ATI RN
NCLEX Questions on Oxygenation and Perfusion Questions
Question 1 of 5
The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test?
Correct Answer: C
Rationale: The correct answer is C: How long has it been since you moved to the United States? This question is important because TB prevalence varies in different countries, and individuals who have recently immigrated from high TB burden countries may have a higher risk of TB infection. It helps the nurse assess the individual's potential exposure risk. A: Do you take any over-the-counter (OTC) medications? - This question is not directly related to TB skin testing and does not provide information relevant to assessing TB risk. B: Do you have any family members with a history of TB? - While a family history of TB can be a risk factor, it is not as directly relevant as the timing of immigration in this context. D: Did you receive the bacille Calmette-Guérin (BCG) vaccine for TB? - While BCG vaccination history is important for interpreting TB skin test results, it is not as crucial as determining recent immigration status when assessing TB risk.
Question 2 of 5
A nurse is caring for a patient with a history of diabetes who is experiencing blurred vision. What is the priority action?
Correct Answer: C
Rationale: The correct answer is C: Administer insulin. Blurred vision in a patient with a history of diabetes could indicate hyperglycemia. Administering insulin would help lower blood glucose levels and alleviate the blurred vision. Monitoring blood glucose levels (choice A) is important but not the priority when the patient is already experiencing symptoms. Administering insulin (choices B and D) is the immediate action needed to address the high blood glucose levels causing the blurred vision.
Question 3 of 5
A nurse is caring for a patient with a history of heart failure. The patient is experiencing fatigue and weakness. What is the priority intervention?
Correct Answer: A
Rationale: The correct answer is A: Administer oxygen. In heart failure, fatigue and weakness can be due to poor oxygenation. Administering oxygen helps improve oxygen levels, alleviating symptoms. Insulin (B) is not indicated for fatigue in heart failure. Antibiotics (C) are not necessary unless there is a confirmed infection. Beta-blockers (D) may be part of the treatment plan but addressing oxygenation is the priority in this scenario.
Question 4 of 5
A nurse is caring for a patient with a history of asthma. The patient is experiencing shortness of breath. What is the priority intervention?
Correct Answer: A
Rationale: The correct answer is A: Administer a bronchodilator. The priority intervention for a patient with asthma experiencing shortness of breath is to administer a bronchodilator to help open up the airways and improve breathing. Bronchodilators work quickly to relieve acute symptoms of asthma by relaxing the muscles around the airways. This intervention is crucial in managing an acute asthma exacerbation. Summary: - Option B: Administer insulin therapy is incorrect because it is not indicated for managing asthma exacerbation. - Option C: Administer short-acting bronchodilators is partially correct but not as specific as option A, which specifies the immediate need for bronchodilator therapy. - Option D: Administer corticosteroids is important for long-term control of asthma but not the priority intervention in an acute exacerbation where immediate relief is needed.
Question 5 of 5
A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO₂ levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?
Correct Answer: C
Rationale: The correct answer is C - Arrange for the patient's caregiver to be present during the teaching. In the context of a patient with COPD, involving the caregiver in the discharge teaching is crucial for several reasons. COPD is a chronic condition that requires ongoing management and lifestyle modifications. By having the caregiver present, the patient is more likely to receive consistent support and reinforcement of the information provided during the teaching session. This support can help the patient adhere to the prescribed treatment plan, medication regimen, and lifestyle changes, ultimately improving compliance and health outcomes. Option A, having the patient repeat the instructions immediately after teaching, may not be as effective in the case of a chronic condition like COPD where ongoing support is crucial. Option B, accomplishing patient teaching just before discharge, may not allow enough time for the patient and caregiver to fully understand and internalize the information provided. Option D, starting discharge teaching during the admission process, may not be as effective as involving the caregiver who will be providing support post-discharge. In an educational context, this question highlights the importance of considering the holistic needs of patients with chronic conditions like COPD. It emphasizes the role of caregivers in supporting patient education and self-management, promoting better health outcomes and improved compliance with treatment plans.