. When administering ophthalmic ointment, the nurse should wipe away any excess from the inner canthus to the outer canthus to prevent contamination of the unaffected eye and to avoid spreading the infection.
B. Instruct guardian to apply erythromycin ophthalmic ointment every morning for 14 days.: This is incorrect because the child has been prescribed bacitracin ophthalmic ointment, not erythromycin. The nurse should instruct the guardian to use the prescribed medication as directed.
C. Gently massage the eyelid to facilitate absorption of the medication.: Massaging the eyelid is unnecessary and could lead to irritation or injury. The medication should be allowed to be absorbed naturally without additional manipulation.
D. Place an occlusive dressing on the affected eye to prevent the spread of infection.: An occlusive dressing is not recommended as it may cause increased irritation or pressure on the eye. The best practice is to maintain proper hygiene and follow the prescribed medication regimen.
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