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1. A patient with chronic obstructive pulmonary disease (COPD) is
admitted to the Med Surg Unit with acute respiratory failure. The nurse is
preparing to administer oxygen therapy as prescribed by the physician.
Which of the following actions should the nurse take first?
A) Assess the patient's oxygen saturation level and respiratory rate.
B) Apply a nasal cannula or a face mask to deliver oxygen.
C) Adjust the oxygen flow rate to achieve the desired oxygen saturation
level.
D) Monitor the patient for signs of oxygen toxicity or carbon dioxide
retention.
Answer: A
Rationale: The nurse should assess the patient's oxygen saturation level
and respiratory rate before initiating oxygen therapy to determine the
baseline status and the need for oxygen. Oxygen therapy can have adverse
effects such as oxygen toxicity or carbon dioxide retention, so the nurse
should monitor the patient closely and adjust the oxygen flow rate
accordingly. Applying a nasal cannula or a face mask is an appropriate
action, but not the first one.
2. A patient with type 2 diabetes mellitus is scheduled for a coronary
artery bypass graft (CABG) surgery. The nurse is reviewing the patient's
preoperative orders and notes that the patient is prescribed metformin, a
biguanide antidiabetic agent. Which of the following actions should the
nurse take?
A) Administer the metformin as ordered on the day of surgery.
B) Hold the metformin on the day of surgery and resume it after surgery.
C) Hold the metformin for 48 hours before and after surgery.
D) Discontinue the metformin permanently and switch to insulin therapy.
Answer: C
Rationale: Metformin can cause lactic acidosis, a potentially fatal
complication, especially in patients with renal impairment or hypoxia.
CABG surgery can increase the risk of these conditions, so the nurse
should hold the metformin for 48 hours before and after surgery to prevent
lactic acidosis. The nurse should resume the metformin after ensuring
normal renal function and adequate tissue perfusion. Administering,
holding, or discontinuing the metformin on the day of surgery are not
appropriate actions
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