ATI RN
Oxygenation NCLEX Questions with Rationale Questions
Question 1 of 5
A client with pulmonary fibrosis is receiving supplemental oxygen. What is the primary goal of oxygen therapy in this condition?
Correct Answer: B
Rationale: The primary goal of oxygen therapy in pulmonary fibrosis is to maintain tissue oxygenation. Pulmonary fibrosis causes scarring of the lungs, leading to impaired gas exchange and reduced oxygen levels in the blood. Supplemental oxygen helps to ensure that the tissues receive an adequate supply of oxygen, preventing hypoxemia and tissue damage. - A: Oxygen therapy does not cure pulmonary fibrosis but helps manage symptoms. - C: Oxygen therapy may prevent acute exacerbations but may not always prevent the need for mechanical ventilation. - D: While oxygen therapy can improve exercise tolerance temporarily, it does not offer a permanent solution for pulmonary fibrosis.
Question 2 of 5
The nurse observes a student who is listening to a patient's lungs. Which action by the student indicates a need to review respiratory assessment skills?
Correct Answer: B
Rationale: The correct answer is B because the student should listen during both inspiratory and expiratory phases without moving the stethoscope in between. This ensures a comprehensive assessment of lung sounds. Choice A is correct as comparing breath sounds from side to side is a good practice. Choice C is also correct as starting at the apices and moving down towards the bases is a proper technique. Choice D is incorrect because instructing the patient to breathe slowly and deeply is a standard instruction for a respiratory assessment.
Question 3 of 5
The nurse assesses a patient with a pleural effusion. Which action should the nurse take to prepare the patient for thoracentesis?
Correct Answer: B
Rationale: The correct answer is B because positioning the patient sitting up on the side of the bed allows for better access to the thoracic cavity during thoracentesis. This position helps to maximize lung expansion, making it easier for the healthcare provider to access the pleural effusion. Starting a peripheral IV line to administer sedatives (Choice A) is not necessary for thoracentesis preparation. Obtaining a collection device to hold 3 liters of pleural fluid (Choice C) is not a necessary step for preparing the patient for the procedure. Reminding the patient not to eat or drink for 6 hours (Choice D) is not a standard requirement for thoracentesis preparation.
Question 4 of 5
A patient is scheduled for pulmonary function tests. Which action should the nurse take to prepare the patient?
Correct Answer: B
Rationale: The correct answer is B: Instruct the patient to refrain from smoking for 6 hours before testing. Rationale: 1. Smoking can affect lung function, so refraining from smoking before pulmonary function tests helps obtain accurate results. 2. Smoking can lead to airway constriction, affecting test outcomes. 3. The 6-hour timeframe allows for a sufficient period for the effects of smoking to diminish. 4. Not smoking before testing ensures that the test results reflect the patient's true lung function. Summary: - Choice A is incorrect because using bronchodilators before the test may alter the test results. - Choice C is incorrect as fasting is not necessary for pulmonary function tests. - Choice D is incorrect as incentive spirometry is not typically performed before pulmonary function tests.
Question 5 of 5
A patient has a positive Mantoux test. What is the next step in care?
Correct Answer: B
Rationale: The correct next step is to schedule a chest x-ray to evaluate for active tuberculosis. A positive Mantoux test indicates exposure to the tuberculosis bacteria but doesn't confirm active disease. A chest x-ray helps determine if there is active infection in the lungs. Starting four-drug therapy for tuberculosis (A) is premature without confirming active disease. Repeating the Mantoux test (C) is unnecessary as it won't differentiate between latent and active infection. Administering the BCG vaccine (D) is not indicated in this case as the patient already has a positive Mantoux test.