Respiratory NCLEX Questions

Respiratory NCLEX Questions ScienceMedicinePulmonology conzy2 Save NCLEX Practice Questions Saunders...24 terms erikakelshPreview Respiratory Disorders NCLEX questi...43 terms SetfiretoitPreview Respiratory NCLEX Questions 131 terms rwillia2Preview Respira 54 terms ma Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

• Hypocapnia
• A hyperinflated chest noted on the chest x-ray
• Increased oxygen saturation with exercise
• A widened diaphragm noted on the chest x-ray
• A hyperinflated chest noted on the chest x-ray

Explanation:

Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?

• Make inhalation longer than exhalation
• Exhale through an open mouth
• Use diaphragmatic breathing
• Use chest breathing
• Use diaphragmatic breathing

Explanation:

In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation.Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

• Simple mask
• Non-rebreather mask
• Face tent
• Nasal cannula
• Non-rebreather mask

Explanation:

A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other modes — simple mask, face tent, and nasal cannula — deliver lower levels of FIO2.A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?

• Inflamed lung tissue
• Sudden onset
• Responsiveness to penicillin
• Elevated white blood cell (WBC) count
• Inflamed lung tissue

Explanation:

The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset.Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren't treated with antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don't.For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

• Restricting fluid intake to 1,000 ml per day
• Enforcing absolute bed rest
• Teaching the patient how to perform controlled coughing
• Administering prescribe sedatives regularly and in large amounts
• Teaching the patient how to perform controlled coughing

Explanation:

Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the patient's ability to maintain a patent airway, causing a high risk for infection from pooled secretions.Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

• The system is functioning normally
• The client has a pneumothorax
• The system has an air leak
• The chest tube is obstructed
• The system has an air leak

Explanation:

Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

• Encouraging the patient to drink three glasses of fluid daily
• Keeping the patient in semi-fowler's position
• Using a high-flow venturi mask to deliver oxygen as prescribe
• Administering a sedative, as prescribe
• Using a high-flow venturi mask to deliver oxygen as prescribed

Explanation:

The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowler's position and should not receive sedatives or other drugs that may further depress the respiratory center.After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

• Monitor fluctuations in the water-seal chamber
• Clamp the chest tube once every shift
• Encourage coughing and deep breathing
• Milk the chest tube every 2 hours
• Encourage coughing and deep breathing

Explanation:

When caring for a patient who is recovering from a pneumonectomy, the nurse should encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. Because the lung has been removed, the water-seal chamber should display no fluctuations. Reinflation is not the purpose of chest tube. Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage.A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

• Area of redness is measured in 3 days and determines whether tuberculosis is present.
• Skin test doesn't differentiate between active and dormant tuberculosis infection.
• Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
• Test stimulates a reddened response in some clients and requires a second test in 3 months.
• Skin test doesn't differentiate between active and dormant tuberculosis infection.

Explanation:

The Mantoux test doesn't differentiate between active and dormant infections. If a positive reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2 days doesn't indicate active tuberculosis.Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

• Contralateral side in a simple pneumothorax
• Affected side in a hemothorax
• Affected side in a tension pneumothorax
• Contralateral side in hemothorax
• Contralateral side in hemothorax

Explanation:

The trachea will shift according to the pressure gradients within the thoracic cavity. In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. If there is no significant air or fluid accumulation, the trachea will not shift. Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the release of normal thoracic pressure gradients on the injured side.

A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

• Drawing blood for a hematocrit and hemoglobin level
• Applying a dressing over the wound and taping it on three sides
• Preparing a chest tube insertion tray
• Preparing to start an I.V. line
• Applying a dressing over the wound and taping it on three sides

Explanation:

The nurse immediately should apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound). Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

• Pleural effusion
• Pulmonary edema
• Atelectasis
• Oxygen toxicity
• Atelectasis

Explanation:

In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space).Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

• Dry cough
• Hermaturia
• Bronchospasm
• Blood-streaked sputum
• Bronchospasm

Explanation:

If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

• pH, 5.0; PaCO2 30 mm Hg
• pH, 7.40; PaCO2 35 mm Hg
• pH, 7.35; PaCO2 40 mm Hg
• pH, 7.25; PaCO2 50 mm Hg
• pH, 7.25; PaCO2 50 mm Hg

Explanation:

In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg.Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.