Podcast
Questions and Answers
What should the nurse do first when the low-pressure alarm sounds on a ventilator and the cause is undetermined?
What should the nurse do first when the low-pressure alarm sounds on a ventilator and the cause is undetermined?
Which sign noted after a bronchoscopy and biopsy should prompt immediate reporting to the physician?
Which sign noted after a bronchoscopy and biopsy should prompt immediate reporting to the physician?
How long should the nurse limit suctioning time when suctioning fluids through a tracheostomy tube?
How long should the nurse limit suctioning time when suctioning fluids through a tracheostomy tube?
If the heart rate decreases during suctioning of an endotracheal tube, what is the appropriate nursing intervention?
If the heart rate decreases during suctioning of an endotracheal tube, what is the appropriate nursing intervention?
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What respiratory pattern would the nurse expect to observe in a client after suffering a fractured rib?
What respiratory pattern would the nurse expect to observe in a client after suffering a fractured rib?
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What is the most distinctive sign of flail chest that the nurse should assess for?
What is the most distinctive sign of flail chest that the nurse should assess for?
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What should the nurse assess for when the high-pressure alarm on the ventilator sounds and breath sounds are absent in the right upper lobe?
What should the nurse assess for when the high-pressure alarm on the ventilator sounds and breath sounds are absent in the right upper lobe?
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What is the earliest sign the nurse should assess for in a client at risk for developing acute respiratory distress syndrome?
What is the earliest sign the nurse should assess for in a client at risk for developing acute respiratory distress syndrome?
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What is the most likely cause of shortness of breath and chest tightness in a college-age client who has been jogging?
What is the most likely cause of shortness of breath and chest tightness in a college-age client who has been jogging?
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Which instruction is a priority for a client with bronchitis?
Which instruction is a priority for a client with bronchitis?
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Which finding after a thoracentesis indicates a need for further assessment?
Which finding after a thoracentesis indicates a need for further assessment?
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Upon auscultation of a client with left lower lobe pneumonia, which breath sound would be documented?
Upon auscultation of a client with left lower lobe pneumonia, which breath sound would be documented?
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What should the nurse have available for a client with empyema in case thoracentesis is ineffective?
What should the nurse have available for a client with empyema in case thoracentesis is ineffective?
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To assess carbon monoxide poisoning in a client admitted with burns, which monitoring should the nurse prioritize?
To assess carbon monoxide poisoning in a client admitted with burns, which monitoring should the nurse prioritize?
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What is the optimal tidal volume for ventilator weaning?
What is the optimal tidal volume for ventilator weaning?
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When suctioning a client's tracheostomy, which practice should the nurse follow?
When suctioning a client's tracheostomy, which practice should the nurse follow?
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In the case of suspected pulmonary embolism, which of the following therapeutic orders is anticipated?
In the case of suspected pulmonary embolism, which of the following therapeutic orders is anticipated?
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What symptom would indicate a possible complication following a thoracentesis?
What symptom would indicate a possible complication following a thoracentesis?
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What action is most appropriate for a client with a pH of 7.30 and a pCO2 of 50 mm Hg?
What action is most appropriate for a client with a pH of 7.30 and a pCO2 of 50 mm Hg?
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Which nursing task can be delegated to a licensed practical nurse?
Which nursing task can be delegated to a licensed practical nurse?
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When is a Mantoux test considered positive?
When is a Mantoux test considered positive?
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What is indicated by fluctuations in the water seal chamber of a closed chest drainage system?
What is indicated by fluctuations in the water seal chamber of a closed chest drainage system?
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Which schedule for chest physiotherapy is likely to be most therapeutic?
Which schedule for chest physiotherapy is likely to be most therapeutic?
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What symptom is NOT associated with a suspected pulmonary embolism?
What symptom is NOT associated with a suspected pulmonary embolism?
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What is the first clinical manifestation that would alert the nurse to a client experiencing adult respiratory distress syndrome (ARDS)?
What is the first clinical manifestation that would alert the nurse to a client experiencing adult respiratory distress syndrome (ARDS)?
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Which finding during an initial assessment would concern the nurse regarding a client's asthma status?
Which finding during an initial assessment would concern the nurse regarding a client's asthma status?
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What is the most appropriate nursing action for a client with severe COPD and increased shortness of breath?
What is the most appropriate nursing action for a client with severe COPD and increased shortness of breath?
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Which test is a priority for confirming a diagnosis of suspected tuberculosis (TB)?
Which test is a priority for confirming a diagnosis of suspected tuberculosis (TB)?
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What finding indicates a positive result for the purified protein derivative (PPD) test?
What finding indicates a positive result for the purified protein derivative (PPD) test?
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What is the significance of blood-tinged, frothy sputum in a client with pulmonary trauma?
What is the significance of blood-tinged, frothy sputum in a client with pulmonary trauma?
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Which statement would be true regarding wheezing sounds in a respiratory assessment?
Which statement would be true regarding wheezing sounds in a respiratory assessment?
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What does a respiratory rate of 23 breaths/min indicate in a client with COPD?
What does a respiratory rate of 23 breaths/min indicate in a client with COPD?
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What is the total number of pack-years for a client who smoked a half pack per day for 5 years and 1 pack per day for 10 years?
What is the total number of pack-years for a client who smoked a half pack per day for 5 years and 1 pack per day for 10 years?
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Which action should the nurse take to improve the appetite of a client with pneumonia?
Which action should the nurse take to improve the appetite of a client with pneumonia?
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What manifestation should the nurse expect in a client with left-sided heart failure progressing to pulmonary edema?
What manifestation should the nurse expect in a client with left-sided heart failure progressing to pulmonary edema?
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What finding might explain the absence of a friction rub during assessment after having one previously auscultated?
What finding might explain the absence of a friction rub during assessment after having one previously auscultated?
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If a client’s chest tube drainage decreased from 90 ml to 5 ml within an hour, what should the nurse suspect?
If a client’s chest tube drainage decreased from 90 ml to 5 ml within an hour, what should the nurse suspect?
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Which clinical manifestations should a nurse monitor for in a client suspected of having pulmonary emphysema?
Which clinical manifestations should a nurse monitor for in a client suspected of having pulmonary emphysema?
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What is a common symptom in clients with pulmonary emphysema?
What is a common symptom in clients with pulmonary emphysema?
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What task may the nurse consider delegating to a licensed practical nurse?
What task may the nurse consider delegating to a licensed practical nurse?
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What condition is indicated by a client presenting with a 'barrel chest'?
What condition is indicated by a client presenting with a 'barrel chest'?
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What statement indicates a client with tuberculosis understands their medication regimen?
What statement indicates a client with tuberculosis understands their medication regimen?
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What protective equipment should a nurse wear when giving a bed bath to a client with tuberculosis?
What protective equipment should a nurse wear when giving a bed bath to a client with tuberculosis?
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Which symptom is most commonly reported by a client who has experienced a pulmonary embolism?
Which symptom is most commonly reported by a client who has experienced a pulmonary embolism?
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What is the interpretation of a 7-mm area of induration from a Mantoux skin test in an HIV-positive client?
What is the interpretation of a 7-mm area of induration from a Mantoux skin test in an HIV-positive client?
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When assessing a client with histoplasmosis, which sign or symptom is the nurse most likely to observe?
When assessing a client with histoplasmosis, which sign or symptom is the nurse most likely to observe?
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Which early sign should a client with sarcoidosis report as a potential exacerbation?
Which early sign should a client with sarcoidosis report as a potential exacerbation?
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What is a common respiratory assessment finding in a client with chronic airflow limitation?
What is a common respiratory assessment finding in a client with chronic airflow limitation?
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Study Notes
Respiratory System - Nurse Licensure Exam
- Adult Respiratory Distress Syndrome (ARDS): Early sign is increasing hypoxemia, followed by dense pulmonary infiltrates ("whited-out" appearance)
- Asthma Exacerbation: Loud wheezing on expiration is a more serious sign, suggesting worsened status, compared to wheezing throughout lung fields or mild wheezing on inspiration.
- COPD: Home oxygen therapy at 2 L/min with a respiratory rate of 23 breaths/minute signals potential worsening. Further assessment, not increasing oxygen, is priority
- Tuberculosis (TB): Priority test is sputum culture positive for Mycobacterium tuberculosis. Chest X-ray, positive PPD test, and sputum-positive blood (hemoptysis) are also important, but less definitive. Airborne precautions are necessary until active TB is confirmed
- TB Testing (PPD): A positive PPD test is characterized by an induration of 10 mm or greater, not area of erythema or a bruise.
- Ventilator Weaning: Optimal tidal volume is 5-8 ml/kg..
- Pulmonary Embolism: Clinical manifestations include dyspnea, chest pain, tachycardia. The nurse anticipates semi-Fowler position or high-Fowler's position, oxygen at 4 L/min, and anticoagulant therapy.
- Pulmonary Edema: ABG results show a pH of 7.30, pCO2 of 50 mm Hg, pO2 of 56 mm Hg, and HCO3 of 24 mm Hg indicating respiratory acidosis. A physician will likely order additional oxygen via a face mask
- Delegating Nursing Tasks: Licensed practical nurses can perform tasks like assisting with pursed-lip breathing, but not clarifying physician orders, administering PPD, or educating about complex procedures like bronchoscopy.
- Mantoux Test: Positive result is an induration of 10 mm or greater, measured 48-72 hours after the injection.
- Chest Physiotherapy: Ideal schedule for twice-daily chest physiotherapy is 7:00 AM and 1:00 PM or 6:00 AM and 4:00 PM, avoiding an 8:00 PM time.
- Closed Chest Drainage System: Fluctuations in the water seal chamber indicate a functioning system, whereas air leaks, kinks, or lack of re-expansion of the lung can cause these problems.
- Acute Onset Respiratory Complaint in Young Adult: Possible causes include pneumonia, bronchitis or pneumoconiosis.
Additional Respiratory Conditions and Assessments
- Bronchitis: Include avoidance of cigarette smoking in instructions for clients with bronchitis.
- Thoracentesis: Diminished breath sounds on the affected side, not crackles, requires further assessment following a thoracentesis.
- Pneumonia: Documented findings from auscultation include absent breath sounds, not bronchovesicular or vesicular sounds.
- Empyema: The nurse should have a chest tube insertion kit if thoracentesis proves ineffective.
- Inhalation Injury: Monitor serum carboxyhemoglobin levels to determine extent of carbon monoxide poisoning
- Tracheostomy Suctioning: Avoid instilling sterile saline into the trachea when suctioning, as this may irritate the tracheal mucosa. Limit suction to 15 seconds.
- Smoking History: Calculate smoking history as pack-years (packs per day x years smoked).
- Left-sided Heart Failure: Symptoms of pulmonary edema include bilateral crackles, not dry hacking cough, fever or peripheral edema.
- Pleurisy: Absence of friction rub suggests a decrease in the inflammatory response or accumulation of pleural fluid.
- Chest Tube Drainage: A significant drop-off in drainage (e.g., from 90ml to 5ml) often signifies an issue like a clot, needing additional investigation.
- Pulmonary Emphysema: Clinical features include copious sputum production, barrel chest, prolonged inspiratory phase, marked weight loss, and severe dyspnea.
- Head and Neck Assessment: A normal finding is a movable, discrete lymph node and symmetrical neck muscles. A non-palpable thyroid is also considered normal.
- Chest Assessment: Assessment include normal thorax measurement (costal margin of less than 90 degrees, and absence of accessory muscles usage), and normal breath sound assessments (as described in item 29)
- Sputum Specimen Collection: Ensure instructions include deep breathing and coughing, and collecting prior to fluids restriction or bedtime.
- Blunt Chest Injury (Pneumothorax): Signs include diminished breath sounds and possible sucking sound at the injury site, while low respiratory rate is not a classic sign
- Acute Respiratory Distress Syndrome (ARDS): The earliest signs include increased respiratory rate, intercostal retractions, and inspiratory crackles, not bilateral wheezing.
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Description
Test your knowledge on critical aspects of the respiratory system as they pertain to the Nurse Licensure Exam. This quiz covers important topics such as ARDS, asthma, COPD, tuberculosis, and ventilator weaning. Prepare effectively for your exam with this focused assessment.
