ATI RN
Oxygenation NCLEX Questions with Rationale Questions
Question 1 of 5
Transmission of mycobacterium tuberculosis is through:
Correct Answer: D
Rationale: Mycobacterium tuberculosis spreads via airborne transmission through droplet nuclei.
Question 2 of 5
While performing an assessment, the nurse hears crackles in the patient's lung fields. The nurse also learns that the patient is sleeping on three pillows. What do these symptoms most likely indicate?
Correct Answer: A
Rationale: The crackles in the lung fields suggest fluid accumulation in the lungs, which is a common sign of left-sided heart failure. When the left side of the heart fails to pump effectively, blood backs up into the lungs, causing fluid leakage and crackles. The patient sleeping on three pillows is likely trying to alleviate difficulty breathing due to the lung congestion. Right-sided heart failure would typically present with symptoms such as peripheral edema and jugular venous distension, not crackles in the lungs. Atrial fibrillation is an arrhythmia that may lead to heart failure but does not directly cause crackles in the lung fields. Myocardial ischemia is related to inadequate blood flow to the heart muscle and does not directly cause crackles in the lungs.
Question 3 of 5
The nurse knows that a closed suction device would be most appropriate for which patient?
Correct Answer: D
Rationale: The correct answer is D because a closed suction device is typically used for patients with respiratory issues like aspiration pneumonia as it helps to clear secretions effectively. For a 75-year-old with aspiration pneumonia following a stroke, maintaining airway patency and clearing secretions are crucial for preventing complications. Choices A, B, and C do not specifically require closed suction devices as their conditions do not primarily involve the need for airway clearance through suctioning.
Question 4 of 5
A nurse is evaluating a client's understanding of the use of a metered-dose inhaler (MDI). Which of the following actions indicates correct use?
Correct Answer: A
Rationale: Correct Answer: A Rationale: Exhaling fully before using the MDI helps create space in the lungs for the medication to reach deeper into the airways upon inhalation. This maximizes the effectiveness of the medication. Holding the breath for a few seconds after inhalation also allows the medication to be absorbed properly. Shaking the inhaler after use is not recommended as it may cause the medication to clump. Using the inhaler while lying flat can lead to improper inhalation technique and reduced effectiveness.
Question 5 of 5
The nurse is assessing a patient with emphysema. Which clinical finding is consistent with this condition?
Correct Answer: C
Rationale: The correct answer is C: Barrel-shaped chest. In emphysema, the chronic destruction of alveoli leads to loss of lung elasticity, causing the chest to become hyperinflated and take on a barrel shape. This is due to air trapping in the lungs. A: Frequent productive cough is commonly seen in conditions like chronic bronchitis, not specific to emphysema. B: Cyanosis of lips and fingertips indicates poor oxygenation, which is more commonly associated with conditions like pneumonia or acute respiratory distress. D: Peripheral edema is a sign of fluid retention and heart failure, not typically seen in emphysema.