Respiratory nclex questions

A client with chronic bronchitis tells the home health care nurse of being exhausted all day due to coughing all night and being unable to sleep. The client can feel thick mucus in the chest and throat. Which interventions can the nurse suggest to help mobilize secretions and improve sleep? Select all that apply.

1. increase fluids to at least 8 glasses 2-3 L of water a day 2. sleep with a cool mist humidifier 3. take prescribed guaifenesin cough medicine before beditime 4. use abdominal breathing and the huff cough technique at bedtime

A client with chronic kidney disease has a large pleural effusion. What findings characteristic of a pleural effusion does the nurse expect.

1. chest pain during inhalation 2. diminished breath sounds 3. dyspnea

A client was medicated with intravenous morphine 2 mg 2 hours ago to relieve moderate abdominal pain after appendectomy. The client becomes lethargic but arouses easily to verbal and tactile stimuli, and is oriented to time, place, and person. The pulse oximeter reading has dropped from 99% to 89% on room air. Which oxygen delivery device is the most appropriate for the nurse to apply?

1. (nasal cannula)

The nurse cares for a client with a pulmonary embolism. Which of the following clinical manifestations would the nurse anticipate? Select all that apply.

2. chest pain 3. dyspnea 4. hypoxemia 5. tachypnea

A self-employed auto mechanic is diagnosed with carbon monoxide poisoning. Admission vital signs are blood pressure 90/42 mm Hg, pulse 84/min, respirations 24/min, and oxygen saturation 94% on room air. What is the nurse's priority action?

Administer 100% oxygen using a nonrebreather mask with flow rate of 15 L/min - to treat hypoxia and eliminate CO.

The nurse assesses a client with a history of cystic fibrosis who is being admitted with a pulmonary exacerbation. Which assessment finding would require immediate action?

Current pulse oximetry reading is 90% on room air.

A student initiates oxygen with a nonrebreather mask for a client with acute respiratory distress. While reassessing the client, the RN notices the reservoir bag is fully deflating on inspiration. What immediate action does the RN take to correct the problem?

Increases the oxygen flow.

A client with type 2 diabetes, coronary artery disease, and peripheral arterial disease developed hospital-acquired pneumonia (HAP) and has been receiving intravenous (IV) antibiotics for 4 days. Which parameter monitored by the nurse best indicates the effectiveness of treatment?

White blood cell count (WBC)

The nurse reviews and reinforces an asthma action plan with a client who has moderate persistent asthma. Which statement by the client indicates an understanding of how to follow a plan appropriately when peak expiratory flow (PEF) readings are in the green, yellow, or red zones?

"If I am in the yellow zone (50%-80%), I will take my rescue medication every 4 hours for 1-2 days and call my health care provider (HCP) for follow up care."

The nurse auscultates the lung sounds of a client with shortness of breath. Based on the sounds heard, which action would the nurse anticipate? Listen to the audio clip.

Administer furosemide IV push

The nurse is caring for a client admitted with incomplete fractures of right ribs 5-7. The nurse notes shallow respirations, and the client reports deep pain on inspiration. what is the priority at this time?

Administer prescribed IV morphine

A nursing diagnosis of "ineffective airway clearance related to pain" is identified for a client who had open abdominal surgery 2 days ago. Which intervention should the nurse implement first?

Administer prescribed analgesic medication for incisional pain.

The charge nurse evaluates the care provided by a new registered nurse (RN) for a client receiving mechanical ventilation (MV). Which action by the new RN indicates the need for further education?

Applies suction when inserting the catheter into the airway.

The client has a chest tube for a pneumothorax. While repositioning the client for an x-ray, the technician steps on the tubing and accidentally pulls the chest tube out. The client's oxygen saturation drops and the pulse is 132/min; the nurse hears air leaking from the insertion site. What is the nurse's immediate action?

Apply an occlusive sterile dressing secured on 3 sides. - decreases the risk for a tension pneumothorax by inhibiting air intake on inspiration and allowing air to escape on expiration.

A client is brought to the emergency department following a motor vehicle collision. The client's admission vital signs are blood pressure 70/50 mm Hg, pulse 123/min, and respirations 8/min. The nurse anticipates the results of which diagnostic test to best evaluate the client's oxygenation and ventilation status?

Arterial blood gases

The medical surgical nurse cares for a client who had a mediastinal tumor removed 2 days ago and reports difficulty breathing. The client becomes confused and restless, and respirations are 30/min. What is the nurse's next action?

Call the rapid response team.

The charge nurse of the emergency department (ED) is mentoring a new registered nurse (RN). They are caring for a client who has a chest tube connected to wall suction for a pneumothorax. The client is being transferred from the ED to the telemetry unit. Which action by the new RN would cause the charge nurse to intervene?

Clamping the chest tube at the insertion site during the transfer.

After receiving a change-of-shift report, the nurse should assess which client first?

Client who has just returned to the floor after undergoing a bronchoscopy.

A nurse is reviewing the laboratory results of a client admitted for an asthma exacerbation. Elevation of which of these cells indicates that the client's asthma may have been triggered by an allergic response?

Eosinophils - Normal eosinophil count is 1%-2%, elevated eosinophils are seen in allergy.

A client comes to the emergency department and reports headache, nausea, and shortness of breath after being stranded at home without electricity due to severe winter weather. While collecting a history, which question is most important for the nurse to ask?

How have you been keeping your house warm during this weather?

The nurse is assessing a client an hour after a left lung lobectomy. The client is awake, alert, and oriented, and reports pain of 6 on a 0-10 scale. Pulse oximetry is 92% on 4 L oxygen via nasal cannula. The chest tube is set to continuous water seal suction at -20 cm H2O. The collection chamber has accumulated 320 mL of frank red drainage in the last hour. What is the priority nursing action?

Notify the heath care provider immediately. - Excess drainage of frank red blood is indicative of hemorrhage and must be managed immediately.

A nurse is caring for an elderly client who had a colectomy for removal of cancer 2 days ago. The client is becoming increasingly restless. He has been given intravenous morphine every 2 hours for severe pain. Respirations are 28/min and shallow. Which arterial blood gas (ABG) results best indicate that the client is in acute respiratory failure (ARF) and needs immediate intervention?

PaO2 49 mm Hg (6.5 kPa), PaCO2 60 mm Hg (8.0 kPa) (75%)

A client is admitted with an exacerbation of asthma following a respiratory viral illness. Which clinical manifestations characteristic of a severe asthma attack does the nurse expect to assess? Select all that apply.

1. Accessory muscle use 2. chest tightness 3. high-pitched expiratory wheeze 5. tachypnea

The nurse assesses a client with left-sided pneumonia who has an intermittent, productive cough with copious amounts of thick, yellow sputum. Which of the following interventions help facilitate secretion removal? Select all that apply.

1. Chest physiotherapy 3. Huff coughing technique

A client is transferred from the post-anesthesia recovery unit to the surgical unit following an open cholecystectomy. Which interventions are most important for the nurse to perform to prevent postoperative pneumonia? Select all that apply.

2. Ambulate within 8 hours after surgery, if possible. 3. Have client cough with splinting every hour 4. Have client deep breathe and use the incentive spirometer every hour. 6. Place client in Fowler's position.

A client with a severe asthma exacerbation following influenza infection is transferred to the intensive care unit due to rapidly deteriorating respiratory status. Which clinical manifestations support the nurse's assessment of impending respiratory failure? Select all that apply.

2. PaCO2 55 mm Hg (7.3 kPa) 3. PaO2 58 mm Hg (7.8 kPa) 4. paradoxical breathing 5. restlessness and drowsiness

The nurse is gathering data on a client with obstructive sleep apnea. Which findings are consistent with this client's diagnosis? Select all that apply

2. excessive daytime sleepiness 3. morning headaches 5. snoring during sleep 6. witnessed episodes of apnea

The nurse cares for a client who returns from the operating room after a tracheostomy tube placement procedure. Which of the following is the nurse's priority when caring for a client with a new tracheostomy?

Checking the tightness of ties and adjusting if necessary, allowing 1 finger to fit under these ties.

A client presents to the emergency department with a stab wound to the chest. The nurse assesses tachycardia, tachypnea, and a sucking sound coming from the wound. Which of the following actions is priority.

Cover the wound with petroleum gauze taped on three sides.

A client with chronic obstructive pulmonary disease reports recent weight loss and poor appetite. The client states that bloating, exhaustion, and shortness of breath make eating "not worth the effort." Which statements by the nurse are appropriate to help improve the client's nutritional status? Select all that apply

1. "Avoid drinking fluids while you are eating meals." 2. "Eat small, frequent meals that are high in calories and protein." 5. "Perform oral hygiene before eating meals."

The nurse is teaching an overweight 54-year-old client about ways to decrease symptoms of obstructive sleep apnea. Which interventions would be most effective? Select all that apply.

2. limiting alcohol intake 3. losing weight

The nurse is caring for a client with a chest tube to evacuate a hemopneumothorax after a motor vehicle accident. The drainage has been consistently 25-50 mL/hr for the majority of the shift. However, over the past 2 hours there has been no drainage. Which actions should the nurse take? select all that apply.

1. Auscultate breath sounds 3. Instruct client to cough and deep breath 5. reposition the client

The nurse assesses a client with fever and productive cough for the last 10 days. Which findings support the presence of pneumonia? Select all that apply.

1. Coarse crackles 3. Pleuritic chest pain 4. Shortness of breath

The nurse provides discharge instructions to a 67-year-old client with chronic bronchitis who was hospitalized for community-acquired pneumonia. Which instructions should be included in the discharge teaching plan? Select all that apply.

1. avoid the use of over-the counter cough suppressant medicines. 4. schedule a follow-up with the health care provider (HCP) and chest x-ray 5. use a cool mist humidifier in your bedroom at night 6. use the incentive spirometer

A client is brought to the emergency department due to loss of consciousness after binge drinking at a college party and then taking alprazolam. Pulse oximetry shows 87% on room air. Which findings would the nurse expect to assess on an arterial blood gas?

Respiratory acidosis and hypoventilation

The nurse is evaluating how well a client with chronic obstructive pulmonary disease understands the discharge teaching. Which statements made by the client indicate an understanding of the pursed-lip breathing technique? Select all that apply.

2. I exhale for 4 seconds through pursed lips 4. I inhale for 2 seconds through my nose, keeping my mouth closed.

The nurse reviews discharge instructions with a client who has advanced chronic obstructive pulmonary disease. Which client statement indicates appropriate understanding? Select all that apply

2. I should report an increase in sputum 4. i will get a pneumococcal vaccine 5. i will use albuterol if i am short of breath

The nurse takes the admission history of a 70-year-old client diagnosed with chronic obstructive pulmonary disease (COPD). Which of the following statements by the client does the nurse recognize as contributing to the development of COPD? Select all that apply.

3. I have smoked about a pack of cigarettes a day since I was 16 years old but quit last year. 5. I was a car mechanic for about 40 years and had my own garage.

A client is scheduled for allergy skin testing to identify asthmatic triggers. Which medications should the nurse instruct the client to withhold before the test to ensure accurate results? Select all that apply.

3. Diphenhydramine 5. loratadine

The nurse is assisting a client with asthma perform a peak flow meter measurement. Place the instructions for measuring peak expiratory flow using a peak flow meter in the correct order. All options must be used

3. Position the indicator on the flow meter scale to the lowest value and assume an upright position. 2. inhale deeply, place mouthpiece in mouth, and use the lips to create the seal. 1. exhale as quickly and completely as possible and note the reading on the scale 5. repeat the procedure 2 more times with a 5- to 10-second rest period between exhalations 4. record the highest of the three measured values in the peak flow log.

A nurse is caring for a college athlete who was recently diagnosed with moderate persistent asthma. Which common asthma trigger should the nurse teach this client to avoid?

Secondhand cigarette smoke.

A home health care nurse visits a client with chronic obstructive pulmonary disease. The nurse teaches the client to use abdominal breathing to perform the "huff" cough technique to facilitate secretion removal. Place the steps in the correct order.

5 - sit upright in a chair with feet spread shoulder width apart and lean forward 2 - perform a slow, deep inhalation with your mouth using your diaphragm 1 - hold your breath for 2-3 seconds and then forcefully exhale quickly 3 - repeat the huff once or twice more, while refraining from performing a normal cough 4 - rest for 5-10 normal breaths and repeat as necessary until mucus is cleared.

A client with Alzheimer disease is found slumped over the lunch tray on the bedside table, coughing violently with emesis visible in the back of the throat. The client has a pulse of 135/min, respirations 32/min, and oxygen saturation 84%. The client also has circumoral cyanosis and decreased level of consciousness. Place the nurse's actions while awaiting the arrival of the rapid response team in priority order.

5. place client in high Fowler's position 4. perform oropharyngeal suctioning 1. administer 100% oxygen by nonrebreather mask 2. assess lung sounds 3. notify the primary health care provider (HCP)

The nurse is caring for a client with a chest tube that was placed 2 hours ago for a pneumothorax. Where would the nurse expect gentle, continuous bubbling?

Suction control chamber

The nurse is assisting the health care provider (HCP) with a client's chest tube removal. Just as the HCP prepares to pull the chest tube, what instructions should the nurse give the client?

Take a breath in, hold it, and bear down.

The client with malignant left pleural effusion undergoes a thoracentesis and 900 mL of excess pleural fluid is removed. Which of these manifestations, if noted on the post-procedure assessment, should the nurse report to the health care provider immediately?

Asymmetrical chest expansion and decreased breath sounds on the left. - complications of thoracentesis include iatrogenic pneumothorax, hemothorax, and infection. Post-procedure, the nurse assesses for pain and difficulty breathing; monitors vital signs and oxygen saturation; observes for changes in respiratory rate and depth, symmetry of chest expansion, and breath sounds.

The home care nurse is making an initial visit to a client just discharged after admission for severe exacerbation of chronic obstructive pulmonary disease (COPD). The nurse observes wall-to-wall stacks of old newspapers and magazines in every room, with pathways that just allow passage from one room to another. What is the priority nursing action?

Teach the safe use of oxygen.

The nurse in the outpatient procedure unit is caring for a client immediately post bronchoscopy. Which assessment data indicate that the nurse needs to contact the health care provider immediately?

Bright red blood mixed with sputum.

The nurse auscultates the lung sounds of a newly admitted client. The nurse understands that the lung sounds heard are consistent with which health condition? Audio clip - Rhonchi: continuous, low-pitched adventitious breath sounds similar to moaning or snoring that occur when thick secretions or foreign bodies obstruct air flow in the upper airways.

Bronchitis.

A hospitalized client with a history of obstructive sleep apnea sleeps while wearing a full face mask with continuous positive airway pressure (CPAP) Oxygen saturation drops to 85% during the night. What is the nurse's first action?

Check the tightness of the straps and mask

A nurse in an urgent care center triages multiple clients. Which client should the nurse assess first?

Client with a sore throat who reports difficulty opening mouth and swallowing - Peritonsillar abscess is an emergent complication of tonsillitis that can lead to life-threatening airway obstruction. Symptoms of peritonsillar abscess include fever, trismus (inability to open the mouth), drooling, muffled voice, and deviation of uvula to one side. - acute otitis media (infection of the middle ear) may develop secondary to rhinitis (common cold, seasonal allergies) due to inflammation of the Eustachian tube

The nurse receives the handoff of care report on four clients. Which client should the nurse see first?

Client with pneumonia who has a temperature of 97.6F, has an SpO2 of 93% on 4 L/min supplemental oxygen, and is becoming restless.

Based on the lung assessment information included in the hand-off report, which client should the nurse assess first?

Client with severe acute pancreatitis who has inspiratory crackles at the lung bases

The nurse responds to the call light of a client with chronic obstructive pulmonary disease (COPD) who says, "I can't breathe." The client seems to be having difficulty breathing and is nervous and tremulous. Vital signs are stable, oxygen saturation is 92% on 2 L, and there are clear breath sounds bilaterally. Which intervention would be most appropriate at this time?

Coach the client through controlled breathing exercises.

The emergency nurse admits a semiconscious client with periorbital bruising and severe tongue edema after a laceration sustained in an unwitnessed tonic-clonic seizure. The health care provider prescribes a nasopharyngeal airway to maintain airway patency. Which initial action by the nurse is appropriate?

Contact the health care provider and clarify the prescription.

The office nurse instructs a client newly diagnosed with asthma about the use of the peak flow meter to evaluate airflow. Which statement made by the client indicates an understanding of the nurse's teaching.

I will exhale as quickly and forcibly as possible through the mouthpiece of the device to obtain a peak flow reading.

The office nurse instructs a client newly diagnosed with asthma about the use of the peak flow meter to evaluate airflow. which statement made by the client indicates an understanding of the nurse's teaching.

I will exhale as quickly and forcibly as possible through the mouthpiece of the device to obtain a peak flow reading.

An elderly client is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Pulse oximetry is 84% on room air. The client is restless, has expiratory wheezing and a productive cough, and is using his accessory muscles to breathe. Which prescription should the nurse question?

IV morphine 2 mg now and may repeat every 2 hours.

The nurse is caring for a client with advanced heart failure on an inpatient hospice unit. The client is having trouble breathing. Which comfort intervention should the nurse implement first?

Elevate the head of the bed.

A nurse is completing discharge teaching to the parent of a child who is postoperative following a tonsillectomy. Which finding should be reported as a priority.

Frequent swallowing.

The nurse provides instruction to a community group about lung cancer prevention, health promotion, and smoking cessation. Which statement made by a member of the group indicates the need for further instruction?

I can't get lung cancer because I don't smoke

A client is admitted with a pulmonary embolus. The nurse assesses restlessness, one-word dyspnea and shortness of breath with activity, tachycardia, pleuritic chest pain, and severe anxiety. Arterial blood gases indicate respiratory alkalosis and hypoxemia. When initiating the care plan, the nurse should choose which nursing diagnosis as the highest priority?

Impaired gas exchange related to ventilation-perfusion imbalance.

The nurse is caring for a 72-year-old client 1 day postoperative colectomy. The nurse assesses an increased work of breathing, diminished breath sounds at the bases with fine inspiratory crackles, respirations 12/min and shallow, and pulse oximetry 96% on 2 L oxygen. There is no jugular venous distention or peripheral edema. Pain is regulated with client-controlled morphine. Which prescription does the nurse anticipate?

Incentive spirometer.

A client's arterial blood gases (ABGs) are shown in the exhibit. The nurse would expect which finding to demonstrate that the client is compensating for the ABGs? Exhibit: PH: 7.25 PO2: 79 mm Hg (10.5 kPa) PaCO2: 35 mm Hg (4.66 kPa) HCO3-: 12 mEq/L (12 mmol/L)

Increase in respiratory rate - Respiratory alkalosis is the body's natural compensation for metabolic acidosis. It is achieved by blowing more CO2 off from the system through rapid breathing.

The nurse is caring for a client receiving mechanical ventilation via tracheostomy 2 weeks following a tracheotomy. The nurse enters the client's room to address a ventilator alarm and notes the tracheostomy tube dislodged and lying on the client's chest. Which action by the nurse is appropriate? Click on the exhibit button for additional information.

Insert a new tracheostomy tube using the bedside obturator. - accidental dislodgement of a tracheostomy tube is a medical emergency. With a mature tracheostomy, an attempt to insert a new tracheostomy tube with the bedside obturator is indicated. If a tube cannot be reinserted, the stoma is covered with a sterile, occlusive dressing. Ventilation is provided with a bag-valve mask over the nose/mouth.

The nurse receives an obese client in the postanesthesia care unit who underwent a procedure under general anesthesia. The nurse notes an oxygen saturation of 88%. Which is the most appropriate initial intervention?

Perform head tilt and chin lift.

The nurse is providing care for a client with cancer of the left lung who will undergo video-assisted thoracic surgery in the morning. The client is nervous, jumpy, and short of breath. Pulse is 120/min, respirations are 30/min and shallow, and expiratory wheezing is auscultated on the left upper and lower lung posteriorly. Which of the following is the priority nursing action?

Place head of the bed in the Fowler's or high Fowler's position

When an unlicensed assistive personnel (UAP) assists a client with a chest tube back to bed from the bedside commode, the plastic chest drainage unit accidently falls over and cracks. The UAP immediately reports this incident to the nurse. What is the nurse's immediate action?

Place the distal end of the chest tube into a bottle of sterile saline.

The home health care nurse visits a 72-year-old client with pneumonia who was discharged from the hospital 3 days ago. The client has less of a productive cough at night but now reports sharp chest pain with inspiration. Which finding is most important for the nurse to report to the health care provider?

Pleural friction rub

The nurse is caring for a client who has been receiving mechanical ventilation (MV) for 4 days. During multidisciplinary morning rounds, the health care provider questions the development of a ventilator-associated pneumonia (VAP). Which of the following manifestations does the nurse assess as the BEST indicator of VAP?

Positive, purulent sputum culture

A client with pneumonia is transferred from the medical unit to the intensive care unit due to sepsis and worsening respiratory failure. Based on the nurse's progress note, which assessment data are most important for the nurse to report to the health care provider (HCP).

Refractory hypoxemia - refractory hypoxemia is the inability to improve oxygenation with increases in oxygen concentration. It is the hallmark of ARDS, a progressive form of acute respiratory failure that has a high mortality rate.