NCLEX-RESPIRATORY

The nurse in the emergency department is reviewing laboratory results for a client with carbon monoxide poisoning. The client's carboxyhemoglobin level is 25%. How would the nurse interpret the severity of carbon monoxide poisoning?

Moderate poisoning

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem?

Peripheral neuritis

The client is admitted to the hospital with a diagnosis of Legionnaires' disease. The nurse is providing information on the disease and treatment expectations. Which statement by the client indicates an understanding of the disease and treatments?

"I cannot give Legionnaires' disease to other people."

Which statement made by a client taking montelukast indicates the need for further teaching?

"I will take the medication when I first notice I am having trouble breathing."

The nurse has just administered the first dose of omalizumab to a client with asthma. Which statement by the client alerts the nurse of a life-threatening effect?

"My lips and tongue are swollen." Submit

The nurse is caring for a client with no significant medical history who tested positive for COVID-19 and is experiencing moderate symptoms of cough, shortness of breath, and loss of sense of smell. The client asks the nurse when the infectious stage of the virus will end and the transmission-based precautions can be safely discontinued. Which is the appropriate nursing response? Select all that apply.

"Your symptoms need to have started to improve." "At least 5 days will need to have passed since your symptoms first appeared." "You need to be fever-free for at least 24 hours without using fever-reducing medications."

The nurse is caring for a client with an endotracheal tube attached to a mechanical ventilator. The high-pressure alarm sounds, and the nurse assesses the client. The nurse determines that the cause of the alarm is most likely to be due to which complication?

A kink in the ventilator circuit

The nurse is planning to obtain blood for arterial blood gas analysis from a client with chronic obstructive pulmonary disease. The nurse would plan time for which activity after the arterial blood specimen is drawn?

Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes

The nurse is caring for a client with a tracheostomy receiving supplemental oxygen via a tracheostomy mask and is preparing to perform tracheostomy care. While preparing the supplies, the nurse notes the tracheostomy tube is pulsing, there is bleeding from the stoma, and the client is increasingly restless. The nurse calls for a rapid response team (RRT) and removes the tracheostomy tube. Which action would the nurse take next?

Assist the primary health care provider (PHCP) with endotracheal intubation Submit

A client is on continuous mechanical ventilation (CMV), and the low-pressure alarm sounds. The nurse would take which action?

Determine whether there are any disconnections in the ventilator tubing.

To prevent postoperative atelectasis in a client recovering from an open cholecystectomy, what would the nurse do first?

Ensure that the client is experiencing adequate pain control.

The nurse caring for a client with sepsis as a result of bacterial pneumonia is monitoring for signs of systemic inflammatory response syndrome (SIRS). Which conditions are indicative of this complication? Select all that apply.

Fever Altered mental status Development of severe hypotension Development of acute respiratory distress syndrome (ARDS)

A client with chronic obstructive pulmonary disease (COPD) is experiencing exacerbation of the disease. The nurse would determine that which finding documented in the client's record is an expected finding with this client?

Hyperinflation of lungs documented by chest x-ray

The nurse is caring for a client with acute respiratory distress syndrome (ARDS). What would the nurse expect to note in the client?

Low arterial PaO2

The nurse is reviewing the ventilator settings on a client with an endotracheal tube attached to mechanical ventilation. The nurse notes that the tidal volume is set at 500 mL. How does the nurse interpret this setting?

It is the amount of air delivered with each set breath.

The nurse is assisting in caring for a client after removal of an endotracheal tube. Which finding would be reported to the primary health care provider (PHCP) immediately?

Stridor

The nurse is caring for a client with a tracheostomy tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse would plan to perform which action?

Suction the client.

A client who has been diagnosed with pneumonia has been given a prescription for erythromycin. Client teaching about this medication would include which best instruction?

Take the medication on an empty stomach.

The nurse is caring for a client diagnosed with COVID-19 experiencing hypercoagulability. Which laboratory result trends would the nurse anticipate? Select all that apply.

Thrombocytopenia Increased D-dimer level Prolonged prothrombin time (PT) Prolonged activated partial thromboplastin time (aPPT)

The nurse has assisted the primary health care provider and the anesthesiologist with placement of an endotracheal (ET) tube for a client in respiratory distress. What is the initial nursing action to evaluate proper ET tube placement?

Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds.

The nurse is admitting a client who is suspected of having tuberculosis (TB) to the nursing unit. The nurse would plan to admit the client to a room that has which properties?

Venting to the outside, six air exchanges per hour, and ultraviolet light

The nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse would determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis?

A person who is an inspector for the U.S. Postal Service

The nurse is providing morning care to a client who has a closed chest tube drainage system to treat a pneumothorax. When the nurse turns the client to the side, the chest tube is accidentally dislodged from the chest. The nurse immediately applies sterile gauze over the chest tube insertion site. Which is the nurse's next action?

Call the primary health care provider.

A client is taking a prescribed course of therapy with ethambutol. The home health nurse assesses the client at each home visit for which adverse effect of this medication?

Visual disturbances

The nurse is caring for a client with a chest injury who has a dry suction chest drainage system. During assessment of the drainage system, what would the nurse expect to find? Select all that apply.

The dry suction control regulation set to the prescribed amount The drainage in the collection chamber marked each shift to monitor the amount of drainage