MED SURG NCLEX RESPIRATORY REVIEW

A nurse is suctioning fluids from a male client via tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maxmium of: A. 1 minute B. 5 seconds C. 10 seconds D. 30 seconds

10 seconds

A female adult client has a tracheostomy but does not require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening for: A. 15 to 60 seconds B. 5 to 20 minutes C. 30 to 40 minutes D. 45 to 60 minutes

5 to 20 minutes (then gradually lengthen the interval according to the patients respiratory status )

A client with Gullain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A. ph: 5 ; PaCO2 30 mm Hg B. ph: 7.4 ; PaCO2 35 mm Hg C. ph: 7.35 ; PaCO2 40 mm Hg D. ph: 7.25 ; PaCO2 50 mm Hg

7.25 ; PaCO2 50 mm Hg

A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? A. Dyspnea B. Bradypnea C. Bradycardia D. Decreased respirations

Dyspnea (shortness of breath) (also tachycardia and chest pain occur)

At 11pm, a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/min. He is anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone I.V. At 11:30pm the client's arterial blood oxygen saturation is 86% and he's still wheezing. The nurse should plan to administer: A. Alprazolam (xanax) B. Propranolol (inderal) C. Morphine D. Albuterol (Proventil)

Albuterol (Proventil) (the client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. the clients greatest need is bronchodilation which can be accomplished by a bronchodilator)

A male client admitted to an acute care facility with pneumonia is recieving supplemental oxygen, 2 L/min via nasal cannula. The clients history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client's respiratory status. Which complication may arise if the client receives a high oxygen concentration? A. Apnea B. Anginas pain C. Respiratory Alkalosis D. Metabolic acidosis

Apnea (temporary cessation of breathing, especially during sleep.)

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: A. Pleural effusion B. Pulmonary edema C. Atelectasis D. Oxygen toxicity

Atelectasis (ineffective cough impedes secretion removal. This in turn causes mucus plugging, which leads to localized airway obstruction - a known cause of atelectasis.)

For a male client with an endotracheal (ET) tube, which nursing action is most essential? A. Auscultating the lungs for bilateral breath sounds B. Turning the client from side to side every 2 hours C. Monitoring serial blood gas values every 4 hours D. Providing frequent oral hygiene

Auscultating the lungs for bilateral breath sounds (used to ensure proper tube placement and effective oxygen delivery)

The nurse in charge formulates a nursing diagnosis of activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include: A. Drink more than 1,500 ml of fluid daily B. Being overweight C. Eating a high-protein snack at bedtime D. Eating more than 3 large meals a day

Being overweight (increases oxygen demand also include smoking, stress, and exposure to temperature extremes)

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? A. Dry cough B. Hermaturia C. Bronchospasm D. Blood streaked sputum

Blood streaked sputum

A female client is undergoing a complete physical examination as a requirement for college. When checking the client's respiratory status, the nurse observes respiratory excursion to help assess: A. Lung vibrations B. Vocal sounds C. Breath sounds D. Chest movements

Chest movements

A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concerns occurs? A. Impaired color discrimination B. Increased urinary frequency C. Decreased hearing acuity D. Increased appetite

Decreased hearing acuity (indicated ototoxicity, a serious adverse effect of streptomycin therapy.)

A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating legionnaires' disease? A. Erythromycin (Erythrocin) B. Rifampin (Rifadin) C. Amantadine (Symmetrel) D. Amphotericin B (Fungizone)

Erythromycin (It can treat infections. It can also treat acne when used topically.) (Legionnaires disease, also known as legionellosis, is a form of atypical pneumonia caused by any type of Legionella bacteria. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches.)

A male client suffers adult respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high pressure alarm on the mechanical ventilator sounds, the nurse starts to check the cause. Which condition triggers the high pressure alarm? A. Kinking of the ventilator tubing B. A disconnected ventilator tube C. An ET cuff leak D. A change in the oxygen concentration without resetting the oxygen level alarm

Kinking of the ventilator tubing

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: A. Lips B. Mucous membrane C. Nail beds D. Earlobes

Mucous membrane (skins color does not effect the Mucous membrane)

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? A. Simple mask B. Non-rebreather mask C. Face tent D. Nasal cannula

Non-rebreather mask (can deliver levels of the fraction of inspired oxygen as high as 100%)

A male client who weighs 175lbs is receiving aminophylline at 50 ml/hr. The theophylline level is reported as 6 mcg/ml. The nurse calls the physical who instructs the nurse to change the dosage to 0.45 mg/kg/hr. The nurse should: A. Question the order because it too low B. Question the order because it's too high C. Set the pump at 45 ml/hr D. Stop the infusion and have the laboratory repeat the theophylline measurement

Question the order because it too low (a therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently recieving 0.5 mg/kg/hr of aminophyilline. Because the client's theophylline level is sub-therapeutic reducing the dose (which is what the physician's order would do) would be inappropriate. Therefore, the nurse should question the order.)

A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the clients chest wall, the nurse expects to elicit: A. Resonant sounds B. Hyper-resonant sounds C. Dull sounds D. Flat sounds

Resonant sounds

After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia? A. Heightened alertness B. Increased heart rate C. Numbness and tingling of the extremities D. Respiratory depression

Respiratory depression

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: A. Area of redness is measured in 3 days and determines whether tuberculosis is present B. Skin test doesn't differentiate between active and dormant tuberculosis infection C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis D. 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 (if a positive reaction occurs, a sputum smear and culture as well as a chest x-ray are necessary to provide information)

Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? A. The system is functioning normally B. The client has a pneumothorax. C. The system has an air leak. D. The chest tube is obstructed.

The system has an air leak. (requires immediate intervention)

Which phrase is used to describe the volume of air inspired and expired with a normal breath? A. Total lung capacity B. Forced vital capacity C. Tidal volume D. Residual volume

Tidal volume (refers to the volume of air inspired and expired with a normal breath)

A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline 200mg P.O every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator C. It stimulates adenosine receptors, causing bronchodilation D. It alters diaphragm movement, increasing chest expansion and enhancing the lung's capacity for gas exchange

It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive

A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention? A. Continue to suction B. Notify the physician immediately C. Stop the procedure and reoxygenate the client D. Ensure that the suction is limited to 15 seconds

Stop the procedure and reoxygenate the client

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A. Make inhalation longer than exhalation B. Exhale through an open mouth C. Use diaphragmatic breathing D. Use chest breathing

Use diaphragmatic breathing (help strengthen the diaphragm and maximizes ventilation)

The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing B. Use of accessory muscles C. Pursed-lip breathing D. Controlled breathing

Use of accessory muscles

A nurse is preparing to obtain sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining a specimen? A. Limiting fluid intake B. Having the client take deep breaths C. Asking the client to spit into the collection container D. Asking the client to obtain the specimen after eating

Having the client take deep breaths (should rinse mouth, breathe deeply, and then cough into a sputum specimen container. Should be encouraged to cough not spit)

After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond? A. In 30 minutes B. In 1 hour C. In 2.5 hours D. In 4 hours

In 30 minutes (onset is 30 min. Peak is 1 hour. Half life is 2.5 hours. Duration is 4 to 6 hours)

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 difference causes of the various types of pneumonia, all of them share which feature? A. Inflamed lung tissue B. Sudden onset C. Responsiveness to penicillin D. Elevated white blood cell (WBC) count

Inflamed lung tissue (inflammatory pulmonary response to the offending organism or agent)

The nurse in charge is teaching a patient with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. It helps prevent early airway clearance B. It increases inspiratory muscle strength C. It decreases use of accessory breathing muscles D. It prolongs the inspiratory phase of respiration

It helps prevent early airway clearance (learning the technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress)