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Right knowledge and proper nursing care can have a great impact in improving
the efficiency of the patient’s respiration and ventilation and increasing the
chance for recovery. This is a 50-item NCLEX style exam that covers the
diseases affecting the Respiratory System. These questions will challenge your
knowledge about the concepts behind Bronchial Asthma, COPD, Pneumonia and
many more.
The will to succeed is important, but what’s more important is the will to prepare.
~ Bobby Knight
Topics
Included topics in this practice quiz are:
Guidelines
Follow the guidelines below to make the most out of this exam:
Questions
EXAM MODE
PRACTICE MODE
TEXT MODE
In Text Mode: All questions and answers are given for reading and answering
at your own pace. You can also copy this exam and make a printout.
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation
1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema
1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds
1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
11. A 66-year-old client has marked dyspnea at rest, is thin, and uses
accessory muscles to breathe. He’s tachypneic, with a prolonged
expiratory phase. He has no cough. He leans forward with his arms
braced on his knees to support his chest and shoulders for breathing.
This client has symptoms of which of the following respiratory
disorders?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
13. Exercise has which of the following effects on clients with asthma,
chronic bronchitis, and emphysema?
15. A 69-year-old client appears thin and cachectic. He’s short of breath
at rest and his dyspnea increases with the slightest exertion. His breath
sounds are diminished even with deep inspiration. These signs and
symptoms fit which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-
Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the physician.
4. How to recognize the signs of an impending respiratory infection.
1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax
19. Which of the following measures can reduce or prevent the
incidence of atelectasis in a post-operative client?
1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer
21. Which of the following treatment goals is best for the client with
status asthmaticus?
1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions
22. Dani was given Dilaudid for pain. She’s sleeping and her respiratory
rate is 4 breaths/minute. If action isn’t taken quickly, she might have
which of the following reactions?
1. Asthma attack
2. Respiratory arrest
3. Improve cardiac output
4. Constipation
1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg
1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis
1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs
27. Following the initial care of a client with asthma and impending
anaphylaxis from hypersensitivity to a drug, the nurse should take
which of the following steps next?
28. A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg;
PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result
represents which of the following conditions?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
29. A nurse plans care for a client with chronic obstructive pulmonary
disease, knowing that the client is most likely to experience what type
of acid-base imbalance?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
31. A nurse reviews the arterial blood gas results of a patient and notes
the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration
of 22 mEq/L. The nurse analyzes these results as indicating:
32. A client is scheduled for blood to be drawn from the radial artery for
an ABG determination. Before the blood is drawn, an Allen’s test is
performed to determine the adequacy of the:
1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation
33. A nurse is caring for a client with a nasogastric tube that is attached
to low suction. The nurse monitors the client, knowing that the client is
at risk for which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
34. A nurse is caring for a client with an ileostomy understands that the
client is most at risk for developing which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis
37. A nurse is caring for a client with renal failure. Blood gas results
indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate
concentration of 20 mEq/L. The nurse has determined that the client is
experiencing metabolic acidosis. Which of the following laboratory
values would the nurse expect to note?
1. Sodium level of 145 mEq/L
2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL
1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.
1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm
1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute
42. A nurse is suctioning fluids from a client through an endotracheal
tube. During the suctioning procedure, the nurse notes on the monitor
that the heart rate decreases. Which of the following is the most
appropriate nursing intervention?
1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxygenated the client
4. Notify the physician immediately.
1. Metabolic acidosis
2. Respiratory acidosis
3. Combined respiratory and metabolic acidosis
4. over compensated respiratory acidosis
1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar
1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min
48. The nurse reviews the ABG values of a client. The results indicate
respiratory acidosis. Which of the following values would indicate that
this acid-base imbalance exists?
1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3- of 20 mEq/L
49. A nurse instructs a client to use the pursed lip method of breathing.
The client asks the nurse about the purpose of this type of breathing.
The nurse responds, knowing that the primary purpose of pursed lip
breathing is:
50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of
30 mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values
as indicating:
2. Answer: 4. Inflammation
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.
5. Answer: 3. Intrinsic
6. Answer: 2. Bronchodilators
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.
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.
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).
Exercise can improve cardiovascular fitness and help the client tolerate periods
of hypoxia better, perhaps reducing the risk of heart attack. Most exercise has
little effect on respiratory muscle strength, and these clients can’t tolerate the
type of exercise necessary to do this. Exercise won’t reduce the number of
acute attacks. In some instances, exercise may be contraindicated, and the
client should check with his physician before starting any exercise program.
Reducing fluid volume reduces the workload of the heart, which reduces oxygen
demand and, in turn, reduces the respiratory rate. It may also reduce edema
and improve mobility a little, but exercise tolerance will still be harder to clear
airways. Reducing fluid volume won’t improve respiratory function, but may
improve oxygenation.
In emphysema, the wall integrity of the individual air sacs is damaged, reducing
the surface area available for gas exchange. Very little air movement occurs in
the lungs because of bronchial collapse, as well. In ARDS, the client’s condition
is more acute and typically requires mechanical ventilation. In asthma and
bronchitis, wheezing is prevalent.
16. Answer: 3. The client breathes only when his oxygen levels dip
below a certain point.
Clients with emphysema breathe when their oxygen levels drop to a certain
level; this is known as the hypoxic drive. They don’t take a breath when their
levels of carbon dioxide are higher than normal, as do those with healthy
respiratory physiology. If too much oxygen is given, the client has little stimulus
to take another breath. In the meantime, his carbon dioxide levels continue to
climb, and the client will pass out, leading to a respiratory arrest.
Using an incentive spirometer requires the client to take deep breaths and
promotes lung expansion. Chest physiotherapy helps mobilize secretions but
won’t prevent atelectasis. Reducing oxygen requirements or placing someone on
mechanical ventilation doesn’t affect the development of atelectasis.
First, the nurse should attempt to rouse the client because this should increase
the client’s respiratory rate. If available, a spot pulse oximetry check should be
done and breath sounds should be checked. The physician should be notified
immediately if of the findings. He’ll probably order ABG analysis to determine
specific carbon dioxide and oxygen levels, which will indicate the effectiveness
of ventilation. Reflexes and heart sounds will be part of the more extensive
examination done after these initial actions are completed.
24. Answer: 4. 80 mm Hg
A client about to go into respiratory arrest will have inefficient ventilation and
will be retaining carbon dioxide. The value expected would be around 80 mm
Hg. All other values are lower than expected.
The client was reacting to the drug with respiratory signs of impending
anaphylaxis, which could lead to eventual respiratory failure. Although the signs
are also related to an asthma attack or a pulmonary embolism, consider the
new drug first. Rheumatoid arthritis doesn’t manifest these signs.
Giving oxygen would be the best first action in this case. Vital signs then should
be checked and the physician immediately notified. If the client doesn’t already
have an I.V. catheter, one may be inserted now if anaphylactic shock is
developing. Obtaining a CBC wouldn’t help the emergency situation.
You all should know this. Practice some problems if you got this wrong.
Before radial puncture for obtaining an ABG, you should perform an Allen’s test
to determine adequate ulnar circulation. Failure to determine the presence of
adequate collateral circulation could result in severe ischemic injury o the hand
if damage to the radial artery occurs with arterial puncture.
Intestinal secretions are high in bicarbonate and may be lost through enteric
drainage tubes or an ileostomy or with diarrhea. These conditions result in
metabolic acidosis.
During suctioning, the nurse should monitor the client closely for side effects,
including hypoxemia, cardiac irregularities such as a decrease in HR resulting
from vagal stimulation, mucosal trauma, hypotension, and paroxysmal
coughing. If side effects develop, especially cardiac irregularities, this procedure
is stopped and the client is reoxygenated.
The venture mask delivers the most accurate oxygen concentration. The Venturi
mask is the best oxygen delivery system for the client with chronic airflow
limitation because it delivers a precise oxygen concentration. The face tent, the
aerosol mask, and the tracheostomy collar are also high-flow oxygen delivery
systems but most often are used to administer high humidity.
46. Answer: 1. “I will take the medication on an empty stomach.”
Pursed lip breathing facilitates maximum expiration for clients with obstructive
lung disease. This type of breathing allows better expiration by increasing
airway pressure that keeps air passages open during exhalation.
In respiratory alkalosis, the pH will be higher than normal and the PCO2 will be
low.
See Also
You may also like these other quizzes and exam tip articles:
TAGS
BRONCHIAL ASTHMA
NCLEX EXAMS
PNEUMONIA
RESPIRATORY SYSTEM
TEXT EXAMS
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