Iggy Chapter 29 Critical Care of Patients with Respiratory Emergencies NCLEX Practice Questions

What is the nurse's best first action when assessing a client who was intubated a few minutes ago and finds the end-tidal carbon dioxide level is 0 and SpO2 is 38%? A. Removing the endotracheal tube and ventilating the client with a bag-valve mask B. Obtaining a different monitor and rechecking the end-tidal carbon dioxide level C. Documenting the finding in the electric health record as the only action D. Initiating the Rapid Response Team

A Removing the endotracheal tube and ventilating the client with a bag-valve mask

Which action will the nurse take first for a client being mechanically ventilated who begins to pick at the bedcovers? A. Assessing for adequate oxygenation B. Administering the prescribed sedating drug C. Explaining to the client that the tube helps with breathing D. Requesting that the family leave to decrease the client's agitation

A Assessing for adequate oxygenation

When caring for a group of clients at risk for or diagnosed with pulmonary embolism, the nurse calls the Rapid Response Team (RRT) for intervention for which client? A. Client treated for pulmonary embolism with IV heparin who has hemoptysis and tachycardia B. Client with deep vein thrombosis who is receiving low-molecular weight heparin and has ongoing calf pain C. Client with a right pneumothorax who is being treated with a chest tube and has a pulse oximeter reading of 94% D. Client who was extubated 3 days ago and had decreased breath sounds at the posterior bases of both lungs.

A Client treated for pulmonary embolism with IV heparin who has hemoptysis and tachycardia

Which new assessment finding in a client being managed for a pulmonary embolism (PE) indicates to the nurse that the client's condition is worsening? A. Distended neck veins in the High Fowler position B. Increasing temperature C. Abdominal cramping D. Hand tremors

A Distended neck veins in the High Fowler position

In addition to notifying the pulmonary health care provider, what is the most important action for the nurse to take first for a client with a pulmonary with a pulmonary embolism whose arterial blood gas values are pH 7.28, PaCO2 50 mm Hg, PaO2 62mm Hg, and HCO3 24 mEq/L? A. Increasing the oxygen flow rate B. Administering sodium bicarbonate C. Assessing for the presence of adventitious lung sounds D. Having the client breathe rapidly and deeply into the paper bag

A Increasing the oxygen flow rate

Which clients will the nurse monitor most closely for respiratory failure? A. 30 yr. old with a C-5 spinal cord injury B. 35 yr. old using client-controlled analgesia C. 40 yr. old with acute pancreatitis D. 50 yr. old experiencing cocaine intoxication E. 55 yr old with a brainstem tumor F. 65 yr. old with COVID-19 pneumonia

A, B, C, E, F C-5 spinal cord injury client-controlled analgesia acute pancreatitis brainstem tumor COVID-19 pneumonia

Which assessment findings in a client at high risk for pulmonary embolism (PE) indicates to the nurse the probable presence of a PE? Select all that apply A. Dizziness and syncope B. Worsening dyspnea for 3 days C. Inspiratory chest pain D. Productive cough E. Pink, frothy sputum F. Tachycardia

A, C, F Dizziness and syncope Inspiratory chest pain Tachycardia

What type of acid-base problem will the nurse expect in a client who is being insufficiently mechanically ventilated for the past 4 hours and whose most recent arterial blood gas results include a pH of 7.29? A. Metabolic acidosis with an acid excess B. Metabolic acidosis with a base deficit C. Respiratory acidosis with an acid excess D. Respiratory acidosis with a base deficit

C Respiratory acidosis with an acid excess

Drugs from which clall with the nurse prepare to administer as first line therapy for a client just diagnosed with pulmonary embolism (PE)? A. Antibiotics B. Anticoagulants C. Antidysrhythmic D. Antihypertensives

B Anticoagulants

What is the best first action when the nurse assesses that the respirations of a sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressure but the ventilator tubing is clear? A. Humidifying the oxygen source B. Suctioning the tracheostomy tube C. Increasing the percentage of oxygen D. Remove the inner cannula of the tracheostomy

B Suctioning the tracheostomy tubing

Which action will the nurse instruct a client with an endotracheal tube to perform during the time the tube is being removed? A. inhale B. exhale C. cough D. hold his/her breath

B exhale

Which action has the highest priority for the nurse to take to prevent harm for a client being mechanically ventilated with 100% oxygen for the past 24 hours who now has new-onset crackles, decreased breath sounds, and a PaO2 level of 95 mm Hg? A. Assessing cognition B. Preparing to suction the client C. Placing the client in the prone position D. Collaborating with the pulmonary health care provider to lower the FiO2 level

D Collaborating with the pulmonary HCP to lower the FiO2 level

What type of percussion note or sound will the nurse expect on the affected chest side of a client who has a hemothorax? A. Hypertympanic B. Hyperresonant C. Crackling D. Dull

D Dull

Which action is a priority for the nurse to prevent harm for a client with a pulmonary embolism who is receiving a continuous heparin infusion? A. Assessing breath sounds B. Comparing pedal pulses bilaterally C. Monitoring the platelet count daily D. Assessing gums daily for indications of bleeding

C Monitoring the platelet count daily

For which problems will the nurse specifically assess when the low-pressure alarm of a client's mechanical ventilator sounds? A. Ventilator tubing is under the client B. Cuff leak in the endotracheal or tracheostomy tube C. Client is not breathing D. Mucous plugs are in the endotracheal tube. E. Leak in the ventilator tubing circuit F. Client is attempting to breathe against the ventilator

B, C, E Cuff leak in the endotracheal or tracheostomy tube Client is not breathing Leak in the ventilator tubing circuit

With which client will the nurse take immediate actions to reduce the risk for developing a pulmonary embolism (PE)? A. 25 yr. old receiving IV antibiotics through a peripheral line B. 36 yr old who had open reduction and internal fixation of the tibia C. 50 yr. old with type 2 diabetes and cellulitis of the leg D. 72 yr. old with dehydration and hypokalemia oral potassium supplements

B. 36 yr. old who had open reduction and internal of the tibia

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. 30 yr. old receiving continuous positive airway pressure (CPAP) and has intermittent wheezing B. 40 yr. old receiving oxygen facemask and whose respiratory rate is 24 breaths/min C. 50 yr. old being mechanically ventilated who has tracheal deviation D. 60 yr. old who was recently extubated and reports a sore throat

C 50 yr. old being mechanically ventilated who has tracheal deviation

What is the primary emphasis for the nurse who is providing care to a client with acute respiratory syndrome (ARDS) currently in the exudative management stage disorder? A. Assessing for abnormal lung sounds B. Performing meticulous mouth care during mechanical ventilation C. Assessing the client at least hourly for tachypnea and dyspnea D. Monitoring urine output to identify multiple organ dysfunction syndrome early

C Assessing the client at least hourly for tachypnea and dyspnea

Which action will the nurse take first while caring for a client being mechanically ventilation when the high-pressure alarm sounds? A. Comparing the ventilator settings with the prescribed setting B. Turning off the alarm then assess the need for suctioning C. Auscultating the client's breath sounds D. Notifying the respiratory therapist

C Auscultating the client's breath sounds

Which assessment finding on a client who is being mechanically ventilated with a positive end-expiratory pressure indicates to the nurse a possible left-sided tension pneumothorax? A. The client has bloody sputum and wheezes B. Left chest caves in on inspiration and "puffs out" on expiration C. Chest is asymmetrical and trachea deviates toward the right side D. The left lung field is dull to percussion and crackles are present on auscultation

C Chest is asymmetrical and trachea deviates toward the side

In addition to the pulmonary health care provider, which other member of the interprofessional team will the nurse expect to collaborate with most frequently when providing care to a client with a pulmonary embolism (PE)? A. Occupational therapist B. Pharmacist C. Registered dietitian nutritionist D. Respiratory therapist

D Respiratory therapist

Which ventilator mode does the nurse expect will be set for a client with a tracheostomy who is beginning to take spontaneous breaths at his own rate and tidal volume between set ventilator breaths? A. Assist-control (AC) ventilations B. Bi-level positive airway pressure (BiPAP) C. Continuous positive airway pressure (CPAP) D. Synchronized intermittent ventilation (SIMV)

D Synchronized intermittent ventilation

Which assessment findings in a post-op client suggest to the nurse the possibility of a pulmonary embolism and pulmonary infarction? A. Fever and tracheal deviation B. Paradoxical chest movements C. Hemoptysis and shortness of breath D. Audible wheezing on inhalation and exhalation

C. Hemoptysis and shortness of breath

Which client will the nurse consider to be at the greatest risk for developing acute respiratory distress syndrome (ARDS)? A. 22 yr. old with a fractured clavicle B. 39 yr. old with uncontrolled diabetes C. 56 yr. old with chronic kidney disease D. 74 yr. old who aspirates a tube feeding

D 74 year old who aspirates a tube feeding

What is the basis for the decreased oxygen saturation the nurse assess in a client with pulmonary embolism (PE)? A. Partial bronchial airway obstruction B. Increased oxygen need resulting from a septic clot PE C. Thickened alveolar membranes and poor gas exchange D. shunting of deoxygenated blood to the left side of the heart

D. Shunting of deoxygenated blood to the left side of the heart