Respiratory Failure Practice Nclex Questions PDF

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Respiratory Failure Practice Nclex Questions 2021...

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Ramapo College of NJ NURS 440 Respiratory Failure Questions 1. The nurse is assessing a client with possible pulmonary embolism. For which symptoms should the nurse assess? Select all that apply. A. B. C. D. E.

Dizziness and fainting Shortness of breath (SOB) worsening over the last 2 weeks (wouldn’t be over 2 weeks) Inspiratory chest pain Productive cough Pink, frothy sputum

2. The nurse is developing the plan of care for the client with pulmonary embolism (PE). Which client problem does the nurse establish as the priority?

A. B. C. D. E.

Inadequate nutrition related to food-drug interactions and anticoagulant therapy Potential for infection related to leukocytosis Hypoxemia related to ventilation-perfusion mismatch (AIRWAY, BREATHING) Insufficient knowledge related to the cause of pulmonary embolism

3. When caring for a client with respiratory distress, which blood gas result does the nurse anticipate early in the course of the disease? A. pH 7.24, PCO2 55, HCO 26, PO2 65 B. pH 7.46, PCO2 30, HCO 26, PO2 60 (PO2 is 60 = hypoxia, pH is alkaline = early) C. pH 7.35, PCO2 45, HCO 24, PO2 80 D. pH 7.47, PCO2 35, HCO 30, PO2 75 4.

Which intervention will be most effective in reducing anxiety in the client with a pulmonary embolism (PE)? A. Remain with the client, and provide oxygen in a calm manner. 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.

5.

The medical-surgical unit nurse should call the Rapid Response Team to assess which of these clients? A. The client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright red hemoptysis. (TOO MUCH HEPARIN – NEED TO STOP AND ORDER PTT AND PROTAMINE (ANTIDOTE)) A. The client with deep vein thrombosis who is receiving low-molecular weight heparin and has ongoing calf pain. 1

B. The client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry of 94% C. The client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs

6.

The nurse is caring for a group of clients. Which clients should be monitored closely for respiratory failure? Select all that apply. A. Client with a brainstem tumor B. Client with sepsis (ARDS) C. Client with a T5 spinal cord injury (CERVICAL SPINE USUALLY THE ONE FOR RESP. FAILURE) D. Client using patient-controlled analgesia (TOO MUCH SEDATION CAN LEAD TO RESP. DEPRESSION) E. Client experiencing cocaine intoxication

7. Which client needs immediate attention by the RN? A. 40-year-old who is receiving continuous positive airway pressure (CPAP) and has intermittent wheezing B. 54-year-old who is mechanically ventilated and has tracheal deviation (TENSION PNEUMOTHORAX DUE TO BAROTRAUMA) C. 57-year-old who was recently extubated and is reporting a sore throat D. 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24 8. The nurse is caring for a client who is receiving mechanical ventilation and hears the high peak inspiratory pressure (PIP) alarm. Which action should the nurse take first? A. B. C. D.

Check the ventilator alarm settings. Assess the set tidal volume. Listen to the client's breath sounds. (ASSESS AIRWAY AND BREATHING FIRST) Call the respiratory therapist

9. All of these nursing actions are included in the plan of care for a client who has just been extubated. Which action should the RN delegate to unlicensed assistive personnel (UAP)? A. B. C. D.

Keep the head of the bed elevated Teach about incentive spirometer use Monitor vital signs every 5 minutes. (CONTINUOUS MONITORING USUALLY NURSE 1:1) Adjust the nasal oxygen flow rate.

10. The nurse coming on shift prepares to perform an initial assessment of the sedated ventilated client. Which are priorities for the nurse to carry out? Select all that apply. A. Ask visitors to leave. B. Assess the client's color and respirations - ASSESS 2

C. Confirm alarms and ventilator settings. - SAFETY D. Ensure that the tube cuff is inflated and is in the proper position. - SAFETY E. Listen for bilateral chest sounds. - ASSESS F. Provide routine tracheotomy and endotracheal and mouth care. – NOT PRIORITY 11. The ventilated client in the intensive care unit begins to pick at the bedcovers and is agitated. Which action should the nurse take next? A. B. C. D.

Increase the sedation Assess for adequate oxygenation, - ASSESS ABCs Explain to the client that he has a tube in his throat to help him breathe, Request that the family leave to decrease the client's agitation,

12. The nurse is caring for a group of clients. The client with which condition is in greatest need of immediate intubation and mechanical ventilation? A. Difficulty swallowing oral secretions B. Shallow, rapid respirations and decreased breath sounds – SIGNS OF RESP. DISTRESS/ ATTEMPTING COMPENSATION C. O2 saturation of 91% D. Thick, purulent secretions and crackles .13. The nurse is assessing a client who is receiving mechanical ventilation with a high positive endexpiratory pressure (PEEP). Which findings would cause the nurse to suspect a left-sided tension pneumothorax? A. B. C. D.

Chest caves in on inspiration and "puffs out" on expiration. Trachea is deviated to the right side and cyanosis is present. The left lung field is dull to percussion with crackles present on auscultation. Client has bloody sputum and wheezes.

14. The nurse is caring for a group of critically ill clients. Which client has the greatest risk for developing acute respiratory distress syndrome (ARDS)? A. B. C. D.

A client with diabetic ketoacidosis (DKA) A client with atrial fibrillation A client with aspiration pneumonia A client with chronic renal insufficiency

15. The nurse is teaching the family of a client who is receiving mechanical ventilation. Which statement reflects appropriate information that the nurse should communicate? A. B. C. D.

Sedation is needed so your loved one does not rip the breathing tube out. Suctioning is important to remove organisms from the lower airway. Paralysis and sedatives help decrease the demand for oxygen. We are encouraging oral and intravenous fluids to keep your loved one hydrated.

16. The nurse is caring for a client with impending respiratory failure who refuses intubation and mechanical ventilation. Which method provides an alternative to mechanical ventilation? 3

A. B. C. D.

Oropharyngeal airway Bi-level positive airway pressure (BiPAP) Non-rebreathing mask with 100% oxygen Positive end-expiratory pressure (PEEP)

17. End tidal CO2 is an indicator of: A. B. C. D.

Oxygenation Ventilation Compensation Acid Base Balance

18. The patient with ARDS has been placed on a ventilator for severe hypoxia. Ventilator settings are: Volume Assist Control- rate 12, Tidal Volume (TV) 420 ml, Fi02 60%. The following ABG's are obtained: pH 7.32, PaC02 55, Pa02 80, HCO3 21. Based upon the results, what provider orders does the nurse anticipate? -

ABGs: RESP. ACIDOSIS PaO2 80 = NORMAL TOO MUCH CO2, NEED TO BREATH IT OUT >>> INCREASE RATE A. B. C. D.

Increase FiO2 to 70% Decrease FiO2 to 50% Increase ventilator rate to 14 Decrease TV to 350 ml

19. A patient with ARDS is on mechanical ventilation. The ventilator settings are AC 12, TV 400 ml, Fi02 50%, Peep 5 cm. ABGs results: pH 7.31, PaC02 46, Pa02 60, HCO3 27 meq. , BP 90/60, HR 90, RR 12 Based upon the results, what ventilator changes are anticipated? -

ABGs: PaO2 60 IS LOW (80-100 IS NORMAL) INCREASE O2 BY INCREASING FiO2 A. Increase Fi02 to 60% B. C.

D.

Increase TV to 500 ml Increase PEEP to 10 cm Decrease Resp Rate to 10/minute...