ATI RN
Fundamentals of Nursing Oxygenation Questions Questions
Question 1 of 5
Which of the following problems with the airway is a common cause of respiratory insufÃciency?
Correct Answer: D
Rationale: The correct answer is D: Obstruction. Obstruction of the airway can lead to respiratory insufficiency by blocking the flow of air in and out of the lungs. This can result in inadequate oxygen exchange, leading to respiratory distress. Expiration (choice A) is the process of exhaling air, not a problem with the airway itself. Hypercapnia (choice B) is an elevated level of carbon dioxide in the blood, which can be a consequence of respiratory insufficiency but is not a direct problem with the airway. Infection (choice C) can also affect the airway, but it is not as common of a cause of respiratory insufficiency as obstruction.
Question 2 of 5
A nurse is caring for a client who has a chest tube. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Monitor the client for subcutaneous emphysema. Subcutaneous emphysema is a potential complication of a chest tube insertion, characterized by air trapped under the skin. The nurse should assess the client for signs like a crackling sensation upon palpation. This action is crucial as early detection can prevent serious complications. Choices B and C are incorrect. Continuous bubbling in the water seal chamber indicates an air leak, which should be reported immediately. Keeping the drainage system above the chest level can lead to backflow of drainage into the client, increasing the risk of infection. Choice D is incorrect as clamping the chest tube during ambulation can cause a tension pneumothorax.
Question 3 of 5
Which client should the medical unit nurse assess first after receiving shift report?
Correct Answer: A
Rationale: The correct answer is A because the elderly client with pneumonia getting restless may indicate a change in condition or potential complications, requiring immediate assessment. Restlessness can be a sign of decreased oxygenation or sepsis in pneumonia patients. Choice B is incorrect as a headache in a young adult with influenza is not typically an immediate priority compared to potential respiratory distress in the elderly client. Choice C is incorrect as tidaling in the chest drainage system is expected and does not necessarily require immediate assessment unless other signs of distress are present. Choice D is incorrect as green drainage from the nose in a client with a sinus infection may indicate a bacterial infection but is not typically an urgent concern compared to potential acute respiratory compromise in the elderly client with pneumonia.
Question 4 of 5
The nurse is evaluating the effectiveness of oxygen therapy in a client with hypoxemia. Which finding indicates improvement?
Correct Answer: B
Rationale: The correct answer is B because an increase in oxygen saturation from 88% to 95% indicates improved oxygenation in the blood, reflecting the effectiveness of oxygen therapy. This improvement directly addresses the underlying issue of hypoxemia. A: Respiratory rate decreasing may indicate improvement, but it is not as specific to oxygenation as oxygen saturation levels. C: Heart rate decreasing could be a sign of improvement, but it is not as directly related to oxygen therapy effectiveness as oxygen saturation levels. D: Client reporting reduced fatigue is subjective and may not always correlate with objective improvement in oxygenation levels.
Question 5 of 5
A client with a tracheostomy is at risk for aspiration. What intervention should the nurse implement?
Correct Answer: B
Rationale: The correct answer is B: Position the client in high Fowler's position during meals. This helps prevent aspiration by promoting proper swallowing and reducing the risk of food or liquids entering the tracheostomy. Keeping the client NPO (A) is not necessary unless directed by a healthcare provider. Suctioning the tracheostomy frequently (C) can increase the risk of infection and is only done when there is visible secretions. Providing thickened liquids (D) may still pose a risk of aspiration, so positioning is more effective in preventing this complication.