ATI RN
Oxygen NCLEX Questions Questions
Question 1 of 5
A nurse is assessing a client who is receiving oxygen therapy. The nurse should identify which of the following findings can indicate oxygen toxicity?
Correct Answer: B
Rationale: The correct answer is B: Ringing in the ears. Oxygen toxicity can manifest with symptoms such as ringing in the ears, also known as tinnitus. This occurs due to damage to the auditory nerve caused by high levels of oxygen. Hypertension (choice A) is not typically associated with oxygen toxicity. Fever (choice C) is more likely a sign of infection or inflammation, not oxygen toxicity. Dilated pupils (choice D) are not a common indicator of oxygen toxicity. In summary, the correct answer is ringing in the ears as it directly relates to the known effects of oxygen toxicity, while the other choices do not align with typical manifestations of oxygen toxicity.
Question 2 of 5
The nurse is teaching a client with asthma about the use of a spacer with an inhaler. Which statement indicates correct understanding?
Correct Answer: B
Rationale: The correct answer is B because a spacer helps to increase the amount of medication that reaches the lungs by slowing down the inhalation and reducing the risk of medication depositing in the mouth or throat. Cleaning the spacer once a week with warm soapy water (choice A) is important but does not reflect understanding of how the spacer works. Exhaling into the spacer before inhaling (choice C) is incorrect and can contaminate the spacer. Choice D is incorrect because using a spacer actually helps improve the effectiveness of inhaled medications, not make them less effective.
Question 3 of 5
A client with bronchitis is prescribed guaifenesin. What should the nurse include in the teaching plan?
Correct Answer: A
Rationale: The correct answer is A: Take the medication with a full glass of water. Guaifenesin is an expectorant that works by thinning and loosening mucus in the airways, making it easier to cough up. Taking it with a full glass of water helps hydrate the patient, which aids in thinning the mucus. This promotes easier expectoration and helps relieve symptoms. Summary: B: Avoid driving while taking this medication - This is not directly related to taking guaifenesin and would be more applicable to medications that cause drowsiness. C: Take the medication on an empty stomach - Guaifenesin can be taken with or without food, so this is not necessary. D: Limit fluid intake to prevent overhydration - Hydration is important when taking guaifenesin to help with expectoration, so limiting fluid intake would not be recommended.
Question 4 of 5
A nurse is monitoring a client receiving a blood transfusion. Which symptom would indicate a potential transfusion-related acute lung injury (TRALI)?
Correct Answer: B
Rationale: The correct answer is B because sudden onset of dyspnea and hypoxemia are key symptoms of transfusion-related acute lung injury (TRALI). This is a serious complication caused by an inflammatory response to transfused blood products. Dyspnea and hypoxemia signify acute respiratory distress. Fever and chills (A) are more indicative of a transfusion reaction or infection. Generalized itching and rash (C) are symptoms of an allergic reaction. Low blood pressure and bradycardia (D) are more likely signs of a hemolytic reaction or sepsis.
Question 5 of 5
The nurse is assessing a client with acute respiratory distress. Which finding requires immediate intervention?
Correct Answer: B
Rationale: The correct answer is B because an oxygen saturation of 85% indicates severe hypoxemia, which can lead to tissue damage and organ failure. Immediate intervention is needed to improve oxygenation. Choice A (respiratory rate of 28) is slightly elevated but not as critical as severe hypoxemia. Choice C (use of accessory muscles) indicates respiratory distress but not as urgent as low oxygen saturation. Choice D (pulse rate of 110) may be elevated due to the body compensating for hypoxemia but addressing oxygenation is the priority.