Author Question: The nurse is caring for a patient who is sedated following a colonoscopy. Which is the priority ... (Read 27 times)

ereecah · **on:** Jul 23, 2018

The nurse is caring for a patient who is sedated following a colonoscopy. Which is the priority action of the nurse?

a. Provide a quiet, dark environment so that the patient can rest comfortably.
b. Monitor the patient's pulse oximetry and respirations closely.
c. Inform the patient that the procedure has been completed.
d. Assess the patient's bowel sounds and passage of flatus.

Question 2

The nurse is caring for a patient whose immune system is destroying red blood cells at a very rapid rate. Which test result will the nurse expect to see in the patient's chart as a result?

a. Bilirubin level 4 mg/dL
b. Platelet count 450,000/mm3
c. Serum uric acid level 1.7 mg/dL
d. Partial thromboplastin time 45 seconds

CAPTAINAMERICA · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: B
The priority intervention for sedated patients is to monitor pulse oximetry and respirations closely because sedation may suppress the respiratory drive. Providing a quiet environment is nice for the patient, but dim lighting may impair the nurse's ability to assess the patient. Informing the patient that the procedure has been completed is not a priority. Assessing the patient's bowel sounds and passage of flatus is not as important as careful respiratory monitoring.

Answer to Question 2

ANS: A
An elevated bilirubin level is the result of increased red blood cell destruction. Normal bilirubin levels are 0.3 to 1.0 mg/dL. Increased platelet count, decreased serum acid level, and decreased partial thromboplastin times are not indicative of increased red blood cell destruction.