NCLEX - Respiratory
A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority? a) Monitor vital signs and oxygen saturation every 15 to 30 minutes. b) Suction the client as needed to obtain a sputum specimen for culture and sensitivity. c) Assess intake and output and maintain adequate hydration. d) Reassure the client that intubation and mechanical ventilation will be temporary.
a) Monitor vital signs and oxygen saturation every 15 to 30 minutes.
During inspiration, which of the following occurs? a) Lungs recoil. b) Diaphragm descends. c) Alveolar pressure is positive. d) Inspiratory muscles relax.
b) Diaphragm descends.
A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client? a) Administering oxygen, coughing, breathing deeply, and maintaining bed rest b) Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer c) Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer d) Administering pain medications, frequent repositioning, and limiting fluid intake
c) Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer
The nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? a) Avoid contact with fur-bearing animals. b) Change filters on heating and air conditioning units frequently. c) Take prescribed medications as scheduled. d) Avoid goose down pillows.
c) Take prescribed medications as scheduled.
A client with severe acute respiratory syndrome (SARS) privately informs the nurse that he doesn't want to be placed on a ventilator if his condition worsens. The client's wife and children have repeatedly expressed their desire that everything be done for the client. The most appropriate action by the nurse would be to: a) inform the family of the client's wishes. b) assure the family that everything possible will be done. c) support the client's decision. d) assure the client that everything possible will be done.
c) support the client's decision.
The nurse is caring for a client who has a tracheostomy tube and is undergoing mechanical ventilation. The nurse can help prevent tracheal dilation, a complication of tracheostomy tube placement, by: a) suctioning the tracheostomy tube frequently. b) using a cuffed tracheostomy tube. c) using the minimal air leak technique with cuff pressure less than 25 cm H2O. d) keeping the tracheostomy tube plugged.
c) using the minimal air leak technique with cuff pressure less than 25 cm H2O.
A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? a) Nonproductive cough and abdominal pain b) Hypertension and lack of fever c) Bradypnea and bradycardia d) Chest pain and dyspnea
d) Chest pain and dyspnea
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Nausea or vomiting b) Abdominal pain or diarrhea c) Hallucinations or tinnitus d) Light-headedness or paresthesia
d) Light-headedness or paresthesia
The nurse assessing a client for tracheal displacement should know that the trachea will deviate toward the: a) contralateral side in a simple pneumothorax. b) affected side in a hemothorax. c) affected side in a tension pneumothorax. d) contralateral side in a hemothorax.
d) contralateral side in a hemothorax.
For a 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
a) Auscultating the lungs for bilateral breath sounds
A nurse is performing a respiratory assessment on a client with pneumonia. She asks the client to say "ninety-nine" several times. Through her stethoscope, she hears the words clearly over his left lower lobe. What term should the nurse use to document this finding? a) Bronchophony b) Tactile fremitus c) Crepitation d) Egophony
a) Bronchophony
The home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? a) Decreased oxygen requirements b) Increased sputum production c) Decreased activity tolerance d) Normothermia
a) Decreased oxygen requirements
A 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)
a) Erythromycin (Erythrocin)
A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/min. These signs are associated with which condition? a) Hypoxia b) Delirium c) Hyperventilation d) Semiconsciousness
a) Hypoxia
A home care nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? a) "I lubricate my lips and nose with K-Y jelly." b) "I make sure my oxygen mask is on tightly so it won't fall off while I nap." c) "I have a 'no smoking' sign posted at my front entry-way to remind guests not to smoke." d) "I clean my mask with water after every meal."
b) "I make sure my oxygen mask is on tightly so it won't fall off while I nap."
For a client with an acute pulmonary embolism, the physician prescribes heparin (Liquaemin), 25,000 U in 500 ml of dextrose 5% in water (D5W) at 1,100 U/hour. The nurse should administer how many milliliters per hour? a) 8 b) 22 c) 30 d) 50
b) 22
A client with chronic obstructive pulmonary disease (COPD) is being evaluated for a lung transplant. The nurse performs the initial physical assessment. Which signs and symptoms should the nurse expect to find? a) Decreased respiratory rate b) Dyspnea on exertion c) Barrel chest d) Shortened expiratory phase e) Clubbed fingers and toes f) Fever
b) Dyspnea on exertion c) Barrel chest e) Clubbed fingers and toes
The nurse is planning care for a client after a tracheostomy. One of the client's goals is to overcome verbal communication impairment. Which of the following interventions should the nurse include in the care plan? a) Make an effort to read the client's lips to foster communication. b) Encourage the client's communication attempts by allowing him time to select or write words. c) Answer questions for the client to reduce his frustration. d) Avoid using a tracheostomy plug because it blocks the airway.
b) Encourage the client's communication attempts by allowing him time to select or write words.
A nurse is completing her annual cardiopulmonary resuscitation training. The class instructor tells her that a client has fallen off a ladder and is lying on his back; he is unconscious and isn't breathing. What maneuver should the nurse use to open his airway? a) Head tilt-chin lift b) Jaw-thrust c) Heimlich d) Seldinger
b) Jaw-thrust
An elderly client with influenza is admitted to an acute care facility. The nurse monitors the client closely for complications. What is the most common complication of influenza? a) Septicemia b) Pneumonia c) Meningitis d) Pulmonary edema
b) Pneumonia
A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? a) Check for an apical pulse. b) Suction the client's artificial airway. c) Increase the oxygen percentage. d) Ventilate the client with a handheld mechanical ventilator.
b) Suction the client's artificial airway.
A client with a pneumothorax receives a chest tube attached to a Pleur-evac. The nurse notices that the fluid of the second chamber of the Pleur-evac isn't bubbling. Which nursing assumption would be most invalid? a) The tubing from the client to the chamber is blocked. b) There is a leak somewhere in the tubing system. c) The client's affected lung has reexpanded. d) The tubing needs to be cleared of fluid.
b) There is a leak somewhere in the tubing system.
A nurse detects bilateral crackles when auscultating a client's lungs. Which statement about crackles is true? a) They're usually heard on expiration and may clear with a cough. b) They're usually heard on inspiration and sometimes clear with a cough. c) They're hissing or musical and are usually heard on inspiration and expiration; if severe, they may be heard without a stethoscope. d) They're creaking and grating and are usually heard over the problem area on both inspiration and expiration.
b) They're usually heard on inspiration and sometimes clear with a cough.
Prednisone (Deltasone) is prescribed to control inflammation in a client with interstitial lung disease. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: a) hyperglycemia and glycosuria. b) acute adrenocortical insufficiency. c) GI bleeding. d) restlessness and seizures.
b) acute adrenocortical insufficiency.
A 47-year-old male client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is: a) lobar pneumonia. b) empyema. c) Pneumocystis carinii pneumonia. d) infected chest tube wound site.
b) empyema.
The nurse is caring for a client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is: a) helping him communicate. b) keeping his airway patent. c) encouraging him to perform activities of daily living. d) preventing him from developing an infection.
b) keeping his airway patent.
The nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: a) the attack is over. b) the airways are so swollen that no air can get through. c) the swelling has decreased. d) crackles have replaced wheezes.
b) the airways are so swollen that no air can get through.
A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? a) "I will have to take the medication for up to a year." b) "This disease may come back later if I am under stress." c) "I will stay in isolation for at least 6 weeks." d) "I will always have a positive test for tuberculosis."
c) "I will stay in isolation for at least 6 weeks."
Which task can be safely delegated to a licensed practical nurse (LPN)? a) Teaching a newly diagnosed diabetic about insulin administration. b) Admitting a client who underwent a thoracotomy to the nursing unit from the postanesthesia care unit. c) Changing the dressing of a client who underwent surgery two days ago. d) Administering an I.V. bolus of morphine sulfate to a client experiencing incisional pain
c) Changing the dressing of a client who underwent surgery two days ago.
A recent immigrant from Vietnam is diagnosed with pulmonary tuberculosis (TB). Which intervention is most important for the nurse to implement with this client? a) Client teaching about the cause of TB b) Reviewing the risk factors for TB c) Developing a list of people with whom the client has had contact d) Client teaching about the importance of TB testing
c) Developing a list of people with whom the client has had contact
The physician orders a palliative care consult for a client with end-stage chronic obstructive pulmonary disease who wishes no further medical intervention. Which step should the nurse anticipate based on her knowledge of palliative care? a) Decreasing administration of pain medications b) Reducing oxygen requirements c) Increasing the need for antianxiety agents d) Decreasing the use of bronchodilators
c) Increasing the need for antianxiety agents
A client who sustained a pulmonary contusion in a motor vehicle accident develops a pulmonary embolism. Which nursing diagnosis takes priority with this client? a) Excess fluid volume related to excess sodium intake b) Acute pain related to tissue trauma c) Ineffective breathing pattern related to tissue trauma d) Activity intolerance related to insufficient energy to carry out activities of daily living
c) Ineffective breathing pattern related to tissue trauma
A client is prescribed rifampin (Rifadin), 600 mg P.O. daily. Which statement about rifampin is true? a) It's usually given alone. b) Its exact mechanism of action is unknown. c) It's tuberculocidal, destroying the offending bacteria. d) It acts primarily against resting bacteria.
c) It's tuberculocidal, destroying the offending bacteria.
A client in the emergency department is diagnosed with a communicable disease. When complications of the disease are discovered, the client is admitted to the hospital and placed in respiratory isolation. Which infection warrants respiratory isolation? a) Chickenpox b) Impetigo c) Measles d) Cholera
c) Measles
A client is receiving conscious sedation while undergoing bronchoscopy. Which assessment finding should receive the nurse's immediate attention? a) Absent cough and gag reflexes b) Blood-tinged secretions c) Oxygen saturation of 90% d) Respiratory rate of 13 breaths/min
c) Oxygen saturation of 90%
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) pH b) Bicarbonate (HCO3-) c) Partial pressure of arterial oxygen (PaO2) d) Partial pressure of arterial carbon dioxide (PaCO2)
c) Partial pressure of arterial oxygen (PaO2)
A client with a history of type 1 diabetes is admitted to the hospital with community-acquired pneumonia. The client's blood glucose level in the emergency care unit was 576 mg/dl. The physician prescribes an I.V. containing normal saline solution, an insulin infusion, and I.V. levofloxacin (Levaquin). The nurse piggybacks the insulin infusion into the normal saline solution. She questions whether she can also piggyback the levofloxacin into the same I.V. line. Which health team member should she collaborate with to check the compatibility of these solutions? a) The physician who prescribed the medications b) The coworker with 20 years nursing experience c) The pharmacist covering the floor d) The infectious disease nurse
c) The pharmacist covering the floor
The nurse 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.
c) The system has an air leak.
A client in acute respiratory distress is brought to the emergency department. After endotracheal (ET) intubation and initiation of mechanical ventilation, the client is transferred to the intensive care unit. Before suctioning the ET tube, the nurse hyperventilates and hyperoxygenates the client. What is the rationale for these interventions? a) They help prevent subcutaneous emphysema. b) They help prevent pneumothorax. c) They help prevent cardiac arrhythmias. d) They help prevent pulmonary edema.
c) They help prevent cardiac arrhythmias.
A client with a suspected pulmonary disorder undergoes pulmonary function tests. To interpret test results accurately, the nurse must be familiar with the terminology used to describe pulmonary functions. Which term refers to the volume of air inhaled or exhaled during each respiratory cycle? a) Vital capacity b) Functional residual capacity c) Tidal volume d) Maximal voluntary ventilation
c) Tidal volume
The nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction 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.
c) Use diaphragmatic breathing.
or a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a) Encouraging the client to drink three glasses of fluid daily b) Keeping the client in semi-Fowler's position c) Using a high-flow Venturi mask to deliver oxygen as prescribed d) Administering a sedative as prescribed
c) Using a high-flow Venturi mask to deliver oxygen as prescribed
A 21-year-old client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician prescribes acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because: a) it's a respiratory depressant. b) it's a respiratory stimulant. c) it may induce bronchospasm. d) it inhibits the cough reflex.
c) it may induce bronchospasm.
The physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which of the following? a) Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years b) Isolation until 24 hours after antitubercular therapy begins c) Nothing, until signs of active disease arise d) Daily doses of isoniazid, 300 mg for 6 months to 1 year
d) Daily doses of isoniazid, 300 mg for 6 months to 1 year
The nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? a) Nonproductive cough and normal temperature b) Sore throat and abdominal pain c) Hemoptysis and dysuria d) Dyspnea and wheezing
d) Dyspnea and wheezing
The nurse is caring for a client with pneumonia. As part of prescribed therapy, the client must use a bedside incentive spirometer to promote maximal deep breathing. The nurse checks to make sure the client is using the spirometer properly. During each waking hour, the client should perform a minimum of how many sustained, voluntary inflation maneuvers? a) One to two b) Three to four c) Five to seven d) Eight to ten
d) Eight to ten
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? a) Hypotension, hyperoxemia, and hypercapnia b) Hyperventilation, hypertension, and hypocapnia c) Hyperoxemia, hypocapnia, and hyperventilation d) Hypercapnia, hypoventilation, and hypoxemia
d) Hypercapnia, hypoventilation, and hypoxemia
On arrival at the intensive care unit, a critically ill client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? a) Fever b) Tachypnea c) Tachycardia d) Hypotension
d) Hypotension
A woman whose husband was recently diagnosed with active pulmonary tuberculosis (TB) is a tuberculin skin test converter. Management of her care would include: a) scheduling her for annual tuberculin skin testing. b) placing her in quarantine until sputum cultures are negative. c) gathering a list of persons with whom she has had recent contact. d) advising her to begin prophylactic therapy with isoniazid (INH).
d) advising her to begin prophylactic therapy with isoniazid (INH).
At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/min. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., 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).
d) albuterol (Proventil).
A 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
d) chest movements
Before administering ephedrine, the nurse assesses the client's history. Because of ephedrine's central nervous system (CNS) effects, it is not recommended for: a) clients with an acute asthma attack. b) clients with narcolepsy. c) clients under age 6. d) elderly clients.
d) elderly clients.
A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: a) instruct the client to drink 2 L of fluid daily. b) maintain the client on bed rest. c) administer anxiolytics, as prescribed, to control anxiety. d) administer pain medication as prescribed.
a) instruct the client to drink 2 L of fluid daily.
A client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should: a) question the order because the dosage is too low. b) question the order because the dosage is too high. c) set the pump at 45 ml/hour. d) stop the infusion and have the laboratory repeat the theophylline measurement.
a) question the order because the dosage is too low.
A slightly obese 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 client's chest wall, the nurse expects to elicit: a) resonant sounds. b) hyperresonant sounds. c) dull sounds. d) flat sounds.
a) resonant sounds.
A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? a) "Clean the tracheostomy tube with alcohol and water." b) "Family members should continue to talk to the client." c) "Oral intake of fluids should be limited for 1 week only." d) "Limit the amount of protein in the diet."
b) "Family members should continue to talk to the client."
A client with end-stage chronic obstructive pulmonary disease requires bi-level positive airway pressure (BiPAP). While caring for the client, the nurse determines that bilateral wrist restraints are required to prevent compromised care. Which client care outcome is associated with restraint use in the client who requires BiPAP? a) The client will remain infection-free. b) The client will maintain adequate oxygenation. c) The client will maintain adequate urine output. d) The client will remain pain-free.
b) The client will maintain adequate oxygenation.
A client recovering from a pulmonary embolism is receiving warfarin (Coumadin). To counteract a warfarin overdose, the nurse would administer: a) heparin. b) vitamin K1 (phytonadione). c) vitamin C. d) protamine sulfate.
b) vitamin K1 (phytonadione).
After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must: a) report fluctuations in the water-seal chamber. b) clamp the chest tube once every shift. c) encourage coughing and deep breathing. d) milk the chest tube every 2 hours.
c) encourage coughing and deep breathing.
A client with chronic sinusitis comes to the outpatient department complaining of headache, malaise, and a nonproductive cough. When examining the client's paranasal sinuses, the nurse detects tenderness. To evaluate this finding further, the nurse should transilluminate the: a) frontal sinuses only. b) sphenoidal sinuses only. c) frontal and maxillary sinuses. d) sphenoidal and ethmoidal sinuses.
c) frontal and maxillary sinuses.
Inspiratory and expiratory stridor may be heard in a client who: a) is experiencing an exacerbation of goiter. b) is experiencing an acute asthmatic attack. c) has aspirated a piece of meat. d) has severe laryngotracheitis.
c) has aspirated a piece of meat.
After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's teenage daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? a) 3 to 5 days b) 1 to 3 weeks c) 2 to 4 months d) 6 to 12 months
d) 6 to 12 months
A client with chronic obstructive pulmonary disease tells the nurse that he feels short of breath. The client's respiratory rate is 36 breaths/min and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer a prescribed nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm done, I'll come assess the client." The nurse's most appropriate action is to: a) notify the primary physician immediately. b) stay with the client until the therapist arrives. c) administer the treatment by metered-dose inhaler. d) give the nebulizer treatment herself.
d) give the nebulizer treatment herself.
A 33-year-old woman with primary pulmonary hypertension is being evaluated for a heart-lung transplant. The nurse asks her what treatments she is currently receiving for her disease. She is likely to mention which treatments? a) Oxygen b) Aminoglycosides c) Diuretics d) Vasodilators e) Antihistamines f) Sulfonamides
a) Oxygen c) Diuretics d) Vasodilators
A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure? a) Partial pressure of arterial oxygen (PaO2) b) Partial pressure of arterial carbon dioxide (PaCO2) c) pH d) Bicarbonate (HCO3-)
a) Partial pressure of arterial oxygen (PaO2)
A trauma victim in the intensive care unit has a tension pneumothorax. Which signs or symptoms are associated with a tension pneumothorax? a) Decreased cardiac output b) Flattened neck veins c) Tracheal deviation to the affected side d) Hypotension e) Tracheal deviation to the opposite side f) Bradypnea
a) Decreased cardiac output d) Hypotension e) Tracheal deviation to the opposite side
A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation? a) Endotracheal suctioning b) Encouragement of coughing c) Use of cooling blanket d) Incentive spirometry
a) Endotracheal suctioning
The nurse administers albuterol (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? a) Respiratory rate of 22 breaths/minute b) Dilated and reactive pupils c) Urine output of 40 ml/hour d) Heart rate of 100 beats/minute
a) Respiratory rate of 22 breaths/minute
A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? a) Shock b) Stroke c) Seizures d) Hyperglycemia
a) Shock
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? a) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. b) The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. c) The client exhibits restlessness and confusion. d) The client exhibits bronchial breath sounds over the affected area.
a) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.
A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: a) chronic obstructive pulmonary disease (COPD). b) bronchial asthma. c) adult respiratory distress syndrome (ARDS). d) renal failure.
c) adult respiratory distress syndrome (ARDS).
A 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.
c) atelectasis.
A client's chest X-ray reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from: a) cardiogenic pulmonary edema. b) respiratory alkalosis. c) increased pulmonary capillary permeability. d) renal failure.
c) increased pulmonary capillary permeability.
A client with advanced acquired immunodeficiency syndrome (AIDS) is diagnosed with active tuberculosis. Which of the following regimens would the nurse expect the physician to prescribe? a) isoniazid (Laniazid) and rifampin (Rifadin) b) ethambutol (Myambutol), pyrazinamide, and isoniazid c) isoniazid, rifampin, ethambutol, and pyrazinamide d) ethambutol, ciprofloxacin (Cipro), pyrazinamide, and streptomycin
c) isoniazid, rifampin, ethambutol, and pyrazinamide
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic alkalosis d) Metabolic acidosis
d) Metabolic acidosis
A client undergoes a tracheostomy after many failed attempts at weaning him from a mechanical ventilator. Two days after tracheostomy, while the client is being weaned, the nurse detects a mild air leak in the tracheostomy tube cuff. What should the nurse do first? a) Call the physician. b) Remove the malfunctioning cuff. c) Add more air to the cuff. d) Suction the client, withdraw residual air from the cuff, and reinflate it.
d) Suction the client, withdraw residual air from the cuff, and reinflate it.
The nurse observes a new environmental services employee enter the room of a client with severe acute respiratory syndrome (SARS). Which action by the employee requires immediate intervention by the nurse? a) The employee wears a gown, gloves, N95 respirator, and eye protection when entering the room. b) The employee doesn't remove the stethoscope, blood pressure cuff, and thermometer that are kept in the room. c) The employee removes all personal protective equipment and washes her hands before leaving the client's room. d) The employee enters the room wearing a gown, gloves, and a mask.
d) The employee enters the room wearing a gown, gloves, and a mask.
A client has a sucking stab wound to the chest. Which action should the nurse take first? a) Draw blood for a hematocrit and hemoglobin level. b) Apply a dressing over the wound and tape it on three sides. c) Prepare a chest tube insertion tray. d) Prepare to start an I.V. line.
b) Apply a dressing over the wound and tape it on three sides.
The physician prescribes triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? a) Administer the triamcinolone and then administer the salmeterol. b) Administer the salmeterol and then administer the triamcinolone. c) Allow the client to choose the order in which the drugs are administered. d) Monitor the client's theophylline level before administering the medications.
b) Administer the salmeterol and then administer the triamcinolone.
A 29-year-old client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute? a) Droplet precautions b) Airborne and contact precautions c) Contact and droplet precautions d) Contact precautions
b) Airborne and contact precautions
A client is admitted to the emergency department with an acute asthma attack. The physician prescribes ephedrine sulfate, 25 mg subcutaneously (S.C.). How soon should the ephedrine take effect? a) Rapidly b) In 3 minutes c) In 1 hour d) In 2 hours
a) Rapidly
What is the normal pH range for arterial blood? a) 7 to 7.49 b) 7.35 to 7.45 c) 7.50 to 7.60 d) 7.55 to 7.65
b) 7.35 to 7.45
On auscultation, which finding suggests a right pneumothorax? a) Bilateral inspiratory and expiratory crackles b) Absence of breath sounds in the right thorax c) Inspiratory wheezes in the right thorax d) Bilateral pleural friction rub
b) Absence of breath sounds in the right thorax
When a client's ventilation is impaired, the body retains which substance? a) Sodium bicarbonate b) Carbon dioxide c) Nitrous oxide d) Oxygen
b) Carbon dioxide
A client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He's placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than: a) 0.21. b) 0.35. c) 0.5 d) 0.7
c) 0.5
A client, confused and short of breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the client's current respiratory problem, the physician orders a chest X-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurse sees many abbreviations. What does a lowercase "a" in an ABG value represent? a) Acid-base balance b) Arterial blood c) Arterial oxygen saturation d) Alveoli
b) Arterial blood
A client with chronic obstructive pulmonary disease presents with respiratory acidosis and hypoxemia. He tells the nurse that he doesn't want to be placed on a ventilator. What action should the nurse take? a) Notify the physician immediately so he can determine client competency. b) Have the client sign a do-not-resuscitate (DNR) form. c) Determine whether the client's family was consulted about his decision. d) Consult the palliative care group to direct care for the client.
a) Notify the physician immediately so he can determine client competency.
An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a) Immediately before a meal b) At least 2 hours after a meal c) When bronchospasms occur d) When secretions have mobilized
b) At least 2 hours after a meal
Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review? a) Fluid intake for the past 24 hours b) Baseline arterial blood gas (ABG) levels c) Prior outcomes of weaning d) Electrocardiogram (ECG) results
b) Baseline arterial blood gas (ABG) levels
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? a) Instruct the client to breathe into a paper bag. b) Administer oxygen by nasal cannula as prescribed. c) Auscultate breath sounds bilaterally every 4 hours. d) Encourage the client to deep-breathe and cough every 2 hours.
b) Administer oxygen by nasal cannula as prescribed.
The nurse is caring for a client with chest trauma. Which nursing diagnosis takes highest priority? a) Impaired gas exchange b) Anxiety c) Decreased cardiac output d) Ineffective cardiopulmonary tissue perfusion
a) Impaired gas exchange
After receiving an oral dose of codeine for an intractable cough, the 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
a) In 30 minutes
A 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? a) Inflamed lung tissue b) Sudden onset c) Responsiveness to penicillin d) Elevated white blood cell (WBC) count
a) Inflamed lung tissue
After receiving the wrong medication, the client's breathing stops. The nurse initiates the code protocol, and the client is emergently intubated. As soon as the client's condition stabilizes, the nurse completes an incident report. What should the nurse do next? a) Place the incident report on the client's chart. b) Document the incident in the nurses' notes. c) Document in the nurses' notes that an incident report was completed. d) Make a copy of the incident report for the client.
b) Document the incident in the nurses' notes.
A 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) Nonrebreather mask c) Face tent d) Nasal cannula
b) Nonrebreather mask
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? a) pH, 7.5; PaCO2 30 mm Hg b) pH, 7.40; PaCO2 35 mm Hg c) pH, 7.35; PaCO2 40 mm Hg d) pH, 7.25; PaCO2 50 mm Hg
d) pH, 7.25; PaCO2 50 mm Hg
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: a) metabolic acidosis. b) metabolic alkalosis. c) respiratory acidosis. d) respiratory alkalosis.
d) respiratory alkalosis.
The nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Inspection b) Chest X-ray c) Arterial blood gas (ABG) levels d)Auscultation
d)Auscultation
A client with chronic obstructive pulmonary disease is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory rate, the nurse notes an abnormal inspiratory-expiratory (I:E) ratio of 1:4. What is a normal I:E ratio? a) 1:2 b) 2:1 c) 1:1 d) 2:2
a) 1:2
The nurse is teaching a client 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 collapse. b) It increases inspiratory muscle strength. c) It decreases use of accessory breathing muscles. d) It prolongs the inspiratory phase of respiration.
a) It helps prevent early airway collapse.
