What 2 orders should the nurse complete first?
Chesty
Start oxygen 3 L via nasal cannula
Acetaminophen 350 mg PO q4h for temperature greater than 101 F (38.3")
Normal saline 150 mi/hour
NPO
Start a IV
Sputum culture
Place the client on a cardiorespiratory monitor
Correct Answer : B,H
A. Not a priority compared to monitoring vital signs and ensuring adequate oxygenation.
B: Increased oxygen flow is necessary to manage the client's respiratory distress and history of smoking. Correct Answer: 3 L, not 1 L as initially listed.
C: Acetaminophen 350 mg PO q4h for temperature greater than 101 F (38.3°C): Important for fever management but not the first priority in acute respiratory distress.
D: Helps maintain hydration but is secondary to respiratory support in this scenario.
E: Not applicable as there is no immediate need for surgery or risk of aspiration currently indicated.
F: Important for medication administration and fluid balance but follows after ensuring respiratory function.
G: Useful for diagnosing the cause of respiratory symptoms but not a first-line action.
H: Essential for continuously assessing the client's respiratory and cardiac status due to difficulty breathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}
Explanation
The client presents with facial droop and garbled speech, which are classic symptoms of a stroke. The CT scan ruled out intracranial hemorrhage, aligning with ischemic stroke symptoms. The neurological assessment indicated left-sided facial droop, diminished hand grasp strength, and garbled speech, all of which are consistent with neurological deficits typically seen in a stroke.
Correct Answer is B
Explanation
A. Level of consciousness is not directly related to the risk of OSAS.
B. Body mass index (BMI) is a significant risk factor for OSAS, as higher BMI is strongly associated with increased risk of sleep apnea.
C. Self-description of pain does not relate to the risk factors for OSAS.
D. Breath sounds might be relevant in assessing respiratory status but do not directly indicate the risk for OSAS.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.