NCLEX Respiratory

The nurse is caring for a client who has a peripherally inserted central catheter (PICC). The client notifies the nurse that the catheter got tangled up in bedclothes and came out. What should the nurse do first? A. Inspect the catheter B. Notify the healthcare provider C. Clamp the remaining device D. Assess respiratory status

A. Inspect the catheter

The nurse is caring for a client who is hyperventilating. The nurse recalls that the client is at risk for what? A. Respiratory acidosis B. Respiratory alkalosis C. Respiratory compensation D. Respiratory decompensation

B. Respiratory alkalosis

A nurse is caring for a client with the diagnosis of emphysema, a chronic obstructive pulmonary disease (COPD). The client is hypoxemic and also has chronic hypercarbia. Which statement reflects the oxygen needs of this client? A. The client may need up to 60% oxygen flow via Venturi mask. B. The client requires lower levels of oxygen delivery, usually 1 to 3 L/min via nasal cannula. C. The client should receive humidified oxygen delivered by a face mask. D. The client's respiratory treatment plan should have oxygen eliminated from it.

B. The client requires lower levels of oxygen delivery, usually 1 to 3 L/min via nasal cannula.

A nurse is involved in an international committee to address global health problems. What suggestion is most appropriate for the nurse to make to best meet the challenge associated with a potential emerging influenza pandemic? A. Stockpile antibiotics. B. Establish a global surveillance plan. C. Limit vaccination programs to school-aged children. D. Initiate vaccination programs during the months of August and September.

B. Establish a global surveillance plan.

The nurse provides teaching to a client who will begin to receive tube feedings after a total laryngectomy. The nurse concludes that the teaching was understood when the client makes which statement about tube feedings? A. "I will need tube feedings until healing of the incision is complete." B. "I will need tube feedings until the gag reflex returns." C. "I will need tube feedings until the ability to belch is restored." D. "I will need tube feedings until my oral feedings can be digested."

A. "I will need tube feedings until healing of the incision is complete."

Which of the following is most commonly found in a patient with emphysema? A. Barrel chest B. Cyanosis C. V/Q mismatch D. Excessive productive cough

A. Barrel chest

In which of the following conditions below do the alveolar sacs lose elasticity which can lead to "air-trapping": A. Chronic Bronchitis B. Emphysema

B. Emphysema

Which of the following is NOT a sign and symptom of chronic bronchitis? A. Productive cough B. Shortness of breath C. Cyanosis D. Barrel chest

D. Barrel chest

Which of the following is NOT a treatment for chronic bronchitis or emphysema? A. Albuterol B. Spirvia C. Theophylline D. Metoprolol

D. Metoprolol

True or False: Hyperinflation of the lungs leads to diaphragm flattening.

True

True or False: V/Q mismatch is found in chronic bronchitis.

True

A nurse provides smoking-cessation education to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that the client is ready to quit smoking when the client makes which statement? A. "I'll just finish the carton that I have at home." B. "I'll cut back to a half pack a day." C. "I find that smoking is the only way I can relax." D. "I should find this easy because I don't smoke when I drink."

B. "I'll cut back to a half pack a day."

The nurse is caring for a client who had a wedge resection of a lobe of the lung and now has a chest tube with a three-chamber underwater drainage system in place. Which main purpose of the third chamber of the underwater drainage system should the nurse consider when planning care? A. Acts as a drainage container B. Provides an airtight water seal C. Controls the amount of suction D. Allows for escape of air bubbles

C. Controls the amount of suction

What response provides evidence that a client with chronic obstructive pulmonary disease (COPD) understands the nurse's instructions about an appropriate breathing technique? A. Inhales through the nose with the mouth closed B. Increases the respiratory rate C. Holds each breath for a second at the end of inspiration D. Progressively increases the length of the inspiratory phase

C. Holds each breath for a second at the end of inspiration

A client arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and legs. Which are the priority nursing assessments? A. Level of consciousness and pupil size B. Characteristics of pain and blood pressure C. Quality of respirations and presence of pulses D. Observation of abdominal contusions and other wounds

C. Quality of respirations and presence of pulses

A client complaining of fatigue is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). What should the nurse do to prevent fatigue? A. Provide small, frequent meals B. Encourage pursed-lip breathing C. Schedule nursing activities to allow for rest D. Encourage bed rest until energy level improves

C. Schedule nursing activities to allow for rest

A client is admitted with suspected atelectasis. Which clinical manifestation does the nurse expect to identify when assessing this client? A. Slow, deep respirations B. Normal oral temperature C. Dry, unproductive cough D. Diminished breath sounds

D. Diminished breath sounds

A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition: A. Hypotension B. Jugular Venous Distention C. Bradycardia D. Tracheal deviation E. Hyperemia F. Tachypnea

A. Hypotension B. Jugular Venous Distention D. Tracheal deviation F. Tachypnea

Which condition can cause a client's partial pressure of end-tidal carbon dioxide (PETCO2) to be 50 mmHg? A. Hypoventilation B. Tracheal extubation C. Pulmonary embolism D. Total airway obstruction

A. Hypoventilation

A nurse is caring for a client who experienced a crushing chest injury. A chest tube is inserted. Which observation indicates a desired response to this treatment? A. Increased breath sounds B. Increased respiratory rate C. Crepitus detected on palpation of the chest D. Constant bubbling in the drainage collection chamber

A. Increased breath sounds

A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side, and there is a large crack in the system. What is your next PRIORITY? A. Place the patient in supine position and clamp the tubing. B. Notify the physician immediately. C. Disconnect the drainage system and get a new one. D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

Which method of oxygen delivery should a nurse anticipate will be prescribed for a client with a pulse oximetry reading of 65%? A. Face tent B. Venturi mask C. Nasal cannula D. Nonrebreather mask

D. Nonrebreather mask

A nurse is teaching Hands Only Basic Life Support for adults in the community. What should the rescuer do first after determining that the person is not responding and the emergency medical system has been activated? A. Identify the absence of pulse. B. Give two rescue breaths with a CPR mask. C. Perform the head tilt-chin lift maneuver. D. Perform chest compression at a rate of 100/min.

D. Perform chest compression at a rate of 100/min.

True or False: Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.

False

A client with a history of hemoptysis and cough for the last six months is suspected of having lung cancer. A bronchoscopy is performed. Two hours after the procedure the nurse identifies an increase in the amount of bloody sputum. What is the nurse's priority? A. Immediately contact the primary healthcare provider B. Document the amount of sputum C. Monitor vital signs every hour D. Increase the frequency of coughing and deep breathing

A. Immediately contact the primary healthcare provider

A client has a closed chest drainage system in place. What should the nurse do to determine the amount of chest tube drainage? A. Refer to the date and time markings on the outside of the collection chamber. B. Aspirate the drainage from the collection chamber. C. Replace the existing system with a new one to access the drainage in the existing system. D. Clamp the chest tube and empty the fluid from the collection chamber.

A. Refer to the date and time markings on the outside of the collection chamber.

A 65-year old client is found to have dilatation of the bronchioles and alveolar ducts. Which suggestions of the nurse would help the client overcome this situation? Select all that apply. A. Suggest the use of incentive spirometry. B. Suggest that the client takes an adequate amount of calcium daily. C. Suggest that the client perform vigorous pulmonary hygiene activities. D. Suggest that the client maintain an upright position as much as possible. E. Suggest that the client talk face-to face with others as much as possible.

A. Suggest the use of incentive spirometry. C. Suggest that the client perform vigorous pulmonary hygiene activities. D. Suggest that the client maintain an upright position as much as possible.

Which statement is CORRECT about a tension pneumothorax? A. This condition happens when an opening to the intrapleural space creates a two-way valve which causes pressure to build up in the space leading to shifting of the mediastinum. B. A tension pneumothorax is a medical emergency and is treated with needle decompression. C. Tracheal deviation is an early sign of a tension pneumothorax D. An open pneumothorax is the only cause of a tension pneumothorax.

B. A tension pneumothorax is a medical emergency and is treated with needle decompression.

A client with acute respiratory distress syndrome is intubated and placed on a ventilator. What should the nurse do when caring for this client and the mechanical ventilator? A. Deflate the cuff on the endotracheal tube for a few minutes every one to two hours. B. Assess the need for suctioning when the high-pressure alarm of the ventilator is activated. C. Adjust the temperature of fluid in the humidification chamber depending on the volume of gas delivered. D. Regulate the positive end-expiratory pressure (PEEP) according to the rate and depth of the client's respirations.

B. Assess the need for suctioning when the high-pressure alarm of the ventilator is activated.

Which findings should the nurse expect to see in a client with chronic obstructive pulmonary disease? Select all that apply. A. Elevated levels of partial arterial oxygen B. Elevated levels of eosinophils C. Elevated levels of neutrophils D. Elevated levels of red blood cells E. Elevated levels of peripheral capillary oxygen saturation

B. Elevated levels of eosinophils C. Elevated levels of neutrophils D. Elevated levels of red blood cells

In which of the following conditions below is there a matched V/Q defect? A. Chronic Bronchitis B. Emphysema

B. Emphysema

Select ALL the options that are TRUE about chronic bronchitis and emphysema: A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow. B. Emphysema and chronic bronchitis are irreversible. C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".

B. Emphysema and chronic bronchitis are irreversible. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".

Which preoperative and postoperative care points should be included when providing education and intervention to a client scheduled for a septoplasty? Select all that apply. A. Teach the client about hot compresses. B. Encourage the client to quit smoking before surgery. C. Observe the surgical site for edema. D. Teach the client about post-surgery activities that are restricted. E. Assess the client's respiratory status. F. Encourage the client to take aspirin before the surgery.

B. Encourage the client to quit smoking before surgery. C. Observe the surgical site for edema. D. Teach the client about post-surgery activities that are restricted. E. Assess the client's respiratory status.

A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as? A. Closed pneumothorax B. Open pneumothorax C. Tension pneumothorax D. Spontaneous pneumothorax

B. Open pneumothorax

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. Which primary purpose of the chest tube will the nurse consider when planning care? A. Lessens the client's chest discomfort B. Restores negative pressure in the pleural space C. Drains accumulated fluid from the pleural cavity D. Prevents subcutaneous emphysema in the chest wall

B. Restores negative pressure in the pleural space

A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention? A. The water seal chamber has intermittent bubbling. B. The patient has slight tracheal deviation to the right side. C. The water seal chamber fluctuates while the patient inhales and exhales. D. The patient complains of tenderness at the chest tube insertion site.

B. The patient has slight tracheal deviation to the right side.

A client with a malignant parotid tumor is treated aggressively with radiation therapy and surgery. Postsurgical arterial blood gas results are as follows: pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq (25 mmol/L). The nurse should take which action? A. Obtain a prescription and administer a diuretic. B. Instruct the client to breathe into a rebreather bag at a slow rate. C. Ask the client to cough forcefully and take deep breaths. D. Obtain a prescription for sodium bicarbonate.

C. Ask the client to cough forcefully and take deep breaths.

You're providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action? A. Keep monitoring the patient because this is a normal finding. B. Increase wall suction to the system until the water fluctuates in the water seal chamber. C. Assess patient's lung sounds to assess if the affected lung has re-expanded. D. Notify the physician.

C. Assess patient's lung sounds to assess if the affected lung has re-expanded.

A nurse is caring for a client with an endotracheal tube. Which is the most effective way for the nurse to loosen respiratory secretions? A. Increase oral fluid intake B. Provide chest physiotherapy C. Humidify the prescribed oxygen D. Instill a saturated solution of potassium iodide

C. Humidify the prescribed oxygen

A client has a bronchoscopy in the ambulatory surgery unit. Which action should the nurse take to prevent laryngeal edema? A. Place ice chips in the client's mouth B. Offer liberal amounts of fluid to the client C. Keep the client in the semi-Fowler position D. Tell the client to suck on medicated lozenges

C. Keep the client in the semi-Fowler position

A client is brought to the emergency department with deep partial-thickness burns on the face and full-thickness burns on the neck, entire anterior chest, and one arm. To assess for heat inhalation, the nurse first should observe for which finding? A. Changes in the chest x-ray findings B. Sputum that contains particles of blood C. Nasal discharge containing carbon particles D. Changes in the arterial blood gases consistent with acidosis

C. Nasal discharge containing carbon particles

In regards to the patient in the question above, which of the following options below is a nursing intervention you would provide to this patient? A. Place the patient in supine position B. Place a non-occlusive dressing over the chest wound C. Place a sterile occlusive dressing over the chest wound and tape it on three sides D. Prepare the patient for a thoracentesis

C. Place a sterile occlusive dressing over the chest wound and tape it on three sides

A nurse is caring for a client with a Venturi mask who is receiving 40% oxygen. What nursing actions are indicated? Select all that apply. A. Keep the oxygen source higher than the client's airway. B. Adjust the liter flow according to the oxygen saturation. C. Prevent the client's blanket from covering the adaptor's orifices. D. Ensure that the bag does not deflate completely during inspiration. E. Check that the appropriate adaptor to deliver the prescribed FiO2 is attached to the mask.

C. Prevent the client's blanket from covering the adaptor's orifices E. Check that the appropriate adaptor to deliver the prescribed FiO2 is attached to the mask.

The nurse observes a client with chronic obstructive pulmonary disease (COPD) breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. What action should the nurse take? A. Encourage the client to take slow, deep breaths and administer 5 L/min oxygen per nasal cannula. B. Place the client in a side-lying position and perform chest physiotherapy using clapping and vibration. C. Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. D. Assist the client in assuming a position of comfort and perform postural drainage.

C. Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula.

While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient's skin that appear to be "bulging" out. These "bulging" areas are located on the patient's neck, face, and abdomen. On palpation on these areas, you note they feel "crunchy". When charting your findings you would refer to this finding as? A. Subcutaneous paresthesia B. Pigment molle C. Subcutaneous emphysema D. Veisalgia

C. Subcutaneous emphysema

Which of the following is a LATE sign of the development of a tension pneumothorax? A. Hypotension B. Tachycardia C. Tracheal deviation D. Dyspnea

C. Tracheal deviation

A client with a tentative diagnosis of lung cancer is scheduled for a mediastinoscopy with biopsy. Which is a priority nursing action? A. Tell the client that chest tubes will be present after the procedure. B. Explain that the procedure will allow visualization of lungs and chest cavity. C. Inform the client that some pleural fluid will be removed during this procedure. D. Advise the client to avoid eating or drinking anything for several hours before the test.

D. Advise the client to avoid eating or drinking anything for several hours before the test.

Endotracheal intubation and positive-pressure ventilation are instituted because of a client's deteriorating respiratory status. What is the priority nursing intervention? A. Facilitate verbal communication B. Prepare the client for emergency surgery C. Maintain sterility of the ventilation system D. Assess the client's response to the mechanical ventilation

D. Assess the client's response to the mechanical ventilation

While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. What is the nurse's immediate action? A. Place the client in the supine position B. Spread a clamp in the insertion site to hold the site open C. Obtain a sterile Vaseline gauze to cover the opening D. Cover the opening with the cleanest material available

D. Cover the opening with the cleanest material available

A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax? A. It can be caused by the rupture of a pulmonary bleb. B. It can occur in patients who are young, tall and thin without a history of lung disease. C. Smoking increases the chances of a patient developing a spontaneous pneumothorax. D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.

D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.

Patients with chronic bronchitis and emphysema can MOST COMMONLY experience what type of acid-base imbalance? A. High oxygen level and high carbon dioxide level B. Low oxygen level and low carbon dioxide level C. High oxygen level and low carbon dioxide level D. Low oxygen level and high carbon dioxide level

D. Low oxygen level and high carbon dioxide level