A nurse is using a non-rebreather mask on a patient. The oxygen flow is set at 10–15 L/min, but the reservoir bag is not inflating. What should the nurse do next?

1. A

   Check for kinks in the tubing

2. B

   Increase the oxygen flow rate

3. C

   Change the mask to a nasal cannula

4. D

   Remove the mask and check the patient's respiratory rate

Appeared in: NORCET 7 Prelims -2024

Explanation

Listen in Hindi

• A non-rebreather mask's reservoir bag must remain inflated to supply high-concentration oxygen.
• When the flow rate is already set high (10-15 L/min) and the bag fails to inflate, it strongly indicates an obstruction in the oxygen delivery path.
• Checking for kinks in the tubing is the most logical, quickest, and most direct first step to identify and resolve a potential obstruction.
• This action directly addresses a common cause of equipment malfunction before escalating to other interventions.

Why Other Options Were Wrong

• Option B: The oxygen flow rate is already set to the appropriate high range (10-15 L/min). Increasing it further will not resolve an obstruction and is not the indicated action for a bag that fails to inflate at all.
• Option C: This is a dangerous intervention. A patient requiring a non-rebreather mask needs high-flow, high-concentration oxygen (up to 95% FiO2). A nasal cannula is a low-flow device that delivers a much lower FiO2 (24-44%).
• Option D: Removing the mask cuts off the patient's supplemental oxygen supply, which can lead to rapid desaturation. The immediate problem is with the equipment, and the focus should be on fixing it.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Troubleshooting of high-flow oxygen delivery systems to guide bedside assessment, documentation, and the next nursing action.
• A non-inflating reservoir bag on a non-rebreather mask is a respiratory emergency. The nurse must be able to troubleshoot the cause systematically and rapidly to prevent patient harm.
• Failure to resolve the issue can lead to severe hypoxemia and hypercapnia, as the patient is not receiving adequate oxygen and may be rebreathing their own exhaled air.
• This scenario emphasizes the importance of checking equipment as a primary step in patient assessment when a clinical parameter (oxygen delivery) is not as expected.

How to Approach the Question

• First, identify the clinical scenario: A patient is on a high-flow oxygen device (non-rebreather mask).
• Next, identify the specific problem: The equipment is malfunctioning (the reservoir bag is not inflating).
• Analyze the given data: The oxygen flow rate is already set correctly at 10–15 L/min.
• Formulate a hypothesis: If the flow rate is adequate but the bag isn't filling, there must be an issue preventing oxygen from reaching the bag, such as an obstruction or a leak.
• Evaluate the options based on this hypothesis. Checking for kinks is the most direct way to investigate a potential obstruction.
• Eliminate options that are illogical (increasing an already high flow rate against a potential blockage) or unsafe (switching to a lower-level device or removing oxygen).

Concept Tested & Keywords

• Concept Tested: Troubleshooting of high-flow oxygen delivery systems
• Stem keywords: non-rebreather mask, reservoir bag, not inflating, 10–15 L/min
• Lead-in keywords: What should the nurse do next
• Clinical cues: The key cue is the non-inflating reservoir bag despite a high flow rate, pointing towards an obstruction or leak rather than an insufficient flow setting.
• Negative lead-in flag: false

Question ID

Qmt_YJ2Xwarmez8_fI9D3W

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 731-733

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 5-7