NCLEX QUIZ

A nurse teaches a client how to perform diaphragmatic breathing. Which instruction should the nurse provide?

Expand the abdomen on inhalation

What should the nurse assess when inspecting the mouth and pharynx of a client suspected of having a pulmonary disorder? Select all that apply.

Gag reflex Gum retraction Poor dentition????????

While caring for a client with asthma, the nurse auscultates a bilateral high-pitched, continuous whistling sound in the anterior lung fields. What finding does the nurse document in the medical record?

Wheezing, an adventitious breath sound, is a high-pitched continuous whistling that does not clear with coughing

The nurse is caring for a client who has been bitten by a raccoon. The client states, "Where I live, there seems to be raccoons and wild animals everywhere." The nurse recalls that rabies can be described as:

An acute viral infection, characterized by convulsions and difficulty swallowing, that affects the nervous system

A graduate nurse reminds a client who just had a laryngoscopy not to take anything by mouth until instructed to do so. Which conclusion should be made about this intervention by the nurse preceptor who is evaluating the performance of the graduate nurse?

Appropriate, because early eating or drinking after such a procedure may cause aspiration

During a first aid class, a student asks what should be done if a person's clothes catch on fire. The nurse explains that after the flames are extinguished it is most important to perform this action. Which action did the nurse describe?

Assess the person's breathing.

Which would the nurse consider to be a potential respiratory system-related complication of surgery?

Atelectasis

The nurse is caring for a client with burns and reviews the client's laboratory results: blood urea nitrogen (BUN), 30 mg/dL (10.2 mmol/L); creatinine, 2.4 mg/dL (184 mcmol/L); serum potassium, 6.3 mEq/L (6.3 mmol/L); pH, 7.1; Po2, 90 mm Hg; and hemoglobin (Hgb), 7.4 g/dL (74 mmol/L). Which condition does the nurse suspect the client has based upon these findings?

Azotemia

What would the nurse state is a serious side effect of x-rays?

Desquamation

Which test would the client undergo to receive a diagnosis of systemic lupus erythematosus?

Direct immunofluorescence test

A nurse teaches a client with a diagnosis of emphysema about the importance of preventing infections. What information is most significant to include?

Importance of meticulous oral hygiene

A client is admitted to the hospital with partial- and full-thickness burns of the chest and face sustained while trying to extinguish a brush fire. Which is the nurse's priority concern?

Inadequate gas exchange caused by smoke inhalation

After abdominal surgery, a goal is to have the client achieve alveolar expansion. The nurse determines that this goal is most effectively achieved by what method?

Incentive spirometry

What would the nurse state is a cause of systemic altered inflammatory response in impaired wound healing?

Leukemia

Which benign tumor forms on the surface of the client's epithelium?

Papilloma

Which disorder would the nurse state is related to the tonsils?

Pharyngitis

A client with a history of rheumatic fever and a heart murmur reports gaining weight in spite of nausea and anorexia. The client also reports shortness of breath several times each day and when performing minor tasks. Which additional information should the nurse obtain?

Presence of a cough and pulmonary secretions

Which key feature does the nurse associate with a stage 2 pressure ulcer?

Presence of non intact skin

A postoperative client is being weaned from mechanical ventilation. What is the most important factor for the nurse to consider when organizing activities?

Remain with the client to assess responses.

A client returns from a radical neck dissection with two portable wound drainage systems at the operative site. Inspection of the neck incision reveals moderate edema of the tissues. Which assessment finding is a priority requiring immediate nursing intervention?

Restlessness with dyspnea

Which surgery is used to treat excessive wrinkling or sagging of facial skin?

Rhytidectomy

Eustachian tube

The eustachian tube is a canal that connects the middle ear to the nasopharynx, which consists of the upper throat and the back of the nasal cavity. It controls the pressure within the middle ear, making it equal with the air pressure outside the body.

A client visited the nurse with a complaint of chalk white patches on the skin. What could be the condition of the client?

Vitiligo

A nurse receives a call from the emergency department about a client with tuberculosis (TB) who will be admitted to the medical unit. Which precaution should the nurse take?

Wear a particulate respirator when caring for the client

A client who has acquired human immunodeficiency syndrome (HIV) develops bacterial pneumonia. On admission to the emergency department, the client's PaO2 is 80 mm Hg. When the arterial blood gases are drawn again, the level is determined to be 65 mm Hg. What should the nurse do first?

increase the O2 flow rate

In preparation for discharge, a client who had a total hip replacement is taught wound care by the nurse. Which statement from the client indicates a correct understanding of the nurse's instructions?

"I will inspect the incision for healing when I change the dressing."

A nurse instructs a client to breathe deeply to open collapsed alveoli. What should the nurse include in the explanation of the relationship between alveoli and improved oxygenation?

"Oxygen is exchanged for carbon dioxide in the alveolar membrane.

After surgery, a client reports sudden severe chest pain and begins coughing. The nurse suspects the client has a thromboembolism. What characteristic of the sputum supports the nurse's suspicion that the client has a pulmonary embolus?

Pink

What should the nurse consider when providing care to a client in the acute phase of treatment for a full-thickness burn?

The risk of septicemia and its potential complications from treatment ????????