Find patient data below.
What actions should the nurse plan for the rest of the shift? Select all that apply.
Monitor the oxygen saturation
Discuss aggressive respiratory treatment options
Obtain a sputum culture
Allow the client to take a position of comfort
Discuss with the client potential asthma triggers
Consider positive pressure ventilation
Wean the supplemental oxygen
Prepare for deep tracheal suctioning
Correct Answer : A,D,E
A) Correct- Continuous monitoring of oxygen saturation ensures the client's oxygen levels remain within an acceptable range.
B) Incorrect - Discussing aggressive respiratory treatment options is not warranted based on the provided information. The current treatment plan includes appropriate interventions.
C) Incorrect - Obtaining a sputum culture is important for identifying infections, but it's not an immediate action in the context of the client's current symptoms.
D) Correct- Promoting comfort can help reduce anxiety and potentially improve breathing.
E) Correct- Educating the client about potential triggers supports better self-management.
F) Incorrect - Considering positive pressure ventilation is not indicated at this stage. The client's symptoms are being managed with other interventions.
G) Incorrect - Weaning supplemental oxygen is not mentioned in the patient data or nurses' notes as something that's currently necessary.
H) Incorrect - Preparing for deep tracheal suctioning is not warranted based on the patient data and the current treatment plan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
No explanation
Correct Answer is B
Explanation
A. Explaining the examination and asking the client to sign the consent form is not within the PN's scope of practice. It is the responsibility of the healthcare provider performing the procedure to explain the risks, benefits, and alternatives of the exam and to obtain informed consent from the client.
B. Checking the medical record for the correct signed consent form prior to the examination is an essential role for the practical nurse. It ensures that informed consent has been obtained and documented before proceeding with any invasive procedure, aligning with the PN's responsibility to verify necessary documentation.
C. Explaining to a family member and obtaining their signature on the consent form may be appropriate only if the client is unable to provide consent and has a legal representative. However, obtaining consent and explaining the procedure is still the responsibility of the healthcare provider, not the PN.
D. Asking if the client understands the exam and why the consent form must be signed is part of the PN's role in ensuring that the client is informed, but the PN cannot assume responsibility for explaining the procedure in detail. This should be done by the healthcare provider who will perform the exam.
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