A client is receiving oxygen at 2 L/min via a nasal cannula. What oxygen concentration is the client receiving?

Choice A rationale
The nurse should prioritize the safety of the patient. If a patient is frequently attempting to remove his feeding tube, it could lead to complications such as infection or injury. Therefore, the nurse might need to consider using a restraint as a last resort. However, it’s important to note that restraints should only be used when all other alternatives have been explored and failed. These alternatives include having staff or a family member sit with the patient, using distraction or de-escalation strategies, offering reassurance, using bed or chair alarms, and administering certain medications.
Choice B rationale
Covering the catheter so the patient cannot see it might not be effective if the patient is aware of its presence and is determined to remove it. This approach does not address the underlying issue and may not prevent the patient from attempting to remove the feeding tube.
Choice C rationale
Providing more stimulation in the patient’s environment might be helpful in some cases, but it may not prevent the patient from attempting to remove the feeding tube. The effectiveness of this approach would depend on the specific circumstances and the patient’s condition.
Choice D rationale
Waiting until tonight to see if the patient continues this behavior could potentially put the patient at risk. If the patient is frequently attempting to remove the feeding tube, immediate action may be necessary to ensure the patient’s safety.

Choice A rationale
Cranberry juice is an acceptable component of a clear liquid diet. Clear liquid diets are often prescribed postoperatively as they are easy to digest and leave no residue in the digestive tract.
Choice B rationale
Lemon sherbet is not part of a clear liquid diet. It is considered part of a full liquid diet, which is more substantial and includes foods that are liquid at room temperature.
Choice C rationale

Carrot juice is not typically included in a clear liquid diet. It may contain pulp and is not clear, which is a requirement of a clear liquid diet.
Choice D rationale
Plain yogurt is not part of a clear liquid diet. It is considered a solid food and is therefore not included.