OTC LPN Oxygenation NCLEX Practice Questions

A client who has had a lobectomy returns to the nursing unit. He has a chest tube attached to portable water seal drainage system and oxygen per nasal cannula. The first nursing measure concerning the water seal drainage is to A. Milk the tubing to prevent accumulation of fibrin and clots. B. Raise the drainage apparatus to bed height to accurately assess the meniscus level. C. Attach the chest tubes to the bed linen to assure that airflow and drainage are unhindered by kinks. D. Mark the time and level of drainage in the collection chamber.

D. Mark the time and level of drainage in the collection chamber. It is important to monitor the amount of chest drainage. Chest tubes are milked only if there is an obstruction in the tubing and only with a physician's order. The chest drainage system should not be raised above chest level. It should remain low. Chest tubes should not be attached to the linens.

11. An order is written for oxygen by nasal cannula at 2 liters per minute. In assessing the adequacy of the oxygen therapy, which of the following is most effective? A. Checking the respiratory rate. B. Checking the color of mucous membranes. C. Measurement of pulmonary functions. D. Measurement of arterial blood gasses.

D. Measurement of arterial blood gasses. Arterial blood gasses give the most specific information of the adequacy of the oxygen therapy. #1. The respiratory rate is a good measure but is not the best measure. #2. Color changes in the mucous membranes are a late sign of hypoxemia. #3. Pulmonary function tests are used to evaluate pulmonary function.

A lower left lobectomy was performed on an adult client. He was returned to his room following an uneventful stay in the recovery room. It is most important for the nurse to A. Encourage him to perform deep breathing and coughing exercises. B. Assist him with arm exercises to prevent shoulder ankylosis. C. Help him perform leg exercises to prevent thrombophlebitis. D. Position him in semi-Fowler's position on his left side.

A. Encourage him to perform deep breathing and coughing exercises. Deep breathing and coughing assume highest priority after a thoracotomy. Arm and leg exercises are also important. He would be positioned in semi-Fowler's position on his right side (nonoperative).

8. An adult is about to have a tracheostomy performed. Which action is of highest priority for the nurse before the procedure is done? A. Establishing means of postoperative communication. B. Drawing blood for serum electrolytes and blood gases. C. Inserting an indwelling catheter and attaching it to dependent drainage. D. Doing a surgical prep of the neck and upper chest wall.

A. Establishing means of postoperative communication. A tracheostomy makes a client unable to speak. Other means of communication will be necessary.

19. An adult has been diagnosed as having pulmonary tuberculosis. Which test(s) would the nurse expect to be ordered before the client is started on Isoniazid (INH) therapy? A. LDH, SGOT (AST) B. BUN, serum creatinine C. Skin test for allergy D. Chest X-ray

A. LDH, SGOT (AST) Liver function tests, SGOT (AST) and LDH would be performed to serve as baseline. Liver toxicity can occur with INH. Renal function tests, BUN and serum creatinine are essential in persons who are receiving streptomycin therapy. There is not a skin test for allergy to INH. A chest X-ray will have been done as part of the diagnostic process but is not necessary again before starting INH therapy.

13. An adult male has had a hacking cough and shortness of breath for several months. He now has chest pain. His family has pressured him into seeking medical consultation. He continues to say, "It is just a smoker's cough." The physician examines the client and arranges for hospital admission for a diagnostic work-up. The nurse is explaining several types of tests that are ordered. Which of these tests is most definitive in the process of ruling out a malignancy? A. Needle biopsy. B. Thoracentesis. C. Bronchogram. D. Sputum analysis.

A. Needle biopsy. Needle biopsy of the lungs detects peripherally located tumors. It provides a firm diagnosis in 80% of cases.

16. What action is essential because the client had a pneumonectomy? A. Observe the tracheal position. B. Auscultate bilateral breath sounds. C. Assess for hypertension. D. Assess for blood streaked sputum.

A. Observe the tracheal position. Tracheal shift can occur following pneumonectomy. Tracheal shift would compromise the client's unaffected lung. There will be no breath sounds on the operative sounds. He has only one lung after a pneumonectomy. Hypotension, not hypertension, is a major sign of hemorrhage. The sputum will probably not be bloody, as the remaining lung was not operated on. A small amount of blood streaked sputum could be the result of intubation during surgery.

12. A client with asbestosis must see his doctor regularly for a check up. What is the primary reason for him to have frequent checkups? A. Patients with asbestosis are at high risk for developing bronchogenic cancer. B. His doctor is monitoring him closely to look for signs of improvement. C. Patients who use low flow oxygen for long periods are at high risk for developing neurological symptoms. D. Periodic sputum samples are needed to follow the progress of the disease.

A. Patients with asbestosis are at high risk for developing bronchogenic cancer. This is true. The doctor is looking for a change in cough, hemoptysis, weight loss, etc. #2. The asbestos fibers in the lungs cannot be removed and the fibrosis is not reversible. Improvement is not expected. #3. is not correct. #4, sputum production is not a characteristic of this disorder. Also, sputum does not give information about the progress of the fibrosis.

18. Which of the following nursing interventions should be instituted the day after surgery for the client who has had a pneumonectomy? A. Provide range of motion exercises to affected arm. B. Strip chest tubes every hour. C. Force fluids to 3500 cc / day. D. Monitor intermittent positive pressure breathing therapy.

A. Provide range of motion exercises to affected arm. Range of motion exercises should be started within 4 hours of surgery to prevent adhesion formation. Intermittent positive pressure breathing therapy will not be used as the pressure could interrupt the suture line. Most physicians do not insert chest tubes in these clients, as the fluid is allowed to accumulate and eventually consolidate in the space. An increased fluid load could lead to respiratory compromise.

4. An adult client had a left thoracotomy. He has portable water seal chest drainage. On the first postoperative day the fluid in the water seal chamber stops fluctuating. What does this most likely indicate? A. The chest tube is clogged by fibrin or a clot. B. There is an air leak in the system. C. Pulmonary edema has occurred due to increased blood volumes in remaining lung tissue. D. The client's left lung has reexpanded.

A. The chest tube is clogged by fibrin or a clot. Fibrin and clots will obstruct the outflow of air from the patient's thoracic cavity. It is too soon for the lung to have reexpanded. An air leak in the system would cause an absence of bubbling in the suction control chamber not the water seal chamber.

9. The nurse is performing tracheal suctioning. Which action is essential to prevent hypoxemia during suctioning? A. Removal of oral and nasal secretions. B. Encouraging the client to deep breathe and cough. C. Administer 100% oxygen before suctioning. D. Auscultate the lungs.

Administer 100% oxygen before suctioning. 00% oxygen is given before and after suctioning to prevent hypoxemia.

10. An adult is admitted to the hospital with progressive dyspnea on exertion, which has become increasingly severe during the last six months. Physical examination reveals crackles at the base of the lung and clubbing of fingers. The client has asbestosis that has caused fibrosis in the alveoli. Soon after admission, the nurse helps the client to the bathroom. Before he returns to bed, he is very short of breath. Considering the severity of his symptoms, it is essential for the nurse to include which of the following in the plan of care. A. Give continuous oxygen via nasal catheter. B. Allow the client to move at his own pace. C. Give bronchodilators to increase his ability to breathe. D. Keep the client in bed to prevent further episodes of dyspnea.

B. Allow the client to move at his own pace. The client is best able to evaluate his symptom of dyspnea. When he wants to rest, he should be allowed to rest. #1 is not correct. Oxygen may be ordered, but is often ordered PRN. A nasal cannula is usually ordered. #3 is not an independent nursing action. #4 is not correct. The client will be allowed to do as much as he is able to prevent complications of bedrest. The day should be planned so that periods of exertion are followed by periods of rest.

5. An adult client had a left lower lobectomy. Passive exercises are started on his left arm after surgery. The exercises are designed to prevent A. Hyperflexion of the wrist. B. Ankylosis of the shoulder. C. Flexion contractures of the elbow. D. Spasticity of the intercostal muscle

B. Ankylosis of the shoulder The muscles have been cut during surgery. Range of motion exercises will help to prevent ankylosis of the shoulder or frozen shoulder. Patients also tend to splint incisional discomfort by limiting movement on the affected side.

20. A patient is admitted with histoplasmosis. Which item in the patient's history is most likely related to the onset of the disease? A. He works in a factory. B. He likes to explore caves. C. He has three cats. D. He smokes four packs of cigarettes a week.

B. He likes to explore caves. Histoplasmosis is caused by a fungus that grows in chicken and bat manure. Bats live in caves. Exploring caves is a likely source of exposure to the fungus. Choice 1, working in a factory, might be related to COPD if the factory had emissions. Choice 3 would be a possible source of toxoplasmosis, not histoplasmosis. Choice 4 is not related to histoplasmosis although it could be related to other respiratory diseases.

6. An adult client is admitted to the acute care hospital with bacterial pneumonia. On admission she was pale to dusky in color. Her respirations were 32, temperature 1030F and pulse 110. Auscultation revealed decreased or absent lung sounds in both bases and rhonchi in both upper lung fields. She was oriented to person, time and place, but her responses were brief. Oxygen per nasal cannula is started at 7 l / minute. IV antibiotics were started. While checking the client one hour after admission the nurse notes that she is less responsive, answering only yes or no questions. Her respirations are somewhat more shallow and have decreased to 27 per minute. What is the best INITIAL action for the nurse to take? A. Increase the IV infusion rate to increase the amount of circulating antibiotics. B. Notify the physician of the client's changed mental status and await further orders. C. Increase the oxygen flow rate to 10 liters / minute. D. Continue to stimulate her until she responds appropriately.

B. Notify the physician of the client's changed mental status and await further orders. Changes in mental status are always significant. Since her respirations are decreasing it is doubtful if oxygen would be effective.

14. Preoperative teaching for the client who is to have a pneumonectomy should include all of the following. Which is of highest priority? A. Management of postoperative pain. B. Turning, coughing and deep breathing exercises. C. How to move with the least pain. D. Leg exercises.

B. Turning, coughing and deep breathing exercises. Turning coughing and deep breathing help to prevent the most frequent, most life threatening complication likely to occur after thoracic surgery. The others are important and should be done.

15. An adult client has just arrived in the recovery room following a pneumonectomy. What is the most appropriate initial action for the nurse? A. Take his vital signs for baseline data. B. Check the IV solution for rate and correct solution. C. Administer oxygen through an appropriate device. D. Auscultate for the presence of breath sounds.

C. Administer oxygen through an appropriate device. An oxygen source is of highest priority as the client is likely to be hypoventilating due to the effects of anesthesia. Oxygen will prevent hypoxia. After starting oxygen the nurse will make all of the other assessments.

An adult client is admitted for diagnosis and treatment of a left lung lesion. A bronchoscopy was performed under local anesthesia. What nursing action is of highest priority when he returns following the bronchoscopy? A. Collect all sputum for examination. B. Assess level of consciousness frequently. C. Withhold food and fluids until gag reflex has returned. D. Monitor blood pressure and pulse at 10 minute intervals.

C. Withhold food and fluids until gag reflex has returned. Food and fluids should be withheld to prevent aspiration. The client will have received a local anesthetic to block the gag reflex during the bronchoscopy. The nurse should observe sputum for color but it is not necessary to collect it. Bronchoscopy is usually done under a local anesthetic so level of consciousness is not a priority. Vital signs may be monitored but preventing aspiration is of highest priority.

7. A tracheostomy tube is inserted in a patient who is in respiratory distress as a result of pneumonia. The family asks why the tube is inserted. What should the nurse include when explaining to the patient and family? The purpose of a tracheostomy tube is to A. Decrease the client's anxiety by increasing the size of the airway. B. Provide increased cerebral oxygenation thereby preventing further respiratory depression. C. Facilitate nursing care since tracheal tubes have fewer side effects than nasotracheal tubes. D. Provide more controlled ventilation and ease removal of secretions the client is unable to handle.

D. Provide more controlled ventilation and ease removal of secretions the client is unable to handle. This is the purpose of a tracheostomy. The client may become less anxious when she is no longer hypoxic. However, relief of anxiety is not the purpose of a tracheostomy tube.

17. The nurse is positioning an adult who has just returned to the surgical nursing care unit following a pneumonectomy. What is the most appropriate position in which to place the client? A. Semi-Fowler's on the unaffected side. B. Semi-Fowler's on the affected side. C. Sims position on the unaffected side. D. Semi-Fowler's on his back.

D. Semi-Fowler's on his back. Semi-Fowler's on the back will neither cause mediastinal shift nor cause hemorrhage at the pulmonary artery stump site. Positioning the client on his affected side could cause hemorrhage at the pulmonary artery stump site. Positioning the client on his unaffected side could cause mediastinal shift.