ATI RN
Fundamentals of Nursing Oxygenation Questions Questions
Question 1 of 5
A nurse is caring for a client receiving high-flow oxygen therapy. Which complication should the nurse monitor for?
Correct Answer: A
Rationale: The correct answer is A: Oxygen toxicity. High-flow oxygen therapy can lead to oxygen toxicity, causing lung damage and respiratory failure. The nurse should monitor for signs such as dyspnea, cough, chest pain, and hypoxemia. Other choices are incorrect because: B: Pulmonary embolism is a complication of blood clots traveling to the lungs, not directly related to high-flow oxygen therapy. C: Carbon dioxide retention is more likely to occur in patients with chronic lung disease and not specifically related to high-flow oxygen therapy. D: Pneumothorax is the accumulation of air in the pleural space, which can happen spontaneously or due to trauma, not directly caused by high-flow oxygen therapy.
Question 2 of 5
The nurse is caring for a client with ARDS on mechanical ventilation. What is the priority assessment?
Correct Answer: A
Rationale: The correct answer is A: Ensuring proper endotracheal tube placement. This is the priority assessment because an improperly placed tube can lead to inadequate oxygenation or ventilation. Steps to ensure proper placement include assessing breath sounds, chest rise, and tube position on chest X-ray. Checking for pressure ulcers (B) is important but not the priority. Assessing for ventilator-associated pneumonia (C) and monitoring for signs of respiratory alkalosis (D) are important but secondary to ensuring proper tube placement for adequate oxygenation and ventilation.
Question 3 of 5
The nurse is providing discharge teaching to a client with obstructive sleep apnea. Which statement by the client indicates correct understanding?
Correct Answer: B
Rationale: The correct answer is B: Using my CPAP device will help reduce daytime sleepiness. This statement shows understanding that continuous positive airway pressure (CPAP) therapy is essential in managing obstructive sleep apnea and reducing daytime sleepiness. CPAP helps keep the airway open during sleep, improving oxygen levels and quality of sleep. It is a standard treatment for sleep apnea. Summary of incorrect choices: A: Sleeping on the back can actually worsen obstructive sleep apnea by causing the tongue to fall back and obstruct the airway. C: Stopping CPAP therapy abruptly can lead to symptoms returning or worsening. It is typically a lifelong therapy for most individuals with sleep apnea. D: Sleeping fewer hours will not improve sleep apnea symptoms; in fact, it can exacerbate daytime sleepiness and other symptoms.
Question 4 of 5
The RN is instructing the unlicensed assistive personnel (UAP) regarding the care of a male client with COPD. What is the highest priority nursing action to share with the UAP?
Correct Answer: B
Rationale: The correct answer is B: Keep the head of the bed elevated to 45 degrees. This is the highest priority action because it helps improve ventilation and oxygenation in clients with COPD by reducing the work of breathing and preventing respiratory complications. Elevating the head of the bed also helps prevent aspiration and promotes comfort. Choice A is incorrect because while ambulation is important, maintaining proper positioning for respiratory function is the priority in COPD. Choice C is incorrect as it does not address the immediate physiological needs of the client's respiratory status. Choice D is incorrect as it is a general task and not specific to managing COPD symptoms.
Question 5 of 5
The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the past 3 days. Which finding is important for the nurse to report to the health care provider?
Correct Answer: A
Rationale: The correct answer is A because an increased respiratory rate of 36 breaths/min in a patient with COPD and worsening dyspnea can indicate respiratory distress or impending respiratory failure. This finding is crucial to report promptly to the healthcare provider for further evaluation and intervention. Choice B is incorrect because an anterior-posterior chest ratio of 1:1 is within normal limits and not directly related to the patient's current respiratory distress. Choice C is incorrect as decreased lung expansion bilaterally can be expected in a patient with COPD and may not necessarily warrant immediate concern unless it is significantly asymmetric or accompanied by other concerning signs. Choice D is incorrect as hyperresonance to percussion may be a typical finding in COPD due to increased lung volumes and is not an immediate priority compared to the elevated respiratory rate.