since you didn't specify what the two questions were, i can't make an assessment as to why one answer was correct for one question and the other answer was correct for the other question. i can tell you this, however. these questions are designed to test your ability to think critically. they involve putting together a number of pieces of information that you are supposed to call to your mind: the nursing process, the disease process and the treatment and nursing interventions that are normally given when you are presented with a scenario.
what i can tell you is this. your very first priority would be to address the patient's physiological need for oxygen, so give oxygen. you may need a doctor's order to do that because oxygen is technically a drug. if you don't, he's going to go hypoxic on you eventually and it won't make any difference if the head of his bed is elevated or not because he is going to be dead from anoxia.
depending on how the question was worded, however, elevating the head of the bed might be the answer choice as your first independent nursing action. you don't need a doctor's order to elevate the head of the bed. you can do that to help ease his breathing while you are running off to the phone to call the doctor for the order for oxygen.
for some questions you have to know from the wording whether they are asking about dependent (requiring a doctor's order) or independent (something a nurse can do on their own) nursing interventions. so the question may also be testing you for your knowledge of nursing law too.
leosrain. . .the reason you position the patient in trendelenberg on their left
side has to do with the normal anatomy and physiology of the circulation of blood through the heart and lungs.(http://www.dgs.k12.il.us:80/heart.htm
) deoxygenated blood is pumped from the heart through the pulmonary artery to the lung where it circulates through the lung to exchange carbon dioxide for oxygen. the oxygenated blood returns to the heart via the four pulmonary veins and goes into the left atrium
and then the left ventricle
. blood is pumped out of the heart and into the general body circulation via the aorta which is kind of like a left side exit off the freeway rather than a normal right hand exit. the aorta and aortic valve are actually located more toward the central area of the heart.
now, think about the physics of this. if you've got some kind of embolus (air, is the more likely candidate) and you want to prevent it from getting into the general body circulation, the best way you can prevent this is to: (1) get the patient into a trendelenberg position. this is where the patient's head is lower than their feet. what does that do? it now makes the left ventricle
of the heart (it's apex) the highest part of the heart if you consider it's relation to the horizon. (2) turn the patient to their left
side. the aortic valve and the aorta are the last places the blood travels as it makes it way out of the heart and it's your last chance to prevent an air embolism from escaping into the general circulation. any air is either going to float to the top of the highest point of the structure it is in (not a danger in the atrium, goes to the apex of the heart if it's in the ventricle). meanwhile, the liquid blood continues to be pumped around normally. if you make a boo-boo and put the patient in reverse trendelenberg and/or turn the patient on their right
side, guess where your air bubble is going if it gets into the left ventricle? you can kiss some major organ goodbye because there's a danger of the air embolism occluding a blood vessel in one of them resulting in anoxia and tissue necrosis.