A nurse is preparing to measure a client’s oxygen saturation and notes edema of the client’s hands and thickened toenails.
Where should the nurse apply the pulse oximeter probe?
Toe
Finger
Skin fold
Earlobe
The Correct Answer is D
Choice A rationale
Applying the pulse oximeter probe to the toe might not provide an accurate reading if the client has poor peripheral circulation. Additionally, thickened toenails can interfere with the reading.
Choice B rationale
Edema in the hands can affect the accuracy of a pulse oximeter reading. The probe might not fit properly or provide a reliable reading if the finger is swollen.
Choice C rationale
Applying the pulse oximeter probe to a skin fold is not recommended. The probe needs to be placed on a relatively flat, thin area of skin to accurately measure oxygen saturation.
Choice D rationale
The earlobe is a suitable alternative site for pulse oximetry if the fingers and toes are not viable options. The earlobe is typically less affected by peripheral vasoconstriction, which can occur with hypothermia, certain medications, and certain diseases. Therefore, Choice D is the correct answer.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While it’s true that a nasal cannula allows the patient to remove it for a while when it gets uncomfortable, this is not the primary reason for using a nasal cannula. The main purpose of a nasal cannula is to deliver oxygen.
Choice B rationale
A nasal cannula delivers the low concentration of oxygen that the patient needs. It is designed to provide a specific amount of oxygen, and the flow rate can be adjusted as needed.
Choice C rationale
While a nasal cannula does deliver a specific concentration of oxygen, it does not do so constantly. The amount of oxygen delivered can vary depending on the patient’s breathing rate and depth.
Choice D rationale
A nasal cannula does not deliver the highest concentration of oxygen possible. Other devices, such as non-rebreather masks, can deliver higher concentrations of oxygen.
Correct Answer is C
Explanation
Choice A rationale
Increasing the client’s oral fluid intake is not the immediate action the nurse should take. While hydration is important, it does not directly address the client’s low oxygen saturation.
Choice B rationale
Initiating humidification therapy can help to thin secretions and improve oxygenation, but it is not the immediate action the nurse should take.
Choice C rationale
Raising the head of the bed is the first action the nurse should take. This position can help to improve lung expansion and oxygenation.
Choice D rationale
Encouraging the client to cough and deep breath can help to clear secretions and improve oxygenation, but it is not the immediate action the nurse should take.
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