Exam 4) Fundamentals Of Nursing Exam 4: Questions & Answers: Latest Updated A+ Guide Solution

Which of the following skills can the nurse delegate to the nursing assistive personnel? Select all that apply 1. Nasotracheal suctioning 2. Oropharyngeal suctioning if a stable patient 3. Suctioning a new artificial airway 4. Permanent tracheostomy tube suctioning 5. Care if an endotracheal tube (Ans- 2,4 Two hours after surgery the nurse assesses a patient who had a chest tube inserted during surgery. There is 200 ML of dark red drainage in the chest tube at this time. What is the appropriate action for the nurse to perform? 1. Record the amount and continue to monitor drainage 2. Notify the physician 3. Strip the chest tube starting at the chest 4. Increase the suction by 10 MMHG (Ans- 1. Record the amount and continue to monitor drainage The nurse is reviewing the results of the patients diagnostic testing. Of the following results the finding the falls within an expected or normal limits is: 1. Palpable elevated hardened area around a tuberculosis skin testing site 2. septum for culture and sensitivity identifies mycobacterium tuberculosis 3. Presence of acid fast bacilli in sputum 4. Arterial oxygen tension of 95MMHG (Ans- 4. Arterial oxygen tension of 95 mm HG A nurse is assessing a client who has had a cute respiratory infection that puts her at high-risk for hypoxemia. Which of the following findings are early indications that should alert the nurse that the client is developing hypoxemia? Select all that apply 1. Restlessness 2. Tachypnea 3. Bradycardia 4. Confusion 5. Pallor (Ans- 1. Restlessness 2. Tachypnea 4. Confusion 5. Pallor A provider is discharging a client who has a prescription of home oxygen therapy via nasal cannula. Client and family teaching by the nurse should include which of the following instructions? Select all that apply 1. Apply petroleum jelly around and inside the Nares 2. Remove the nasal cannula during meal times 3. Check the position of the cannula frequently 4. Report any nasal stiffness nausea or fatigue 5. Post no smoking signs in a prominent location (Ans- 3. Check the position of the cannula frequently 4. Report any nasal stiffness nausea or fatigue 5. Post no smoking signs in a prominent location A nurse is caring for a client who is having difficulty breathing. The client is laying in bed and it's already receiving oxygen therapy via it'll cannula. Which of the following intervention is the nurses priority? 1. Increased oxygen flow 2. Assist the client to Fowlers position 3. Promote removal of pulmonary secretions 4. Obtain a specimen for arterial blood gases (Ans- 2 assist the client to fowlers position A nurse is preparing to perform endotracheal suctioning for a client. The nurse should follow which of the following guidelines? Select all that apply 1. Apply suction while withdrawing the catheter