ATI RN
NCLEX Questions on Oxygenation and Perfusion Questions
Question 1 of 5
The nurse observes an air leak in the chest tube system. What is the appropriate action?
Correct Answer: C
Rationale: The correct action is to check the system for loose connections (Choice C). First, ensure that all connections are secure to prevent further air leakage. Clamping the chest tube (Choice A) can create tension leading to more air leaks. Repositioning the chest tube (Choice B) may not address the underlying issue of loose connections. Notifying the healthcare provider (Choice D) is important but addressing the immediate concern of loose connections should be the initial action to prevent complications.
Question 2 of 5
A patient with asthma is prescribed salmeterol. What is the nurse's priority teaching point?
Correct Answer: B
Rationale: The correct answer is B because salmeterol is a long-acting beta agonist that needs to be taken regularly, twice a day, to control asthma symptoms effectively. This teaching point is crucial for the patient to understand the importance of adherence to the medication regimen. Choice A is incorrect because salmeterol is not a rescue inhaler for immediate relief during an asthma attack. Choice C is incorrect as salmeterol does not require shaking before use. Choice D is incorrect because rinsing the mouth after inhaling is typically advised for corticosteroid inhalers to prevent oral thrush, not for salmeterol.
Question 3 of 5
The nurse is caring for a patient with acute respiratory distress. What assessment finding is the priority to report?
Correct Answer: A
Rationale: The correct answer is A: Oxygen saturation of 86% on room air. This is the priority finding to report because it indicates severe hypoxemia, which is a life-threatening condition requiring immediate intervention to prevent tissue damage and organ failure. Oxygen saturation should ideally be above 90%. Choice B (Respiratory rate of 28 breaths per minute) is important but not as critical as severe hypoxemia. Choice C (Heart rate of 102 beats per minute) may be a compensatory response to hypoxemia, and while important, it is not as urgent as addressing the low oxygen saturation. Choice D (Blood pressure of 140/92 mm Hg) is within normal range and does not indicate immediate danger compared to severe hypoxemia.
Question 4 of 5
The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take?
Correct Answer: A
Rationale: The correct answer is A because bacteriologic testing for tuberculosis involves blood tests to confirm the diagnosis. The nurse should teach the patient about the reason for these blood tests to ensure understanding and cooperation. Option B is incorrect because a chest x-ray is not the appropriate test for bacteriologic testing. Option C is incorrect as it refers to collecting specimens for other types of tests, not bacteriologic testing. Option D is incorrect because sputum specimens are not typically used for bacteriologic testing for tuberculosis.
Question 5 of 5
A patient with a history of heart failure is experiencing shortness of breath. What is the priority intervention?
Correct Answer: A
Rationale: The correct answer is A: Administer supplemental oxygen. In a patient with heart failure experiencing shortness of breath, the priority intervention is to improve oxygenation. Supplemental oxygen helps increase oxygen levels and alleviate respiratory distress. This is crucial to prevent further deterioration and potential complications. Administering a diuretic (B) would help with fluid overload but does not address the immediate need for oxygen. Administering an IV analgesic (C) is not indicated for shortness of breath in heart failure. Administering a vasodilator (D) may worsen the condition by decreasing blood pressure and cardiac output.