Nokea
The health-care provider asks for a stat pulse oximetry reading on a patient wearing dark nail polish. What action will you take first?
- A. Ask the patient to remove her nail polish while you obtain a pulse oximeter
- B. Auscultate the patient's lungs for abnormal breath sounds
- C. Apply a pulse oximeter to the patient's finger to obtain the stat reading
- D. Obtain fingernail polish remover and remove the polish from one nail and then attach the pulse oximeter to that finger
Correct Answer: D
Rationale: Dark nail polish can interfere with pulse oximetry readings, so removing it from one nail ensures accuracy.
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A patient who has chronic lung disease is stimulated to breathe because the chemoreceptors detect:
- A. low oxygen in the blood.
- B. high oxygen in the blood.
- C. low carbon dioxide in the blood.
- D. high carbon dioxide in the blood.
Correct Answer: A
Rationale: In patients with chronic lung disease (such as COPD), the body becomes accustomed to high levels of carbon dioxide, so the usual CO?-driven respiratory drive is blunted. As a result, low oxygen levels become the primary stimulus to breathe?this is called a hypoxic drive.
You are caring for a patient who has lung disease. Yesterday, the patient was pleasant and cooperative. Today, the patient is irritable, restless, and a little confused. She is also complaining of a headache. What concerns you the most about this situation?
- A. The patient's complaint of headache. Along with her other symptoms, it could indicate an impending stroke
- B. All of the symptoms concern you because they could all be signs of early hypoxia
- C. The confusion concerns you the most because it could indicate the beginning of Alzheimer's disease
- D. None of these symptoms concerns you greatly because the patient is probably just having a bad day
Correct Answer: B
Rationale: Irritability, restlessness, confusion, and headache are classic signs of early hypoxia in a patient with lung disease.
You listen to the patient's lungs and hear adventitious breath sounds bilaterally. You note a frequent productive cough of thick yellow sputum. Which other assessments will you quickly make?
- A. Perform pulse oximetry to determine SaO2
- B. Assess color of the lips, nailbeds, and mucous membranes
- C. Assess respiratory rate, character, and quality
- D. Palpate for crepitus
- E. Determine how much fluid intake the patient has had in the past 24 hours
Correct Answer: A,B,C
Rationale: These assessments evaluate oxygenation, respiratory status, and signs of infection, critical in this scenario.
When you look at the arterial blood gas results on your patient, you see that his pH is 7.32. What concern do you have for this patient?
- A. He is in alkalosis
- B. He is in acidosis
- C. He is in respiratory failure
- D. He is hyperventilating
Correct Answer: B
Rationale: A pH of 7.32 indicates acidosis, as it is below the normal range of 7.35-7.45.
Your patient has a blood pH of 7.48 and is on oxygen at 8 L/min. Which oxygen delivery device is best for this patient?
- A. A simple face mask
- B. A Venturi mask
- C. A partial rebreathing mask
- D. A face tent
Correct Answer: B
Rationale: A Venturi mask delivers precise oxygen concentrations, ideal for a patient with alkalosis (pH 7.48) to avoid over-oxygenation.