Crucial Exams

NCLEX RN Practice Question

A client hospitalized for community-acquired pneumonia suddenly becomes restless and anxious. Assessment findings are: respirations 32/min, heart rate 120/min, blood pressure 136/80 mm Hg, and oxygen saturation 89 % on room air. Which action should the nurse take first?

  • Increase the intravenous normal saline rate to 150 mL/hr.

  • Obtain a stat arterial blood gas sample for analysis.

  • Apply oxygen at 2 L/min via nasal cannula and reassess oxygen saturation.

  • Encourage the client to cough and deep-breathe to mobilize secretions.

NCLEX RN
Physiological Integrity
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