A nurse is preparing to administer oxygen to a client who has heart failure and is having severe difficulty breathing. Which of the following oxygen delivery equipment should the nurse select to provide the highest concentration of oxygen to the client?
Nasal cannula
Simple face mask
Venturi mask
Nonrebreather mask
The Correct Answer is D
A: A nasal cannula provides a low to moderate concentration of oxygen and is not suitable for a client experiencing severe difficulty breathing.
B: A simple face mask provides a higher concentration of oxygen than a nasal cannula but may not deliver a high enough concentration for a client experiencing severe respiratory distress.
C: A Venturi mask can provide a precise and adjustable concentration of oxygen but may not deliver the highest concentration needed in this scenario.
D: A nonrebreather mask can deliver the highest concentration of oxygen (up to 100%) and is the most appropriate choice for a client experiencing severe difficulty breathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Ask a family member who speaks the client's primary language to interpret: While involving family members may seem helpful, it is not the most effective way to ensure accurate and complete communication. There may be language barriers or misunderstandings.
B. Plan a long teaching session initially to introduce the necessary material: Lengthy teaching sessions may overwhelm the client and reduce their ability to absorb and retain information, especially when there is a language barrier.
C. Provide the least important information first: This approach is not recommended because it does not prioritize the client's understanding of essential preoperative instructions.
D. Provide handouts written in the client's primary language: Correct. Providing written materials in the client's primary language allows them to review the information at their own pace and increases the likelihood of understanding important preoperative instructions.
Correct Answer is C
Explanation
A: While explaining the negative consequences of refusal is important, it may not change the client's decision, and respect for the client's autonomy must be upheld.
B: Discussing the treatment with the client's partner without the client's consent may breach patient confidentiality and privacy.
C: Correct. The nurse should document the client's refusal of the medical treatment in the client's medical record. This documentation is essential for legal and ethical purposes and to ensure that the refusal is adequately communicated to the healthcare team.
D: Trying to convince the client to undergo the treatment is not appropriate and may violate the principle of informed consent. The client has the right to refuse treatment after being adequately informed of the risks and benefits.
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