ATI RN
NCLEX Questions on Oxygen Therapy Questions
Question 1 of 5
A nurse is caring for a patient with a history of diabetes who is complaining of blurred vision. What is the priority action?
Correct Answer: C
Rationale: The correct answer is C: Monitor the patient's blood glucose levels. This is the priority action because blurred vision can be a sign of uncontrolled blood glucose levels in diabetic patients. By monitoring the patient's blood glucose levels, the nurse can assess if the blurred vision is related to high or low blood sugar levels, and take appropriate actions such as administering insulin or providing glucose if needed. Checking the blood glucose level (choice A) is a single-point assessment and may not provide the full picture. Monitoring blood glucose levels (choice B) is repetitive and not specific to the current complaint. Administering intravenous fluids (choice D) is not necessary unless the patient is severely dehydrated, which is not indicated by the complaint of blurred vision.
Question 2 of 5
A nurse is caring for a patient who is experiencing shortness of breath and is on a ventilator. What is the priority intervention?
Correct Answer: C
Rationale: The correct answer is C: Perform chest physiotherapy. Shortness of breath in a ventilated patient may be due to secretion accumulation in the airways. Performing chest physiotherapy helps to mobilize and clear secretions, improving ventilation. Checking ventilator settings (A) is important but not the priority when the patient is experiencing distress. Administering IV fluids (B and D) is not directly related to the respiratory distress and should not take precedence over addressing the immediate breathing issue.
Question 3 of 5
A nurse is caring for a patient with a history of myocardial infarction (MI). What is the priority intervention?
Correct Answer: A
Rationale: The correct answer is A: Administer aspirin. Aspirin is the priority intervention for a patient with a history of MI as it helps prevent further clot formation and reduces the risk of another cardiac event. Administering IV fluids (choices B and C) may be necessary depending on the patient's condition, but aspirin takes precedence to address the immediate cardiac issue. Administering morphine (choice D) is not the priority as it may mask symptoms and delay definitive treatment. Overall, the main goal in a patient with a history of MI is to prevent further clot formation and reduce the risk of complications, making aspirin the most appropriate intervention.
Question 4 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: Listening only during inspiration and moving the stethoscope misses expiratory sounds, indicating a need for review.
Question 5 of 5
The nurse completes discharge instructions for a patient with a total laryngectomy. Which statement by the patient indicates that additional instruction is needed?
Correct Answer: A
Rationale: An occlusive dressing could block the stoma, impairing breathing; a breathable cover is needed instead.