Respiratory NCLEX Questions I And 2 - 100 Questions and Answers With Rationale

Respiratory NCLEX Questions I And 2 - 100 Questions and Answers With Rationale Respiratory NCLEX Questions I 1. An elderly client with pneumonia may appear with which of the following symptoms first? a. Altered mental status and dehydration b. Fever and chills c. Hemoptysis and dyspnea d. Pleuritic chest pain and cough Rationale: Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response. 2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop? a. Atelectasis b. Bronchiectasis c. Effusion d. Inflammation Rationale: The most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur with pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia. 3. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? a. Acute asthma b. Bronchial pneumonia c. Chronic obstructive pulmonary disease (COPD) d. Emphysema Rationale: Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed COPD or emphysema. 4. Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? a. Circumoral cyanosis b. Increased forced expiratory volume c. Inspiratory and expiratory wheezing d. Normal breath sounds Rationale: Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may be present in extreme cases of respiratory distress. The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Breath sounds will be “tight” sounding or markedly decreased; they won’t be normal. 5. Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection? a. Emotional b. Extrinsic c. Intrinsic d. Mediated Rationale: Intrinsic asthma doesn’t have an easily identifiable allergen and can be triggered by the common cold. Asthma caused be emotional reasons is considered to be in the extrinsic category. Extrinsic asthma is caused by dust, molds, and pets; easily identifiable allergens. Mediated asthma doesn’t exist. 6. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? a. Beta-adrenergic blockers b. Bronchodilators c. Inhaled steroids d. Oral steroids Rationale: Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren’t used for emergency relief. 7. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? a. Take a full medication history b. Give a bronchodilator by nebulizer c. Apply a cardiac monitor to the client d. Provide emotional support to the client Rationale: The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. First, resolve the acute phase of the attack ad how to prevent attacks in the future. It may not be necessary to place the client on a cardiac monitor because he’s only 19- years-old, unless he has a past medical history of cardiac problems. 8. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? a. Adult respiratory distress syndrome (ARDS) b. Asthma c. Chronic obstructive bronchitis d. Emphysema Rationale: Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Clients with asthma and emphysema tend not to have a chronic cough or peripheral edema. 9. The term “blue bloater” refers to which of the following conditions? a. Adult respiratory distress syndrome (ARDS) b. Asthma c. Chronic obstructive bronchitis d. Emphysema Rationale: Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don’t exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting). 10. The term “pink puffer” refers to the client with which of the following conditions? a. Adult respiratory distress syndrome (ARDS) b. Asthma c. Chronic obstructive bronchitis d. Emphysema Respiratory NCLEX questions 2 1. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to: a. Promote expectoration b. Suppress the cough c. Relax smooth muscles of the bronchial airway d. Prevent infection Rational: Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway 2. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? a. Constipation b. Diarrhea c. Bradycardia d. Tachycardia Rational: Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. 3. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? a. Removes the cap and shakes the inhaler well before use b. Presses the canister down with finger as he breathes in. c. Inhales the mist and quickly exhales d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed Rational: The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist. 4. A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client? a. “Is there any possibility that you could be pregnant?” b. “Are you wearing any metal chains or jewelry?” c. “Can you hold your breath easily?” d. “Are you able to hold your arms above your head?” Rational: The most important item to ask about is the client’s pregnancy status because pregnant women should not be exposed to radiation. Clients are also asked to remove any chains or metal objects that could interfere with obtaining an adequate film. A chest radiograph most often is done at full inspiration, which gives optimal lung expansion. If a lateral view of the chest is ordered, the client is asked to raise the arms above the head. Most films are done in posterior-anterior view. 5. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? a. Encouraging additional fluids for the next 24 hours b. Ensuring the return of the gag reflex before offering foods or fluids c. Administering atropine intravenously d. Administering small doses of midazolam (Versed). Rational: After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Additional fluids is unnecessary because no contrast dye is used that would need to be flushed from the system. Atropine and Versed would be administered before the procedure, not after. 6. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: a. Brachial and radial arteries, and then releases them and observes the circulation of the hand. b. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. c. Radial artery and observes for color changes in the affected hand. d. Ulnar artery and observes for color changes in the affected hand. Rational: Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen’s test. This involves compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is adequate. 7. 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 Rational: 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. 8. A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences: a. Decreased anxiety level b. Increased comfort level c. Reduction of N/V d. Decreased frequency and intensity of cough Rational: Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. 9. 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 Rational: A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions. The temperature should be below 100*F (37.8*C) with no chills or diaphoresis. A productive cough with chest pain indicated pulmonary infection, not an URI. 10. 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