Question

A client admitted with respiratory difficulty and decreased oxygen saturation keeps pulling off the oxygen mask. What action does the nurse take?

a) Apply a restraint to prevent mask removal.
b) Educate the client about the importance of the oxygen mask.
c) Assess the client's respiratory status and consider alternative interventions.
d) Administer a sedative to keep the client calm.

Answer 1

The nurse should assess the client's respiratory status and consider alternative oxygen delivery methods instead of immediately applying restraints or administering sedatives.

Step-by-step explanation:

When faced with a client who keeps pulling off the oxygen mask, the appropriate action for the nurse to take would be c) Assess the client's respiratory status and consider alternative interventions. This is because it is important to first determine the reason the client is uncomfortable with the oxygen mask and because assessing the client's needs is a priority over applying restraints or administering medication without a proper evaluation. Additionally, the nurse may then be able to identify a more suitable and comfortable method of oxygen delivery for the client, such as a nasal cannula, and re-educate the client on the importance and correct use of the oxygen delivery device.