A patient receiving oxygen has cold fingers and a pulse oximeter reading of 86%, but is alert, pink and breathing comfortably. Which action should the nurse take first?
Correct answer: B. Warm the hand and repeat the reading
- A. Increase the oxygen flow immediately
- B. Warm the hand and repeat the reading
- C. Document severe hypoxaemia
- D. Apply a non-rebreather mask
Explanation
Cold peripheral tissue can reduce pulse oximeter accuracy and produce a falsely low reading. The nurse should warm the hand, check the probe position and reassess the patient before changing oxygen therapy.
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About Oxygen Therapy and Airway Care
Airway care includes positioning, suctioning, coughing and deep-breathing exercises, incentive spirometry, oxygen delivery devices and humidification. Questions address indications, flow rates, safety precautions and monitoring for hypoxia or oxygen toxicity, while distinguishing nasal cannula, simple mask, non-rebreather mask and Venturi mask use.
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