Patient Data.

What is the rationale for the order of supplemental oxygen 10 L/min via nasal cannula? Select the best answer.

To prevent hypoxia and tissue damage due to pneumonia.

To lower the blood pressure and reduce the workload of the heart.

To increase the oxygen saturation and improve the respiratory function.

To dilate the bronchioles and decrease the inflammation of the lungs.

None

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Supplemental oxygen is given to the patient to prevent hypoxia and tissue damage due to pneumonia. Pneumonia is an infection that inflames the air sacs in one or both lungs, which may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing. Hypoxia occurs when the body or a region of the body is deprived of adequate oxygen supply at the tissue level. It can cause serious damage to your heart, brain, and other organs. Hence, supplemental oxygen is administered to ensure that the patient’s tissues receive adequate oxygen.

Choice B rationale:

While supplemental oxygen can indirectly help lower blood pressure by improving oxygen supply and reducing strain on the heart, it is not primarily used for this purpose. Enalapril, which the patient is already taking, is an angiotensin-converting enzyme (ACE) inhibitor that is commonly used to lower blood pressure and reduce the workload of the heart.

Choice C rationale:

Supplemental oxygen does increase the oxygen saturation and improve respiratory function. However, this is a more general rationale for providing supplemental oxygen and not specific to this patient’s condition of pneumonia.

Choice D rationale:

Supplemental oxygen does not directly dilate the bronchioles or decrease inflammation in the lungs. Medications such as bronchodilators and corticosteroids are typically used for these purposes. In this case, supplemental oxygen is being used to prevent hypoxia and tissue damage due to pneumonia.

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Correct Answer is ["A","B","C","E"]

Explanation

Choice A rationale:

Stopping the heparin infusion immediately is essential when the client's aPTT is significantly elevated (in this case, 120 seconds). A prolonged aPTT indicates a higher risk of bleeding, and discontinuing the heparin infusion is a crucial step in preventing further bleeding.

Choice B rationale:

Administering protamine sulfate is necessary when a client on heparin therapy experiences excessive bleeding or if the aPTT is significantly elevated. Protamine sulfate acts as a heparin antagonist and can reverse the anticoagulant effects of heparin.

Choice C rationale:

Notifying the healthcare provider of the significantly prolonged aPTT is essential because it may indicate a need for adjustments in the heparin dosage or therapy. The provider can determine the appropriate course of action based on the client's clinical condition.

Choice D rationale:

Drawing a prothrombin time (PT) and international normalized ratio (INR) level is not necessary in this situation. PT and INR are more relevant parameters when assessing clients on warfarin therapy, not heparin.

Choice E rationale:

Monitoring the client for signs and symptoms of bleeding is crucial when the aPTT is prolonged, as it indicates a higher risk of bleeding. This action allows for early detection and intervention to prevent complications.

A. Elevated serum creatinine level. B. Elevated serum alanine aminotransferase level. C. Elevated serum potassium level. D. Elevated white blood cell count. E. Elevated platelet count.

Correct Answer is ["A","B","D"]

Explanation

Choice A rationale:

An elevated serum creatinine level can indicate kidney dysfunction or damage, which can be a possible adverse effect of amoxicillin-clavulanate. The kidneys are responsible for excreting the medication, and elevated creatinine levels suggest impaired renal function.

Choice B rationale:

An elevated serum alanine aminotransferase (ALT) level is indicative of liver dysfunction or damage. Amoxicillin-clavulanate can sometimes cause hepatotoxicity as a side effect, and elevated ALT levels may suggest this adverse effect.

Choice D rationale:

An elevated white blood cell count (leukocytosis) can be a possible adverse effect of amoxicillin-clavulanate, indicating an increase in the body's immune response. This could be due to an allergic reaction or other adverse reactions to the medication.

Choice C rationale:

An elevated serum potassium level is not typically associated with amoxicillin-clavulanate use. This finding is more likely related to other factors such as kidney dysfunction or certain medications like potassium-sparing diuretics.

Choice E rationale:

An elevated platelet count is not typically associated with amoxicillin-clavulanate use. This finding is more likely related to other factors, such as a bone marrow disorder or inflammation.

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Patient Data. What is the rationale for the order of supplemental oxygen 10 L/min via nasal cannula? Select the best answer.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who is receiving intravenous unfractionated heparin.The nurse notes that the client’s activated partial thromboplastin time (aPTT) is 120 seconds.What are the appropriate nursing actions in this situation? Select all that apply.*.

Correct Answer is ["A","B","C","E"]

Explanation

A nurse is reviewing laboratory results for a client who has been taking amoxicillin-clavulanate (Augmentin) for a bacterial respiratory tract infection.Which of the following findings should alert the nurse to a possible adverse effect of this medication? (Select all that apply.).

Correct Answer is ["A","B","D"]

Explanation

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A client arrives at the emergency department with chest pain after taking sildenafil.Based on the client's history, which medication should the nurse withhold?

The practical nurse (PN) is completing a focused assessment on a client who is prescribed oxygen at 3 liters per minute by nasal cannula. Which assessment finding by the PN requires immediate action?

Patient Data.

What is the rationale for the order of supplemental oxygen 10 L/min via nasal cannula? Select the best answer.