The patient has new-onset restlessness and confusion. His pulse ...

[a0266361136]

The patient has new-onset restlessness and confusion. His pulse rate is elevated, as is his respiratory rate. His oxygen saturation, however, is 94 according to the portable pulse oximeter.
 
  The nurse ignores the oximeter reading and calls the physician to obtain an order for an arterial blood gas (ABG). The nurse does this because many things can cause inaccurate pulse oximetry readings, including which of the following? (Select all that apply.)
  a. O2 saturations (SaO2) >70
  b. Carbon monoxide inhalation
  c. Nail polish
  d. Hypothermia at the assessment site
  e. Intravascular dyes

Question 2

When temperature assessment is required, which of the following cannot be delegated to nursing assistive personnel?
 
  a. Temperature measurement
  b. Assessment of changes in body temperature
  c. Selection of appropriate route and device
  d. Consideration of factors that falsely raise temperature

[karmakat49]

Answer to Question 1

ANS: B, C, D, E
Inaccurate pulse oximetry readings can be caused by outside light sources, carbon monoxide (caused by smoke inhalation or poisoning), patient motion, jaundice, intravascular dyes (methylene blue), nail polish, artificial nails, metal studs, or dark skin. Other factors include peripheral vascular disease (atherosclerosis), hypothermia at the assessment site, pharmacological vasoconstrictors (e.g., epinephrine), low cardiac output, hypotension, peripheral edema, and tight probes.

Answer to Question 2

ANS: B
The skill of temperature measurement can be delegated. The nurse is responsible for assessing changes in body temperature. The nurse instructs nursing assistive personnel to select the appropriate route and device to measure temperature and to consider specific factors that falsely raise or lower temperature.

[a0266361136]

TY

[karmakat49]

You're welcome