Difficulty: Medium
Average Score: 92%
Simulated
The nurse is caring for a client on a ventilator from complications of pneumonia. The nurse observes the low-pressure ventilator alarm and a pulse oximetry reading of 85%. What should be the nurse's first action?
Correct answer
C
Rationale
A low-pressure alarm and low oxygen saturation (85%) indicate inadequate ventilation. Manual ventilation with a bag-valve-mask ensures oxygenation while troubleshooting. Other actions are secondary.