A nurse is assisting with the care of a client in a PACU. Provider Prescriptions
1100:
Oxygen 2 to 5 L/min via nasal cannula to maintain oxygen saturation greater than 92%.
Which of the following actions should the nurse take during the management of oxygenation for this client?
Select all that apply.
Place the client in the supine position.
Prepare to administer oxygen via Venturi face mask.
Add a humidifier to the oxygen device.
Encourage the client to perform deep breathing exercises.
Examine the client's nail beds.
Correct Answer : C,D,E
When managing oxygenation for a client in a PACU, the nurse should take several actions. The nurse should add a humidifier to the oxygen device to help prevent dryness of the nasal passages¹. The nurse should also encourage the client to perform deep breathing exercises to promote oxygenation¹. Additionally, the nurse should examine the client's nail beds for signs of cyanosis, which can indicate inadequate oxygenation¹.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
During a seizure, the child's muscles may contract forcefully, which can lead to accidental biting of the tongue or inner cheek. Inspecting the child's mouth for any signs of injury, such as bleeding or lacerations, is important for assessing and addressing immediate needs.
Instead of placing the child in a supine position (flat on their back), it is recommended to position them on their side (recovery position) to help maintain an open airway and prevent aspiration in case of vomiting or secretions. This position also helps promote drainage of saliva or other fluids from the mouth.
Seizures can be frightening for both the child and their caregivers. Providing a calm and soothing environment, offering comfort, and reassuring the child and their family can help alleviate anxiety and promote a sense of safety.
Administering medication or offering fluids should be determined based on the healthcare provider's orders and individual circumstances. It is essential to consult with the healthcare team for specific instructions regarding medications and fluid management after a seizure episode.
Correct Answer is D
Explanation
The correct action to take in this situation is to place a pillow or cushion under the child's head.
This will help protect the child from injuring their head during the seizure.
It is important not to turn the child onto their back during a seizure, as this can obstruct the airway and potentially lead to respiratory distress.
Restraining the child's upper extremities is also not recommended, as it can cause injury to the child or the person trying to restrain them.
Placing a padded tongue blade or any object in the child's mouth is no longer recommended during a seizure. Doing so can cause injury to the child's mouth or teeth and is not necessary for seizure management.
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