Exam 30: Oxygenation

A patient reports chest pain.The nurse is attempting to assess the pain to differentiate the pain as cardiac,respiratory,or gastrointestinal.The nurse can properly identify the pain as cardiac in origin when the patient states that the cardiac pain:

The nurse is evaluating a patient who has a chest tube.To properly maintain chest tube function,what is the nurse's best action?

On entering the room,a nurse finds the patient sitting upright in bed with the upper torso resting on the over-bed table.The nurse assesses that this patient is experiencing acute hypoxemia.Which of the following are symptoms of acute hypoxemia? (Select all that apply.)

A patient with a tracheostomy is experiencing thick and tenacious secretions.To maintain this patient's airway,what is the most appropriate action for the nurse?

A patient has been admitted to the cardiac unit with the diagnosis of bradycardia.The patient states "I am confused about what the doctor said is wrong with me,he said my pacemaker is not working.I don't have a pacemaker." What is the nurse's best response?

A 36-year-old patient diagnosed with meningitis has a fever of 102.3° F.A family member verbalizes a concern that the patient is "breathing fast." Upon assessment,the nurse notes a respiratory rate of 20 breaths/min,pulse oximetry is 92% on 2L/O?,and lungs clear to auscultation.What is the best explanation for the rapid respiratory rate that the nurse can give the family member?

A college student who smokes asks a healthcare professional if there really is a connection between smoking and lung cancer.What is the healthcare worker's best response?

The home care nurse is admitting a patient with COPD.The primary healthcare provider has ordered O? /nasal cannula at 3 L/min.To promote safety,the nurse would instruct the patient on which of the following safety measures? (Select all that apply.)

The assistive personnel reports that an older patient is complaining of shortness of breath and palpitations.The nurse connects the patient to an electrocardiogram monitor and analyzes the rhythm with normal P wave and normal QRS and T waves.The rate is 116 beats per minute and regular.The nurse identifies this rhythm as which of the following?

The guardians of a premature infant who was delivered at 31-weeks' gestation is expected to be discharged from the hospital within the next few days.The guardians have voiced concern regarding how to prevent respiratory syncytial virus (RSV)exposure to the baby.What is the best response from the nurse?

An adult collapsed at the grocery store.Before being transported to the emergency department,an automated external defibrillator (AED)was used.The nurse remembers learning that the AED is effective in saving a life because of which factors? (Select all that apply.)

A 58-year-old Caucasian woman is at the clinic for her annual check-up.She tells the nurse that she noticed her blood pressure is higher than it was when she was younger.She asks the nurse why this would happen.What is the nurse's best response?

A 47-year-old woman with a history of diabetes and hypertension calls the clinic complaining of epigastric pain and shortness of breath with activity.She has taken antacids with no relief.What type of pain is the patient experiencing?

A nurse is being oriented to work for an intensive care unit.The hemodynamic data indicate that the patient has a decreased preload.Which information indicates the nurse has a correct understanding of the concept of preload?

A health care worker received an annual tuberculosis test administered 56 hours ago.The injection site is very red and flat.The certified nurse who is reading the test should take which action?

A 45-year-old patient was diagnosed with an anterior myocardial infarction.The patient asks the nurse why his chest hurt when he had his heart attack.What is the best response from the nurse?

What is the best indicator the nurse can use to determine the adequacy of a patient's cardiac output?

The nurse is educating a patient who has recently been diagnosed with chronic obstructive pulmonary disease (COPD).The nurse explains how the gasses in the lungs move between the air spaces and the bloodstream.Which process is the nurse describing?

A patient presents with an acute myocardial infarction that resulted in right ventricular damage.The nurse needs to assess the patient for right-sided heart failure,which includes which of the following?

A patient who is 7 months pregnant with her first child is visiting the health care provider for her scheduled prenatal checkup.She tells the nurse that she is short of breath and fatigued.What is the best response from the nurse?