An anxious adult patient is experiencing a respiratory rate of 40 breaths/min. The most appropriate intervention that the nurse could do is to instruct the patient to:
pant with mouth open
sit up
lie down
breathe through a re-breather mask
The Correct Answer is B
Choice A reason: Panting with mouth open is not an appropriate intervention for an anxious patient with a high respiratory rate. This could increase the risk of hyperventilation and respiratory alkalosis, which could worsen the anxiety and cause symptoms such as dizziness, tingling, and muscle spasms.
Choice B reason: Sitting up is an appropriate intervention for an anxious patient with a high respiratory rate. This could help the patient relax and breathe more deeply and slowly, which could reduce the anxiety and normalize the blood gas levels.
Choice C reason: Lying down is not an appropriate intervention for an anxious patient with a high respiratory rate. This could make the patient feel more claustrophobic and increase the anxiety and the respiratory rate.
Choice D reason: Breathing through a re-breather mask is not an appropriate intervention for an anxious patient with a high respiratory rate. This could increase the oxygen concentration in the blood, which could reduce the stimulus for breathing and cause respiratory depression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Intracellular to the extracellular fluid shift is not the cause of low blood pressure in this case. This fluid shift occurs when the cells lose water due to osmosis, such as in dehydration or hypernatremia.
Choice B reason: Interstitial to intravascular fluid shift is not the cause of low blood pressure in this case. This fluid shift occurs when the fluid moves from the tissue spaces to the blood vessels, such as in hypovolemia or hypotonic fluid administration.
Choice C reason: Interstitial to the intracellular fluid shift is not the cause of low blood pressure in this case. This fluid shift occurs when the fluid moves from the tissue spaces to the cells, such as in overhydration or hyponatremia.
Choice D reason: Intravascular to the interstitial fluid shift is the cause of low blood pressure in this case. This fluid shift occurs when the fluid moves from the blood vessels to the tissue spaces, such as in edema, inflammation, or increased capillary permeability. This reduces the blood volume and lowers the blood pressure.
Correct Answer is A
Explanation
Choice A reason: This is correct because 3.5 to 5.0 mEq/L is the normal range of serum potassium level in adults. Potassium is an electrolyte that is important for nerve and muscle function, as well as acid-base balance.
Choice B reason: This is incorrect because 8.5 to 10.5 mg/dL is the normal range of serum calcium level in adults, not potassium. Calcium is an electrolyte that is involved in bone health, muscle contraction, and blood clotting.
Choice C reason: This is incorrect because 135 to 145 mEq/L is the normal range of serum sodium level in adults, not potassium. Sodium is an electrolyte that is essential for fluid balance, nerve transmission, and muscle contraction.
Choice D reason: This is incorrect because 1.8 to 2.6 mEq/L is the normal range of serum magnesium level in adults, not potassium. Magnesium is an electrolyte that is important for muscle and nerve function, as well as enzyme activity.
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