Author Question: While caring for a patient with respiratory disease, the nurse observes that the patient's SpO2 ... (Read 50 times)

krzymel · **on:** Jun 25, 2018

While caring for a patient with respiratory disease, the nurse observes that the patient's SpO2 drops from 93 to 88 while the patient is ambulating in the hallway. What is the priority action of the nurse?

a. Notify the health care provider.
b. Document the response to exercise.
c. Administer the PRN supplemental O2.
d. Encourage the patient to pace activity.

Question 2

On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?

a. Inspiratory crackles at the bases
b. Expiratory wheezes in both lungs
c. Abnormal lung sounds in the apices of both lungs
d. Pleural friction rub in the right and left lower lobes

guyanai · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: C
The drop in SpO2 to 85 indicates that the patient is hypoxemic and needs supplemental oxygen when exercising. The other actions are also important, but the first action should be to correct the hypoxemia.

Answer to Question 2

ANS: A
Crackles are low-pitched, bubbling sounds usually heard on inspiration. Wheezes are high-pitched sounds. They can be heard during the expiratory or inspiratory phase of the respiratory cycle. The lower third of both lungs are the bases, not apices. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.