ATI LPN
Oxygenation NCLEX Questions Questions
Question 1 of 5
A nurse provides discharge teaching for a client who had a below-knee amputation. Which instructions should the nurse include?Select one that doesn't apply.
Correct Answer: B
Rationale: 1. To prevent skin breakdown and infection, it is important for the client to thoroughly clean and dry the socket. 3. Clean, well-fitted liners are necessary to prevent skin breakdown and to promote a secured prosthesis. 4. Shoes should fit symmetrically and evenly. This would indicate an accurate fit of the prosthetic limb. 6. The skin should be assessed daily for signs of skin breakdown, drainage, infection, inflammation and/or shrinkage.
Question 2 of 5
A client reports shortness of breath and has the following cardiac rhythm. Which medication should the nurse prepare to administer?
Correct Answer: A
Rationale: The ECG represents sinus bradycardia in which the heart rate is less than 60 beats per minute. Atropine is the treatment for symptomatic sinus bradycardia. Atropine is a parasympatholytic or vagolytic agent. (Note: The document does not specify the rhythm, but the rationale indicates sinus bradycardia.)
Question 3 of 5
A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The client who has heat stroke will have which of the following?
Correct Answer: A
Rationale: Heat stroke is a medical emergency with elevated body temperature and organ dysfunction. Hypotension (A) occurs due to dehydration and vasodilation. Bradycardia (B) is incorrect as tachycardia is typical. Clammy skin (C) is more associated with heat exhaustion; heat stroke presents with hot dry skin. Bradypnea (D) is incorrect as tachypnea is common. Thus A is correct for heat stroke symptoms.
Question 4 of 5
The client has been admitted with complaints of shortness of breath of 2 weeks duration and has received the nursing diagnosis Impaired Gas Exchange. Which admission laboratory result would support the choice of this diagnosis?
Correct Answer: A
Rationale: Impaired Gas Exchange leads to chronic hypoxia prompting the body to increase erythrocyte production to enhance oxygen-carrying capacity resulting in increased hematocrit (A). Decreased BUN (B) relates to renal function not gas exchange. Increased blood sugar (C) is unrelated to oxygenation. Increased sedimentation rate (D) indicates inflammation but is nonspecific making A the supportive finding for this diagnosis.
Question 5 of 5
The nurse encourages the client to expectorate sputum rather than swallowing it. What is the rationale for this direction?
Correct Answer: C
Rationale: Expectorating sputum allows the nurse to assess its quality (color consistency) and quantity (C) aiding in diagnosis and treatment evaluation. Sputum bacteria (A) are not inherently harmful if swallowed as stomach acid neutralizes them. Swallowing sputum (B) is not dangerous unless aspiration occurs which is unlikely if swallowing is intact (D). Thus C is the primary rationale for expectoration.