KEY Resp Nclex type questions PDF

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N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA An elderly client admitted with pneumonia (PNA) and dementia has attempted several times to pull out the IV and Foley catheter. The nurse obtains an order for bilateral soft wrist restraints. Which nursing action is MOST appropriate? 1. Perform circulation checks to bilateral upper extremities each shift 2. Attach the ties of the restrains to the bedframe 3. Reevaluate the need for restraints and document weekly 4. Ensure the restraint order has been signed by the physician within 72 hours 2 – Secure the restraints to the bedframe, not the side rails, to ensure that the side rails can be raised and lowered safely. Circulation checks, re-evaluating need for restrains, and documentation should be done every 1 to 2 hours. Medical restraint orders must be renewed and signed by a physician or HCP q 24 hours. A 79 yo is admitted to the hospital with a dx of bacterial PNA. While obtaining the client’s health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which of the following would MOST likely be a predisposing factor for PNA? 1. Age 2. Osteoarthritis 3. Vegetarian diet 4. Daily bathing 1- The client’s age is a predisposing factor for PNA; PNA is more common in elderly or debilitated clients. Other predisposing factors include smoking, upper resp tract infx, malnutrition, immunosuppression, and presence of a chronic illness. See Table 23-2 on Risk Factors and Preventive Measures for PNA p. 591 Which of the following are significant to gather from a client who has been diagnosed with PNA? Select ALL that apply. 1. Quality of breath sounds 2. Presence of bowel sounds 3. Occurrence of chest pain 4. Amount of peripheral edema 5. Color of nail beds 1, 3, 5 – A resp. assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with PNA. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the client with pneumonia. A client with bacterial PNA is to be started on IV antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? 1. Urinalysis 2. Sputum culture 3. Chest radiograph 4. RBC count 2 – A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibx can be prescribed. Beginning antibx tx before obtaining the sputum specimen may alter the results of the test. UA, a chest radiograph (x-ray), and an RBC do not need to be obtained fefore the initiation of antibiotic tx for pneumonia. However, the causative organism is not identified in half of community-acquired pneumonia cases when therapy is initiated.

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N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA

5. When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following lab values? 1. Serum sodium 2. Serum potassium 3. Serum creatinine 4. Serum calcium 3 - It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibx because of the potential of this type of drug to cause tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels. 6. Penicillin (PCN) has been prescribed for a client admitted to the hospital for a treatment of PNA. Prior to administering the first dose of PCN, the nurse should ask the client: 1. Do you have a history of seizures? 2. Do you have any cardiac history? 3. Do you have any recent infection? 4. Have you had a precious allergy to PCN? 4 - The nurse should determine if the client is allergic to PCN prior to administering the drug. H/O seizures, recent infections, and a cardiac history are not contraindications for this client to receiving PCN. While important to know, recent infections will not keep this client from receiving PCN at this time. 7. A client with PNA has a temperature of 102.6 F (39.2 C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? 1. Position changes every 4 hours 2. Nasotracheal suctioning to clear secretions 3. Frequent linen changes 4. Frequent offering of a bedpan 3 – Frequent linen changes are appropriate for this client b/c of the diaphoresis. The client should be kept dry to promote comfort. Positions changes need to be done every 2 hours and prn. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario. 8. The cyanosis that accompanies bacterial PNA is PRIMARILY caused by which of the following? 1. Decreased cardiac output 2. Pleural effusion 3. Inadequate peripheral circulation 4. decreased oxygenation of the blood 4 – A client with PNA has less lung surface available for the diffusion of gases b/c of the inflammatory pulmonary response that creates lung exudate and results in in reduced oxygenation of the blood. The client becomes cyanotic b/c blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. Decreased cardiac output may be a comorbid condition in some clients with PNA; however, it is not the cause of cyanosis. 9. A client with PNA is experiencing pleuritic chest pain. The nurse should assess the client for: 1. A mild but constant acing in the chest 2. Severe midsternal pain 3. Moderate pain that worsens on inspiration 4. Muscle spasm pain the accompanies coughing 3-25-19 BMB

N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA 10. Which of the following mental status changes may occur when a client with PNA is first experiencing hypoxia? 1. Coma 2. Apathy 3. Irritability 4. Depression 11. Which of the following is an expected outcome for an elderly client following treatment for bacterial pneumonia? 1. RR of 25 to 30 bpm 2. The ability to perform ADLs 3. A maximum loss of 5 to 10 lb. (2.27 to 4.53 kg) of body weight 4. Chest pain that is minimized by splinting the rib cage TUBERCULOSIS 12. A client newly admitted with TB is being admitted with the prescription for “isolation precautions for TB”. The nurse should assign the client to which type of room? 1. A room at the end of the hall 2. A private room to implement airborne precautions - negative pressure air flow 3. A room near the nurses’ station to ensure privacy 4. A room with windows to allow sunlight 13. Which of the following symptoms is common in clients with active TB? 1. Weight loss –what are the other clinical manifestations of TB? 2. Increased appetite 3. Dyspnea on exertion 4. Mental status changes 14. The client with TB is to be discharged home with community health nursing follow-up. Of the following nursing interventions, which should have the HIGHEST priority? 1. Offering the client emotional support 2. Teaching the client about the disease and its treatment 3. Coordinating various agency services 4. Assessing the client’s environment for sanitation 15. The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) indicate(s) that the client has understood the nurse’s instructions? Select all that apply. 1. “I will need to dispose of my old clothing when I return home” 2. “I should always cover my mouth and nose when sneezing” 3. “It is important that I isolate myself from family when possible” actually, family members may be on prophylactic INH medication 4. “I should use paper tissues to cough in and dispose of them promptly” 5. “I can use regular plates and utensils whenever I eat” 2, 4, 5 When teaching the client how to avoid the transmission of tubercule bacilli, it is important for the client to understand that the organism is transmitted by droplet infection. Therefore, covering the mouth and nose when sneezing, using paper tissues to cough in with prompt disposal, and using regular plates and utensils indicate that the client has understood the nurse’s instructions about preventing the spread of airborne droplets. It is not essential to discard clothing, nor does the client need to be isolated from the family members.

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N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA 16. A client has had a positive reaction to the Mantoux test. The nurse interprets this reaction to mean that the client has 1. Active TB 2. Had contact with Mycobacterium tuberculosis exposure 3. Developed a resistance to tubercule bacilli 4. Developed passive immunity to TB 17. A client who has been diagnosed with TB has been placed on drug therapy. The medication regimen includes rifampin (Rifadin). Which of the following instructions should the nurse include in the client’s teaching plan related to the potential adverse effects of rifampin? Select all that apply. 1. Having eye examinations every 6 months 2. Maintaining follow-up monitoring of liver enzymes - hepatoxicity 3. Decreasing protein intake in the diet 4. Avoiding alcohol intake 5. The urine may have an orange color 18. The nurse is providing follow-up care to a client with tuberculosis who does not regularly take the prescribed medication. Which nursing action would be MOST appropriate for this client? 1. Ask the client’s spouse to supervise the daily administration of the medications also known as directly observed therapy - DOT 2. Visit the client weekly to verify compliance with taking the medication 3. Notify the physician of the client’s noncompliance and request a different prescription 4. Remind the client that TB can be fatal if not treated promptly COPD 19. The nurse is instructing a client with chronic obstructive pulmonary disease (COPD) how to do pursed-lip breathing. In which order should the nurse explain the steps to the client? 1. “Breathe in normally through your nose for two counts (while counting to yourself, one, two)” 2. “Relax your neck and shoulder muscles” 3. “Pucker your lips as if you were going to whistle” 4. “Breathe out slowly through pursed lips for four counts (while counting to yourself, one, two, three, four”) 2, 1, 3, 4 20. When developing a discharge plan to manage the care of a client with COPD, the nurse should advise the client to expect to: 1. Develop respiratory infections easily 2. Maintain current status 3. Require less supplemental oxygen 4. Show permanent improvement 21. The nurse is admitting a 45-yr-old patient with asthma in acute respiratory distress. The nurse auscultates the patient's lungs and notes cessation of the inspiratory wheezing. The patient has not yet received any medication. What should this finding suggest to the nurse? 1. Spontaneous resolution of the acute asthma attack 2. An acute development of bilateral pleural effusions 3. Airway constriction requiring immediate intervention 4. Overworked intercostal muscles resulting in poor air exchange

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N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA When a patient in respiratory distress has inspiratory wheezing and then it ceases, it is an indication of airway obstruction. This finding requires emergency action to restore airway patency. Cessation of inspiratory wheezing does not indicate spontaneous resolution of the acute asthma attack, bilateral pleural effusion development, or overworked intercostal muscles in this asthmatic patient that is in acute respiratory distress.

22. Which of the following indicates that the client with COPD who has been discharged to home understands the plan of care? 1. The client promises to do pursed-lip breathing 2. The client states actions to reduce pain 3. The client will use oxygen via a nasal cannula at 5L/min –watch the O2, too high an O2 level for a COPD patient 4. The client agrees to call the physician if dyspnea on exertion increases 23. Which of the following physical assessment finding are normal for a client with advanced COPD? 1. Increased anteroposterior chest diameter – “barrel” chest 2. Underdeveloped neck muscles 3. Collapsed neck veins 4. increased chest excursions with respiration 24. When instructing clients on how to decrease the risk of COPD, the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises 2. Maintain a high-protein diet 3. Avoid exposure to people with known respiratory infections 4. Abstain from cigarette smoking 25. Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake 2. To strengthen the diaphragm 3. To strengthen the intercostal muscles 4. To promote carbon dioxide elimination – prolong expiration time and decrease air trapping 26. Which of the following is a priority goal for the client with COPD? 1. Maintaining functional ability – pacing activities permits patient to perform activities without excessive distress. 2. Minimizing chest pain 3. Increasing CO2 levels in the blood 4. Treating infectious agents 27. The nurse teaches a client with COPD to assess for signs and symptoms of right-sided heart failure. Which of the following S&S should be included in the teaching plan? 1. Clubbing of nail beds 2. Hypertension 3. Peripheral edema 4. Increased appetite 28. The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds 3-25-19 BMB

N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA 2. Prolonged inspiration 3. Normal chest movement 4. Coarse crackles and rhonchi

29. A client with COPD is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer O2 as prescribed. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause coughing and dyspnea 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe – as per the book – O2 therapy is variable in patient with COPD; its aim in COPD is to achieve an acceptable O2 level without a fall in the pH (increasing hypercapnia) p. 643 3. Increased oxygen use will cause the client to become dependent on the oxygen 4. Increased oxygen is contraindicated in clients who are using bronchodilators 30. Which of the following diets would be MOST appropriate for a client with COPD? 1. low-fat, low-cholesterol diet 2. Bland, soft diet 3. low-sodium diet 4. high-calorie, high-protein diet – many of these patients have trouble with gaining and maintaining weight 31. The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for which of the following? 1. Suppression of the client’s respiratory infection 2. Decrease in bronchial secretions 3. Less difficulty breathing 4. Thinning of tenacious, purulent sputum THE client with ASTHMA 32. A client uses a metered-dose inhaler (MDI) to aid in management of asthma. Which action indicates to the nurse that the client needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration 2. The client inspires rapidly when using the MDI 3. The client holds his breath for 3 seconds after inhaling with the MDI 4. The client shakes the MDI after use 5. The client performs puffs in rapid succession 33. A 34 yo female with a history of asthma is admitted to the ED. The nurse notes that the client is dyspneic, with a RR of 35 breaths per minute, nasal flaring, and use of accessory muscles. Auscultation of lung fields reveals greatly diminished breath sounds. Based on those finding, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes 2. Draw blood for an ABG 3. Encourage the client to relax and breathe slowly through the mouth 4. Administer bronchodilators as prescribed 34. A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation 2. Act as an expectorant 3-25-19 BMB

N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA 3. Have an anti-inflammatory effect 4. Prevent development of respiratory infections

35. The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following indicates that the client is using the MDI correctly? Select all that apply. 1. The inhaler is held upright 2. The head is tilted down while inhaling the medicine 3. The client waits 5 minutes between puffs 4. The client rinses the mouth with water following administration 5. The client lies supine for 15 minutes following administration 36. Which of the following is an expected outcome for an adult client with well-controlled asthma? 1. Chest x-ray demonstrates minimal hyperinflation 2. Temperature remains lower than 100 F (37.8 C) 3. Venous blood sample for red bloods cells demonstrates increased count 4. Breath sounds are clear 37. A client diagnosed with asthma has been prescribed fluticasone (Flovent) one puff every 12 hours per inhaler. Place in correct order the statements the nurse would use when teaching the client how to properly use the inhaler with a spacer. 1. Hold your breath for at least 10 seconds, then breathe in and out slowly 2. Take off the cap and shake the inhaler 3. Rinse your mouth 4. Breathe out all of your air. Hold the mouth-piece of your inhaler and spacer between your teeth with your lips closed around it 5. Press down on the inhaler once and breathe in slowly 6. Attach the spacer 2, 6, 4, 5, 1, 3 38. The nurse is caring for a client who has asthma. The nurse should conduct a focused assessment to detect which of the following? 1. increased forced expiratory volume 2. Normal breath sounds 3. Inspiratory and expiratory wheezing 4. Morning headaches MISC 39. A client has developed a hospital-acquired pneumonia. When preparing to administer cephalexin 500mg, the nurse notices that the pharmacy sent cefazolin. What should the nurse do? Select all that apply. 1. Administer the cefazolin 2. Verify the medication prescription as written by the physician 3. Contact the pharmacy and speak to a pharmacist 4. Request that cephalexin be sent promptly 5. Return the cefazolin to the pharmacy

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N3561 REVIEW QUESTIONS Exam 2 KEY PNA, TB, BRONCHITIS, COPD, ASTHMA, DYSPNEA

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