A nurse is reinforcing teaching with a newly licensed nurse about a nonrebreather mask. Which of the following instructions should the nurse include?
The reservoir bag on a nonrebreather mask should collapse with exhalation.
A nonrebreather mask dries a patient's mucous membranes.
A nonrebreather mask should fit snugly over a patient's face.
Use a nonrebreather mask to deliver low-flow oxygen
The Correct Answer is C
Choice A reason: The reservoir bag on a nonrebreather mask should not collapse with exhalation. It is designed to maintain a continuous flow of oxygen and reserve a volume of oxygen for the patient to inhale with each breath.
Choice B reason: While high-flow oxygen can dry a patient's mucous membranes, a nonrebreather mask typically has a high oxygen flow rate, and humidification can be used to prevent drying.
Choice C reason: A nonrebreather mask must fit snugly over the patient's face to ensure that the highest concentration of oxygen is delivered and that there is minimal dilution with room air.
Choice D reason: A nonrebreather mask is used to deliver high-flow oxygen, not low-flow. It is designed to provide a high concentration of oxygen, typically around 60% to 90% FiO2.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Aspirating fluid from the IV cannula is not recommended as it does not address the issue of infiltration or extravasation.
Choice B reason: Placing the affected extremity below the level of the client's heart could worsen the swelling and is
not recommended.
Choice C reason: Slowing the IV infusion is a correct immediate action to minimize further infiltration and should be done while further assessment and interventions are planned.
Choice D reason: Placing a pressure dressing over the IV site is not recommended as it may exacerbate the infiltration
and increase discomfort.
Correct Answer is B
Explanation
Choice A reason: Dark-colored urine can be a sign of dehydration or the presence of certain substances in the urine, such as blood or bile, but it is not typically associated with urinary retention.
Choice B reason: Leakage of urine, or overflow incontinence, can occur in urinary retention when the bladder is overfilled and the pressure within the bladder exceeds urethral resistance. This can lead to involuntary release of urine.
Choice C reason: Blood in the urine, or hematuria, can indicate various conditions, including infections, stones, or tumors, but it is not a common finding specifically associated with urinary retention.
Choice D reason: Cloudy urine may suggest the presence of phosphates (a normal occurrence in alkaline urine), infection, or the presence of pus (pyuria). While it could be associated with a urinary tract infection that might lead to urinary retention, cloudy urine itself is not a direct indicator of urinary retention.
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