Author Question: A nurse is conducting a morning assessment of an elderly client who is being rehabilitated after ... (Read 43 times)

cookcarl · **on:** Jul 22, 2018

A nurse is conducting a morning assessment of an elderly client who is being rehabilitated after orthopedic surgery. In addition to vital signs, the nurse assesses the client's oxygenation by pulse oximetry.

At what SpO2 reading should the nurse begin to consider additional respiratory assessments and interventions? A) SpO2 96
B) SpO2 93
C) SpO2 89
D) SpO2 86

Question 2

A 45-year-old woman with diabetes who has been hospitalized with diabetic ketoacidosis. Which of the following is most important for the nurse to assess during bath time?

a. Skin bruising
b. Condition of teeth
c. Sensation to the foot
d. Skin folds for dirt

patma1981 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

C
Feedback:
In general, the nurse should consider additional assessments and interventions if a client's oxygen level is below 90. The normal range is 95 to 100.

Answer to Question 2

C
Assess patients with diseases that affect peripheral circulation and sensation for the adequacy of circulation and sensation of the feet. Palpate the dorsalis pedis and posterior tibial pulses and as-sess for intact sensation to light touch, pinprick, and temperature. Foot ulceration is the most common single risk factor for lower extremity amputations among persons with diabetes. The other responses are necessary to assess but not the highest priority for this patient with a diabetic diagnosis.