ATI RN
Oxygenation Nursing Practice Questions Questions
Question 1 of 5
The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement, if made by the patient, indicates that the teaching was successful?
Correct Answer: D
Rationale: In this scenario, option D, "I will elevate my head for 48 hours to minimize swelling," is the correct answer because elevating the head post-rhinoplasty helps reduce swelling by promoting proper drainage of fluids and decreasing edema. This instruction is crucial for optimal postoperative recovery and outcomes. Option A is incorrect because while some initial improvement in appearance may occur, expecting a completely normal appearance within 24 to 48 hours is unrealistic and misleading. Option B is incorrect as taking 800 mg ibuprofen every 6 hours may lead to exceeding the maximum daily dosage and potential complications. Option C is incorrect because removing and reapplying nasal packing daily can disrupt the healing process and increase the risk of complications such as bleeding or infection. Educationally, understanding the rationale behind postoperative care instructions is essential for nurses to effectively teach and support patients in their recovery process. By explaining the reasons behind specific instructions, nurses empower patients to actively participate in their care and promote better adherence to postoperative protocols, ultimately leading to improved patient outcomes.
Question 2 of 5
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy. Which information should the nurse include about the patient's postoperative care?
Correct Answer: C
Rationale: Educational Rationale: The correct answer is option C) Frequent use of an incentive spirometer. The rationale behind this is that after a pneumonectomy (surgical removal of a lung), it is crucial for the patient to engage in deep breathing exercises to prevent complications such as atelectasis (lung collapse) and promote lung expansion. Incentive spirometry helps the patient take slow, deep breaths to keep the air sacs in the lungs open and prevent mucus buildup, aiding in the recovery process. Option A) Bed rest for the first 24 hours is incorrect because early ambulation and movement are crucial in preventing postoperative complications like blood clots and pneumonia. Prolonged bed rest can lead to decreased lung expansion and increase the risk of respiratory issues. Option B) Positioning only on the right side is incorrect as it restricts movement and may not be comfortable for the patient. Positioning changes are necessary postoperatively to prevent complications such as pressure ulcers and promote lung expansion. Option D) Chest tube placement to continuous suction is also incorrect because after a pneumonectomy, chest tubes are not typically used, as the remaining lung is usually able to compensate for the loss of the removed lung. Continuous suction can lead to excessive drainage and increase the risk of complications such as infection. Educationally, understanding the rationale behind postoperative care after a pneumonectomy is essential for nurses to provide safe and effective care to their patients. By knowing the correct interventions, nurses can promote optimal recovery and prevent complications, ultimately improving patient outcomes and quality of care. It is crucial for nurses to stay updated on evidence-based practices to deliver the best possible care to patients undergoing complex procedures like pneumonectomy.
Question 3 of 5
The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)?
Correct Answer: A
Rationale: The correct answer is A) Document the amount of drainage every 8 hours. This task can be delegated to the unlicensed assistive personnel (UAP) because it is a routine, non-invasive activity that does not require clinical judgment. Documenting drainage volume is essential to monitor the patient's condition and ensure appropriate management of the chest tube. Option B) Obtain samples of drainage for culture requires a level of skill and understanding of the rationale behind collecting samples for culture, which falls outside the scope of practice for UAPs. Option C) Assessing the patient's pain level associated with the chest tube involves subjective interpretation and critical thinking, which are nursing responsibilities that should not be delegated to UAPs. Option D) Checking the water-seal chamber for the correct fluid level involves interpreting the functioning of the chest tube system and ensuring its proper operation, which requires nursing knowledge and clinical judgment. Educationally, it is vital for nurses to understand the scope of practice for UAPs and to delegate tasks appropriately based on the complexity and level of skill required. By knowing which tasks can be safely delegated, nurses can optimize patient care while allowing UAPs to contribute to the healthcare team effectively.
Question 4 of 5
A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, 'I wish I were dead! I'm just a burden on everybody.' Based on this information, which nursing diagnosis is most appropriate?
Correct Answer: B
Rationale: In this scenario, option B, "Chronic low self-esteem related to physical dependence," is the most appropriate nursing diagnosis. The patient's statement of feeling like a burden and expressing a desire to be dead indicates a deep sense of worthlessness linked to their physical dependence due to COPD. This reflects a chronic issue with self-esteem that needs to be addressed. Option A, "Complicated grieving related to expectation of death," is incorrect because the patient is expressing feelings of worthlessness and burden, not necessarily grieving or accepting the expectation of death. Option C, "Ineffective coping related to unknown outcome of illness," is incorrect as the patient's statement is more about self-perception and feelings of being a burden rather than coping with the unknown outcome of the illness. Option D, "Deficient knowledge related to lack of education about COPD," is not the most appropriate diagnosis in this situation as the patient's statement does not directly indicate a lack of knowledge about COPD. Educationally, it is important for nurses to understand how to interpret patients' statements and behaviors to identify underlying nursing diagnoses accurately. This case highlights the significance of assessing patients' emotional well-being and self-perception in the context of their illness to provide appropriate care and support. Addressing issues of self-esteem and feelings of worthlessness is crucial in promoting the overall well-being of patients with chronic conditions like COPD.
Question 5 of 5
A patient is scheduled for a computed tomography (CT) scan of the chest with contrast media. Which assessment findings should the nurse report to the health care provider before the patient goes for the CT (select all that apply)?
Correct Answer: A
Rationale: The correct answer, A) Allergy to shellfish, is crucial to report before a patient undergoes a CT scan with contrast media due to the potential iodine sensitivity associated with shellfish allergy. Iodinated contrast media used in CT scans can cause allergic reactions, especially in individuals with known shellfish allergies. Additionally, individuals with elevated creatinine levels may have impaired renal function, which is a contraindication for contrast media use as it can further compromise kidney function. Option B) Patient reports claustrophobia is not directly related to the administration of contrast media for a CT scan and would not impact the procedure itself. Option C) Inability to remove a wedding band is also not directly relevant to the CT scan procedure. Option D) Recent bronchodilator inhaler use is important information to document but is not specifically significant in the context of a CT scan with contrast media. In an educational context, understanding the importance of assessing and reporting specific patient information before procedures such as CT scans with contrast media is essential for ensuring patient safety and optimal outcomes. Nurses must be able to identify relevant patient factors that may impact the procedure and communicate effectively with the healthcare team to prevent adverse events and provide quality care.