The nurse is obtaining a pulse oximetry reading for a client admited with exacerbation of chronic obstructive pulmonary disease (COPD). When observing a reading of 91%. what action should the nurse perform?
No action is required, because this may be normal for the client
The nurse should prepare intubation equipment for the health care provider
Administer oxygen at 6 L/m by nasal cannula
Have the client breath into a paper bag
The Correct Answer is A
A. This is the most appropriate response. Clients with COPD often have chronically elevated carbon dioxide levels, which can lead to a compensatory decrease in the oxygen saturation level. A reading of 91% may be within their normal range.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Stridor is a high-pitched, inspiratory sound that indicates partial obstruction of the upper airway. It is a common finding in newborns and can occur due to the presence of mucus, fluid, or a small airway that has not yet fully developed. It is important to note that while stridor is an expected finding in newborns, it should still be assessed and monitored closely by healthcare professionals.
Bruits are abnormal sounds heard over blood vessels and are not related to breath sounds. Crackles are a series of brief, discontinuous, nonmusical sounds heard during inspiration or expiration, indicating fluid in the lungs. Wheezing is a high-pitched, musical sound heard during expiration and can indicate the narrowing of the airways. These sounds are not typically expected in the breath sounds of a newborn.
Correct Answer is B
Explanation
Choice A reason: This is incorrect because it shows that the PN is not familiar with the nursing diagnosis criteria. Three defining characteristics are not the least number required for the diagnosis of Impaired Verbal Communication.
Choice B reason: This is correct because it shows that the PN is familiar with the nursing diagnosis criteria. One defining characteristic is the least number required for the diagnosis of Impaired Verbal Communication, according to the NANDA-I taxonomy.
Choice C reason: This is incorrect because it shows that the PN is not familiar with the nursing diagnosis criteria. Four defining characteristics are not the least number required for the diagnosis of Impaired Verbal Communication.
Choice D reason: This is incorrect because it shows that the PN is not familiar with the nursing diagnosis criteria. Two defining characteristics are not the least number required for the diagnosis of Impaired Verbal Communication.
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