A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best?
Determine if the client can switch to a nasal cannula during the meal.

Assess the client’s oxygen saturation and, if normal, turn off the oxygen.

Have the client lift the mask off the face when taking bites of food.

Turn the oxygen off while the client eats the meal and then restart it.

Determine if the client can switch to a nasal cannula during the meal

Answer and Explanation

The Correct Answer is C

Choice A Reason:

Assess the client’s oxygen saturation and, if normal, turn off the oxygen. This option is not ideal because turning off the oxygen completely can lead to a rapid drop in oxygen saturation levels, especially in patients who require continuous oxygen therapy. Monitoring oxygen saturation is crucial, but turning off the oxygen is not recommended unless specifically advised by a healthcare provider. Normal oxygen saturation levels typically range from 95% to 100%1. If the levels drop below 90%, it can lead to hypoxemia, which can cause serious complications.

Choice B Reason:

Have the client lift the mask off the face when taking bites of food. This option is also not ideal because it can be cumbersome for the client and may lead to inconsistent oxygen delivery. The Venturi mask is designed to provide a precise concentration of oxygen, and lifting it off repeatedly can disrupt this consistency. Additionally, it can be uncomfortable and impractical for the client to manage the mask while eating.

Choice C Reason:

Turn the oxygen off while the client eats the meal and then restart it. This option is not recommended for similar reasons as Choice A. Turning off the oxygen can lead to a significant drop in oxygen saturation levels, which can be dangerous for the client. Continuous oxygen therapy is essential for maintaining adequate oxygen levels in patients who require it. Interrupting this therapy, even temporarily, can have adverse effects on the client’s health.

Choice D Reason:

Determine if the client can switch to a nasal cannula during the meal. This is the best option because a nasal cannula allows the client to receive continuous oxygen while eating. The nasal cannula is less obtrusive and more comfortable for the client, enabling them to eat without significant interruption to their oxygen therapy. Nasal cannulas are commonly used for patients who need supplemental oxygen but also need to perform activities such as eating and talking. This approach ensures that the client maintains adequate oxygen levels while having their meal.

Correct Answer Reason:

Determine if the client can switch to a nasal cannula during the meal. This is the best option because a nasal cannula allows the client to receive continuous oxygen while eating. The nasal cannula is less obtrusive and more comfortable for the client, enabling them to eat without significant interruption to their oxygen therapy. Nasal cannulas are commonly used for patients who need supplemental oxygen but also need to perform activities such as eating and talking. This approach ensures that the client maintains adequate oxygen levels while having their meal.

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Correct Answer is B

Explanation

Choice A Reason:

Documenting that the nasogastric tube is in the correct place is not appropriate in this scenario. The normal pH range for gastric contents is typically between 1.5 and 3.5. A pH of 7.35 is much higher than this range, indicating that the tube may not be in the stomach. Therefore, documenting the tube as correctly placed could lead to potential complications, such as improper feeding or medication administration.

Choice B Reason:

Notifying the health care provider is the correct action. A pH of 7.35 suggests that the nasogastric tube may be misplaced, possibly in the respiratory tract or another non-gastric location. Immediate notification of the health care provider is crucial to prevent any adverse outcomes and to take corrective measures, such as confirming placement with an X-ray or re-inserting the tube.

Choice C Reason:

Checking for placement by auscultating for air injected into the tube is not a reliable method for verifying nasogastric tube placement. While this method was traditionally used, it has been found to be inaccurate and is no longer recommended. The sound of air entering the stomach can be misleading and does not confirm correct placement.

Choice D Reason:

Retesting the pH using another strip is not the best immediate action. While it is important to ensure the accuracy of the pH reading, a pH of 7.35 is significantly outside the normal gastric range, and retesting is unlikely to yield a different result. The priority should be to notify the health care provider to address the potential misplacement of the tube.

A. Encourage dietary intake B. Encourage plenty of fat C. Serve dairy products D. Order a high-fiber diet

Correct Answer is D

Explanation

Order a high-fiber diet

Choice A Reason:

Encourage dietary intake

Encouraging dietary intake is generally important for maintaining nutritional status, but it is not specific to the preparation for a barium enema. The preparation for a barium enema typically involves dietary restrictions to ensure the colon is clear for the procedure. Therefore, this choice is not correct.

Choice B Reason:

Encourage plenty of fat

Encouraging plenty of fat is not appropriate for the preparation of a barium enema. High-fat foods can slow down the digestive process and may interfere with the clarity of the images obtained during the procedure. Therefore, this choice is not correct.

Choice C Reason:

Serve dairy products

Serving dairy products is not recommended before a barium enema. Dairy products can cause gas and bloating, which can interfere with the procedure. Additionally, some patients may be lactose intolerant, which can further complicate the preparation. Therefore, this choice is not correct.

Choice D Reason:

Order a high-fiber diet

Ordering a high-fiber diet is the correct choice. A high-fiber diet helps to clear the intestines by promoting bowel movements. This is important for ensuring that the colon is empty and clear for the barium enema, which allows for better imaging and more accurate results.

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A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best? Determine if the client can switch to a nasal cannula during the meal.

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Naxlex Comprehensive Predictor Exams

The nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents, checks the gastric pH, and notes a pH of 7.35. Based on this information, which action should the nurse take at this time?

Correct Answer is B

Explanation

A nurse is preparing a client with Crohn’s disease for a barium enema. What should the nurse do the day before the test?

Correct Answer is D

Explanation

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A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best?
Determine if the client can switch to a nasal cannula during the meal.