Pneumonia Nursing

Care Management
NCLEX Challenge
Exam (Quiz #6: 30
Questions)
UPDATED ON OCTOBER 17, 2023
BY MATT VERA BSN, R.N.

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1 point(s)
1. Question

A comatose client needs a nasopharyngeal

airway for suctioning. After the airway is
inserted, he gags and coughs. Which
action should the nurse take?

A. Remove the airway and insert

a shorter one.

B. Reposition the airway.

C. Leave the airway in place until

the client gets used to it.

D. Remove the airway and

attempt suctioning without it.

Incorrect
Correct Answer: A. Remove the
airway and insert a shorter one.
If the client gags or coughs after
nasopharyngeal airway placement,
the tube may be too long. The nurse
should remove it and insert a
shorter one. A nasopharyngeal
airway device (NPA) is a hollow
plastic or soft rubber tube that a
healthcare provider can utilize to
assist with patient oxygenation and
ventilation in patients who are
difficult to oxygenate or ventilate via
bag mask ventilation, for example.
Option B: Simply
repositioning the airway
won’t solve the problem.
NPAs are passed into the
nose and through to the
posterior pharynx. NPAs do
not cause patients to gag
and are, therefore, the best
airway adjunct in an awake
patient and a better choice in
a semiconscious patient that
may not tolerate an
oropharyngeal airway due to
the gag reflex.
Option C: The client won’t
get used to the tube because
it’s the wrong size. When
placing an NPA, the
healthcare provider should
be knowledgeable regarding
the sizing of the NPA. Adult
sizes range from 6 to 9 cm.
Sizes 6 to 7 cm should be
considered in the small adult,
7 to 8 cm in the medium size
adult, and 8 to 9 cm in the
large adult.
Option D: Suctioning without
a nasopharyngeal airway
causes trauma to the natural
airway. When the NPA is too
long for the patient, it can
create a direct route of
ventilation of the stomach,
causing gastric distention,
increasing vomiting risk, and
decreasing oxygenation and
ventilation of the lungs.

1 point(s)
2. Question

An 87-year-old client requires long-term

ventilator therapy. He has a tracheostomy
in place and requires frequent suctioning.
Which of the following techniques is
correct?

A. Using intermittent suction

while advancing the catheter.

B. Using continuous suction

while withdrawing the catheter.

C. Using intermittent suction

while withdrawing the catheter.

D. Using continuous suction

while advancing the catheter.

Incorrect
Correct Answer: C. Using
intermittent suction while
withdrawing the catheter.
Intermittent suction should be
applied during catheter withdrawal.
To prevent hypoxia, suctioning
shouldn’t last more than 10-
seconds at a time. Suction
shouldn’t be applied while the
catheter is being advanced. Ensure
preoxygenation with 100% FiO2 was
done with adequate pulse oximetry
measurements. Preoxygenation is
required because airway suctioning
procedure may be associated with
significant hypoxemia.
Option A: Suctioning of the
lower airways should be done
in a sterile manner with
single-use gloves and
suction catheters to prevent
contamination and secondary
infection. The catheter
should be introduced to a
depth no more than the tip of
the artificial airway to prevent
trauma and bleeding from
airway mucosa.
Option B: Suction pressure
should be kept less than 200
mmHg in adults. It should be
set at 80 mmHg to 120
mmHg in neonates. The
catheter size used for
suction should be less than
50% of the internal diameter
of the endotracheal tube. A
common conversion is that a
1 mm diameter is equal to a 3
French.
Option D: The duration of
suctioning should be less
than 15 seconds per suction
attempt. Following airway
suction, the patient should
be allowed to recover for at
least 10 to 15 seconds and
re-oxygenate as needed
before re-suctioning occurs.
Standard precautions should
be followed while suctioning
by the care provider.

1 point(s)
3. Question

A client’s ABG analysis reveals a pH of 7.18,

PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg,
and HCO3- of 24 mEq/L. What do these
values indicate?

A. Metabolic acidosis

B. Respiratory alkalosis

C. Metabolic alkalosis

D. Respiratory acidosis

Correct
Correct Answer: D. Respiratory
acidosis
Respiratory acidosis is a state in
which there is usually a failure of
ventilation and an accumulation of
carbon dioxide. The primary
disturbance of elevated arterial
PCO2 is the decreased ratio of
arterial bicarbonate to arterial
PCO2, which leads to a lowering of
the pH. To compensate for the
disturbance in the balance between
carbon dioxide and bicarbonate
(HCO3-), the kidneys begin to
excrete more acid in the forms of
hydrogen and ammonium and
reabsorb more base in the form of
bicarbonate. This compensation
helps to normalize the pH.
Option A: Metabolic acidosis
is characterized by an
increase in the hydrogen ion
concentration in the systemic
circulation resulting in a
serum HCO3 less than 24
mEq/L. Blood pH
distinguishes between
acidemia (pH less than 7.35)
and alkalemia (pH greater
than 7.45). Metabolic
acidosis is due to alterations
in bicarbonate, so the pCO2
is less than 40 since it is not
the cause of the primary
acid-base disturbance. In
metabolic acidosis, the
distinguishing lab value is a
decreased bicarbonate
(normal range 21 to 28
mEq/L).
Option B: A decrease in pH
below this range is acidosis,
an increase above this range
is alkalosis. Respiratory
alkalosis is by definition a
disease state where the
body’s pH is elevated to
greater than 7.45 secondary
to some respiratory or
pulmonary process.
Option C: A decrease in pH
below this range is acidosis,
an increase over this range is
alkalosis. Metabolic alkalosis
is defined as a disease state
where the body’s pH is
elevated to greater than 7.45
secondary to some metabolic
process.

1 point(s)
4. Question

A police officer brings in a homeless client

to the ER. A chest x-ray suggests he has
TB. The physician orders an intradermal
injection of 5 tuberculin units/0.1 ml of
tuberculin purified derivative. Which needle
is appropriate for this injection?

A. 5/8” to ½” 25G to 27G

needle.

B. 1” to 3” 20G to 25G needle.

C. ½” to 3/8” 26 or 27G
needle.

D. 1” 20G needle.

Correct
Correct Answer: C. ½” to 3/8” 26
or 27G needle.
Intradermal injections like those
used in TN skin tests are
administered in small volumes
(usually 0.5 ml or less) into the
outer skin layers to produce a local
effect. A TB syringe with a ½” to
3/8” 26G or 27G needle should be
inserted about 1/8” below the
epidermis.
Option A: For neonates (first
28 days of life) and preterm
infants, a 5/8″ needle is
recommended if the skin is
stretched flat between the
thumb and forefinger and the
needle is inserted at a 90-
degree angle to the skin.
Option B: The deltoid muscle
is most often used as the site
for IM injections in adults.
Needle length is usually 1″–
1½”, 22–25 gauge, but a
longer or shorter needle may
be needed depending on the
patient’s weight. An alternate
site for IM injection in adults
is the anterolateral thigh
muscle. The needle length
and gauge are the same as
when the deltoid muscle is
used, i.e., 1″–1½” length, 22–
25 gauge.
Option D: For adults
weighing less than 130 lbs
(60 kg), use of a 1” needle is
recommended. However, a
5/8″ needle may be used for
IM injection in the deltoid
muscle if the fatty tissue
overlying the deltoid muscle
is flattened (i.e., not bunched
between thumb and fingers
during the injection) and the
needle is inserted at a 90-
degree angle to the skin.

1 point(s)
5. Question

A 76-year old client is admitted for elective

knee surgery. Physical examination reveals
shallow respirations but no signs of
respiratory distress. Which of the following
is a normal physiologic change related to
aging?

A. Increased elastic recoil of the

lungs.

B. Increased number of
functional capillaries in the alveoli.

C. Decreased residual volume.

D. Decreased vital capacity.

Incorrect
Correct Answer: D. Decreased
vital capacity.
Reduction in VC is a normal
physiologic change in the older
adult. Other normal physiologic
changes include decreased elastic
recoil of the lungs, fewer functional
capillaries in the alveoli, and an
increase is residual volume. Lung
volumes depend on body size,
especially height. Total lung
capacity (TLC) corrected for age
remains unchanged throughout life.
Functional residual capacity and
residual volume increase with age,
resulting in a lower vital capacity.
Option A: There is marked
variation in the effect of
aging on lung function. Aging
is associated with reduction
in chest wall compliance and
increased air trapping. The
decline in FEV1 with age
likely has a nonlinear phase
with acceleration in rate of
decline after age 70 years.
Option B: Additionally,
decreased strength and
function of respiratory
muscles is observable. All of
these changes drop an aging
patient’s threshold in