The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the client’s needs?

Partial non-rebreathing mask

Simple (Oxy Plus) mask

Nasal cannula

Non-rebreathing mask

Answer and Explanation

The Correct Answer is C

A. Partial non-rebreathing mask:

This mask delivers higher concentrations of oxygen than a nasal cannula. It has a reservoir bag that allows the client to rebreathe some exhaled air, increasing the oxygen concentration delivered. However, it may not be necessary for a client with mild shortness of breath and slightly reduced oxygen saturation.

B. Simple (Oxy Plus) mask:

The simple mask provides a higher concentration of oxygen than a nasal cannula but lacks the reservoir bag found in the non-rebreathing mask. It is generally used for moderate oxygen needs. However, it might be more than what is required for a client with mild shortness of breath and slightly reduced oxygen saturation.

C. Nasal cannula:

Nasal cannulas are commonly used for clients with mild respiratory distress. They deliver a lower to moderate concentration of oxygen and are well-tolerated by most clients. They are suitable for individuals with mild shortness of breath and can be adjusted based on the required flow rate.

D. Non-rebreathing mask:

The non-rebreathing mask provides the highest concentration of oxygen among the options listed. It includes a reservoir bag to deliver a higher oxygen concentration. It is typically reserved for clients with higher oxygen requirements. For a client with mild shortness of breath and slightly reduced oxygen saturation, this may be more than necessary.

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Correct Answer is B

Explanation

A. Standard precautions:

Standard precautions are the basic level of infection control and should be used for all patient care. These precautions include practices like hand hygiene, the use of personal protective equipment (PPE), and safe injection practices.

B. Airborne precautions:

These precautions are used to prevent the transmission of infectious agents that are spread through the air. In the case of tuberculosis (TB), which is caused by Mycobacterium tuberculosis, airborne precautions are necessary to reduce the risk of airborne transmission.

C. Contact precautions:

Contact precautions are used for patients with known or suspected infections that can be transmitted by direct or indirect contact. Examples include Clostridium difficile infection and multidrug-resistant organisms. These precautions involve the use of PPE and may include patient placement in a private room.

D. Droplet precautions:

Droplet precautions are used when a patient is known or suspected to be infected with pathogens that are transmitted by respiratory droplets. Examples include influenza and certain types of bacterial meningitis. These precautions include placing the patient in a private room and using PPE.

A. Kyphosis and clubbing of the fingers B. Dyspnea and hypoxemia C. Sepsis and pneumothorax D. Bradypnea and pursed-lip breathing

Correct Answer is C

Explanation

A. Kyphosis and clubbing of the fingers:

Kyphosis refers to an excessive forward curvature of the spine, which is not directly related to diminished breath sounds. Clubbing of the fingers is often associated with chronic respiratory conditions, but it is not directly linked to the finding of diminished breath sounds.

B. Dyspnea and hypoxemia:

Dyspnea (shortness of breath) and hypoxemia (low oxygen levels in the blood) are common symptoms in COPD, but diminished breath sounds may indicate an additional concern, such as pneumothorax or other complications.

C. Sepsis and pneumothorax:

Diminished breath sounds can be a sign of pneumothorax, a condition where air accumulates in the pleural space, leading to lung collapse. Sepsis is a risk in clients with COPD due to the potential for respiratory infections. Monitoring for these complications is crucial.

D. Bradypnea and pursed-lip breathing:

Bradypnea (slow breathing) and pursed-lip breathing are coping mechanisms that individuals with COPD may use to manage their breathing difficulties. While they are relevant in the context of COPD, they are not directly associated with the finding of diminished breath sounds.

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The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the client’s needs?

Nursing Test Bank

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