NORCERT 8 Mains-2025
Medical & Surgical Nursing
Medium
A patient has an 85% oxygen saturation in room air. What should be the next nursing priority?
Appeared in: NORCERT 8 Mains-2025
Explanation
- An oxygen saturation (SpO2) of 85% signifies severe hypoxemia, requiring immediate intervention to deliver a high concentration of oxygen.
- A non-rebreather mask (NRM) is the most appropriate initial device for a spontaneously breathing patient with severe hypoxemia, as it can deliver an inspired oxygen fraction (FiO₂) of up to 80-95%.
- The immediate goal is to rapidly increase the patient's blood oxygen levels to prevent tissue hypoxia and subsequent organ damage.
- The flow rate for an NRM should be set high enough (10-15 L/min) to keep the reservoir bag inflated during inspiration, ensuring high FiO₂ delivery.
Why Other Options Were Wrong
- Option B: A nasal cannula delivers a low flow and low concentration of oxygen (24-44% FiO₂), which is inadequate to correct an SpO2 of 85%.
- Option C: Intubation is an invasive procedure and is not the first-line intervention for a patient who is still breathing spontaneously and can maintain their own airway.
- Option D: Bag-mask ventilation is used to manually provide breaths to a patient who is not breathing (apneic) or has ineffective respiratory effort.
Related Visual
- Visual 1: Chart - A comparative chart of oxygen delivery devices, showing the FiO₂ range, flow rates, and primary indications for nasal cannula, simple mask, non-rebreather mask, and Venturi mask. This helps visualize why the NRM is chosen for severe hypoxemia.
- Visual 2: Diagram - An illustration of a non-rebreather mask correctly applied to a patient, highlighting the reservoir bag and one-way valves. This clarifies how the device functions to deliver high-concentration oxygen.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of Severe Hypoxemia to guide bedside assessment, documentation, and the next nursing action.
- Recognizing and acting on severe hypoxemia (SpO2 less than 90%) is a critical nursing skill to prevent life-threatening complications like cardiac arrest or brain injury.
- Nurses must be proficient in selecting the appropriate oxygen delivery device based on the patient's clinical status and the degree of hypoxemia.
- What if? If the patient's SpO2 was 92% and they reported mild shortness of breath, the priority would change. A nasal cannula at 2-4 L/min would be a more appropriate initial intervention, as this represents mild hypoxemia not requiring high-flow oxygen.
How to Approach the Question
- First, identify the critical information in the stem: the patient's oxygen saturation is 85% on room air.
- Recognize that an SpO2 below 90% indicates severe hypoxemia, which is a medical emergency requiring rapid intervention.
- Evaluate the patient's respiratory status described. The question implies the patient is still breathing spontaneously, as it doesn't mention apnea or respiratory arrest.
- Analyze the options based on the goal: to deliver a high concentration of oxygen quickly and non-invasively.
- Compare the oxygen delivery devices: A nasal cannula is for low-flow, an NRM is for high-flow, BMV is for non-breathing patients, and intubation is an advanced, invasive airway.
- Select the option that best matches the clinical need. The non-rebreather mask is the most appropriate initial choice for severe hypoxemia in a spontaneously breathing patient.
Concept Tested & Keywords
- Concept Tested: Management of Severe Hypoxemia
- Stem keywords: 85% oxygen saturation, room air, nursing priority
- Lead-in keywords: next, priority
- Clinical cues: SpO2 of 85% indicates severe hypoxemia, which is a medical emergency.
Question ID
Q8_Sncya-NNiTNXCQYJrGD
Practise the full NORCERT 8 Mains-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Gas Exchange and Respiratory Function Questions
- Which is the most relevant knowledge about oxygen administration to a client with COPD?
- Patient in emergency department diagnosed to have fluid and air present in lung. What is the above-mentioned condition known as?
- Patient is suffering from dyspnea. Which position will you provide for patient to relieve?
- Identify the following instrument which is used in diagnostic procedures:
- Identify the instrument shown in the following image:
- Identify the tube in the following image:
- Which of the following method is used for high flow oxygen administration:
- The following conditions can be diagnosed using chest X-ray; EXCEPT:
- The X-ray finding in a patient with pleural effusion reveals that fluid starts to build up as a result of gravity in:
- Surgical procedure used to correct a deviated nasal septum is:
More NORCERT 8 Mains-2025 Questions
- A patient admitted in the ICU is receiving feeding through a Ryles tube. The nursing officer is about to give the next feed, which is scheduled for e…
- What clinical condition is shown in the image below?
- What is the most significant diagnostic test that needs to be done prior to a lumbar puncture?
- Identify the device shown in the image.
- The nurse is monitoring a child with burns during treatment. Which assessment provides the most accurate guide to determine the adequacy of fluid res…
- Which of the following assessment techniques should be avoided in a child with Wilms' tumor?
- In a conscious and stable patient, what instructions should be given while removing the central venous catheter to minimize complications?
- A nurse is caring for a schizophrenia patient who is experiencing auditory hallucinations. Which intervention is MOST appropriate?
- A belief that persists despite evidence to the contrary is characteristic of what?
- A schizophrenic patient with renal failure is admitted to the psychiatric ward for dialysis. When the time for the procedure arrives, the patient ref…