ATI RN
NCLEX Style Questions on Oxygenation Questions
Question 1 of 5
The nurse is caring for a patient with newly diagnosed pulmonary embolism (PE). What is the priority nursing intervention?
Correct Answer: A
Rationale: The priority nursing intervention for a patient with newly diagnosed pulmonary embolism (PE) is to administer prescribed anticoagulants (Choice A). This is because anticoagulants help to prevent further clot formation and reduce the risk of complications such as worsening of the PE or development of additional blood clots. Administering anticoagulants promptly is crucial in managing PE and improving outcomes for the patient. Positioning the patient supine and applying oxygen (Choice B) may be important, but it is not the priority over administering anticoagulants. Preparing for chest x-ray and CT scan (Choice C) and starting IV fluids (Choice D) are important assessments and interventions but are not the priority in the immediate management of PE.
Question 2 of 5
The nurse notes a large air leak in the chest tube system of a patient with a pneumothorax. What is the nurse's priority action?
Correct Answer: C
Rationale: The correct answer is C: Check all connections for leaks. The priority action is to identify and address the source of the air leak to prevent complications such as tension pneumothorax. Clamping the chest tube (A) can lead to a life-threatening situation. Notifying the healthcare provider (B) is important but not the immediate action. Repositioning the chest tube (D) does not address the air leak issue. Checking all connections for leaks (C) ensures the integrity of the chest tube system and allows for prompt intervention.
Question 3 of 5
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective?
Correct Answer: C
Rationale: The correct answer is C. Keeping the windows closed at home helps prevent the spread of TB bacteria by reducing the circulation of contaminated air. This statement shows understanding of how TB is transmitted through the air. Explanation: A: Taking the bus instead of driving does not relate to TB transmission. B: Having the spouse sleep in another room may reduce transmission, but it does not address other potential sources. D: Staying indoors whenever possible does not address the risk of exposure to contaminated air inside the home.
Question 4 of 5
A nurse is caring for a patient with chronic kidney disease (CKD). Which intervention should the nurse prioritize?
Correct Answer: A
Rationale: The correct answer is A: Administer diuretics. In CKD, the kidneys are unable to effectively remove waste and excess fluid from the body. Diuretics help to manage fluid overload by increasing urine output. This can help prevent complications such as edema and fluid overload. Increasing fluid intake (choice B) would worsen fluid overload. Providing a warm compress to the foot (choice C) is not a priority in CKD. Administering a platelet inhibitor (choice D) is not directly related to managing CKD.
Question 5 of 5
A nurse is caring for a patient with a history of hypertension. The patient is experiencing a hypertensive crisis. What is the priority intervention?
Correct Answer: C
Rationale: The priority intervention for a patient experiencing a hypertensive crisis is to reduce blood pressure gradually to prevent complications like stroke or heart attack. Encouraging deep breathing exercises helps lower blood pressure by promoting relaxation and reducing stress. Administering antihypertensive medication or nitroglycerin may cause a sudden drop in blood pressure, leading to hypoperfusion of vital organs. Thrombolytic therapy is not indicated for hypertensive crisis. Deep breathing exercises are a safe and effective first-line intervention to manage the hypertensive crisis.