Respiratory NCLEX Questions

Respiratory NCLEX questions 1. You are preparing to care for a client with a history of COPD on the med surg floor, who has been admitted with acute exacerbation of COPD. What findings would you expect when you assess this client? Select all that apply A. B. C. D. E. Decreased 02 saturation on mild exertion. Widened diaphragm on chest radiology. Increased vital capacity during pulmonary function testing. Hypocapnia Hyperinflated lung on chest x-ray. Rationale : Clinical manifestations of COPD ➔ ➔ ➔ ➔ ➔ ➔ ➔ Hypoxia Hypercapnia Dyspnea on exertion and at rest Oxygen desaturation with exercise Use of accessory muscles during respiration Flattened diaphragm Decreased vital capacity This question is based on content. We must have an understanding of COPD and the pathophysiology. The best strategy here guys is to use the true/ false method when you have select all that apply questions. A.: Correct /true , due to narrowed airway clearance and inability to exchange oxygen for c02 your client will exhibit low 02 saturation levels. Clients with COPD usually sat around 85%. B: Incorrect/ false in a client with COPD the diaphragm will appear flat on x-ray due to accumulated scar tissue and decreased lung compliance from long standing hyperinflation damage. C: incorrect / False: We will see a decreased vital capacity due to damage to the lung tissue and diaphragm D: Incorrect,/false, we know that a client suffering from COPD will have hypercapnia . This occurs because of narrowing airways and inability to exchange 02 and co2. You may also see ABG results showing respiratory acidosis because of this. E: Correct/true , this is a clinical manifestation of COPD. Hyperinflated lungs can be caused by blockages in the air passages or by air sacs that are less elastic, which interferes with the expulsion of air from the lungs. 2. You are suctioning a client via endotracheal tube. During the procedure you note that the client's heart rate decreases from 78 bpm to 57 bpm. What is the priority nursing action? A. B. C. D. Ensure that you are only suctioning for 15 seconds Continue to suction and document the client's response Immediatly stop the procedure and reoxingate the client Notify the HCP Rationale Priority nursing actions during endotracheal tube suctioning With priority questions think, if I as the nurse could do only one thing for this client then leave the room, what would be the most safe, the most important, and provide a positive outcome? ➔ Monitor for : Hypoxemia, cardiac irregularities including decreased heart rate that results from vagal stimulation, mucosal trauma, paroxysmal coughing, hypotension. A. Incorrect, you want to suction for only 10 seconds to decrease the risk of vagal stimulation & hypoxemia Remember to hyperoxygenate your client before suction and in between passes. B. Incorrect, the client is having vagal reaction , your priority in this case is to stop suction and oxygenate the client. This is also incorrect because it does nothing for your client to help them get better. C. Correct, priority in this case is to stop suction and oxygenate the client. D. Incorrect, this is inappropriate because there are nursing actions you can take before calling the HCP. Always think what can YOU do before calling backup, this is also considered passing the buck. 3. You are educating a group of high school students in a low socioeconomic area on signs and symptoms of tuberculosis. You assess the teaching has been effective if the students identify which as the one of the first signs of tuberculosis? A. B. C. D. E. Chest pain Night sweats Dyspnea Bloody sputum A productive cough that produces mucus Rationale Signs and symptoms of TB These types of questions are assessing your ability to apply the knowledge you have about TB. Notice the word first? That indicates you need to know the progressive pathophysiology of this disease process. They are asking what symptom would you initially see in a client with TB. This could be mild or severe. ➔ ➔ Early : Mucus producing cough that lasts more than three weeks, flu like symptoms Late : Dyspnea, night sweats, chills, fever, bloody sputum production A. B. C. D. E. Incorrect , this is a late manifestation Incorrect , this is a late manifestation Incorrect , this is a late manifestation Incorrect, this is a late manifestation this is a sign that the TB has settled into the lungs Correct, development of A lingering productive cough that produces mucus is one of the first signs of TB 4. You are caring for a client in the ICU whom is on a ventilator. The low- pressure alarm sounds. You assess the client and the ventilator and are unable to determine the cause of the alarm. What is your initial action? A. B. C. D. Check the clients vitals Administer oxygen Ventilate the client manually Initiate CPR Rationale Ventilator alarm priority setting With priority questions think, if I as the nurse could do only one thing for this client then leave the room, what would be the most safe, the most important, and provide a positive outcome? Causes of Low-pressure alarm If at anytime you cannot find the cause of the alarm, the client is to be disconnected from the ventilator and oxygenated manually to support respirations until the problem can be fixed. ➔ Disconnection or leak in the ventilator or in the client's airway cuff. ➔ The client spontaneously stops breathing A. Incorrect, while vitals are vital we need to think about our ABC’s in this case we have a breathing problem that can quickly become a circulation problem. Obtaining vitals is not the priority action. B. Incorrect, this answer looks good and oxygen can be helpful in this situation it will not provide proper ventilation to the client, the lungs need to be expanded. C. Correct, If at anytime you cannot find the cause of the alarm, the client is to be disconnected from the ventilator and oxygenated manually to support respirations until the problem can be fixed. D. Incorrect , there is no evidence that initiation of CPR is needed. 5. You are the nurse on a med surg floor caring for a client admitted with COPD. The client is using his accessory muscles to breathe and is becoming tired. What is your priority action for this client? A. B. C. D. Lower the head of bed Call the HCP Administer oxygen at 100% Educate the client on pursed lip breathing Rationale Know your interventions for COPD With priority questions think, if I as the nurse could do only one thing for this client then leave the room, what would be the most safe, the most important, and provide a positive outcome? ➔ Interventions for COPD ➔ Monitor vitals ➔ Administer 02 at low concentrations 1-2 L/min Nasal cannula ➔ Monitor oxygen saturation levels ➔ Provide respiratory treatments and Chest physiotherapy ➔ Educate the client on abdominal, diaphragmatic , and pursed lip breathing to help expel c02 A. B. C. D. Incorrect, lowering the head of the bed will make it harder for them to breathe. You want to elevate the HOB Incorrect, think! What else can you do for this client before calling the HCP. This client is not in distress yet. Incorrect, you want to Administer 02 at low concentrations 1-2 L/min Nasal cannula Correct, Educating the client on abdominal, diaphragmatic , and pursed lip breathing will aid in lung expansion and help expel c02