A client is receiving oxygen at 4 L per nasal cannula. What comfort measure may the nurse delegate to assistive personnel (AP)?

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Oxygenation NCLEX Questions Quizlet Questions

Question 1 of 5

A client is receiving oxygen at 4 L per nasal cannula. What comfort measure may the nurse delegate to assistive personnel (AP)?

Correct Answer: A

Rationale: Oxygen can be drying; applying water-soluble ointment to nares and lips is a delegable comfort measure.

Question 2 of 5

The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first?

Correct Answer: C

Rationale: 3+ proteinuria is a hallmark of preeclampsia, indicating significant kidney involvement.

Question 3 of 5

The nurse is caring for a client admitted with septic shock. Which early clinical manifestation might indicate the development of ARDS?

Correct Answer: C

Rationale: Tachypnea (C) is an early sign of ARDS as the body attempts to compensate for hypoxia. Cyanosis (B) is a late sign, while retractions (A) and tachycardia (D) are less specific initially.

Question 4 of 5

The nurse is planning care for the client diagnosed with chronic obstructive pulmonary disease (COPD) who has a breathing rate of 32 per minute, elevated blood pressure, and fatigue. Which nursing diagnosis is the priority for this client?

Correct Answer: D

Rationale: An elevated breathing rate and fatigue indicate an Ineffective Breathing Pattern (D) as the priority, addressing the primary respiratory issue.

Question 5 of 5

The primary cells involved in infection by respiratory syncytial virus (RSV) are the

Correct Answer: C

Rationale: RSV primarily infects squamous epithelial cells of the bronchioles and alveoli (C), leading to inflammation and obstruction.

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