ATI RN
Oxygenation NCLEX Questions Questions
Question 1 of 5
How should a nurse position a patient for a thoracentesis with a left-sided pleural effusion?
Correct Answer: B
Rationale: The correct answer is B, sitting upright with arms supported on an over-bed table. This position allows for better visualization of the thoracentesis site, facilitates proper needle insertion, and minimizes the risk of complications such as pneumothorax. High-Fowler's position with the left arm extended (choice A) may not provide adequate access to the pleural effusion. Supine with the head of the bed elevated 30 degrees (choice C) may not allow for proper drainage and visualization. Lying on the right side with the left arm elevated (choice D) is incorrect as it does not facilitate proper access to the pleural effusion site.
Question 2 of 5
A patient reports severe chest pain and difficulty breathing after a thoracentesis. What is the nurse's priority action?
Correct Answer: C
Rationale: The correct answer is C because reassessing vital signs and oxygen saturation is crucial to determine the patient's current status and the severity of the symptoms. This step allows the nurse to quickly identify any potential complications or deterioration in the patient's condition. Administering analgesic (choice A) may temporarily alleviate pain but does not address the underlying issue. Notifying the healthcare provider (choice B) is important but should not delay immediate assessment and intervention. Positioning the patient on the affected side (choice D) is not appropriate in this scenario and may worsen the symptoms.
Question 3 of 5
A patient with acute asthma exacerbation reports worsening symptoms despite frequent inhaler use. What should the nurse prioritize?
Correct Answer: B
Rationale: Correct Answer: B (Reassess the patient's peak expiratory flow) Rationale: Reassessing the peak expiratory flow is crucial to determine the severity of the asthma exacerbation and guide further treatment. It helps assess lung function and response to therapy, aiding in adjusting the treatment plan promptly. This step is essential in managing acute asthma exacerbations effectively. Administering systemic corticosteroids (choice A) is important but should follow proper assessment. Teaching about triggers (choice C) is beneficial but not the priority during an exacerbation. Notifying the healthcare provider (choice D) can be done after reassessment.
Question 4 of 5
The nurse palpates the posterior chest while the patient says "99" and notes absent fremitus. Which action should the nurse take next?
Correct Answer: D
Rationale: The correct answer is D: Auscultate anterior and posterior breath sounds bilaterally. This is the next appropriate action after noting absent fremitus during palpation of the posterior chest. Auscultation helps assess breath sounds and detects abnormalities such as wheezing or crackles. It provides valuable information about the patient's lung health and can help identify potential respiratory issues. Palpating the anterior chest or observing for barrel chest (choice A) is not the immediate priority when fremitus is absent. Encouraging the patient to turn, cough, and deep breathe (choice B) may be beneficial but does not directly address the absence of fremitus. Reviewing the chest x-ray report for evidence of pneumonia (choice C) is important but does not address the immediate need to further assess breath sounds in this scenario.
Question 5 of 5
A patient with a history of asthma is admitted with an exacerbation. Which action should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Administer a short-acting bronchodilator. The first step in managing an asthma exacerbation is to provide quick relief by administering a short-acting bronchodilator like albuterol. This medication helps to open up the airways rapidly, providing immediate relief of symptoms such as wheezing and shortness of breath. Administering a bronchodilator is crucial in the acute management of an asthma exacerbation as it targets bronchoconstriction. Oral steroids (choice C) are typically used for more severe exacerbations or when initial bronchodilator therapy is ineffective. Administering an inhaled beta-agonist (choice D) is a valid option, but a short-acting bronchodilator is preferred for immediate relief in the initial management of an exacerbation.