ATI RN
NCLEX Questions on Oxygenation and Perfusion Questions
Question 1 of 5
The nurse is caring for a client with acute asthma exacerbation. What priority assessment would concern the nurse most?
Correct Answer: C
Rationale: The correct answer is C because inspiratory wheezing and a respiratory rate greater than 30 indicate severe airway obstruction and impending respiratory failure in acute asthma exacerbation. This warrants immediate intervention to prevent respiratory arrest. A: Shortness of breath and low-grade fever are common in asthma exacerbation but not as concerning as severe airway obstruction. B: Low oxygen saturation and elevated pulse rate are also expected in asthma exacerbation but are not as critical as severe airway obstruction. D: Tachycardia and pursed-lip breathing are common in asthma exacerbation but do not indicate severe airway obstruction as clearly as inspiratory wheezing and high respiratory rate.
Question 2 of 5
The nurse is teaching a client with a new diagnosis of COPD about pursed-lip breathing. What is the primary benefit of this technique?
Correct Answer: B
Rationale: The correct answer is B: Reduces airway resistance. Pursed-lip breathing helps to slow down the exhalation process, which in turn reduces the amount of air trapped in the lungs and decreases airway resistance. This technique promotes better oxygen exchange and helps the client breathe more efficiently. A: Increases oxygen intake - Pursed-lip breathing does not directly increase oxygen intake but rather improves the efficiency of oxygen exchange by reducing airway resistance. C: Slows the respiratory rate - While pursed-lip breathing may slow down the breathing pattern, the primary benefit is the reduction of airway resistance, not solely slowing the respiratory rate. D: Prevents hyperventilation - Pursed-lip breathing can help prevent hyperventilation by promoting more controlled breathing, but the primary benefit is the reduction of airway resistance for clients with COPD.
Question 3 of 5
The nurse is assessing a client with a chest tube. Which finding requires immediate action?
Correct Answer: A
Rationale: The correct answer is A because continuous bubbling in the water seal chamber indicates an air leak in the chest tube system, which can lead to pneumothorax. Immediate action is needed to prevent respiratory compromise. Choice B is incorrect because drainage of 50 mL in the past hour is within normal limits for a chest tube output. Choice C, tidaling in the water seal chamber, is a normal finding indicating proper functioning of the chest tube system. Choice D is incorrect because although the chest tube dressing intact with no drainage is a good sign, it does not require immediate action compared to an air leak.
Question 4 of 5
The nurse is teaching a client with obstructive sleep apnea about lifestyle changes. Which recommendation is most appropriate?
Correct Answer: C
Rationale: The correct answer is C: Lose weight to reduce airway obstruction. This recommendation is most appropriate as excess weight can contribute to airway obstruction in obstructive sleep apnea. Losing weight can help reduce the amount of fatty tissue around the airway, improving airflow during sleep. A: Sleeping in a supine position may worsen obstructive sleep apnea by causing the tongue and soft tissues to block the airway. B: Limiting fluid intake in the evening may help reduce nighttime trips to the bathroom but does not directly address the underlying cause of obstructive sleep apnea. D: Avoiding the use of CPAP even if symptoms improve is not recommended as CPAP therapy is an effective treatment for obstructive sleep apnea and helps maintain open airways during sleep.
Question 5 of 5
The nurse is preparing a client for a thoracentesis. What position should the client be placed in?
Correct Answer: B
Rationale: The correct answer is B: High Fowler's with arms supported on a table. This position allows for easier access to the thoracic cavity, facilitating the thoracentesis procedure. High Fowler's position also helps the client breathe more comfortably and reduces the risk of complications. A: Supine with arms at the sides would not provide optimal access to the thoracic cavity. C: Prone with a pillow under the chest would hinder access to the thoracic cavity and compromise the procedure. D: Side-lying with the affected side down could also impair access to the thoracic cavity and make the procedure more challenging.