Advanced Skills Exam 2

Front 1

What position is it best to perform a respiratory assessment?

Back 1

Sitting position

Front 2

What would you note during a respiratory assessment?

Back 2

Bilateral, even chest expansion, rate and depth of respiration’s, O2 saturation of 90-100.

Front 3

What is the rate of tachypnea and bradypnea?

Back 3

Tachypnea- rate greater than 24 bpm

Bradypnea- rate less than 12 bpm

Front 4

Orthopnea:

Back 4

Having to sit or stand to breathe

Front 5

Tripod breathing:

Back 5

Leaning over with hands on knees to be able to fully inflate lungs.

Front 6

Rules for auscultation:

Back 6

Never listen over clothing, use a zigzag approach comparing findings at each point

Front 7

Describe a sibilant wheeze:

Back 7

High pitched squeaking sounds caused by narrowed airways.

Front 8

Describe crackles:

Back 8

Fluid in the bronchioles and alveoli, short discrete interrupted crackling or bubbling sounds that are heard during inspiration.

Front 9

Describe stridor:

Back 9

High pitched, inspiratory, crowing sound louder in the neck than over the chest

Front 10

Describe pleural friction rubs:

Back 10

A rubbing, grating or squeaking sound

Front 11

What would you do upon hearing adventitious breath sounds?

Back 11

Instruct patient to cough and listen again.

Front 12

What is the percentage of oxygen in room air?

Back 12

21%

Front 13

What is the definition of fraction of inspired oxygen? (FiO2)

Back 13

The percentage or concentration of oxygen delivered

Front 14

Does oxygen burn or explode?

Back 14

Supports combustion but doesn’t burn or explode. Enabled fire but doesn’t cause it.

Front 15

What amount of oxygen can be delivered through the nasal cannula?

Back 15

1-6 L/min

Front 16

What amount of oxygen can be delivered through a face mask?

Back 16

5-8 L/min

Front 17

What amount of oxygen can be delivered through a Venturi mask?

Back 17

4-10 L/min

Front 18

What amount of oxygen can be delivered through a partial rebreather mask?

Back 18

6-12 L/min b

Front 19

What amount of oxygen can be delivered through a non rebreather mask?

Back 19

6-15 L/min

Front 20

S&S of Hypoxia

Back 20

Anxiety, restlessness, behavioral changes, cardiac dysrhythmias, cyanosis, decreased ability to concentrate, decreased LOC, digital clubbing (chronic), dyspnea, elevated BP, tachycardia to bradycardia, tachypnea to bradypnea, pallor and vertigo

Front 21

How would you deliver oxygen in a patient with a tracheostomy?

Back 21

Transtracheal catheter, inserted into the trachea between 2nd and 3rd tracheal cartilages

Front 22

What can you apply to lubricate the nostrils?

Back 22

Water soluble lubricant

Front 23

What is the driving force for respiration’s in a patient with COPD?

Back 23

Hypoxia; if you give to much oxygen you will decrease their respiratory drive

Front 24

What are some benefits to a transtracheal catheter?

Back 24

Give oxygen in entire respiratory cycle, can eat, drink and talk with it in.

Front 25

What is some patient teaching for oxygen therapy?

Back 25

Stress dangers of adjusting ordered oxygen, instruct pt to ambulate or change position, TCDB, maintain fluid intake and avoid dairy.

Front 26

How long does a transtracheal catheter last?

Back 26

3 months; it can be removed periodically for cleaning after it has healed

Front 27

What should the patient be instructed to report to the HCP?

Back 27

Redness, swelling, excessive exudate (small clear exudate is expected)

Front 28

What is an endotracheal tube?

Back 28

A tube inserted through the patient’s mouth and into the upper airway to provide a patent airway.

Front 29

What are some reasons for tracheostomy?

Back 29

Apnea, respiratory obstruction, prevent aspiration of secretions and blood and easier access to lower airways

Front 30

How can you minimize infection risk as a nurse with a tracheostomy?

Back 30

Evaluate patient for excess secretions and suction prn, constant airway humidification, change or clean reap. Equipment every 8 hours, remove water in equipment tubing and provide freq oral care.

Front 31

Who are cuffed tracheostomy tubes used for?

Back 31

Patients at risk for aspiration because of swallowing difficulties and mechanical ventilation

Front 32

Who chooses the tracheostomy tube?

Back 32

The physician and the respiratory therapist based on size shape and purpose of the tracheostomy.

Front 33

How can you ensure adequate ventilation and oxygen for a patient with a tracheostomy?

Back 33

Listen to lungs sound, elevate HOB, turn pt every 2 hours, evaluate the effects of respiratory therapy frequently

Front 34

What is a psychosocial intervention you can provide for a patient with a tracheostomy?

Back 34

Communication board, encourage staff and family to talk to the patient, reorient patient frequently if necessary(?)

Front 35

What is an advantage of a tracheostomy with an inner and outer cannula?

Back 35

Being able to remove the inner cannula reduces the risk of occlusion and a buildup of secretions

Front 36

Who are cuffed tracheostomy tubes used commonly for?

Back 36

Patients who require mechanical ventilation

Front 37

Who are Uncuffed single tube tracheostomy’s used for?

Back 37

Neonates, infants and young children.

Front 38

How can you prevent depression of the respiratory center?

Back 38

Give analgesics and sedatives with caution, suctioning as needed (maybe as often as 5 minutes post op)

Front 39

How can you know when a patient needs suctioning?

Back 39

Respiration’s are noisy, pulse and RR increased.

Front 40

How would you humidify the air or oxygen given through a tracheostomy?

Back 40

A t tube or tracheostomy collar.

Front 41

Do scenarios for the skills now.

Back 41

Have fun :)