ATI RN
Fundamentals of Nursing Oxygenation Practice Questions Questions
Question 1 of 5
The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider?
Correct Answer: D
Rationale: The correct answer is D. The most important result to report immediately is a pH of 7.31, which indicates acidosis, a potentially life-threatening condition. A low pH can lead to organ dysfunction and requires prompt intervention. The other choices have pH levels within normal limits. PaO2, PaCO2, and O2 saturation are also important, but in this case, the critical value is the pH. Choices A, B, and C have pH values closer to normal range and, although abnormalities in PaO2, PaCO2, or O2 saturation should be monitored, they are not as urgent as a pH indicating acidosis.
Question 2 of 5
The nurse observes a student performing tracheostomy care. Which action by the student requires correction?
Correct Answer: B
Rationale: The correct answer is B because changing the tracheostomy ties before cleaning the stoma can lead to contamination of the stoma site. The correct sequence should be to first clean the stoma with saline solution, then change the tracheostomy ties, and finally apply a new sterile dressing. This helps prevent infection and ensures proper hygiene. Choices A, C, and D are incorrect because using sterile technique for suctioning, applying a new sterile dressing, and cleaning the stoma with saline solution are all appropriate actions in tracheostomy care.
Question 3 of 5
Which action by the nurse is most important when administering a bronchodilator via nebulizer?
Correct Answer: D
Rationale: The correct answer is D: Ensuring the patient is sitting upright during the treatment. This is important because being in an upright position optimizes lung expansion and airflow, promoting better drug delivery to the lungs. Sitting upright also helps prevent potential aspiration of the medication. Choice A is incorrect because the breathing technique (in through nose, out through mouth) is not the most critical aspect of nebulizer administration. Choice B is incorrect because while monitoring for tachycardia is important, it is not the most crucial action during bronchodilator administration. Choice C is incorrect because diluting the medication with normal saline may be necessary for certain medications, but it is not the most important action when administering a bronchodilator via nebulizer.
Question 4 of 5
A patient presents with pleuritic chest pain and fever. Which action should the nurse take first?
Correct Answer: A
Rationale: The correct action is to assess for diminished lung sounds first. Pleuritic chest pain and fever can indicate a potential respiratory issue like pneumonia. Assessing lung sounds can provide immediate information on the patient's respiratory status and guide further interventions. Administering antipyretics can help manage the fever but does not address the underlying cause. Obtaining a sputum sample for culture is important for identifying the specific pathogen causing the infection but is not the first priority. Placing the patient in a high Fowler's position can improve oxygenation but should come after assessing lung sounds to ensure appropriate positioning.
Question 5 of 5
A patient recovering from thoracotomy reports shortness of breath and chest pain. What should the nurse do first?
Correct Answer: B
Rationale: The correct answer is B: Assess for tracheal deviation. This is the priority because it can indicate a pneumothorax, a potentially life-threatening complication of thoracotomy. Tracheal deviation could suggest a tension pneumothorax, which requires immediate intervention to prevent respiratory distress and cardiac compromise. Administering analgesics (A) may be necessary but not the first priority. Encouraging the use of an incentive spirometer (C) and positioning the patient in semi-Fowler's position (D) can help improve lung function but are not as urgent as assessing for tracheal deviation.