12F EAQ es - Elsevier Adaptive Quizzing fundamentals 12 PDF

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9/27/21, 11:38 AM

Elsevier Adaptive Quizzing - Quiz performance

Performance Exit

Week 12 Quiz Due Oct 17, 2021 by 8:59 pm

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96% 72 out of 75 questions answered correctly

Completed on Sep 25, 2021 8:06 pm

Incorrect (3)

What is the advantage of the device that is illustrated in the image?

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This device relieves upper airway obstruction. This device encourages voluntary deep breathing. This device supports cardiopulmonary gas exchange. This device helps with maintaining adequate ventilation.

Rationale The image illustrates an incentive spirometer, which encourages voluntary deep breathing by providing visual feedback to the patients about inspiratory volume. An endotracheal tube helps to relieve upper airway obstruction, protects against https://eaqng.elsevier.com/#/quizPerformance/20473240

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aspiration, and clears secretion. Invasive mechanical ventilation is life-saving positive pressure ventilation because it supports cardiopulmonary gas exchange by increasing lung volume and reducing the work of breathing. Positioning helps with maintaining adequate ventilation. p. 902

What is the rationale for hyperventilating the patient who has a head injury prior to suctioning? To decrease the stimulus to breathe To reduce the possibility of hypocarbia To reduce the potential increase in intracranial pressure (ICP) To reduce the risk of spreading microorganisms into the lower respiratory tract

Rationale The nurse should be cautious while suctioning patients who have head injuries. Suctioning elevates the intracranial pressure (ICP). The risk is reduced by hyperventilating prior to suctioning, which results in hypocarbia. This condition induces vasoconstriction, which reduces the potential increase in ICP. The nurse should limit the introduction of the catheter to two times with each suctioning procedure. While performing suctioning in patients who have chronic obstructive pulmonary disorder (COPD) and who are breathing spontaneously, the nurse should be cautious of the high levels of oxygen therapy because it results in a decreased stimulus to breathe. The nurse should not routinely use normal saline instillation into the airway before endotracheal and tracheostomy suctioning because this action results in the spread of microorganisms into the lower respiratory tract. p. 911

Which oxygen delivery system is indicated for long-term oxygen use at https://eaqng.elsevier.com/#/quizPerformance/20473240

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home? Oxymizer Partial mask Nasal cannula Nonbreather mask

Rationale Oxymizer (oxygen-conserving cannulas) are indicated for long-term oxygen use at home. Partial masks, nasal cannulas, and nonrebreather masks are used for short periods. p. 903

Correct (72)

While performing oropharyngeal suctioning, which intervention performed by the registered nurse helps move secretions from the lower to the upper airway and then into the mouth? Encouraging the patient to cough Lubricating the catheter before insertion Keeping the oxygen mask near patient’s face Applying of suction pressure while introducing the catheter

Rationale Coughing moves secretions from lower to upper airways into the mouth. Therefore, the nurse should encourage the patient to cough. Lubricating the catheter may ease the insertion of the catheter, but does not move secretions. An oxygen mask should be https://eaqng.elsevier.com/#/quizPerformance/20473240

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kept near the patient’s face, which allows access to the patient’s mouth while having access to the oxygen-delivery system. Suction pressure is applied while introducing a catheter into the nasopharyngeal tissues, which increases the risk of damage to the mucosa. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 909

What should the nurse do when a patient with a tracheostomy tube experiences the signs and symptoms of respiratory distress? Perform manual ventilation Remove the outer cannula of the endotracheal tube Remove secretions around the stoma Seek the assistance of the nursing assistive personnel

Rationale If a patient with a tracheostomy tube has difficulty breathing, the nurse should manually ventilate the patient. The caregiver should not remove the patient’s outer cannula without the permission of the health care provider. Removing secretions around the stoma helps to maintain asepsis. Nursing assistive personnel are not eligible to assist in endotracheal tube care. p. 922

Why should the roller clamp be closed while preparing tubing using existing intravenous infusion? To permit the flow of fluid https://eaqng.elsevier.com/#/quizPerformance/20473240

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To prevent the spillage of fluid To remove air from the tube To prevent the complete infusion of fluid

Rationale The roller clamp is closed to prevent the spillage of fluid from the tube. Placing the incision spike into the new tubing allows the flow of the fluid. Closing the roller clamp when full prevents the air from entering into the tube. Infusion of the fluid at a slow rate can prevent complete infusion of the fluid. p. 984

A patient wants to understand the mechanism of respiration. What should the nurse explain to the patient? Select all that apply. Normal breathing is quiet with minimum or no effort. Ventilation is the process of air moving in and out of lungs. Normal breathing is noisy and requires all the chest muscles. The diaphragm is an important muscle that helps in breathing. Ventilation is the process of oxygenated blood flowing in the body.

Rationale Normal breathing is a quiet process, which requires minimum effort. Ventilation is the process of air moving in and out of lungs. The major muscles in breathing are the diaphragm and the intercostal muscles. Noisy breathing occurs in diseased conditions or in the presence of some obstruction. All chest muscles, such as pectorals and sternocleidomastoid, are used in labored breathing. Perfusion is a process by which the cardiovascular system delivers oxygen-rich blood to the tissues and returns deoxygenated blood to the lungs. https://eaqng.elsevier.com/#/quizPerformance/20473240

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pp. 872-873

Which ions are cations? Select all that apply. Sodium Calcium Chloride Potassium Bicarbonate

Rationale Positively charged ions are called cations. Negatively charged ions are called anions. Sodium (Na +), calcium (Ca +), and potassium (K + ) are cations. Chloride (Cl -) and bicarbonate (HCO 3-) ions are anions. 935

A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min. While in the supine position for a bath, the patient complains of shortness of breath. Which is the most appropriate first nursing action? Increase the flow of oxygen. Perform tracheal suctioning. Report this to the healthcare provider. Assist the patient to semi-Fowler’s position.

Rationale https://eaqng.elsevier.com/#/quizPerformance/20473240

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Breathing is easier in semi-Fowler’s position because it permits greater expansion of the chest cavity. If repositioning does not improve the situation, then oxygenation and contacting the health care provider might be appropriate. The patient would not benefit from tracheal suctioning.  Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. pp. 889, 890, 896

The primary health care provider tells the nurse to observe the intravenous connections and patency of systems of a patient who is on intravenous fluids. What is the rationale behind this order? Detecting bleeding Ensuring proper fluid administration Maintaining pressure to prevent bleeding Reducing the transmission of microorganisms

Rationale Observing intravenous connections and the patency of systems ensures proper fluid administration to the patient. Observing the puncture site detects bleeding. Applying sterile folded gauze helps to prevent bleeding. Discarding the used supplies and performing hand hygiene reduces the risk of infection. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 986

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Which body fluid is considered an intravascular fluid? Synovial fluid Plasma of the blood Fluid outside the cells Fluid outside the blood vessels

Rationale Blood plasma is considered an intravascular fluid. Synovial fluid is considered a transcellular fluid. Extracellular fluid is located outside the cells. Interstitial fluid is located outside the blood vessels. 935

The registered nurse instructs the nursing assistive person (NAP) to frequently reposition the elastic strap on the patient’s oxygen mask. What is the rationale behind this? To prevent epistaxis To prevent skin breakdown To prevent continued hypoxia To prevent nasal mucosal dryness

Rationale Frequently repositioning the elastic strap of an oxygen mask helps reduce pressure, thereby preventing skin breakdown. Epistaxis can be avoided by monitoring humidification if the oxygen flow rate is greater than 4 L/minute. To avoid continuous hypoxia, follow-up of pulse oximetry and arterial blood gas (ABG) assessment should be performed. To prevent nasal mucosal dryness, sterile nasal saline should be used intermittently with the orders of the health care provider. https://eaqng.elsevier.com/#/quizPerformance/20473240

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p. 916

A patient has been diagnosed with severe iron deficiency anemia. To determine the patient’s oxygen status, the nurse should assess for which symptoms during physical assessment? Increased breathlessness and increased activity tolerance Decreased breathlessness and decreased activity tolerance Increased activity tolerance and decreased breathlessness Decreased activity tolerance and increased breathlessness

Rationale Hypoxia occurs because of decreased circulating blood volume, which leads to decreased oxygen to muscles, causing fatigue, decreased activity tolerance, and a feeling of shortness of breath. Test-Taking Tip: While you breathe deeply and tell yourself to stay calm, notice the parallel construction of the choices for this question. Each one has breathlessness and activity tolerance. Ask yourself which is a sign of anemia (= 'bad'): increased or decreased breathlessness (increased); and increased or decreased activity tolerance (decreased). Notice that one measure is increased and the other is decreased in anemia. This helps you eliminate two of the options because they have both increased or both decreased. Then reexamine the remaining options, looking for increased breathlessness and decreased activity tolerance. Voila! You have the answer. p. 876

While receiving a blood transfusion, a patient develops chills, tachycardia, and flushing. What is the nurse’s priority action? Notify a health care provider. Insert an indwelling catheter. https://eaqng.elsevier.com/#/quizPerformance/20473240

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Alert the blood bank. Stop the transfusion.

Rationale Development of chills, tachycardia, and flushing during a blood transfusion indicate an acute hemolytic reaction. The nurse should stop the transfusion immediately so no more of the incompatible blood reaches the patient. Test-Taking Tip: Remember that the nurse’s number 1 priority is the patient’s safety! Although the nurse may eventually notify the health care provider and alert the blood bank, stopping the transfusion is the first priority, and thus the best response. p. 963

Which complication would the nurse suspect if an endotracheal tube cuff is underinflated? Aspiration Impaired skin integrity Impaired oxygenation Necrosis of tracheal tissue

Rationale An underinflated cuff increases the patient’s risk of aspiration. An inability to control secretions and pressure from airway devices may increase the risk of impaired skin integrity and infection. A buildup of secretions in the airways is responsible for impaired oxygenation. An overinflated cuff may result in ischemia or necrosis of the tracheal tissue. p. 915 https://eaqng.elsevier.com/#/quizPerformance/20473240

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A patient reports having shortness of breath and fatigue on brisk walking for the past 2 weeks. The patient has also experienced menorrhagia for the past 2 months. The patient’s blood reports show decreased hemoglobin and an increased red blood cell count. Which condition is the patient most likely experiencing? Decreased surfactant in the lungs Decreased lung compliance Decreased oxygenation of blood Decreased fraction of inspired oxygen concentration

Rationale An examination would likely indicate that the patient has anemia as a result of menorrhagia. In anemia, oxygenation decreases. Over a long period, the body responds by increasing the production of red blood cells, resulting in polycythemia. Surfactant is a chemical produced by the lungs that prevents alveolar collapse. It is highly unlikely the patient has decreased surfactant. Lung compliance is the ability of the lungs to expand and is affected by intraalveolar pressure. A decrease in the fraction of inspired oxygen concentration occurs in upper or lower airway obstruction. p. 876

During assessment a patient states, 'It’s hard for me to breathe and I feel short-winded all the time.' Which is the most appropriate terminology for the nurse to use when documenting this assessment? Apnea Dyspnea Tachypnea Respiratory fatigue https://eaqng.elsevier.com/#/quizPerformance/20473240

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Rationale Dyspnea is a subjective description reflective of the patient’s statement indicating difficulty in breathing. Apnea refers to absence of breathing. Tachypnea refers to an increased rate of breathing, usually greater than 20 breaths per minute. Respiratory fatigue is a subjective description. It usually refers to the patient exhibiting signs and symptoms associated with a comprehensive respiratory assessment. The respiratory assessment includes laborious breathing, use of accessory muscles, and slowing of respirations. Study Tip: Be sure to review medical terminology, so that you recall the meanings of the Latin and Greek word parts, such as dys-, which means difficult, and - pnea, which means breathing. pp. 881-882

After reviewing a patient’s laboratory reports, the nurse instructs him or her to consume dairy products. Which electrolytic imbalance may have prompted this instruction? Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia

Rationale Hypocalcemia is characterized by decreased calcium levels. Dairy products such as milk are rich sources of calcium; therefore, the nurse instructs the patient to consume dairy products. The nurse should instruct a patient with hypokalemia to consume a potassium-rich diet. The nurse would recommend a potassium-free diet to a patient with hyperkalemia. The consumption of dairy products can further increase the risk of hypercalcemia.

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p. 941

What is the significance of the action depicted in the figure?

To maintain a patent airway To prevent accidental extubation To remove secretions from the stoma To diminish the patient's need to cough

Rationale The image depicts reinsertion of the inner cannula. The inner cannula is replaced daily to prevent infection and maintain a patent airway. Maintaining the proper position of an endotracheal tube may help to prevent accidental extubation. Cleaning around the stoma helps to remove secretions from the stoma site. Endotracheal, tracheal,

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nasopharyngeal, or oropharyngeal suctioning helps to diminish the patient's need to cough. p. 919

Which ion is an example of an anion? Sodium Calcium Chloride Potassium

Rationale Positively charged ions are called cations. Negatively charged ions are called anions. A chloride (Cl -) ion is an anion. Sodium (Na +), calcium (Ca +), and potassium (K +) are cations. 935

Which electrolyte is necessary for the production of adenosine triphosphate? Calcium (Ca 2+) Potassium (K + ) Phosphate (PO 4 3-) Magnesium (Mg 2+)

Rationale Phosphate (PO 43-) is necessary for the production of adenosine triphosphate. Calcium (Ca 2+) is necessary for muscle contractions. Potassium (K +) is necessary for normal https://eaqng.elsevier.com/#/quizPerformance/20473240

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2+

muscle function. Magnesium (Mg ) influences the function of neuromuscular junctions. p. 941

Which is a clinical manifestation of hypoxia? Cyanosis Xanthelasma Periorbital edema Splinter hemorrhages

Rationale Cyanosis indicates decreased tissue oxygenation or hypoxia. Xanthelasma is an ophthalmic abnormality indicative of hyperlipidemia. Periorbital edema is a clinical manifestation of renal disease. Splinter hemorrhages is a clinical manifestation of bacterial endocarditis. p.884

The registered nurse is teaching a nursing student about the care for patients with artificial airways. Which statements should the nurse exclude from the teaching? 'Normal saline solution should be instilled into artificial airways.' 'Artificial airways should be positioned in case of deviation.' 'Suctioning should be performed through artificial airways.' 'Sterile techniques should be used to maintain endotracheal and tracheal airways.'

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Rationale Instilling normal saline into artificial airways is no longer evidence-based clinical practice because there is no evidence that it helps to loosen secretions. Artificial airways should be positioned correctly in case o...