6. A nurse is providing teaching for a client who has a new prescription for an incentive spirometer. Which of the follo

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6. A nurse is providing teaching for a client who has a new
prescription for an incentive
spirometer. Which of the following instructions should the nurse
include?
a) Exhale into the incentive spirometer.
b) Use the incentive spirometer every hour while awake.
c) Hold your breath for 10 seconds when using the incentive
spirometer.
d) Use the incentive spirometer two times each session.
7. A nurse is caring for a client who requires 1 L of oxygen. Which
of the following oxygen
delivery devices should the nurse expect to use?
a) Nasal cannula
b) Nonrebreather mask
c) Partial rebreather mask
d) Simple face mask
8. A nurse is assessing a client who is being discharged. The nurse
notes the client has
regular and quiet breathing. The nurse should identify this
breathing pattern as which of
the following?
a) Normal breathing
b) Kussmaul breathing
c) Cheyne-Stokes breathing
d) Apnea
9. A nurse is caring for a client who requires 7 L of oxygen to
maintain oxygen saturation.
Which of the following oxygen delivery devices should the nurse
expect to use?
a) Nasal cannula
b) Nonrebreather mask
c) Partial rebreather mask
d) Simple face mask
10. A nurse is caring for an adolescent who presents to the
emergency department. (Use the
notes below to help you answer the question.)
Nurses' Notes
1500:
Adolescent's parents report the adolescent has been weak and short
of breath, and has not
eaten in the past 3 days.
Dry cough with some wheezing noted in bilateral upper lobes.
Dyspnea noted during assessment with adolescent sitting in upright
position. Adolescent
reports, "I breathe better sitting straight up."
Provider notified.
1515:
Respiratory therapist administered humidified oxygen via nasal
cannula at 2 L/min
1930:
Adolescent sitting upright. Reports dyspnea with activity.
Maintaining oxygen at 2 L/min via
nasal cannula. Ate a portion of their dinner tray. Mild wheezing
noted in upper lung lobes.
Voided 900 mL clear yellow urine.
Vital Signs
1500:
Blood pressure 143/92 mm Hg
Apical pulse rate 110/min
Respiratory rate 26/min
Temperature 37.2º C (99º F)
Oxygen saturation 94% on room air
Weight 50 kg (110 lb.)
1930:
Blood pressure 129/72 mm Hg
Apical pulse rate 92/min
Respiratory rate 20/min
Temperature 37.1º C (98.8º F)
Oxygen saturation 97% on 2 L/min via nasal cannula
Provider Prescriptions
1510:
Humidified oxygen at 2 L/min via nasal cannula
Furosemide IV 20 mg daily
Digoxin 0.5 mg PO daily; hold if apical pulse is less than
70/min
Enalopril 5 mg PO twice daily
Regular diet with no added table salt
Record intake and output daily
Medication Administration Record
1530:
Administered furosemide IV 20 mg
Administered enalopril 5 mg PO
Administered digoxin 0.5 mg PO; apical pulse 110/min
Medical History
ALLERGIES: Penicillin, tramadol
Adolescent has a history of cardiomyopathy with manifestations of
heart failure.
The nurse reassesses the adolescent at 1930. For each assessment
finding, click to specify if
the finding indicates that the adolescent's condition has improved,
has not changed, or has
declined.
Assessment Finding Improved
No Change Declined
Oral intake
Blood pressure
Oxygen saturation
Lung sounds
Assessment Finding Improved
No Change Declined
Dyspnea
Heart rate
Respiratory rate