Exam 6 Ch25 | 暗記メーカー

暗記メーカー

Exam 6 Ch25

12問 • 2年前

問題一覧

1

1. A nurse caring for a client removes the client’s oxygen as prescribed. The client is now breathing what percentage of oxygen in the room air?

b. 21%

2

2. A client is scheduled to have a tracheostomy placed in an hour. What action by the nurse is the priority?

b. Ensure that informed consent is on the chart.

3

3. A client has a tracheostomy that is 3 days old. Upon assessment, the nurse notes that the client’s face is puffy and the eyelids are swollen. What action by the nurse takes best?

a. Assess the client’s oxygen saturation.

4

4. A client has a tracheostomy tube in place. When the nurse suctions the client, food particles are noted. What action by the nurse is best?

b. Measure and compare cuff pressures.

5

5. An assistive personnel (AP) was feeding a client with a tracheostomy. Later that evening, the UAP reports that the client had a coughing spell during the meal. What action by the nurse is best?

a. Assess the client’s lung sounds.

6

6. A nurse is providing tracheostomy care. What action by the nurse requires intervention by the charge nurse?

c. Tying a square knot at the back of the neck

7

7. A nurse is demonstrating suctioning a tracheostomy during the annual skills review. What action by the student demonstrates that more teaching is needed?

a. Applying suction while inserting the catheter

8

8. A nurse is caring for a client using oxygen while in the hospital. What assessment finding indicates that outcomes for client safety with oxygen therapy are being met?

b. Intact skin behind the ears

9

9. A nurse is assessing a client who has a tracheostomy. The nurse notes that the tracheostomy tube is pulsing with the heartbeat as the client’s pulse is being taken. No other abnormal findings are noted. What action by the nurse is most appropriate?

d. Stay with the client and have someone else call the primary health care provider immediately.

10

10. A client with a new tracheostomy is being seen in the oncology clinic. What finding by the nurse best indicates that goals for the client’s decrease in self-esteem are being met?

b. The client has joined a book club that meets at the library.

11

11. A client is receiving oxygen at 4 L per nasal cannula. What comfort measure may the nurse delegate to assistive personnel (AP)?

a. Apply water-soluble ointment to nares and lips.

12

12. A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best?

b. Determine if the client can switch to a nasal cannula during the meal.

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問題一覧

1

1. A nurse caring for a client removes the client’s oxygen as prescribed. The client is now breathing what percentage of oxygen in the room air?

b. 21%

2

2. A client is scheduled to have a tracheostomy placed in an hour. What action by the nurse is the priority?

b. Ensure that informed consent is on the chart.

3

3. A client has a tracheostomy that is 3 days old. Upon assessment, the nurse notes that the client’s face is puffy and the eyelids are swollen. What action by the nurse takes best?

a. Assess the client’s oxygen saturation.

4

4. A client has a tracheostomy tube in place. When the nurse suctions the client, food particles are noted. What action by the nurse is best?

b. Measure and compare cuff pressures.

5

5. An assistive personnel (AP) was feeding a client with a tracheostomy. Later that evening, the UAP reports that the client had a coughing spell during the meal. What action by the nurse is best?

a. Assess the client’s lung sounds.

6

6. A nurse is providing tracheostomy care. What action by the nurse requires intervention by the charge nurse?

c. Tying a square knot at the back of the neck

7

7. A nurse is demonstrating suctioning a tracheostomy during the annual skills review. What action by the student demonstrates that more teaching is needed?

a. Applying suction while inserting the catheter

8

8. A nurse is caring for a client using oxygen while in the hospital. What assessment finding indicates that outcomes for client safety with oxygen therapy are being met?

b. Intact skin behind the ears

9

9. A nurse is assessing a client who has a tracheostomy. The nurse notes that the tracheostomy tube is pulsing with the heartbeat as the client’s pulse is being taken. No other abnormal findings are noted. What action by the nurse is most appropriate?

d. Stay with the client and have someone else call the primary health care provider immediately.

10

10. A client with a new tracheostomy is being seen in the oncology clinic. What finding by the nurse best indicates that goals for the client’s decrease in self-esteem are being met?

b. The client has joined a book club that meets at the library.

11

11. A client is receiving oxygen at 4 L per nasal cannula. What comfort measure may the nurse delegate to assistive personnel (AP)?

a. Apply water-soluble ointment to nares and lips.

12

12. A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best?

b. Determine if the client can switch to a nasal cannula during the meal.