ATI RN
NCLEX Practice Questions Oxygenation Questions
Question 1 of 5
A patient with COPD is receiving long-term oxygen therapy. Which statement indicates a need for further teaching?
Correct Answer: B
Rationale: The correct answer is B) "I can adjust my oxygen flow rate if I feel short of breath." This statement indicates a need for further teaching because patients on long-term oxygen therapy should not adjust their oxygen flow rate on their own without consulting their healthcare provider. Changing the flow rate without medical guidance can lead to serious complications like oxygen toxicity or inadequate oxygenation. Option A is correct as it indicates the patient's intention to follow the prescribed oxygen therapy plan, which is essential for managing COPD and maintaining adequate oxygen levels in the blood. Option C is also correct as checking oxygen tubing for kinks is a good practice to ensure the uninterrupted flow of oxygen, which is crucial for effective therapy. Option D is correct as well because it is important for patients using oxygen therapy to avoid open flames as oxygen supports combustion and can lead to fires. In an educational context, it is crucial to emphasize to patients the importance of following the prescribed oxygen therapy plan, not making adjustments without consulting healthcare providers, regularly checking equipment for proper functioning, and adhering to safety measures to prevent accidents. Patients should be educated on the potential risks associated with improper oxygen use and the necessity of seeking medical guidance for any concerns or changes in their condition.
Question 2 of 5
The nurse observes a drop in oxygen saturation from 92% to 86% in a patient ambulating with COPD. What is the nurse's priority?
Correct Answer: B
Rationale: In this scenario, the nurse's priority should be option B) Assist the patient back to bed. This is the correct choice because a drop in oxygen saturation in a patient with COPD while ambulating indicates a potential worsening of their condition. Moving the patient back to bed will help decrease their oxygen demand and workload on the respiratory system, potentially improving oxygenation. Option A) Increase oxygen flow rate is incorrect because simply increasing oxygen flow may not address the underlying issue causing the drop in saturation. It is essential to assess the patient's overall condition first. Option C) Reassess oxygen saturation in 5 minutes is not the priority because the immediate action should be taken to address the drop in oxygen saturation and ensure the patient's safety. Option D) Encourage pursed-lip breathing is not the priority in this situation as it may not be effective enough to quickly improve oxygen saturation in a patient experiencing a drop while ambulating. In an educational context, this question highlights the importance of prioritizing patient safety and addressing acute changes in oxygenation levels promptly, especially in individuals with underlying respiratory conditions like COPD. Understanding the significance of oxygen saturation monitoring and appropriate interventions is crucial for nurses caring for patients with compromised respiratory function.
Question 3 of 5
A patient with tuberculosis is started on isoniazid. Which side effect should the nurse monitor for?
Correct Answer: A
Rationale: The correct answer is A) Peripheral neuropathy. Isoniazid, a medication commonly used to treat tuberculosis, can lead to peripheral neuropathy as a side effect. This occurs due to the depletion of vitamin B6 (pyridoxine) by isoniazid, leading to nerve damage. Monitoring for symptoms such as numbness, tingling, or burning sensations in the extremities is crucial to prevent worsening of this condition. Option B) Orange discoloration of body fluids is incorrect as this side effect is associated with rifampin, another medication used in TB treatment. Option C) Visual changes are not typically associated with isoniazid use. Option D) Hearing loss is not a known side effect of isoniazid. In an educational context, understanding the side effects of medications used in the treatment of tuberculosis is essential for nurses caring for patients with this condition. Monitoring for and recognizing potential adverse effects early can help in providing safe and effective care to patients undergoing TB treatment.
Question 4 of 5
What is the nurse's first action when a patient with a chest tube exhibits subcutaneous emphysema?
Correct Answer: C
Rationale: The correct answer is C) Assess for tube obstruction. When a patient with a chest tube exhibits subcutaneous emphysema, which is the accumulation of air under the skin, the nurse's first action should be to assess for tube obstruction. Subcutaneous emphysema can indicate that air is not draining properly through the chest tube, which can lead to serious complications such as a tension pneumothorax. Notifying the healthcare provider (option A) may be necessary after assessing for tube obstruction, but it is not the first action. Repositioning the chest tube (option B) should only be done under the guidance of a healthcare provider to prevent further complications. Monitoring the area and documenting findings (option D) is important but not the priority when the patient's condition may be deteriorating due to a possible tube obstruction. In an educational context, understanding the priority actions in managing chest tube complications is crucial for nurses caring for patients with respiratory issues. Assessing for tube obstruction ensures timely intervention to prevent respiratory compromise and further complications, highlighting the importance of prompt and accurate nursing assessment skills in critical situations.
Question 5 of 5
A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action should the nurse plan to promote airway clearance?
Correct Answer: B
Rationale: In the context of a patient with bacterial pneumonia exhibiting coarse crackles and thick sputum, the correct action to promote airway clearance is to teach the pursed-lip breathing technique (Option B). This technique helps improve oxygenation and facilitates the removal of secretions by creating positive pressure in the airways during exhalation. Option A, restricting oral fluids during the day, is incorrect as hydration is essential for thinning respiratory secretions, making them easier to expectorate. Option C, encouraging the patient to wear the nasal O2 cannula, is also incorrect because while oxygen therapy may be necessary, it does not directly address airway clearance. Option D, assisting the patient to splint the chest when coughing, is not the most effective intervention for promoting airway clearance in this scenario. From an educational standpoint, understanding the rationale behind the correct answer is crucial for nursing students preparing for the NCLEX exam. Teaching them the pursed-lip breathing technique equips them with a practical skill that can be applied in real clinical situations to improve patient outcomes, especially in cases of respiratory conditions like pneumonia where airway clearance is a priority.