NURS 211 - NCLEX Style Questions (Gas
Exchange) Exam Latest Update
A nurse is assessing a client with chronic airflow limitation and notes that the client has
a "barrel chest." The nurse interprets that this client has which of the following forms of
chronic airflow limitation?
A. Chronic obstructive bronchitis
B. Emphysema
C. Bronchial asthma
D. Bronchial asthma and bronchitis - ANSWER Correct Answer: B. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the
diaphragm. These lead to increased anteroposterior diameter, which is referred to as
"barrel chest." The client also has dyspnea with prolonged expiration and has
hyperresonant lungs to percussion.
Which of the following would be an expected outcome for a client recovering from an
upper respiratory tract infection? The client will:
A. Maintain a fluid intake of 800 ml every 24 hours.
B. Experience chills only once a day.
C. Cough productively without chest discomfort.
D. Experience less nasal obstruction and discharge. - ANSWER Correct Answer: D.
Experience less nasal obstruction and discharge.
A client recovering from an URI should report decreasing or no nasal discharge and
obstruction. Decongestants and combination antihistamine/decongestant medications
can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in
children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and
sneezing during the first 2 days of a cold in adults
Which of the following individuals would the nurse consider to have the highest priority
for receiving an influenza vaccination?
A. A 60-year-old man with a hiatal hernia.
,B. A 36-year-old woman with 3 children.
C. A 50-year-old woman caring for a spouse with cancer.
D. A 60-year-old woman with osteoarthritis. - ANSWER Correct Answer: C. A 50-year-old
woman caring for a spouse with cancer.
Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza to
prevent transmission to those who have a decreased capacity to deal with the disease.
The wife who is caring for a husband with cancer has the highest priority of the clients
described.
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After
3 days, she developed a cough productive of yellow sputum. The nurse auscultates her
lungs and hears diffuse crackles. How would the nurse best interpret these assessment
findings?
A. It is likely that the client is developing a secondary bacterial pneumonia.
B. The assessment findings are consistent with influenza and are to be expected.
C. The client is getting dehydrated and needs to increase her fluid intake to decrease
secretions
D. The client has not been taking her decongestants and bronchodilators as prescribed.
- ANSWER Correct Answer: A. It is likely that the client is developing a secondary
bacterial pneumonia.
Pneumonia is the most common complication of influenza, especially in the elderly. The
development of a purulent cough and crackles may be indicative of a bacterial infection
that is not consistent with a diagnosis of influenza.
A client with COPD reports steady weight loss and being "too tired from just breathing
to eat." Which of the following nursing diagnoses would be most appropriate when
planning nutritional interventions for this client?
A. Altered nutrition: Less than body requirements related to fatigue.
B. Activity intolerance related to dyspnea.
C. Weight loss related to COPD.
D. Ineffective breathing pattern related to alveolar hypoventilation. - ANSWER Correct
Answer: A. Altered nutrition: Less than body requirements related to fatigue.
,The client's problem is altered nutrition—specifically, less than required. The cause, as
stated by the client, is the fatigue associated with the disease process. Instruct the
patient to frequently eat high caloric foods in smaller portions. COPD patients expend an
extraordinary amount of energy simply on breathing and require high caloric meals to
maintain body weight and muscle mass.
When developing a discharge plan to manage the care of a client with COPD, the nurse
should anticipate that the client will do which of the following?
A. Develop infections easily.
B. Maintain current status.
C. Require less supplemental oxygen.
D. Show permanent improvement. - ANSWER Correct Answer: A. Develop infections
easily.
A client with COPD is at high risk for development of respiratory infections. In
emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils
and macrophages are recruited and release multiple inflammatory mediators. Oxidants
and excess proteases leading to the destruction of the air sacs. The protease-mediated
destruction of elastin leads to a loss of elastic recoil and results in airway collapse
during exhalation.
Which of the following outcomes would be appropriate for a client with COPD who has
been discharged to home? The client:
A. Promises to do pursed lip breathing at home.
B. States actions to reduce pain.
C. States that he will use oxygen via a nasal cannula at 5 L/minute.
D. Agrees to call the physician if dyspnea on exertion increases. - ANSWER Correct
Answer: D. Agrees to call the physician if dyspnea on exertion increases.
Increasing dyspnea on exertion indicates that the client may be experiencing
complications of COPD, and therefore the physician should be notified. There are things
that everyone with COPD should do to manage their disease; quitting smoking (if they
smoke) is the most important. In addition, there are other non-medication treatments
that can help relieve symptoms and improve quality of life.
Which of the following physical assessment findings would the nurse expect to find in a
, client with advanced COPD?
A. Increased anteroposterior chest diameter.
B. Underdeveloped neck muscles.
C. Collapsed neck veins.
D. Increased chest excursions with respiration. - ANSWER Correct Answer: A.
Increased anteroposterior chest diameter.
Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is
trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The
result is the typical barrel-chested appearance. In addition, coarse crackles beginning
with inspiration may be heard.
Which of the following is the primary reason to teach pursed-lip breathing to clients with
emphysema?
A. To promote oxygen intake.
B. To strengthen the diaphragm.
C. To strengthen the intercostal muscles.
D. To promote carbon dioxide elimination. - ANSWER Correct Answer: D. To promote
carbon dioxide elimination.
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the
client relax, pursed-lip breathing helps the client learn to control the rate and depth of
respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the
diaphragm, or strengthen intercostal muscles.
A 34-year-old woman with a history of asthma is admitted to the emergency department.
The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute,
nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals
greatly diminished breath sounds. Based on these findings, what action should the
nurse take to initiate care of the client?
A. Initiate oxygen therapy and reassess the client in 10 minutes.
B. Draw blood for an ABG analysis and send the client for a chest x-ray.
Exchange) Exam Latest Update
A nurse is assessing a client with chronic airflow limitation and notes that the client has
a "barrel chest." The nurse interprets that this client has which of the following forms of
chronic airflow limitation?
A. Chronic obstructive bronchitis
B. Emphysema
C. Bronchial asthma
D. Bronchial asthma and bronchitis - ANSWER Correct Answer: B. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the
diaphragm. These lead to increased anteroposterior diameter, which is referred to as
"barrel chest." The client also has dyspnea with prolonged expiration and has
hyperresonant lungs to percussion.
Which of the following would be an expected outcome for a client recovering from an
upper respiratory tract infection? The client will:
A. Maintain a fluid intake of 800 ml every 24 hours.
B. Experience chills only once a day.
C. Cough productively without chest discomfort.
D. Experience less nasal obstruction and discharge. - ANSWER Correct Answer: D.
Experience less nasal obstruction and discharge.
A client recovering from an URI should report decreasing or no nasal discharge and
obstruction. Decongestants and combination antihistamine/decongestant medications
can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in
children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and
sneezing during the first 2 days of a cold in adults
Which of the following individuals would the nurse consider to have the highest priority
for receiving an influenza vaccination?
A. A 60-year-old man with a hiatal hernia.
,B. A 36-year-old woman with 3 children.
C. A 50-year-old woman caring for a spouse with cancer.
D. A 60-year-old woman with osteoarthritis. - ANSWER Correct Answer: C. A 50-year-old
woman caring for a spouse with cancer.
Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza to
prevent transmission to those who have a decreased capacity to deal with the disease.
The wife who is caring for a husband with cancer has the highest priority of the clients
described.
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After
3 days, she developed a cough productive of yellow sputum. The nurse auscultates her
lungs and hears diffuse crackles. How would the nurse best interpret these assessment
findings?
A. It is likely that the client is developing a secondary bacterial pneumonia.
B. The assessment findings are consistent with influenza and are to be expected.
C. The client is getting dehydrated and needs to increase her fluid intake to decrease
secretions
D. The client has not been taking her decongestants and bronchodilators as prescribed.
- ANSWER Correct Answer: A. It is likely that the client is developing a secondary
bacterial pneumonia.
Pneumonia is the most common complication of influenza, especially in the elderly. The
development of a purulent cough and crackles may be indicative of a bacterial infection
that is not consistent with a diagnosis of influenza.
A client with COPD reports steady weight loss and being "too tired from just breathing
to eat." Which of the following nursing diagnoses would be most appropriate when
planning nutritional interventions for this client?
A. Altered nutrition: Less than body requirements related to fatigue.
B. Activity intolerance related to dyspnea.
C. Weight loss related to COPD.
D. Ineffective breathing pattern related to alveolar hypoventilation. - ANSWER Correct
Answer: A. Altered nutrition: Less than body requirements related to fatigue.
,The client's problem is altered nutrition—specifically, less than required. The cause, as
stated by the client, is the fatigue associated with the disease process. Instruct the
patient to frequently eat high caloric foods in smaller portions. COPD patients expend an
extraordinary amount of energy simply on breathing and require high caloric meals to
maintain body weight and muscle mass.
When developing a discharge plan to manage the care of a client with COPD, the nurse
should anticipate that the client will do which of the following?
A. Develop infections easily.
B. Maintain current status.
C. Require less supplemental oxygen.
D. Show permanent improvement. - ANSWER Correct Answer: A. Develop infections
easily.
A client with COPD is at high risk for development of respiratory infections. In
emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils
and macrophages are recruited and release multiple inflammatory mediators. Oxidants
and excess proteases leading to the destruction of the air sacs. The protease-mediated
destruction of elastin leads to a loss of elastic recoil and results in airway collapse
during exhalation.
Which of the following outcomes would be appropriate for a client with COPD who has
been discharged to home? The client:
A. Promises to do pursed lip breathing at home.
B. States actions to reduce pain.
C. States that he will use oxygen via a nasal cannula at 5 L/minute.
D. Agrees to call the physician if dyspnea on exertion increases. - ANSWER Correct
Answer: D. Agrees to call the physician if dyspnea on exertion increases.
Increasing dyspnea on exertion indicates that the client may be experiencing
complications of COPD, and therefore the physician should be notified. There are things
that everyone with COPD should do to manage their disease; quitting smoking (if they
smoke) is the most important. In addition, there are other non-medication treatments
that can help relieve symptoms and improve quality of life.
Which of the following physical assessment findings would the nurse expect to find in a
, client with advanced COPD?
A. Increased anteroposterior chest diameter.
B. Underdeveloped neck muscles.
C. Collapsed neck veins.
D. Increased chest excursions with respiration. - ANSWER Correct Answer: A.
Increased anteroposterior chest diameter.
Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is
trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The
result is the typical barrel-chested appearance. In addition, coarse crackles beginning
with inspiration may be heard.
Which of the following is the primary reason to teach pursed-lip breathing to clients with
emphysema?
A. To promote oxygen intake.
B. To strengthen the diaphragm.
C. To strengthen the intercostal muscles.
D. To promote carbon dioxide elimination. - ANSWER Correct Answer: D. To promote
carbon dioxide elimination.
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the
client relax, pursed-lip breathing helps the client learn to control the rate and depth of
respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the
diaphragm, or strengthen intercostal muscles.
A 34-year-old woman with a history of asthma is admitted to the emergency department.
The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute,
nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals
greatly diminished breath sounds. Based on these findings, what action should the
nurse take to initiate care of the client?
A. Initiate oxygen therapy and reassess the client in 10 minutes.
B. Draw blood for an ABG analysis and send the client for a chest x-ray.
