ATI RN
NCLEX Questions on Oxygen Therapy Questions
Question 1 of 5
A client receiving mechanical ventilation has high-pressure alarms sounding. What is the nurse's priority action?
Correct Answer: B
Rationale: The correct answer is B: Checking for kinks or obstructions in the tubing. This is the priority action because high-pressure alarms indicate a blockage or restriction in the ventilator circuit, which can lead to inadequate ventilation and hypoxia. By checking for kinks or obstructions first, the nurse can address the immediate issue causing the alarm and ensure the client's safety. Silencing the alarm and notifying the healthcare provider (Choice A) can be done after addressing the alarm cause. Increasing oxygen flow rate (Choice C) may not resolve the issue and could potentially worsen the situation. Suctioning the client immediately (Choice D) is not appropriate without first identifying and addressing the cause of the high-pressure alarms.
Question 2 of 5
A client with pulmonary edema is receiving furosemide (Lasix). Which assessment finding indicates the medication is effective?
Correct Answer: A
Rationale: The correct answer is A: Decreased peripheral edema. Furosemide is a diuretic that helps reduce fluid volume in the body, which leads to decreased edema. Peripheral edema is a common manifestation of pulmonary edema, so a decrease in peripheral edema indicates that the furosemide is effectively reducing fluid overload. Increased respiratory rate (B) is a sign of respiratory distress, not medication effectiveness. Blood pressure of 150/90 mmHg (C) is within normal range and not a specific indicator of furosemide effectiveness. Weight gain of 2 kg in 24 hours (D) is a sign of fluid retention and not a desirable outcome when treating pulmonary edema.
Question 3 of 5
The nurse is assessing a client with pleural effusion. Which finding is most expected?
Correct Answer: B
Rationale: The correct answer is B: Dullness to percussion over the affected area. Pleural effusion is an accumulation of fluid in the pleural space, causing dullness to percussion due to the fluid-filled space. Bilateral crackles (A) would suggest a different condition like pulmonary edema. Hyperresonance (C) would be indicative of pneumothorax. Increased fremitus (D) would typically be found in conditions with lung consolidation, such as pneumonia, not pleural effusion. Therefore, the most expected finding in pleural effusion is dullness to percussion over the affected area due to the presence of fluid.
Question 4 of 5
A client with COPD is prescribed a corticosteroid inhaler. What should the nurse include in the teaching?
Correct Answer: B
Rationale: The correct answer is B: Rinse your mouth after each use to prevent thrush. Corticosteroid inhalers can increase the risk of oral thrush due to their effect on the immune system. Rinsing the mouth after each use helps to prevent this side effect. A: Using the inhaler only during flare-ups is incorrect as corticosteroid inhalers are often prescribed for daily maintenance to control COPD symptoms. C: Using the inhaler before taking a bronchodilator is not necessary as the order of inhaler use does not impact their effectiveness. D: Taking the medication with meals to prevent stomach upset is incorrect as corticosteroid inhalers are inhaled and do not typically cause stomach upset.
Question 5 of 5
A nurse is choosing a catheter to use to suction a patient's endotracheal tube via an open system. On which variable would the nurse base the size of the chosen catheter?
Correct Answer: B
Rationale: The correct answer is B: The size of the endotracheal tube. The nurse should base the size of the chosen catheter on the size of the endotracheal tube to ensure proper suctioning and prevent injury. Using a catheter that is too large can damage the airway, while using one that is too small may not effectively remove secretions. Age, type of secretions, and patient's height and weight do not directly determine the appropriate catheter size for endotracheal suctioning. It is crucial to match the catheter size with the endotracheal tube size for safe and effective suctioning.