Respiratory NCLEX Questions PDF

Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 1. Which of these clients will the charge D) A nurse working in the PACU nurse on the medical unit assign to an would be familiar with assessing RN who has floated from the po...

Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 1. Which of these clients will the charge D) A nurse working in the PACU nurse on the medical unit assign to an would be familiar with assessing RN who has floated from the postanes- vital signs and respiratory status thesia care unit (PACU)? after procedures such as thora- A. Client with allergic rhinitis scheduled centesis. for skin testing B. Client with emphysema who needs teaching about pulmonary function testing C. Client with pancreatitis who needs a preoperative chest x-ray D. Client with pleural effusion who has had 1200 mL removed by thoracentesis 2. An RN and an LPN/LVN are working to- D) Developing the teaching plan gether to provide care for a client hospi- is the most complex of the skills talized with dyspnea who requires all of listed and requires RN education these nursing actions. Which of these and licensure. actions is best accomplished by the RN? A. Administer the purified protein deriv- ative (PPD) for tuberculosis testing. B. Assess vital signs and the puncture site after thoracentesis. C. Monitor oxygen saturation using pulse oximetry every 4 hours. D. Plan client and family teaching re- garding upcoming pulmonary function testing. 3. A client has returned to the postanes- D) A nursing assistant working in thesia care unit (PACU) after a bron- the PACU would have experience choscopy. Which of these nursing tasks in taking client vital signs after the is best for the charge nurse to delegate client has had conscious seda- to the experienced nursing assistant tion or anesthesia. working in PACU? A. Assess breath sounds. B. Check gag reflex. 1 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy C. Determine level of consciousness. D. Monitor blood pressure and pulse. 4. The RN has received report about all A) An oxygen saturation level of these clients. Which client needs the less than 91% indicates hypox- most immediate assessment? emia and requires immediate as- A. Client with acute asthma who has sessment and intervention to im- an oxygen saturation of 89% by pulse prove blood and tissue oxygena- oximetry tion. B. Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes C. Client with bronchogenic lung can- cer who returned from bronchoscopy 3 hours ago D. Client with pleural effusion who has decreased breath sounds at the right base 5. The home health nurse is assigned to A) This client has an appropriate visit all of these clients when a change Spo2 for home oxygen use. in agency staffing requires that one of the clients should be rescheduled for a visit on the following day. Which of these clients would be best to resched- ule? A. Client with emphysema who has been on home oxygen for a month and has SPO2 levels of 91% to 93% B. Client with history of a cough, weight loss, and night sweats who has just had a positive Mantoux test C. Client with newly diagnosed pleural effusion who needs an admission visit and an initial intake assessment D. Client with percutaneous lung biopsy yesterday who called in to report in- creased dyspnea 6. 2 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy Which of these assessment findings B) Bronchial breath sounds are will be of greatest concern when the not normally heard in the periph- nurse is assessing a client with emphy- ery and may indicate increased sema? lung density, as in a tumor or an A. Barrel-shaped chest infective process such as pneu- B. Bronchial breath sounds heard at the monia. bases C. Hyperresonance to percussion of the chest D. Ribs lying horizontal 7. People involved in which occupations Bakers or activities are encouraged to wear Coal miners masks and to have adequate ventila- Furniture refinishers tions? Select all that apply. Potters A. Bakers B. Coal miners A) Being exposed to flour as C. Electricians a baker for prolonged periods D. Furniture refinishers of time may cause a condition E. Plumbers called occupational asthma. F. Potters B) Coal miners are at risk to de- velop pneumoconiosis as the re- sult of inhalation of coal dust. D) Owing to the chemicals used to refinish furniture (paint strip- pers, solvents), masks and ade- quate ventilation are essential for furniture refinishers. One of the main solvents involved will me- tabolize in the body to carbon monoxide and will impair the abil- ity of the tissue to extract oxygen. F) Silicosis or inhalation of silica dust is a hazard for professional and recreational potters. 8. Which nursing intervention is the prior- C) If the client has been smoking, ity in preparing the client for pulmonary this may alter parts of the PFT function testing (PFT)? 3 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A. Administer bronchodilator medica- (diffusing capacity [DlCO]), yield- tion on call. ing inaccurate results. B. Encourage clear fluid intake 12 hours before the procedure. C. Ensure no smoking 6 hours before the test. D. Provide supplemental oxygen as testing begins. 9. The nurse is performing a client assess- B) This client is dyspneic when ment for the client's potential employer. climbing stairs or walking on an The client reports dyspnea when climb- incline but not on level walking. ing stairs but is not dyspneic at rest. Therefore, this client is employ- Which dyspnea classification does the able only for a sedentary job or nurse assign to this client in the report under special circumstances. to the employer? A. Class I, can perform perform manual labor B. Class II, can perform desk job C. Class III, minimally employable D. Class IV, must remain at home 10. A client comes to the emergency de- C) Pink frothy sputum is com- partment with a productive cough. mon with pulmonary edema and Which symptom does the nurse look for requires immediate attention and that will require immediate attention? intervention to prevent the client's A. Blood in the sputum condition from getting worse. B. Mucoid sputum C. Pink frothy sputum D. Yellow sputum 11. A client with asthma reports shortness A) Adventitious sounds are ad- of breath. What is the nurse assessing ditional breath sounds superim- when auscultating this client's chest? posed on normal sounds. They A. Adventitious breath sounds indicate pathologic changes in B. Fremitus the lung. C. Oxygenation status D. Respiratory excursion 12. 4 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy Four clients are sent back to the emer- A) An acute allergic reaction can gency department from triage at the lead to immediate respiratory dis- same time. Which client requires the tress. This is an emergent situa- nurse's immediate attention? tion that requires the immediate A. Client with acute allergic reaction attention of the nurse. B. Client with dyspnea on exertion C. Client with lung cancer with cough D. Client with sinus infection with fever 13. The nurse auscultates popping, discon- A) Crackles are described as tinuous sounds over the client's anteri- a popping, discontinuous sound or chest. How does the nurse classify caused by air moving into previ- these sounds? ously deflated airways. The air- A. Crackles ways have been deflated due B. Rhonchi to the presence of fluids in the C. Pleural friction rub lungs, and crackles should be D. Wheeze considered to be a sign of fluid overload. 14. In the older adult client, which respi- A) Increased AP diameter is nor- ratory change does not require further mal with aging. assessment by the nurse? A. Increased anteroposterior (AP) diam- eter B. Increased respiratory rate C. Shortness of breath D. Sputum production 15. In assessing the client's respiratory sta- B) The arterial blood gases tus, blood gas test results reveal pH of (ABGs) indicate respiratory alka- 7.50, PaO2 of 99, PaCO2 of 29, and HCO losis, which is commonly caused of 22. What action does the nurse need by hyperventilation. Encouraging to take first? the client to slow down his breath- A. Call the physician. ing rate may help him return to B. Encourage the client to slow his normal breathing and may cor- breathing rate. rect this abnormality. C. Nothing. These results are within the normal range. D. Provide oxygen support. 5 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 16. The client returns to the medical unit af- B) Until the client has a gag re- ter a therapeutic bronchoscopy. Which flex and is fully alert, he should intervention does the nurse apply first? be maintained on NPO status to A. Assess the puncture site for prevent aspiration. drainage. B. Implement NPO (nothing by mouth) status. C. Monitor for signs of anaphylaxis. D. Perform aggressive chest physio- therapy 17. Why are the turbinates important? B) The turbinates increase the A. They decrease the weight of the skull surface area of the nose, so that on the neck. more heating, filtering, and hu- B. They increase the surface area of the midifying of inspired air can oc- nose for heating and filtering. cur before air passes into the na- C. They move inspired particles from sopharynx. nose to throat for removal. D. They separate two nasal passages down the middle. 18. A client is having surgery. He asks his C) The glottis is the opening of nurse, "When they put that tube in my the vocal cords into which the en- throat, where does it really go?" What dotracheal tube is passed during is the name of the opening of the vocal intubation for surgery. cords? A. Arytenoid cartilage B. Epiglottis C. Glottis D. Palatine tonsils 19. Where does gas exchange occur? B) The alveolus is the structural A. Acinus unit of the lung where gas ex- B. Alveolus change occurs. C. Bronchus D. Carina 20. The client has a fever of 104° F (40° C). In C) A client with fever has a higher which direction, if any, will this shift the demand for oxygen, so the curve oxyhemoglobin dissociation curve? 6 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A. Down will shift to the right for easier dis- B. To the left sociation. C. To the right D. Will not shift 21. Which of the components of a client's A) Clients with asthma often have family history are of particular impor- a family history of allergies. It will tance to the home health nurse who is be important to assess whether assessing a new client with asthma? this client has any allergies that A. Brother is allergic to peanuts. may serve as triggers for an asth- B. Father is obese. ma attack. C. Mother is diabetic. D. Sister is pregnant. 22. Four clients arrive in the emergency C) Chest pain radiating to the department simultaneously with chest shoulder should be assumed to pain. The client with which type of chest be cardiac in origin until proven pain requires immediate attention by otherwise; this requires the im- the nurse? mediate attention of the nurse. A. Client with pain on deep inspiration B. Client with pain on palpation C. Client with pain radiating to the shoulder D. Client with pain that is rubbing in nature 23. The nurse is working in an urgent clinic. D) A client should be able to Which of these four clients needs to be speak in sentences of more than evaluated first by the nurse? three words, and Sao2 of 90% in- A. Client who is short of breath after dicates hypoxemia that requires walking up two flights of stairs intervention on the part of the B. Client with soreness of the arm af- nurse. ter receiving purified protein derivative (PPD) (Mantoux) skin test C. Client with sore throat and fever of 39° C oral D. Client who is speaking in three-word sentences and has SaO2 of 90% by pulse oximetry 7 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 24. A client is admitted to the medical floor A) Anxiety causes increased oxy- with a new diagnosis of lung cancer. gen consumption. Oxygen avail- How can the nurse assist the client ini- ability is limited in lung cancer. tially with the anxiety associated with The availability of the nurse to an- the new diagnosis? swer questions and listen to the A. Encourage client to ask questions client's concerns will decrease and verbalize concerns. anxiety. B. Leave client alone to deal with his own feelings. C. Medicate client with diazepam (Vali- um) for anxiety every 8 hours. D. Provide journals about cancer treat- ment. 25. A client is admitted to the surgical floor C) CT scans, especially spiral with chest pain, shortness of breath, or helical CT scans, with inject- and hypoxemia after having a knee re- ed contrast can detect pulmonary placement. What diagnostic test will the emboli. nurse teach the client about to help con- firm the diagnosis? A. Bronchoscopy B. Chest x-ray C. Computed tomography (CT) scan D. Thoracoscopy 26. You are a charge nurse on a surgical C) Administering oxygen and re- floor. The LPN/LVN informs you that a assessing vital signs to observe new client who had an earlier bron- for improvement is the first action. choscopy has the following vital signs: Administration of oxygen by itself heart rate 132, respiratory rate 26, and may help relieve the client's anx- blood pressure 98/50. The client is anx- iety. ious and his skin is cyanotic. What will be your first action? A. Call the Rapid Response Team. B. Give methylene blue 1% 1 to 2 mg/kg by IV injection C. Administer oxygen. D. Notify the physician immediately. 8 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 27. A client had a thoracentesis 1 day ago. C) A pneumothorax would be He calls the home health agency and the complication of thoracentesis tells the nurse that he is very short of that causes the greatest concern, breath and anxious. What is the major along with these symptoms. concern of the nurse? A. Abscess B. Pneumonia C. Pneumothorax D. Pulmonary embolism 28. The nursing assistant has taken vital A) Bright red blood indicates a signs of the ventilated postoperative rupture in the carotid artery and client who has had radical neck surgery. requires immediate attention. What does the nurse tell the assistant to be especially vigilant for? A. Bright red blood rapidly seeping through the dressing B. Decreased level of consciousness C. Effective pain management D. Heart rate and blood pressure trend- ing up over several hours 29. The nurse answers the client's call light D) The first step the nurse and realizes that the client has an upper will take is to determine the airway obstruction. What is the nurse's cause of the obstruction. After first action? the cause has been determined A. Attempts to remove the obstruction (e.g., tongue, food, inflamma- B. Calls the Rapid Response Team to tion), the nurse can decide the intubate immediately next course of action. C. Calls the Rapid Response Team to perform an emergency cricothyroidoto- my D. Determines the cause of obstruction 30. Which two factors in combination are A) The combination of alcohol the greatest risk factors for head and and tobacco use is one of the neck cancer? greatest risk factors for head and A. Alcohol and tobacco use neck cancer. B. Chronic laryngitis and voice abuse 9 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy C. Marijuana use and exposure to in- dustrial chemicals D. Poor oral hygiene and use of chewing tobacco 31. The nurse is planning care for the B) A picture board overcomes non-English-speaking client who is on language barriers and can be complete voice rest. What alternative used to communicate with clients method of communication does the who do not speak English as well nurse implement? as their family members if a trans- A. Alphabet board lator or a translation phone is not B. Picture board readily available. C. Translator at the bedside D. Word board 32. Which clinical manifestation requires D) Tachypnea is a sign of respi- immediate action by the nurse for the ratory distress that may accom- client with laryngeal trauma? pany laryngeal trauma. This re- A. Aphonia quires immediate action on the B. Hemoptysis part of the nurse. C. Hoarseness D. Tachypnea 33. Which finding in the postoperative C) Excessive swallowing in a client after nasoseptoplasty requires client who has undergone a na- immediate intervention by the nurse? soseptoplasty may indicate pos- A. Ecchymosis terior nasal bleeding and requires B. Edema immediate attention. C. Excessive swallowing D. Sore throat 34. The client has received packing for a A) Ibuprofen is contraindicated posterior nosebleed. In reviewing the in a client with a nosebleed be- client's orders, which order does the cause NSAIDs inhibit clotting. nurse question? A. "Give ibuprofen 800 mg every 8 hours as needed for pain." B. "Encourage bed rest, with the head of the bed elevated 45 to 60 degrees." 10 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy C. "Provide humidified air." D. "Suction at the bedside." 35. Which clinical manifestation in the D) Stridor is an indication of a client with facial trauma is the nurse's partial airway obstruction and re- first priority? quires immediate attention. A. Bleeding B. Decreased visual acuity C. Pain D. Stridor 36. The client admitted for sleep apnea A) During sleep, the muscles re- asks the nurse, "Why does it seem like I lax and the tongue and neck wake up every 5 minutes?" What is the structures are displaced with the nurse's best response? tongue falling back, causing an A. "Because your body isn't getting upper airway obstruction. This rid of carbon dioxide. This is what obstruction leads to apnea and stimulates your body to wake up and increased levels of carbon diox- breathe." ide. Respiratory acidosis stimu- B. "Because your body isn't getting lates neural centers in the brain, enough oxygen. Not getting enough and the client awakens, takes a oxygen is what stimulates you to wake deep breath, and goes back to up and breathe." sleep. After the client returns to C. "Because your tongue may be block- sleep, the cycle may be repeated ing your throat, and you wake up be- as often as every 5 minutes as cause you are choking." the airway is re-obstructed. D. "It isn't really that often. It just feels that way." 37. Which statement by the client with a la- D) Loose clothing or a covering ryngectomy indicates the need for fur- such as a scarf can be used to ther discharge teaching? cover the stoma if the client de- A. "I must avoid swimming." sires. B. "I can clean the stoma with soap and water." C. "I can project mucus when I laugh or cough." D. "I can't put anything over my stoma to cover it." 11 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 38. When suctioning a client with an en- A) Suctioning can be anxiety pro- dotracheal tube for the first time, what ducing for the client. Explaining does the nurse do first? the procedure can decrease the A. Briefly explains the procedure client's anxiety level and, in do- B. Preoxygenates the client ing so, can decrease oxygen con- C. Sets up a sterile field sumption. Each time the client is D. Suctions for 10 to 15 seconds suctioned, reinforcement of how the procedure is completed can decrease anxiety. 39. The client is scheduled for a total laryn- B) A laryngectomy does not in- gectomy. Which statement by the client volve the taste buds, so the client indicates the need for further teaching will still be able to taste foods. about the procedure? However, laryngectomies do af- A. "I hope I can learn esophageal fect the sense of smell, and this speech." has an effect on taste. B. "I really will miss the taste of my favorite food." C. "I won't be able to breathe through my nose anymore." D. "It is hard to believe that I will never hear my own voice again." 40. A newly hired RN with no previous A) The initial treatment for epis- emergency department (ED) experi- taxis is upright positioning with di- ence has just completed a 1-month ori- rect lateral pressure to the nose. entation. Which of these clients would A nurse with minimal ED experi- be most appropriate to assign to this ence could be expected to safe- nurse? ly provide care for this client. In A. Client with epistaxis with profuse addition, laboratory work should bleeding on warfarin (Coumadin) be obtained to assess the client's B. Client with facial burns caused by a ability to clot, given that he is on mattress fire while sleeping warfarin (Coumadin) C. Client with possible facial fractures after a motor vehicle collision (MVC) D. Client with suspected bilateral vocal cord paralysis and stridor 41. 12 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy The nurse manager at a long-term care D) Personal hygiene is within the facility is planning care for a client who scope of practice of the nursing is receiving radiation therapy for laryn- assistant. geal cancer. Which of these tasks will be best to delegate to a nursing assistant? A. Administering throat-numbing lozenges B. Assessing the mouth for inflamma- tion and infection C. Teaching about skin care while re- ceiving radiation D. Washing the skin with soap and water 42. A client with laryngeal cancer is ad- A) Administering medication is a mitted to the medical-surgical unit the skill within the LPN/LVN scope of morning before a scheduled total laryn- practice. As a reminder, anxiolyt- gectomy. Which of these preoperative ics must be administered AFTER interventions can be accomplished by the operative consent has been an LPN/LVN working on the unit? signed, or the consent will be in- A. Administering preoperative antibi- valid. otics and anxiolytics B. Assessing the client's nutritional sta- tus and need for nutrition supplements C. Having the client sign the operative consent form D. Teaching the client about the need for tracheal suctioning after surgery 43. A client who has fallen off a roof ar- B) If the cervical spine has not rives in the emergency department with already been stabilized by EMS possible head, neck, and chest trauma. (emergency medical services), All of these physician requests are re- this is the nurse's top priority. ceived. Which action will the nurse take The neck should be held in place first? manually until a properly fitted A. Give oxygen to keep O2 saturation cervical collar can be applied. In- greater than 93%. nervation of the diaphragm is be- B. Immobilize the neck with a cervical tween cervical spine levels 3 and collar. 5. C. Infuse normal saline by large-bore IV 13 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy catheter. D. Obtain CT scan of head, neck, and chest. 44. The standard laryngectomy plan of care B) In the immediate postoper- for a client admitted with laryngeal can- ative period, relieving pain and cer includes these interventions. Which anxiety is going to be a major intervention will be most important for priority. Because the client will be the nurse to accomplish before the unable to communicate verbally, surgery? establishing a way to communi- A. Educate the client about ways to cate before the surgery will help avoid aspiration when swallowing after by having a plan in place. the surgery. B. Establish a means for communica- tion during the immediate postopera- tive period, such as a Magic Slate or an alphabet board. C. Discuss appropriate clothing to wear that will help cover the laryngectomy stoma and decrease social isolation af- ter surgery. D. Teach the client and significant oth- ers about how to suction and do wound care of the stoma. 45. A client's mother asks what is the most D) It is extremely important that important thing she will need to know to the client always have wire cut- care for her son who is having an inner ters in the event of emesis, so maxillary fixation (IMF) completed as an the wires can be cut to prevent outpatient. What does the RN tell her? aspiration. Remind the client to A. "Give him Phenergan (promethazine) contact the surgeon as soon as by rectum around the clock so he does possible if the wires have been not vomit." cut, so that fixation can be re-es- B. "He can only drink milk and eat ice tablished. cream until the wires come off." C. "He must brush his teeth every 2 hours." D. "Make sure he always has wire cut- ters with him." 14 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 46. A client with sleep apnea who has a A) The nurse should assess new order for continuous positive air- whether the client has actually way pressure (CPAP) with a facemask consistently been using CPAP at returns to the outpatient clinic after 2 night because clients may have weeks with a report of ongoing day- difficulty with the initial adjust- time sleepiness. Which action should ment to this therapy. the nurse take first? A. Ask the client whether CPAP has been used consistently at night. B. Discuss the use of autotitrating pos- itive airway pressure (APAP). C. Plan to teach the client about treat- ment with modafinil (Provigil). D. Suggest that a nasal mask be used instead of a full facemask. 47. Your client has been diagnosed with D) Lorazepam is a short-acting oral and laryngeal cancer. He complet- antianxiety medication that would ed a course of radiation, and it is 2 days be the most appropriate choice since he underwent a total laryngecto- for this client. my. The client had been very anxious about his surgery. Which of the follow- ing medications would you expect to find on his home medication list? A. Amitriptyline (Elavil) B. Diazepam (Valium) C. Ketorolac (Toradol) D. Lorazepam (Ativan) 48. The client is 1 day postoperative from C) Morphine or other opioids are a total laryngectomy for cancer. He has the best choice for this client in indicated to you that he is experiencing the immediate postoperative pe- pain. Pain management for him is best riod. They can be given both as achieved with which medication? a bolus dose and continuous- A. IV ketorolac (Toradol) ly by patient-controlled analge- B. IV midazolam (Versed) sia (PCA). The client's airway and C. IV morphine sulfate (Morphine) respiratory status must be care- D. Oral acetaminophen (Tylenol) fully observed. 15 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 49. A client who has had a recent laryngec- A) NSAIDs are an excellent ad- tomy continues to report pain. Which junct when used with narcotics or of the following medications would be opioid analgesia. best used as an adjunct to a narcotic once he can take oral nutrition? A. Liquid NSAIDs B. Liquid steroids C. Opioid antagonists D. Oral diazepam 50. Your client is the football coach at a A) Nodules on the vocal cords local high school. His chief problem is from overuse may cause hoarse- hoarseness. Which of the following is ness. Complete voice rest is the the best recommendation the nurse can best recommendation. make regarding his care? A. Complete voice rest B. Drinking hot tea with lemon C. Prescription for antibiotics D. Whispering instead of using full voice 51. What is the purpose of wearing fluoride C) The gel trays help prevent radi- gel trays during radiation therapy of the ation scatter when the beam hits mouth? metal in the mouth. A. Keep the mouth moist during treat- ments B. Keep the teeth from turning yellow after treatment C. Prevent radiation scatter when the beam hits metal in the mouth D. Protect the taste buds on the tongue 52. A new client arrives in the medical-sur- D) A complete assessment of the gical unit with a flap. The flap appears area including Doppler activity of dusky in color. What is the nurse's first major feeding vessels needs to action? be completed and the surgeon A. Apply a hot pack over the flap site. needs to be notified because the B. Massage the flap site vigorously. client may have to be returned to C. Place a tight dressing over the flap. the operating room immediately. 16 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy D. Use a Doppler to assess flow to the area. 53. All of these clients are being cared for A) Because asthma is a common on the intensive care step-down unit. pediatric diagnosis, the pediatric Which client should the charge nurse nurse would be familiar with the assign to an RN who has floated from assessment and care needed for the pediatric unit? a client with this diagnosis. A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask. B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour. C. Client with emphysema who requires instruction about correct use of oxygen at home. D. Client with lung cancer who has just been transferred from the ICU after hav- ing a left lower lobectomy the previous day. 54. The RN and the nursing assistant are D) Client education is an RN level working together to provide care for a skill, but reinforcement of previ- group of clients. Which of these nursing ously taught material can be del- activities could the RN delegate to the egated to unlicensed personnel nursing assistant? who are caring for the client. A. Auscultate for improvement in breath sounds in a client who has had a right lower lobectomy. B. Document discharge instructions for a client being discharged with new asthma medications. C. Monitor the effectiveness of oxygen therapy for a client admitted with chron- ic bronchitis. D. Reinforce the use of slow expiration through pursed lips to maximize gas exchange for a client with sarcoidosis. 17 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy 55. A client has just been admitted to the in- A) Airway and oxygenation are tensive care unit (ICU) after having a left main priorities in the immediate lower lobectomy with a video-assisted postoperative period. The client thoracoscopic surgery (VATS). Which of will likely be intubated, so coor- these requests will the nurse implement dination of care with Respiratory first? Therapy will be important. A. Adjust oxygen flow rate to keep O2 saturation at 93% to 100%. B. Administer 2 g of cephalothin (Keflin) IV now. C. Give morphine sulfate 4 to 6 mg IV for pain. D. Infuse 1 unit of packed red blood cells (PRBCs) over the next 2 hours. 56. The change-of-shift report has just B) The client with cystic fibrosis, been completed on the medical-surgi- an elevated temperature, and an cal unit. Which of the following clients elevated respiratory rate is ex- will the oncoming nurse plan to assess hibiting signs of an exacerbation first? and needs to be assessed first. A. Client with COPD who is ready for discharge but is not able to pay for pre- scribed home medications. B. Client with cystic fibrosis (CF) who has an elevated temperature and a res- piratory rate of 38. C. Hospice client with terminal pul- monary fibrosis and an oxygen satura- tion level of 89%. D. Client with lung cancer who needs an IV antibiotic administered before going to surgery. 57. A client with asthma has pneumonia, A) Albuterol is a beta2 agonist is reporting increased shortness of that acts rapidly as a bronchodila- breath, and has inspiratory and expi- tor. ratory wheezes. All of these medica- tions are prescribed. Which medication should the nurse administer first? 18 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A. Albuterol (Proventil) 2 inhalations B. Fluticasone (Flovent) 2 inhalations C. Ipratropium (Atrovent) 2 inhalations D. Salmeterol (Serevent) 2 inhalations 58. Your client has been diagnosed with D) The term mucolytic means chronic bronchitis and started on a mu- "breaking down mucus." Mucolyt- colytic. What is the rationale for order- ics cause secretions to thin and ing a mucolytic for this client? make them easier to be expecto- A. Mucolytics decrease secretion pro- rated. This is important for a client duction. with chronic bronchitis. B. Mucolytics increase gas exchange in the lower airways. C. Mucolytics provide bronchodilation in clients with chronic obstructive pul- monary disease (COPD). D. Mucolytics thin secretions, making them easier to expectorate. 59. The client has asthma that only gets C) Montelukast is a leukotriene worse during the summer. She tells the antagonist that works well for nurse she will be taking a medicine asthma that occurs during certain every day so she does not get short of seasons. It is taken on a daily breath when she walks to work. About basis as a preventive medication. which medicine does the nurse need to educate the client? A. Albuterol (Proventil) inhaler B. Guaifenesin (Organidin) C. Montelukast (Singulair) D. Omalizumab (Xolair) 60. The client is a marathon runner who has D) Short-acting beta agonist asthma. Which category of medication medications have a rapid on- is used as a rescue inhaler? set and cause bronchodilation. A. Corticosteroids These medications would be ex- B. Long-acting beta agonists cellent for marathon running be- C. NSAIDs cause some types of asthma may D. Short-acting beta agonists be exercise induced. 61. 19 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A client has been diagnosed with asth- B) Slow and deep breaths en- ma. Which statement below indicates sure that the medication is reach- that he correctly understands how to ing deeply into the lungs. The use an inhaler with a spacer correctly? whistling noise serves as a re- A. "I don't have to wait between the two minder to the client of which tech- puffs if I use a spacer." nique needs to be used. B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I should rinse my mouth and then swallow the water to get all of the med- icine." D. "Shake the inhaler only if you want to see whether it is empty." 62. What does the nurse do first when set- B) Oxygen is highly flammable. ting up a safe environment for the new The nurse needs to ensure that client on oxygen? no open flames or combustion A. Ensures that staff wear protective hazards are present in a room clothing where oxygen is in use. B. Ensures that no combustion hazards are present in the room C. Sets the oxygen delivery to maintain no fewer than 16 breaths per minute D. Uses a pulse oximetry unit 63. For relief of hypoxemia in the newly ad- A) The client who is hypoxemic mitted client with chronic obstructive and also has chronic hypercarbia pulmonary disease (COPD), what does requires lower levels of oxygen the client most likely need? delivery, usually 1 to 2 L/min via A. Oxygen flow rate of 1 to 2 L/min via nasal cannula. A low arterial oxy- nasal cannula gen level is this client's primary B. Oxygen flow rate of 2 to 4 L/min via drive for breathing. nasal cannula C. Oxygen flow rate of up to 60% via Venturi mask D. 100% non-rebreather mask 64. Because clients with cystic fibrosis A) A serious bacterial infection (CF) are at increased risk for infection, for clients with CF is Burkholderia 20 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy what does the nurse advise the client cepacia, which is spread by ca- with CF to do? sual contact from one CF client A. Avoid Cystic Fibrosis Founda- to another. For this reason, the tion-sponsored events. Cystic Fibrosis Foundation bans B. Avoid the hospital. infected clients (those who have C. Stay at home most of the time. had a positive sputum culture) D. Use an antiseptic hand gel. from participating in any founda- tion-sponsored events. 65. While the nurse is talking with the post- A) Gentle bubbling in the wa- operative thoracic surgery client, the ter seal chamber is normal dur- client coughs and the chest tube collec- ing the client's exhalation, force- tion water seal chamber bubbles. What ful cough, or position changes. does the nurse do? A. Calmly continues talking B. Checks the tube for blocks or kinks C. Immediately calls the physician D. Strips the chest tube 66. An environmental assessment of a fac- D) Teaching everyone to use a tory is conducted, and inhalation ex- mask when working in areas with posure with a high level of particulate high levels of particulate matter matter is found. What does the factory can reduce individual exposure. nurse do to generate the quickest com- pliance? A. Encourages proper building ventila- tion B. Refers workers to a tobacco cessa- tion program C. Suggests that workers find another job D. Teaches workers how to use a mask 67. After receiving education on the cor- C) Because asthma attacks can- rect use of emergency drug therapy for not always be predicted, clients asthma, which statement by the client with asthma must always car- indicates understanding of the nurse's ry a rescue inhaler such as a instructions? short-acting beta agonist (SABA) A. "Asthma drugs help everybody like albuterol (Proventil). 21 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy breathe better." B. "I must carry my emergency inhaler only when activity is anticipated." C. "I must have my emergency inhaler with me at all times." D. "Preventive drugs can stop an at- tack." 68. The client says, "I hate this stupid B) Encourage the client and the COPD." What is the best response by family to express their feelings the nurse? about limitations on their lifestyle A. "Then you need to stop smoking." and about disease progression. B. "What is bothering you?" C. "Why do you feel this way?" D. "You will get used to it." 69. Which statement by the client with B) An annual influenza vaccine chronic obstructive pulmonary disease (flu shot) is important for all (COPD) indicates the need for addition- clients with COPD. At the same al follow-up instruction? time, a pneumonia vaccine could A. "I don't need to use my oxygen all the be offered since pneumonia is time." one of the most common compli- B. "I don't need to get the flu shot." cations of COPD. C. "I need to eat more protein." D. "It is normal to feel more tired than I use to." 70. A client is admitted with asthma. How D) The client may be complete- is this disease differentiated from other ly symptom free between exacer- chronic lung disorders? bations. A. It affects only young people. B. The client has dyspnea. C. The client is coughing. D. The client is symptom free between exacerbations. 71. In a presentation to middle school stu- C) Cigarette smoking is the num- dents, what does the nurse teach as the ber one risk factor for lung cancer major risk factor for lung cancer? and COPD. A. Alcohol consumption 22 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy B. Asbestos exposure C. Cigarette smoking D. Smoking marijuana 72. The nurse has been teaching im- C) Maintaining a baseline Spo2 proved airflow techniques to the client, of 92% after ambulating 50 feet who has continued to have restrictive is an excellent indicator that the breathing problems. Which is the best client has achieved better airflow, indicator of success? and that the nurse's teaching has A. Peak flowmeter readings that are yel- been effective. low after the third reading B. Productive cough C. SpO2 level of 92% after ambulating 50 feet D. Stable arterial blood gases (ABGs) 73. A newly diagnosed client with asthma D) The client is newly diagnosed says that his peak flow meter is reading with asthma. This would be an ex- 82% of his personal best. What does the cellent opportunity for the nurse nurse do? to observe the client using the A. Nothing. This is in the green zone. peak flow meter to ensure that B. Provides the rescue drug and re- the client is using it properly, so assesses readings are accurate and in the C. Provides the rescue drug and seeks green zone, at least 80% of the emergency help client's personal best. D. Repeats the peak flow test 74. The nurse is teaching the client who has B) Skin in the path of radiation been newly diagnosed with cancer. For is more sensitive to sun damage; which side effect specific to radiation therefore clients must avoid direct does the nurse teach prevention tech- skin exposure to the sun during niques? treatment and for at least 1 year A. Hair loss after radiation is completed. B. Increased risk for sunburn C. Loss of appetite D. Pain at site of treatment 75. After surgery for placement of a chest A) Assessing the ABCs is the pri- tube, the client reports burning in the ority to determine possible caus- chest. What does the nurse do first? es of burning in the client's chest. 23 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A. Assesses airway, breathing, and cir- culation B. Calls for the Rapid Response Team C. Checks the patency of the chest tubes D. Listens for breath sounds 76. The nurse is caring for a group of C) Surgery and immobility are clients. Which person does the nurse risks for deep vein thrombosis identify as having the highest risk for (DVT) and PE. pulmonary embolism (PE)? A. A client with diabetes and cellulitis of the leg B. A client receiving IV fluids through a peripheral line C. A client returning from an open re- duction and internal fixation of the tibia D. A client with hypokalemia receiving potassium supplements 77. Which client has a higher risk for devel- A) People who engage in pro- oping a pulmonary embolism (PE)? longed and frequent air travel are A. 25-year-old woman who frequently at higher risk for PE. flies to different countries B. 67-year-old man who works on a farm C. 45-year-old man admitted for a heart attack D. 23-year-old woman with a bleeding disorder 78. The nurse is assessing a client with A) Syncope, hypotension, and possible pulmonary embolism. For fainting are symptoms associat- which symptoms should the nurse as- ed with pulmonary embolism. sess? Select all that apply. C) Sharp, pleuritic, inspiratory A. Dizziness and fainting chest pain is characteristic of PE. B. Shortness of breath (SOB) worsen- ing over the last 2 weeks C. Inspiratory chest pain 24 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy D. Productive cough E. Pink, frothy sputum 79. The nurse is developing the plan of C) Restoring adequate oxygena- care for the client with pulmonary em- tion and tissue perfusion takes bolism (PE). Which client problem does priority when a client presents the nurse establish as the priority? with a PE. A. Inadequate nutrition related to food-drug interactions and anticoagu- lant therapy B. Potential for infection related to leukocytosis C. Hypoxemia related to ventilation-per- fusion mismatch D. Insufficient knowledge related to the cause of pulmonary 80. The registered nurse is overseeing a B) The international normalized nursing student who is administering ratio (INR), a measurement of an- medications to a group of clients with ticoagulation with Coumadin, is in pulmonary disorders. Under which cir- the therapeutic range between 2 cumstance does the nurse NOT correct and 3. the student? ------- A. "You will receive enoxaparin A) Enoxaparin (Lovenox) is a (Lovenox) through the intravenous line low-molecular weight heparin for 3 days." that must be given by the subcu- B. "Therapy with warfarin (Coumadin) taneous route. is effective when your INR is between 2 C) Heparin and Coumadin are and 3." overlapped until the INR is in the C. "Once the physician orders warfarin therapeutic range, then the he- (Coumadin), we will discontinue the in- parin can be discontinued. travenous heparin." D) Aminocaproic acid (Amicar) is D. "If bleeding develops, we will give used as an antidote for throm- you aminocaproic acid to reverse the bolytic therapy and in the treat- anticoagulant." ment of subarachnoid hemor- rhage. 81. When caring for a client with pulmonary B) Hyperventilation triggered by embolism, which blood gas result does hypoxia and pain first leads to 25 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy the nurse anticipate early in the course respiratory alkalosis, indicated by of the disease? low partial pressure of arterial A. pH 7.24, PCO2 55, HCO 26, PO2 56 carbon dioxide (Paco2) and high B. pH 7.46, PCO2 30, HCO 26, PO2 68 pH. No compensation is present C. pH 7.35, PCO2 45, HCO 24, PO2 80 as the HCO3 is normal, and hy- D. pH 7.47, PCO2 35, HCO 30, PO2 75 poxemia is present, consistent with PE. 82. Which intervention will be most effec- A) The underlying cause for anxi- tive in reducing anxiety in the client ety with a PE is hypoxemia, which with a pulmonary embolism (PE)? will be alleviated by oxygen. Re- A. Remain with the client, and provide maining with a client in distress is oxygen in a calm manner. appropriate. B. Have the client breathe into a brown paper bag using pursed lips. C. Offer the client a mild sedative. D. Allow a family member to remain in the room 83. The nurse is caring for a client who was D) Use of aspirin and salicylates discharged 3 weeks ago after a diagno- will prolong the INR and cause sis of pulmonary embolism (PE). He is gastric irritation. currently admitted with gastrointestinal bleeding and an international normal- ized ratio (INR) of 6.9. For which of the following should the nurse assess this client? A. Consumption of green leafy vegeta- bles B. Prolonged exhalation C. Client has massaged his calves. D. Use of aspirin or salicylates 84. The medical-surgical unit nurse should A) This client is showing signs of call the Rapid Response Team to as- possible pulmonary infarction or sess which of these clients? bleeding abnormality secondary A. The client with a diagnosed pul- to heparin. This indicates a sig- monary embolism who is receiving IV nificant decline in status and war- heparin and has bright red hemoptysis 26 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy B. The client with deep vein thrombosis rants activation of the Rapid Re- who is receiving low-molecular weight sponse Team. heparin and has ongoing calf pain C. The client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry of 94% D. The client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs 85. The nurse is caring for a group of A) Pressure on the brainstem clients. Which clients should be moni- may depress respiratory function. tored closely for respiratory failure? Se- B) Acute pancreatitis is a risk lect all that apply. factor for acute respiratory dis- A. Client with a brainstem tumor tress syndrome (ARDS); abdomi- B. Client with acute pancreatitis nal distention also ensues, which C. Client with a T3 spinal cord injury can limit respiratory excursion. D. Client using patient-controlled anal- D) Opiates, which can depress gesia the brainstem, present risk fac- E. Client experiencing cocaine intoxica- tors for respiratory failure. tion 86. Which client needs immediate attention B) This client is showing signs by the RN? of a tension pneumothorax that A. 40-year-old who is receiving contin- could lead to decreased car- uous positive airway pressure (CPAP) diac output and shock if not ad- and has intermittent wheezing dressed promptly. B. 54-year-old who is mechanically ven- tilated and has tracheal deviation C. 57-year-old who was recently extu- bated and is reporting a sore throat D. 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24 87. The nurse is caring for a client who C) A typical reason for the high is receiving mechanical ventilation and pressure alarm to sound is the hears the high-pressure alarm. Which need for suctioning with tension action should the nurse take first? pneumothorax. 27 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy A. Check the ventilator alarm settings. B. Assess the set tidal volume. C. Listen to the client's breath sounds. D. Call the respiratory therapist 88. All of these nursing actions are includ- A) Positioning of clients is includ- ed in the plan of care for a client who ed in UAP education and the job has just been extubated. Which action description and can be delegated should the RN delegate to unlicensed to UAP. assistive personnel (UAP)? A. Keep the head of the bed elevated. B. Teach about incentive spirometer use. C. Monitor vital signs every 5 minutes. D. Adjust the nasal oxygen flow rate. 89. The nurse coming on shift prepares to B) The first priority when caring perform an initial assessment of the se- for the critically ill client is to as- dated ventilated client. Which are prior- sess airway and breathing. ities for the nurse to carry out? Select C) Alarm settings should be con- all that apply. firmed each shift, more frequently A. Ask visitors to leave. if necessary. B. Assess the client's color and respira- D) Ensuring that the client cannot tions. speak ensures that air is going C. Confirm alarms and ventilator set- through the endotracheal tube tings. and not around it. D. Ensure that the tube cuff is inflated E) Auscultating for equal bilateral and is in the proper position. breath sounds assists in confirm- E. Listen for bilateral chest sounds. ing that the tube is above the ca- F. Provide routine tracheotomy and en- rina. dotracheotomy and mouth care. 90. The client has been admitted for a B) Daily platelet counts are pulmonary embolism and is receiving a safety priority in assess- heparin infusion. What safety priority ing for thrombocytopenia. He- does the nurse include in the plan of parin-induced thrombocytopenia care? is a possible side effect. A. Teach the client to avoid using dental floss. 28 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy B. Monitor the platelet count daily. C. Ensure adequate staffing for the unit. D. Notify radiology of an impending scan. 91. The ventilated client in the intensive B) Restlessness, agitation, anx- care unit begins to pick at the bedcov- iety, and tachycardia are early ers. Which action should the nurse take symptoms of hypoxemia. next? A. Increase the sedation, B. Assess for adequate oxygenation, C. Explain to the client that he has a tube in his throat to help him breathe, D. Request that the family leave to de- crease the client's agitation, 92. The nurse is caring for a group of B) Intubation may be indicated clients. The client with which condition for the client who is hypoventi- is in greatest need of immediate intuba- lating and has decreased breath tion? sounds. A. Difficulty swallowing oral secretions B. Hypoventilation and decreased breath sounds C. O2 saturation of 90% D. Thick, purulent secretions and crack- les 93. Which intervention for the client in the A) ICU psychosis can be mini- intensive care unit will decrease the in- mized not only by encouraging cidence of "ICU psychosis"? sleep, but also by keeping to a A. Decreasing nighttime disruptions regular routine. B. Keeping the lights on to promote ori- entation C. Administering sedation D. Providing television or radio for stim- ulation 94. The nurse is assessing a client who B) Symptoms of tension pneu- is receiving mechanical ventilation mothorax include chest asym- with positive end-expiratory pressure metry, tracheal deviation toward 29 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy (PEEP). Which findings would cause the the unaffected side, dyspnea, ab- nurse to suspect a left-sided tension sent breath sounds, JVD (jugu- pneumothorax? lar venous distention), cyanosis, A. Chest caves in on inspiration and and hyperresonance to percus- "puffs out" on expiration. sion over the affected area. B. Trachea is deviated to the right side and cyanosis is present. C. The left lung field is dull to percus- sion with crackles present on ausculta- tion. D. Client has bloody sputum and wheezes. 95. The nurse is caring for a group of crit- C) Aspiration of acidic gastric ically ill clients. Which client has the contents is a risk for ARDS. greatest risk for developing acute res- piratory distress syndrome (ARDS)? A. A client with diabetic ketoacidosis (DKA) B. A client with atrial fibrillation C. A client with aspiration pneumonia D. A client with acute renal failure 96. The nurse is teaching the family of a C) Paralytics and sedation de- client who is receiving mechanical ven- crease oxygen demand. tilation. Which statement reflects ap- propriate information that the nurse should communicate? A. Sedation is needed so your loved one does not rip the breathing tube out. B. Suctioning is important to remove organisms from the lower airway. C. Paralysis and sedatives help de- crease the demand for oxygen. D. We are encouraging oral and intra- venous fluids to keep your loved one hydrated. 97. 30 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy The nurse is caring for a client with im- B) Bi-level positive-pressure ven- pending respiratory failure who refuses tilation is a noninvasive method intubation and mechanical ventilation. that may provide short-term ven- Which method provides an alternative tilation without intubation. to mechanical ventilation? A. Oropharyngeal airway B. Bi-level positive airway pressure (Bi- PAP) C. Non-rebreathing mask with 100% oxygen D. Positive end-expiratory pressure (PEEP) 98. Which of these clients would be appro- B) This finding, although abnor- priate to assign to the new nurse work- mal, is anticipated for a client with ing on the unit? chronic obstructive pulmonary A. A client with diabetic ketoacidosis disease (COPD) and is stable for and change in mental status who has a a new graduate. pH of 7.18 B. A client with emphysema and celluli- tis with a PaCO2 level of 58 mm Hg C. A client with reactive airway disease, wheezing, and a PaO2 level of 62 mm Hg D. A client with a small bowel obstruc- tion and vomiting with a bicarbonate level of 40 mEq/L 99. A new nurse graduate is caring for a A) Respiratory acidosis is caused postoperative client with the following by CO2 retention and impaired arterial blood gases (ABGs): pH, 7.30; chest expansion secondary to PCO2, 60 mm Hg; PO2, 80 mm Hg; bicar- anesthesia. The nurse takes bonate, 24 mEq/L; and O2 saturation, steps to promote CO2 elimi- 96%. Which of these actions by the new nation, including maintaining a graduate is indicated? patent airway and expanding the A. Encourage the client to use the in- lungs through breathing tech- centive spirometer and to cough. niques. B. Administer oxygen by nasal cannula. C. Request a prescription for sodi- 31 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy um bicarbonate from the health care provider. D. Inform the charge nurse that no changes in therapy are needed. 100. The nurse is caring for a client with hy- D) Placing a peripheral pulse poxemia and metabolic acidosis. Which oximeter is a standardized nurs- of these tasks can be delegated to the ing skill that is within the scope nursing assistant who is helping with of practice for unlicensed person- the client's care? nel. A. Assess the client's respiratory pat- tern. B. Increase the IV normal saline to 120 mL/hr. C. Titrate O2 to maintain an O2 satura- tion of 95% to 100%. D. Apply the pulse oximeter for contin- uous readings. 101. Which nursing intervention takes pri- D) The nurse follows the ABCs ority for a client admitted with severe and initiates cardiac monitoring metabolic acidosis? to observe for signs of hyper- A. Perform medication reconciliation. kalemia or cardiac arrest. B. Assess the client's strength in the extremities. C. Obtain a diet history for the past 3 days. D. Initiate cardiac monitoring. 102. The nurse is caring for a critically ill A) Increased lactate levels are client with septic shock. The serum lac- associated with hypoxia and tate level is 6.2. For which of the follow- metabolic acidosis secondary to ing acid-base disturbances should the anaerobic metabolism. nurse assess? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis 103. 32 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy The nurse is caring for a client who has B) Diuretics (non-potassium taken a large quantity of furosemide sparing) cause metabolic alkalo- (Lasix) to promote weight loss. The sis. nurse anticipates the finding of which acid-base imbalance? A. PO2 of 78 mm Hg B. HCO of 34 mEq/L C. PCO2 of 56 mm Hg D. pH of 7.31 104. The nurse is caring for a client with an C) Support with mechanical ven- oxygen saturation of 88% and acces- tilation may be needed for clients sory muscle use. The nurse provides who cannot keep their oxygen oxygen and anticipates which of these saturation at 90% or who have physician orders? respiratory muscle fatigue. A. Administration of IV sodium bicar- bonate B. Computed tomography (CT) of the chest, stat C. Intubation and mechanical ventila- tion D. Administration of concentrated potassium chloride solution 105. The nurse is caring for a group of C) If acidosis is metabolic in ori- clients with acidosis. The nurse recog- gin, the rate and depth of breath- nizes that Kussmaul respirations are ing increase as the hydrogen consistent with which situation? ion level rises; this is known as A. Client receiving mechanical ventila- Kussmaul respirations. Metabolic tion acidosis is caused by alcoholic B. Use of hydrochlorothiazide beverages, methyl alcohol, and C. Aspirin overdose acetylsalicylic acid (aspirin). D. Administration of sodium bicarbon- ate 106. Which action should the nurse take first A) Because respiratory alkalosis for the client who is admitted to the is caused by hyperventilation, the emergency department (ED) with a pan- nurse's first action should be to ic attack and whose blood gases indi- 33 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy cate respiratory alkalosis? assist the client in slowing the A. Encourage the client to take slow respiratory rate. breaths. B. Obtain a prescription for a fluid and electrolyte infusion. C. Administer oxygen using ED stan- dard orders. D. Place an emergency cart close to the client's room. 107. To decrease the risk of acid-base im- D) Maintaining blood glucose lev- balance, what goal must the client with els within normal limits is the diabetes mellitus strive for? best way to decrease the risk of A. Checking blood glucose levels once acid-base imbalance. daily B. Drinking 3 L of fluid per day C. Eating regularly, every 4 to 8 hours D. Maintaining blood glucose level with- in normal limits 108. Which client is most likely to exhibit the B) Hydromorphone (Dilaudid), a following ABG results: pH, 7.30; PaCO2, narcotic analgesic, can cause 49; HCO , 26; PO2, 76? respiratory depression, hypoven- A. Client with kidney failure tilation, and respiratory acidosis, B. Client taking hydromorphone (Dilau- as this blood gas reading demon- did) strates. C. Client with anxiety disorder D. Client with hyperkalemia 109. When caring for a group of clients at D) Cigarette smoking worsens risk for respiratory acidosis, the nurse gas exchange, leading to disor- identifies which person as at highest ders that contribute to hypoventi- risk? lation and respiratory acidosis. A. An athlete in training B. Pregnant woman with hyperemesis gravidarum C. Person with uncontrolled diabetes D. Client who smokes cigarettes 110. 34 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy Which acid-base disturbance does the C) Respiratory acidosis is relat- nurse anticipate the client with morbid ed to CO2 retention secondary obesity may develop? to respiratory depression, inad- A. Metabolic acidosis equate chest expansion, airway B. Metabolic alkalosis obstruction, and reduced alveo- C. Respiratory acidosis lar-capillary diffusion, common in D. Respiratory alkalosis the morbidly obese, who expe- rience inadequate chest expan- sion owing to their size and work of breathing. 111. When caring for a client with a pulse B) Applying oxygen is the first pri- oximetry level of 89%, which action ority for a client with hypoxemia. should the nurse take first? A. Get the client out of bed. B. Apply oxygen as prescribed. C. Notify the client's physician. D. Auscultate breath sounds. 112. The nurse is caring for a client who is A) First-generation antihista- taking a first-generation antihistamine. mines cause drowsiness. What is the most important fact for the nurse to teach the client? A. "Do not drive after taking this med- ication." B. "Make sure you drink a lot of liquids while on this medication." C. "Take this medication on an empty stomach." D. "Do not take this medication for more than 2 days." 113. The nurse is caring for a client in the D) Second-generation antihista- clinic who states that he is afraid of mines are often called nonsedat- taking antihistamines because he is a ing antihistamines. These may be truck driver. What is the best informa- safer for the client to take, but the tion for the nurse to give this client? client should still monitor for signs A. "Take the medication only when you of excessive sedation. are not driving." 35 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy B. "Take a lower dose than normal when you have to drive." C. "You are correct, you should not take antihistamines." D. "You may be able to safely take a second-generation antihistamine." 114. The client tells the nurse that she has a B) The client needs an expecto- bad cold, is coughing, and feels like she rant. This medication will help the has "stuff" in her lungs. What should client cough the "stuff" out of her the nurse do? lungs. Dextromethorphan and flu- A. Administer dextromethorphan. ticasone will not help the client B. Administer guaifenesin. expectorate. There is no informa- C. Encourage the client to drink fluids tion about the client's fluid intake, hourly. so hourly fluids may be too much. D. Administer fluticasone (Flonase). 115. What is the most important thing for the B) Loratadine (Claritin) does not nurse to teach a client who is switch- affect the central nervous system ing allergy medications from diphenhy- and therefore is nonsedating. dramine (Benadryl) to loratadine (Clar- itin)? A. This medication can potentially cause dysrhythmias. B. This medication has fewer sedative effects. C. This medication has increased bron- chodilating effects. D. This medication causes less gas- trointestinal upset. 116. A client complains of worsening nasal B) Oxymetazoline (Afrin) is an ef- congestion despite the use of oxymeta- fective nasal decongestant, but zoline (Afrin) nasal spray every 2 hours. overuse results in worsening or What is the nurse's best response? "rebound" congestion. It should A. "Oxymetazoline is not an effective not be used more than every 4 nasal decongestant." hours. To avoid future rebound B. "Overuse of nasal decongestants re- congestion with nasal sprays, it is sults in rebound congestion." 36 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy C. "Oxymetazoline should be admin- recommended that they be used istered every hour for severe conges- for no more than 3 to 5 days. tion." D. "You are probably displaying an idio- syncratic reaction to oxymetazoline." 117. Which statement indicates that the B) Beclomethasone diproprion- client understands the teaching about ate (Beconase) is a steroid spray beclomethasone diproprionate (Be- administered nasally. It is used conase)? to prevent allergy symptoms. Its A. "I will need to taper off the medica- effect is localized, and therefore tion to prevent acute adrenal crisis." the client does not have systemic B. "This medication will help prevent side effects with normal use and the inflammatory response of my aller- does not have to worry about gies." weaning off the medication as C. "I will need to monitor my blood with oral corticosteroids. sugar more closely because it may in- crease." D. "I need to take this medication only when my symptoms get bad." 118. A client is prescribed an antitussive A) Antitussive medications also medication. What is the most important affect the CNS, thus causing thing for the nurse to teach the client? drowsiness and dizziness. A. "This medication may cause drowsi- ness and dizziness." B. "Watch out for diarrhea and abdomi- nal cramping." C. "This may cause tremors and anxi- ety." D. "Headache and hypertension are common side effects." 119. Which is the best instruction for the C) Expectorant drugs are used to nurse to include when teaching a client decrease viscosity of secretions about the use of expectorants? and allow them to be more easily A. Restrict fluids in order to decrease expectorated. Increasing fluid in- mucus production. take helps this action. B. Take the medication once a day only, 37 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy at bedtime. C. Increase fluid intake in order to de- crease viscosity of secretions. D. Increase fiber and fluid intake to pre- vent constipation. 120. The nurse is caring for a client with a C) The therapeutic theophylline theophylline level of 14 mcg/mL. What level is 10 to 20 mcg/mL. The is the priority nursing intervention? nurse should continue interven- tions and monitor oxygenation. a. Increase the IV drip rate. b. Monitor the client for toxicity. c. Continue to assess the client's oxy- genation. d. Stop the IV for an hour then restart at lower rate. 121. Discharge teaching to a client receiving D) A beta-agonist bronchodilator a beta-agonist bronchodilator should stimulates the beta receptors of emphasize reporting which side effect? the sympathetic nervous system, resulting in tachycardia, bron- a. Hypoglycemia chodilation, hyperglycemia (if se- b. Nonproductive cough vere), and alertness. c. Sedation d. Tachycardia 122. The nurse is instructing a client about D) Salmeterol (Serevent) has a the advantages of salmeterol (Serevent) longer duration of action, requir- over other beta2 agonists such as al- ing the client to use it only twice buterol (Proventil). How will the nurse a day instead of four times a day explain to the client the difference in with albuterol (Proventil). these two medications? a. Salmeterol has a shorter onset of ac- tion. b. Salmeterol does not have any side effects. c. Albuterol has a longer onset of ac- tion. 38 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy d. Salmeterol has a longer duration of action. 123. A client with a history of asthma is short C) In an acute asthmatic attack, of breath and says, "I feel like I'm hav- the short-acting sympathomimet- ing an asthmatic attack." What is the ics are the first line of defense. nurse's best action? a. Call a code. b. Ask the client to describe the symp- toms. c. Administer a beta2 adrenergic ago- nist. d. Administer a long-acting glucocorti- coid. 124. A client demonstrates understanding of B) Flunisolide (AeroBid) is an in- flunisolide (AeroBid) by saying that he haled corticosteroid. Rinsing the will do what? mouth will help prevent oral can- didal infections. It is not used to a. Take two puffs to treat an acute asth- treat an acute asthma attack and ma attack. should be taken with the client's b. Rinse his mouth with water after each bronchodilator medications. If the use. client is taking oral prednisone, it c. Immediately stop taking his oral pred- needs to be tapered off to pre- nisone when he starts using AeroBid. vent acute adrenal crisis because d. Not use his albuterol inhaler while he flunisolide is minimally absorbed is taking AeroBid. systemically. 125. The nurse is caring for a young child D) If a child is unable to use who has been prescribed an inhaler for the inhaler, the medication will control of her asthma. The child is hav- be trapped in the mouth. Using a ing difficulty using the inhaler. What is spacer helps the medication to be the nurse's best action? deposited to the lungs. a. Tell the parent to hold the inhaler for the child. b. Ask the health care provider to switch to oral medications. 39 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy c. Tell the parent that young children should not use inhalers. d. Teach the child to use a spacer. 126. The nurse is caring for clients on the D) The side effects of epineph- pulmonary unit. Which client should not rine include tachycardia, dys- receive epinephrine if ordered? rhythmias, and palpitations. This client should not receive epineph- a. The client with a history of emphyse- rine. ma b. The client with a history of type 2 diabetes c. The client who is 16 years old d. The client with atrial fibrillation with a rate of 100 127. The health care provider orders B) Administering the bronchodila- ipratropium bromide (Atrovent), al- tor albuterol (Proventil) first al- buterol (Proventil), and beclometha- lows the other drugs to reach sone (Vanceril) inhalers for a client. deeper into the lungs as the What is the nurse's best action? bronchioles dilate. Anticholiner- gics such as ipratropium bromide a. Question the order; three inhalers (Atrovent) also help bronchodi- should not be given at one time. late, but to a lesser extent. Cor- b. Administer the albuterol first, wait ticosteroids such as beclometha- 5 minutes, and administer ipratropium sone (Vanceril) do not dilate and bromide, followed by beclomethasone are therefore given last. several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipra- tropium bromide, followed by the al- buterol several minutes later. 128. Which instruction will the nurse include C) Holding the breath for 10 sec- when teaching a client about the proper onds allows the medication to be use of metered-dose inhalers? absorbed in the bronchial tree 40 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy a. "After you inhale the medication rather than be immediately ex- once, repeat until you obtain relief." haled. b. "Make sure that you puff out air re- peatedly after you inhale the medica- tion." c. "Hold your breath for 10 seconds if you can after you inhale the medica- tion." d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." 129. What will the nurse expect to find that C) Acetylcysteine is a mucolytic would indicate a therapeutic effect of drug used to liquefy and loosen acetylcysteine (Mucomyst)? bronchial secretions in order to enhance their expectoration. a. Decreased cough reflex b. Decreased nasal secretions c. Liquefying and loosening of bronchial secretions d. Relief of bronchospasms 130. What is the most important thing for the C) Beta2 agonists may increase nurse to teach the client with a history blood glucose levels. Clients with of diabetes and asthma who has started diabetes should monitor serum on albuterol PRN? glucose levels frequently while taking this medication. a. Take Tylenol for headaches when tak- ing albuterol. b. Monitor for orthostatic hypotension every 2 hours when taking albuterol. c. Monitor blood glucose levels every 4 hours when taking albuterol. d. An antianxiety agent may be pre- scribed to help with nervousness. 131. A client is prescribed ipratropium and B) When using an anticholiner- cromolyn sodium. What will the nurse gic in conjunction with an in- teach the client? haled glucocorticoid or cromolyn, 41 / 42  Respiratory NCLEX Questions Study online at https://quizlet.com/_21gxpy the ipratropium should be used 5 a. "Do not take these medications with- minutes before the steroid. This in 4 hours of each other." causes the bronchioles to dilate b. "Take the ipratropium at least 5 min- so the steroid or cromolyn can utes before the cromolyn." get deeper into the lungs. c. "Administer both medications to- gether in a metered-dose inhaler." d. "Take the ipratropium only in the mornings." 42 / 42