A nurse is obtaining an oxygen saturation on a client.
Which of the following actions should the nurse take?

Relocate the sensor every 8 hrs.

Wait 10 sec after placing the probe before obtaining the oxygen saturation reading.

Choose a finger with a capillary refill less than 2 sec.

Place the sensor probe on the same extremity as an electronic blood pressure cuff.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Relocating the sensor every 8 hours is not necessary when obtaining oxygen saturation readings unless there is a specific clinical reason to do so, such as skin irritation or poor perfusion at the sensor site. Frequent relocation can cause unnecessary disruption for the patient.

Choice B rationale:

Waiting 10 seconds after placing the probe before obtaining the oxygen saturation reading is not required. Modern pulse oximeters provide real-time readings, and there is no need to wait after placing the probe. The reading is usually stable within seconds.

Choice C rationale:

Choosing a finger with a capillary refill time of less than 2 seconds is an essential consideration when obtaining oxygen saturation readings. Capillary refill time is a measure of peripheral perfusion, and choosing a finger with good perfusion ensures accurate oxygen saturation measurements.

Choice D rationale:

Placing the sensor probe on the same extremity as an electronic blood pressure cuff is generally acceptable. However, it is crucial to ensure that the sensor does not interfere with the blood pressure cuff's function and that it is securely attached to the patient's finger for accurate readings.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A rationale:

Positioning the client supine with legs elevated is not an appropriate intervention for a client with ascites due to cirrhosis. It may help with other conditions, but in ascites, it can increase pressure on the abdomen and worsen fluid accumulation.

Choice C rationale:

Restricting the client's sodium intake to 3g per day is a valid intervention for a client with ascites due to cirrhosis. However, measuring the abdominal girth daily is a more immediate and actionable intervention to monitor the progression of ascites and adjust treatment accordingly.

Choice D rationale:

Keeping the client's daily protein intake below 0.8 g/kg is not the standard practice for managing ascites in cirrhosis. In fact, adequate protein intake is important to prevent malnutrition in these clients, so protein restriction is not recommended unless specifically indicated by a healthcare provider.

A. Inject additional insulin before exercising. B. Eat a piece of fruit before exercising. C. Exercise when insulin is at its peak action. D. Avoid protein before exercising.

Correct Answer is B

Explanation

Choice A rationale:

Injecting additional insulin before exercising is not a recommended practice for individuals with type 1 diabetes mellitus. It can lead to hypoglycemia (low blood sugar) during exercise. The goal is to ensure that blood glucose levels are within a safe range before starting physical activity.

Choice B rationale:

Eating a piece of fruit before exercising is a suitable recommendation for someone with type 1 diabetes mellitus. Consuming a source of carbohydrates, such as fruit, can help prevent hypoglycemia during exercise. Carbohydrates provide a steady source of glucose for energy.

Choice C rationale:

Exercising when insulin is at its peak action can be risky for individuals with type 1 diabetes. At this time, the risk of hypoglycemia is higher because insulin is actively lowering blood sugar levels. It is generally recommended to exercise when insulin is at a moderate or lower level of activity to reduce the risk of hypoglycemia.

Choice D rationale:

Avoiding protein before exercising is not a specific recommendation for individuals with type 1 diabetes mellitus. While protein does not directly impact blood glucose levels as carbohydrates do, it is an essential nutrient for overall health. A balanced meal or snack that includes carbohydrates and protein is typically a better choice before exercise.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is obtaining an oxygen saturation on a client.Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is contributing to the plan of care for a client who has ascites due to cirrhosis.Which of the following interventions should the nurse recommend to include in the plan?

Correct Answer is B

Explanation

A client who has type 1 diabetes mellitus asks a nurse about beginning an exercise regimen.Which of the following instructions should the nurse include?

Correct Answer is B

Explanation

A nurse is reinforcing teaching about foot care with a client who has type 2 diabetes mellitus.Which of the following statements by the client indicates an understanding of the teaching?

A nurse is reinforcing teaching with a client who is postpartum about the measles, mumps, and rubella (MMR) vaccine.Which of the following instructions should the nurse include in the teaching?

A nurse is evaluating a client's acceptance of having a new ileostomy.Which of the following statements by the client indicates acceptance?

A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day. The nurse interrupts the bath and obtains a healthy meal for the client. This action by the nurse is an example of which of the following?

The nurse is assisting in the care of the client who is on the behavioral health unit. Exhibits Select words from the choices below to fill in each blank in the following sentence (Separate using commas). The nurse should plan to dropdownand dropdown

A nurse is helping to place a client into the prone position. The nurse should use a small pillow to relieve pressure from which of the following areas of the client's body?

A nurse is collecting data from a client who has pyelonephritis and is receiving gentamicin via IV infusion.Which of the following manifestations should the nurse identify as an adverse effect of the treatment?

A nurse is implementing a bladder training program for a client who had a stroke.Which of the following interventions should the nurse take first?

A nurse is obtaining an oxygen saturation on a client.
Which of the following actions should the nurse take?