The nurse must administer 1600 mL of total parenteral nutrition (TPN) over 24 hours. The nurse should set the IV pump to deliver how many mL/hr? (Round to the nearest tenth, do not use trailing zeros, use a leading zero if it applies)

Maintaining adequate oxygenation is the primary goal for a client with impaired gas exchange due to an asthma exacerbation. Pulse oximetry is a non-invasive method to monitor the oxygen saturation of a patient’s blood, and values above 94% indicate sufficient oxygenation.

Choice A reason:

The client will demonstrate decreased episodes of coughing at night is important but not the priority goal. While reducing coughing can improve comfort and sleep quality, it does not directly address the critical issue of impaired gas exchange. The primary concern in an asthma exacerbation is ensuring that the client maintains adequate oxygen levels.

Choice B reason:

The client’s pulse oximetry values will remain above 94% on room air for the majority of the time is the priority goal. This goal directly addresses the issue of impaired gas exchange by ensuring that the client maintains adequate oxygenation. Pulse oximetry values above 94% indicate that the client’s blood is sufficiently oxygenated, which is crucial for preventing hypoxemia and ensuring that the body’s tissues receive enough oxygen to function properly.

Choice C reason:

The client’s breath sounds will only have slight wheezing by discharge is a relevant goal but not the priority. While reducing wheezing is an indicator of improved airway function, it is not as directly measurable or critical as maintaining adequate oxygen saturation. Wheezing can persist even when oxygen levels are adequate, so it is not the most reliable indicator of improved gas exchange.

Choice D reason:

The client will correctly demonstrate the use of a peak flow meter is an important educational goal but not the priority in an acute setting. Proper use of a peak flow meter can help the client monitor their asthma and prevent future exacerbations, but it does not directly address the immediate issue of impaired gas exchange. The priority in an acute asthma exacerbation is to ensure that the client is adequately oxygenated.

Choice A reason:

Monitoring skin color is not specifically required for clients on ethambutol therapy. While changes in skin color can indicate various health issues, they are not directly related to the side effects of ethambutol.

Choice B reason:

Visual acuity should be monitored because ethambutol can cause optic neuropathy, which can lead to vision loss. Regular eye exams, including tests for visual acuity and color discrimination, are recommended to detect any early signs of optic nerve damage.

Choice C reason:

Monitoring cardiac rhythm is not specifically required for clients on ethambutol therapy. Ethambutol does not typically affect the heart’s rhythm. Cardiac monitoring would be more relevant for medications that have known cardiotoxic effects.

Choice D reason:

Monitoring urine output is not specifically required for clients on ethambutol therapy. While renal function should be monitored due to the drug’s excretion through the kidneys, urine output itself is not a primary concern unless there are signs of renal impairment.