exam 2 practice questions

which client would the nurse assess first after a shift report? a. a 6 month old with a croupy cough and inspiratory stridor with exertion b. a 2 year old with asthma who required a prn albuterol treatment 2 hours ago c. a 3 year old with cystic fibrosis and pneumonia who required 22% oxygen all night d. a 20 month old with bronchiolitis and bilateral crackles who is receiving 23% oxygen

a. a 6 month old with a croupy cough and inspiratory stridor with exertion

which clinical findings would the nurse expect when assessing a child with acute laryngotracheobronchitis? select all that apply. a. fever b. crackles c. hoarseness d. barking cough e. inspiratory stridor

a. fever c. hoarseness d. barking cough e. inspiratory stridor

which action would the nurse take first when a client with acute bronchitis and emphysema reports feeling anxious and short of breath? a. obtain oxygen saturation b. provide oxygen at 2 L/min c. offer the prescribed rescue inhaler d. suggest use of pursed lip breathing

a. obtain oxygen saturation

after the nurse teaches a client about self management techniques for smoking cessation, which client statement indicates the need for further teaching? a. "i should list the reasons why i should stop smoking" b. "i should visit all the places i where i started smoking" c. "i should remove all ashtrays and lighters from my home" d. "i should try replacing tobacco with sugarless mints and gum"

b. " i should visit all the places where i started smoking"

when caring for a client with COPD exacerbation and an oxygen saturation of 87%, which prescribed action by the health care provider would the nurse question? a. infuse 5% dextrose in 0.45 saline at 50 ml/hr b. administer oxygen at no more than 3 L/minute c. assist the client to sit up at the bedside for meals d. give ibuprofen 400 mg very 6 hours prn pain or fever

b. administer oxygen at no more than 3 L/minute

which intervention would the nurse provide a 3 month old infant hospitalized with RSV? a. administering an antiviral agent b. clustering care to conserve energy c. administering a bronchodilator every 4 hours d. providing an antitussive agent whenever necessary

b. clustering care to conserve energy

when a client with COPD is receiving oxygen, which assessment findings indicate increasing carbon dioxide retention? select all that apply. a. anxiety b. drowsiness c. irregular pulse d. mental confusion e. increased respirations

b. drowsiness c. irregular pulse d. mental confusion

which finding would be of most concern when the nurse assesses a client with emphysema? a. barrel chest b. oral cyanosis c. pursed-lip expiration d. respirations 26 breaths per minute

b. oral cyanosis

when a client with intermittent claudication has been instructed to stop smoking and says, "i don't understand why this is necessary", which response by the nurse is best? a. "tobacco smoking causes many health problems" b. "nicotine use is a risk factor for heart and lung diseases" c. "nicotine makes blood vessels smaller and will worsen your pain" d. "smoking is prohibited for both clients and staff members in the hospital"

c. "nicotine makes blood vessels smaller and will worsen your pain"

which condition unrelated to cardiac disease is the major cause of right ventricular failure? a. hypovolemic shock b. chronic kidney disease c. COPD d. systemic inflammatory response syndrome

c. COPD

when a client is newly diagnosed with COPD, which action by the nurse has highest priority? a. teach the client how to use the prescribed inhalers b. discuss the normal progression of the disease process c. ask whether the client is interested in quitting smoking d. explain the purpose of a pulmonary rehabilitation program

c. ask whether the client is interested in quitting smoking

which action would the nurse take to prevent postoperative respiratory complications after abdominal surgery? a. implement postural drainage b. encourage pursed lip breathing c. assist with incentive spirometry d. teach sustained exhalation

c. assist with incentive spirometry

when performing a focused respiratory assessment, which action would the nurse take first? a. examine for any abnormal respiratory patterns b. inspect for changes in skin color or temperature c. check for any evidence of respiratory distress d. determine the shape and symmetry of the chest

c. check for any evidence of respiratory distress

the nurse is assessing four clients in a health care setting who have respiratory disorders. which client findings indicate possible metabolic acidosis? a. client 1- tachypnea b. client 2- pursed lip breathing c. client 3- kussmaul respirations d. client 4- abdominal paradox

c. client 3- kussmaul respirations

which type of adventitious breath sound would the nurse expect when auscultating the posterior chest of a client with pleurisy who is reporting sharp chest pain with deep breathing? a. stridor b. rhonchi c. pleural friction rub d. high pitched crackles

c. pleural friction rub

a client with COPD is breathing rapidly and using accessory muscles of respiration. the nurse auscultates the lungs and hears crackles and wheezes. which 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's 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's position and administer 2 L/min oxygen per nasal cannula

which assessment findings would indicate a possible asthma exacerbation? select all that apply. a. fever b. stridor c. wheezing d. tachycardia e. hypotension

c. wheezing d. tachycardia

a client has COPD. to decrease the risk of CO2 intoxication, which would the nurse do? a. initiate pulmonary hygiene to clear air passages of trapped mucous b. instruct to deep breathe slowly with inhalation longer than exhalation c. encourage continuous rapid panting to promote respiratory exchange d. administer oxygen at a low concentration to maintain respiratory drive

d. administer oxygen at a low concentration to maintain respiratory drive

the nurse is teaching pursed-lip breathing to a client with COPD. the client asks about the benefit of the exercises. which explanation would the nurse give? a. prevents complications that are associated with COPD b. relieves shortness of breath by increasing the breath rate c. increases the amount of air that the client can inhale with each breath d. keeps the airway open longer to decrease the work that goes into breathing

d. keeps the airway open longer to decrease the work that goes into breathing

which action would the nurse take first after noting stridor in a client who just arrived in the PACU after receiving a general anesthetic? a. have the client cough b. check respiratory rate c. auscultate breath sounds d. notify the health care provider

d. notify the health care provider