ATI RN
Chapter 41 Oxygenation NCLEX Questions Questions
Question 1 of 5
What is the priority nursing action for a patient presenting with possible pulmonary embolism?
Correct Answer: B
Rationale: The correct answer is B because applying oxygen and elevating the head of the bed will help improve oxygenation and reduce the workload on the heart. This is crucial in a patient with possible pulmonary embolism to prevent further complications. Administering anticoagulants (A) is important but not the priority as oxygenation takes precedence. Chest x-ray (C) can help confirm diagnosis but is not immediate. Notifying the healthcare provider (D) is important but not as urgent as ensuring adequate oxygenation.
Question 2 of 5
A patient with an acute asthma attack is using an albuterol inhaler frequently. What is the nurse's best action?
Correct Answer: A
Rationale: The correct answer is A: Assess the patient's technique for inhaler use. This is crucial because improper inhaler technique can lead to ineffective medication delivery. By assessing the technique, the nurse can ensure the patient is using the inhaler correctly to optimize treatment efficacy. Providing education on spacer devices (B) may be beneficial, but assessing the current technique should be the initial step. Notifying the healthcare provider for additional treatment options (C) is premature without first assessing the current technique. Teaching the patient to use the inhaler only as needed (D) does not address the core issue of proper technique.
Question 3 of 5
The nurse reviews arterial blood gas results for a patient with respiratory distress: pH 7.25, PaCO2 55 mm Hg, HCO3- 26 mEq/L. What is the interpretation?
Correct Answer: B
Rationale: The correct answer is B: Uncompensated respiratory acidosis. The low pH (acidosis) and high PaCO2 (respiratory component) indicate respiratory acidosis. The HCO3- level is within normal range, suggesting no metabolic compensation. Therefore, it is uncompensated respiratory acidosis. Option A is incorrect because the pH is not within the normal range, indicating partial compensation has not occurred. Option C is incorrect as the HCO3- level is normal, ruling out metabolic acidosis. Option D is incorrect because the patient's pH is acidic, not alkalotic.
Question 4 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 because accomplishing patient teaching just before discharge ensures the information is fresh in the patient's mind. This timing maximizes retention and understanding of instructions, increasing compliance post-discharge. Choice A lacks timing specificity. Choice B may not always be feasible, and the caregiver may not be available. Choice D is a duplicate of choice B and does not address the timing issue. Ultimately, timing the teaching just before discharge is the most effective strategy for improving compliance.
Question 5 of 5
A nurse is caring for a patient with pneumonia. Which assessment finding would indicate that the treatment is effective?
Correct Answer: A
Rationale: Step 1: Monitoring vital signs for changes is crucial to assess the patient's overall condition and response to treatment. Step 2: Vital signs include temperature, pulse rate, respiratory rate, and blood pressure. Step 3: Improvement in vital signs such as decreased temperature, heart rate, and respiratory rate would indicate treatment effectiveness. Step 4: Respiratory status and oxygen saturation levels are important but may not provide a comprehensive assessment of treatment efficacy. Step 5: Administering antibiotics is part of the treatment plan but does not directly indicate treatment effectiveness. Summary: Monitoring vital signs for changes is the most direct and reliable way to assess the effectiveness of treatment for pneumonia, making it the correct choice. The other options may provide valuable information but are not as direct indicators of treatment efficacy.