ATI LPN
Acute Respiratory Care Nursing Questions Questions
Question 1 of 5
A nurse cares for a client who is one hour post vaginal delivery. Which findings are an early sign of postpartum hemorrhage?
Correct Answer: C
Rationale: An increasing heart rate is often one of the first indicators of inadequate blood volume and the earliest sign of shock. The heart rate increases to keep cardiac output and mean arterial pressure at normal levels. A uterus that is enlarging may indicate clots are accumulating in the uterus and lead to uterine atony and postpartum hemorrhage.
Question 2 of 5
A nurse discovers a small paper fire in a trash can in a client's bathroom. The client has been taken to safety and the alarm has been activated. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The document incorrectly lists Class C (B) for a paper fire which requires a Class A extinguisher (water or dry chemical). Opening windows (A) can spread smoke and fire. Removing electrical equipment (C) is unnecessary for a paper fire and delays response. Wet towels (D) are for containment not extinguishing. The rationale corrects the error: a Class A extinguisher is needed for paper fires but based on the document B is listed as correct.
Question 3 of 5
When planning care,for which client should the nurse include close observation for a decreased or absent cough reflex?
Correct Answer: B
Rationale: The cough reflex relies on vagus nerve (cranial nerve X) conduction to the medulla. Impairment of vagus nerve function (B) such as from spinal cord injury or CNS depression can decrease or eliminate the cough reflex increasing risks of aspiration and respiratory infections requiring close monitoring. Nasal fractures (A) and sinus infections (C) do not typically affect the cough reflex. Reduced respiratory membrane conduction (D) impacts gas exchange
Question 4 of 5
Upon assessment,the nurse notes that a client has dyspnea crackles in both lung bases and tires easily upon exertion. Which nursing diagnosis is best supported by these assessment details?
Correct Answer: C
Rationale: Crackles in both lung bases (C) indicate fluid or mucus in the airways supporting Ineffective Airway Clearance where the client struggles to clear secretions leading to dyspnea and fatigue. Ineffective Breathing Pattern (A) focuses on altered rhythm or depth not crackles. Anxiety (B) lacks specific respiratory findings. Impaired Gas Exchange (D) relates to oxygenation deficits not primarily airway clearance making C the best-supported diagnosis.
Question 5 of 5
The nurse needs to hyperinflate a client prior to suctioning. How should the nurse proceed with this requirement?
Correct Answer: C
Rationale: Hyperinflation before suctioning prevents hypoxia by delivering 2-3 breaths at 1.5 times the tidal volume (C) typically via a manual resuscitator or ventilator setting. Adjusting suction level (A) does not address oxygenation. Increasing oxygen flow (B) is insufficient for hyperinflation. Coughing (D) does not ensure adequate oxygenation making C the correct method to maintain oxygen levels during suctioning.