Question about giving O2

hypocaffeinemia, BSN, RN · Jul 31, 2009

The question being asked by the OP required the rationales for why the sequence of nursing actions was to
Semi-fowler position
ask staff member to stay with pt
call MD
give O2 NC at 4L/min
not debate the need for the type of medical intervention needed.

I am aware of what the question was asking. Nursing, however, doesn't exist in multiple choice. The student should be proactive in assessing what interventions might be needed for the patient. Especially when the interventions in the question are not adequate for the patient's condition.

This might lead to the answer of why "Call MD" comes before "O2 at 4L via NC".

allnurses Guide · Aug 3, 2009

The patient in the scenario was very clearly severely hypoxic-- see the altered mental status with tachypnea and tachycardia. The chronic lung disease is relatively irrelevant in this acute situation. I don't care about O2 reducing their respiratory drive when their RR is 50. Intubation on this patient is necessary not only to maintain airway (look at the neuro status), but also to at least attempt some aveolar recruitment and get some full FiO2 100% breaths down.
The alternative to not intubating the patient in respiratory failure (regardless of chronic lung disease) is to start preparing your post-mortem kit.
As an aside, the "O2 decreases a COPDer's respiratory drive" may be popular wisdom, but it isn't supported by evidence nor should it take precedence over acute hypoxic issues. We can always control the patient's respiratory rate.

With all due respect, I have many years' experience in critical care and I'm well aware of the treatments required in "real life". I was responding to the OPs question.

Nursing does exist in multiple choice on NCLEX!

MattiesMama · Aug 9, 2009

One thing I've learned with NCLEX-style questions...any time there is a sequencial order question with those kind of options, ALWAYS "call the MD" before you give any type of medication, unless it specifically says there is a standing order. It generally goes:

1.) Do something within your scope of practice to improve the situation (in this case, having pt. in semi-fowlers and having staff stay with him)

2.) Call the MD

3.) Medical intervention

kgh31386, BSN, MSN, RN · Aug 10, 2009

But they always say, if an intervention like that is an option, you're to assume there was already an order in place.

NurseKitten, MSN, RN · Aug 10, 2009

It's a crappy question, IMHO. How long does it really take to pop 4 LPM on someone as you're sitting them up in high fowler's? Or call respiratory therapy (if you're in an inpatient setting) to do it while you're on the phone with a doc.

But yes, NCLEX isn't about the real world, it's about multiple choice, so for now, go with your instructor's rationale. You'll learn better soon enough.

Music in My Heart · Aug 10, 2009

It's a crappy question, IMHO. How long does it really take to pop 4 LPM on someone as you're sitting them up in high fowler's? Or call respiratory therapy (if you're in an inpatient setting) to do it while you're on the phone with a doc.
But yes, NCLEX isn't about the real world, it's about multiple choice, so for now, go with your instructor's rationale. You'll learn better soon enough.

Of course, this wasn't an NCLEX question... just one that some instructor made up or, more likely, came out of a test bank.

Many of our test-bank questions were horribly written or came with an incorrect answer. Usually the instructor would give in if we could state our case well.

MattiesMama · Aug 10, 2009

But they always say, if an intervention like that is an option, you're to assume there was already an order in place.

Who is "they"?

If your teacher said that, then I would argue that your response was correct but in general, I've always been taught that unless the question specifically states there is a standing order or PRN in place then you assume there isn't one. I think that's how it is on the NCLEX.

I'm glad I'm not the only one who has stooopid test questions though...and our instructors are usually too lazy to find out the correct answer. We had a test recently and the "correct answer" to a question was that insulin is an IM injection :banghead: They actually did look that one up and correct it but I mean seriously, I was like you people have masters degrees, you had to look it up?!