ATI RN
Fundamentals of Nursing Oxygenation Questions Questions
Question 1 of 5
The nurse assesses a patient with pneumonia who is experiencing pleuritic chest pain. Which action should the nurse take?
Correct Answer: B
Rationale: Correct Answer: B Rationale: 1. Placing the patient in a side-lying position on the affected side helps improve lung expansion and ventilation in the affected area, reducing pleuritic chest pain. 2. This position can also help prevent pooling of secretions and potential complications like atelectasis. 3. Encouraging shallow breaths (Choice A) may worsen the patient's condition by leading to decreased lung expansion. 4. Administering morphine (Choice C) may mask the pain but does not address the underlying cause or promote lung expansion. 5. Incentive spirometry (Choice D) is beneficial for preventing atelectasis but may not provide immediate relief for pleuritic chest pain.
Question 2 of 5
The nurse teaches a patient how to minimize exposure to others while being treated for tuberculosis (TB). Which statement by the patient indicates a need for further teaching?
Correct Answer: C
Rationale: The correct answer is C because the patient should continue wearing a mask even after symptoms improve to prevent the spread of TB. Step 1: Wearing a mask helps minimize airborne transmission. Step 2: Discontinuing mask prematurely increases infection risk. Step 3: Options A, B, and D are correct as they promote isolation, ventilation, and precautions during the contagious period.
Question 3 of 5
The nurse observes bubbling in the water-seal chamber of a chest tube drainage system. What is the nurse's best action?
Correct Answer: C
Rationale: The correct action is to check the system for air leaks (Option C) because bubbling in the water-seal chamber indicates air is leaking into the system, which can compromise the chest tube's function. By identifying and addressing the air leak, the nurse can ensure proper drainage and prevent complications. Clamping the chest tube (Option A) can lead to tension pneumothorax. Increasing suction (Option B) can worsen the problem. Notifying the healthcare provider (Option D) should be done after checking for air leaks.
Question 4 of 5
Which finding in a patient with asthma indicates a need for immediate intervention?
Correct Answer: A
Rationale: The correct answer is A: Use of accessory muscles during respiration. This finding in a patient with asthma indicates a need for immediate intervention because it signifies severe respiratory distress and impending respiratory failure. Accessory muscle use suggests that the patient is struggling to breathe and is unable to maintain adequate oxygenation. This requires prompt medical attention to prevent further deterioration. Summary: B: Oxygen saturation of 92% on room air may indicate mild hypoxemia but is not as urgent as the use of accessory muscles. C: Mild expiratory wheezing is a common finding in asthma exacerbations and may not necessarily require immediate intervention. D: Peak expiratory flow rate of 85% of personal best indicates moderate airflow limitation but does not necessarily require immediate intervention unless accompanied by other severe symptoms.
Question 5 of 5
Which assessment finding in a patient with pneumonia requires immediate notification of the healthcare provider?
Correct Answer: C
Rationale: The correct answer is C: Oxygen saturation of 85% despite oxygen therapy. This finding indicates severe hypoxemia, which can lead to tissue damage or organ failure. Immediate notification is crucial to address the patient's inadequate oxygenation. Crackles in the lower lung fields (A) are common in pneumonia but don't require immediate notification. A respiratory rate of 24 breaths per minute (B) may indicate respiratory distress but is not as concerning as severe hypoxemia. Productive cough with yellow sputum (D) is a common symptom of pneumonia but doesn't indicate an urgent need for provider notification.