NCLEX Review Respiratory Questions (61-65)

Welcome to NCLEX Review Respiratory Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


61. A client scheduled for pneumonectomy tells the nurse that a friend of his had lung surgery and had chest tubes. The client asks the nurse about how long his chest tubes will be in place after surgery. The nurse responds that:

a) they will be removed after 3 to 4 days
b) they will be in place for 24 to 48 hours
c) they usually remain in place for a full week after surgery
d) most likely, there will be no chest tubes in place after surgery

62. A nurse is caring for a client with active tuberculosis who has started medication therapy that includes rifampin (Rifadin). The nurse instructs the client to expect which side effect of this medication?

a) bilious urine
b) yellow sclera
c) orange secretions
d) clay-colored stools

63. The nurse sends a sputum specimen to the laboratory for culture from a client with suspected active tuberculosis (TB). The results report that Mycobacterium tuberculosis is cultured. How would the nurse correctly analyze these results?

a) results are positive for active tuberculosis
b) results indicate a less virulent  strain of tuberculosis
c) results are inconclusive until a repeat sputum is sent
d) results are unreliable unless the client has also had positive Mantoux test

64. A client with a history of respiratory disease is ambulating with the nurse to the doorway of the hospital room. The client becomes pale and dyspneic. The nurse has the client sit and takes the client's vital signs. The client's respiratory rate is 32 breaths per minute, oxygen saturation is 90%, and the heart rate has increased from 76 to 98 beats per minute. The nurse interprets that this client is experiencing:

a) activity intolerance
b) impaired physical mobility
c) ineffective airway clearance
d) ineffective breathing pattern

65. The ambulatory care nurse is assessing a client with chronic sinusitis. The nurse determines that which manifestation reported by the client is unrelated to this problem?

a) anosmia
b) chronic cough
c) purulent nasal discharge
d) headache more pronounced in the evening






NCLEX Review Respiratory Questions
Answers and Rationale

61) D
- Pneumonectomy involves removal of the entire lung, usually caused by extensive disease such as bronchogenic carcinoma, unilateral tuberculosis, or lung abscess. Chest tubes are not inserted because the cavity is left to fill with serosanguineous fluid, which later solidifies. Therefore, options A,B, and C are incorrect.

62) C
- Secretions will become orange in color as a result of the rifampin. The client should be instructed that this side effect will likely occur and should be told that soft contact lenses, if used by the client, will become permanently discolored. Options A, B, and D are not expected effects.

63) A
- Culture of Mycobacterium tuberculosis from sputum or other body secretions or tissue is the only method of confirming the diagnosis. Options B and C are incorrect statements. The Mantoux test is performed to assist in diagnosing TB but does not confirm active disease.

64) A
- Activity intolerance is characterized by exertional dyspnea, adverse changes in blood pressure or heart rate with activity, and fatigue. Ineffective breathing pattern occurs when the rate, timing, depth, or rhythm of breathing is insufficient to maintain optimal ventilation. Ineffective airway clearance occurs when the client is unable to clear his or her own secretions from the airway. Impaired physical mobility occurs when the client is limited in physical movement and has limited muscle strength, range of motion, or coordination.

65) D
- Chronic sinusitis is characterized by persistent purulent nasal discharge, a chronic cough resulting from nasal discharge, anosmia (loss of smell), nasal stuffiness, and headache that is worse upon arising after sleep.



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NCLEX Review Respiratory Questions (56-60)

Welcome to NCLEX Review Respiratory Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


56. A client has a left pleural effusion that has not yet been treated. The nurse plans to have which of the following items available for immediate use?

a) intubation tray
b) paracentesis tray
c) thoracentesis tray
d) central nervous line insertion tray

57. A client with acute respiratory distress syndrome has an order to be placed on a continuous positive airway pressure (CPAP) face mask. The nurse implements which of the following for this procedure to be most effective?

a) obtains baseline arterial blood gases
b) obtains baseline pulse oximetry levels
c) applies the mask to the face with a snug fit
d) encourages the client to remove the mask frequently for coughing and deep breathing exercises

58. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to do pursed-lip breathing. Evaluation of understanding is evident if the client demonstrates which of the following?

a) breathes in and then holds the breath for 30 seconds
b) loosens the abdominal muscles while breathing out
c) breathes so that expiration is three times as long as inspiration
d) inhales with pursed lips and exhales with the mouth open wide

59. A physician is inserting a chest tube. The nurse selects which of the following materials to be used as the first layer of the dressing at the chest tube insertion site?

a) sterile 4x4 gauze pad
b) petrolatum jelly gauze
c) absorbent gauze dressing
d) gauze impregnated with povidone-iodine

60. A client being seen in the physician's office for follow-up 2 weeks after pneumonectomy complains of numbness and tenderness at the surgical site. The nurse tells the client that this is:

a) not likely to be permanent, but may last for some months
b) a severe problem and the client will probably be rehospitalized
c) probably caused by permanent nerve damage as a result of surgery
d) often the first sign of a wound infection and checks the client's temperature






NCLEX Review Respiratory Questions
Answers and Rationale

56) C
- The client with a significant pleural effusion is usually treated by thoracentesis. This procedure allows drainage of the fluid, which may then be analyzed to determine the precise cause of the effusion. The nurse ensures that a thoracentesis tray is readily available in case the client's symptoms should rapidly become more severe. A paracentesis tray is needed for the removal of abdominal effusion. Options A and D are not specifically indicated for this procedure.

57) C
- The face mask must be applied over the nose and mouth with a snug fit, which is necessary to maintain positive pressure in the client's airways. The nurse obtains baseline respiratory assessments and arterial blood gases to evaluate the effectiveness of therapy, but these are not done to increase the effectiveness of the procedure. A disadvantage of the CPAP face mask is that the client must remove it for coughing, eating, or drinking. This removes the benefit of positive pressure in the airway each time it is removed.

58) C
- Prolonging expiration time reduces air trapping caused by airway narrowing that occurs in COPD. Tightening (not loosening) the abdominal muscles aids in expelling air. Exhaling through pursed lips (not with the mouth wide open) increases the intraluminal pressure and prevents the airways from collapsing. The client is not instructed to breathe in and hold the breath for 30 seconds; this action has no useful purpose for the client with COPD.

59) B
- The first layer of the chest tube dressing is petrolatum gauze, which allows for an occlusive seal at the chest tube insertion site. Additional layers of gauze cover this layer, and the dressing is secured with a strong adhesive tape or Elastoplast tape.

60) A
- Clients who undergo pneumonectomy may experience numbness, altered sensation, or tenderness in the area that surrounds the incision. These sensations may last for months. It is not considered to be a severe problem and is not indicative of a wound infection.


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Renal Failure NCLEX Practice Questions (71-75)

Welcome to Renal Failure NCLEX Practice Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


71. A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further instruction if the client states to:

a) use a strong adhesive tape to anchor the catheter dressing
b) use meticulous aseptic technique for dialysate bag changes
c) take own vital signs daily
d) monitor own weight daily

72. A nurse has given a client with a nephrostomy tube instructions to follow after hospital discharge. The nurse determines that the client understands the instructions if the client states he or she should drink at least how many glasses of water per day?

a) 1 to 3
b) 6 to 8
c) 12 to 14
d) 16 to 18

73. Renal Failure NCLEX Practice Questions about a nurse who notes that a client's urinalysis report contains a notation of positive red blood cells (RBC). The nurse interprets that this finding is unrelated to which of the following items that is part of the client's medical record?

a) diabetes mellitus
b) concurrent anticoagulant therapy
c) history of kidney stones
d) history of recent blow to the right flank

74. A client with acute glomerulonephritis has had a urinalysis sent to the laboratory. The report reveals that there are hematuria and proteinuria in the urine. The nurse interprets that these results are:

a) consistent with glomerulonephritis
b) inconsistent with glomerulonephritis
c)unclear, and no conclusion can be drawn
d) indicative of impending renal failure

75. A young female client with acute pyelonephritis is scheduled for a voiding cystourethrogram. The nurse determines that this client would likely benefit from increased support and teaching about the procedure because:

a) radiopaque contrast is injected into the bloodstream with a syringe
b) radioactive material is injected into the bladder with a syringe
c) the client must lie on an x-ray table in a cold, barren room
d) the client must void while the micturition process is filmed






Renal Failure NCLEX Practice Questions
Answers and Rationale

71) A
- The client is at risk for impairment of skin integrity because of the presence of the catheter, exposure to moisture, and irritation from tape and cleansing solutions. The client should be instructed to use paper or nonallergenic tape to prevent skin irritation and breakdown. It is proper procedure for the client to use aseptic technique, and self-monitor vital signs and weight daily.

72) B
- The client with a nephrostomy tube needs to have adequate fluid intake to dilute urinary particles that could cause calculus and to provide good mechanical flushing of the kidney and tube. The nurse encourages the client to take in at least 2000 mL of fluid per day, which is roughly equivalent to 6 to 8 glasses of water. Options C and D represent high fluid volumes and could possibly place undue distention on the renal pelvis. Option A is an amount that is lower than recommended.

73) A
- Hematuria can be caused by trauma to the kidney, such as with blunt trauma to the lower posterior trunk or flank. Kidney stones can cause hematuria as they scrape the endothelial lining of the urinary system. Anticoagulant therapy can cause hematuria as a side effect. Diabetes mellitus does not cause hematuria, although it can lead to renal failure from prerenal causes.

74) A
- Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis. The urine may be small in volume, dark or smoky in color from the hematuria, and foamy from the proteinuria. Concurrent serum studies would reveal elevated blood urea nitrogen, creatinine, C-reactive protein level, and antistreptolysin O titer.

75) D
- Having to void in the presence of others can be very embarrassing for clients, and may actually interfere with the client's ability to void. The nurse teaches the client about the procedure to try to minimize stress from lack of preparation, and gives the client encouragement and emotional support. Screens may be used in the radiology department to try to provide an element of privacy during this procedure.



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Renal NCLEX Questions (66-70)

Welcome to Renal NCLEX Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


66. A nurse has administered a dose of epoetin alfa (Epogen) to a client with chronic renal failure. The nurse interprets that which of the following hemodynamic effects experienced by the client is a side effect of this medication?

a) bradycardia
b) tachycardia
c) hypotension
d) hypertension

67. A client with chronic renal failure who has just undergone repair of an umbilical hernia is complaining of postoperative pain. The nurse should call the physician if which of the following opioid analgesics is prescribed for this client?

a) meperidine hydrochloride (Demerol)
b) morphine sulfate
c) codeine sulfate
d) oxycodone (OxyContin, Roxicodone)

68. Renal NCLEX Questions about a client with chronic renal failure who did not receive any juice on the breakfast meal tray. The nurse asks the nursing assistant to give the client a cup of which of the following juices from the unit kitchen?

a) grape
b) grapefruit
c) orange
d) prune

69. A nurse is caring for a client with chronic renal failure whose daily fluid allotment is determined by calculating the previous day's output plus insensible losses through the lungs. If the client's urine output for the previous day was 300 ml, the nurse anticipates how many milliliters of fluid will be allotted for today?

a) 400 ml
b) 700 ml
c) 1000 ml
d) 1200 ml

70. A nurse has instructed a client about the procedure for continuous ambulatory peritoneal dialysis (CAPD). The nurse determines that the client needs further instruction if the client:

a) states that dwell times will vary depending on whether it is a daytime or nighttime
b) allows air to get into the dialysis tubing
c) warms the dialysate solution before infusion
d) plans on doing four exchanges per day




Renal NCLEX Questions
Answers and Rationale

66) D
- The client taking exogenous erythropoietin may develop or have an increase in the degree of hypertension. This probably results from increased blood viscosity and the hemodynamic changes that accompany it. The nurse monitors the client's blood pressure carefully and regularly. Options A, B, and C are not associated with the use of epoetin alfa.

67) A
- Although all of the medications listed in the options are metabolized by the liver, meperidine hydrochloride is metabolized partially to normeperidine, which must be excreted by the kidneys. Seizure activity can occur in the client with chronic renal failure from accumulation of normeperidine in the client's system. It is also generally true that dosages for all opioid analgesics will be reduced for the client with chronic renal failure.

68) A
- Apple juice and grape juice are lower in potassium and are the better choices of juice for the client with chronic renal failure. Prune, orange, and grapefruit juices are higher in potassium and should be used cautiously or avoided in these clients.

69) B
- The lungs expire about 400 mL of water per day. Therefore, if the client's urine output for the previous day was 300 mL, then 700 mL of fluid is to be allotted (400 mL from the lungs and 300 mL urine output).

70) B
- Peritoneal dialysis tubing is flushed to avoid introducing air into the peritoneal cavity. With CAPD, there are usually four exchanges planned per day, with dwell times varying, depending on whether it is a daytime or nighttime exchange. The dialysate solution should be slightly warmed (37° C) prior to use.


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Renal NCLEX Questions (1-7)


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Test for Kidneys (NCLEX 61-65)

Welcome to Test for Kidneys. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


61. A client with chronic renal failure is scheduled to begin hemodialysis therapy. As part of general teaching about hemodialysis, the nurse tells the client to expect the typical dialysis schedule to be:

a) 2 to 3 hours treatment 5 days per week
b) 2 hours of treatment 6 days per week
c) 5 hours of treatment 2 days per week
d) 3 to 4 hours of treatment 3 days per week

62. A nurse is hemodialyzing a client. The client suddenly becomes short of breath and complains of chest pain. The nurse notes that the client is tachycardic, pale, and anxious. The nurse should take which action?

a) monitor vital signs every half hours for the next 2 hours
b) bolus the client with 500 ml normal saline
c) check the tubing for air and continue dialysis at a slower rate
d) discontinue dialysis and notify the physician

63. A nurse is teaching a hemodialysis client about self-monitoring between hemodialysis treatments. The nurse tells the client to record which of the following on a daily basis?

a) calorie count
b) activity log
c) pulse, respiratory rate
d) intake and output, weight

64. A nurse is providing home care instructions to a client who has a cystoscopy in the physician's office. The nurse gives the client which instruction?

a) take cold tub baths two or three times a day
b) expect small episodes of bright red bleeding
c) drink increased amounts of fluids
d) try to avoid taking analgesic medications

65. A nurse has taught a client with chronic renal failure about medication therapy used in its treatment. The nurse determines that the client needs additional teaching if the client states which medication is needed to enhance red blood cell (RBC) production?

a) calcium carbonate (Tums)
b) multivitamins (MVI)
c) ferrous sulfate (Feosol)
d) folic acid (Folvite)






Test for Kidneys
Answers and Rationale

61) D
- The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments may be made according to variables such as the size of the client, type of dialyzer, the rate of blood flow, personal client preferences, and others. Options A, B, and C do not represent the typical hemodialysis schedule.

62) D
- The signs and symptoms exhibited by the client are compatible with air embolism. If the client experiences air embolus during hemodialysis, the nurse should stop the dialysis immediately, notify the physician, and administer oxygen as needed. All of the other actions are incorrect.

63) D
- The client monitors his or her own status between dialysis procedures by measuring intake and output and daily weight. These measures will assist the client in preventing fluid volume excess. The other options do not need to be recorded by the client daily.

64) C
- Because clients may be discharged immediately after cystoscopy, clients must understand home care measures. Pink-tinged urine is common, but not bright red bleeding. Increased intake of fluids helps prevent this from occurring. Clients often experience bladder spasm and bladder pain, feelings of bladder fullness and burning, and burning on urination after this procedure. Mild analgesics and warm tub baths are recommended to relieve these discomforts.

65) A
- Calcium carbonate is a calcium salt that is used as a phosphate binder in the client with chronic renal failure. It has nothing to do with the treatment of anemia. Folic acid is a vitamin that is needed for RBC production, and it is usually deficient in the client with chronic renal failure. Iron supplements (ferrous sulfate) are needed to produce adequate hemoglobin. Multivitamins supplement dietary vitamins and minerals but do not specifically enhance RBC production.



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Test for Kidneys (NCLEX 1-7)


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Nursing Management Styles (NCLEX 71-75)

Welcome to Nursing Management Styles. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


71. A student nurse is developing a plan of care for a paranoid client with a nursing diagnosis of Disturbed thought processes. The registered nurse reviews the interventions developed by the student and suggests revising the plan if the student has documented which intervention?

a) sit with the client and hold the client's hand
b) display a nonjudmental attitude
c) use simple and clear language when speaking to the client
d) diffuse angry and hostile verbal attacks with nondefensive stand

72. A benzodiazepine anxiolytic has been prescribed for a client for the management of anxiety, and a student nurse prepares to provide instructions to the client regarding the administration of the medication. The registered nurse who is supervising the student intervenes if the student plans to tell the client which of the following?

a) avoid driving or other activities requiring alertness until the response to the medication
b) do not skip medication doses and do not double up on missed doses
c) double a dose if a dose was missed
d) avoid the use of alcohol while taking the medication

73. A nurse is reviewing the critical paths of the clients on the nursing unit. In performing a variance analysis, which of the following would indicate the need for further action and analysis?

a) clear breath sounds in client with congestive heart failure
b) a postoperative client who develops a cough and a fever
c) the absence of a wound infection in a client who had a coronary artery bypass graft
d) a client with diabetes mellitus demonstrating accurate use of a glucometer following teaching

74. A nurse is told that the nursing model used in the nursing facility is a functional nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice?

a) a task approach methods is used to provide care to clients
b) a single registered nurse (RN) is responsible for providing nursing care to a group of clients
c) managed care concepts and tools are used in providing client care
d) nursing personnel are led by a RN in providing care to a group of clients

75. A nurse manager has implemented a change in the method of documenting nursing care. A licensed practical nurse (LPN) is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following would be the best approach in dealing with the LPN?

a) ignore the resistance
b) tell the LPN that the registered nurse will do all of the documentation
c) confront the LPN, and encourage verbalization of feelings regarding the change
d) tell the LPN that she must comply with the change






Nursing Management Styles 
Answers and Rationale

71) A
- When caring for a paranoid client, the nurse must avoid any physical contact. The nurse should ask the client's permission if touch is necessary because touch may be interpreted as a physical or sexual assault. The nurse should use simple and clear language when speaking to the client to prevent misinterpretation and to clarify the nurse's intent and actions. A warm approach is avoided because it can be frightening to a person who needs emotional distance. Anger and hostile verbal attacks are diffused with a nondefensive stand. The anger a paranoid client expresses is often displaced, and when a staff member becomes defensive, anger of both the client and staff member escalates. A nondefensive and nonjudgmental attitude provides an environment in which feelings can be explored more easily.

72) C
- The client should be instructed to take the medication exactly as directed and not to skip or double up on the doses. The client should also be instructed not to increase doses or to abruptly withdraw the medication. Abrupt withdrawal may cause tremors, nausea, vomiting, and abdominal or muscle cramps. The client is also advised to avoid driving or other activities requiring alertness until response to the medication is known and to avoid taking alcohol or other central nervous system depressants concurrently with this medication.

73) B
- Variances are actual deviations or detours from the critical paths. Variances can be positive or negative, avoidable or unavoidable, and can be caused by a variety of things. Positive variance occurs when the client achieves maximum benefit and is discharged earlier than anticipated. Negative variance occurs when untoward events prevent a timely discharge. Variance analysis occurs continually in order to anticipate and recognize negative variance early so that appropriate action can be taken.

74) A
- In functional nursing, a task approach method is used to provide care to clients. Option B exemplifies primary nursing. Option C exemplifies a component of case management. Option D exemplifies team nursing.

75) C
- Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the subject at hand will allow verbalization of feelings, identification of problems and subjects, and development of strategies to solve the problem. Option A will not address the problem. Option B might provide a temporary solution to the resistance but will not specifically address the concern. Option D might produce additional resistance.


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Nursing Management Styles (NCLEX 66-70)

Welcome to Nursing Management Styles. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.

66. A physician wrote an order for wrist restraints to be applied to a client. The nurse instructs the nursing assistant to apply the restraints. When checking the client, which observation would indicate that the nursing assistant performed unsafe care?

a) a safety (hitch) knot was used to secure the restraints
b) restraints were released every 2 hours
c) restraints were applied snugly and tightly
d) the call light was placed within reach of the client's hand

67. A registered nurse assigns a new nursing graduate to care for a client with a diagnosis of active tuberculosis, and the registered nurse explains the use of a particulate respirator to the graduate. Which observation indicates that the new nursing graduate understands how the particulate respirator operates?

a) the nosepiece is readjusted if air is detected escaping around the nose
b) another particulate respirator is obtained if air is escaping around the nose
c) the new nursing graduate states that a fit check is not needed
d) the new nursing graduate states that a fit check is necessary only when putting on the respirator for the first time

68. A registered nurse has instructed a new nursing graduate about the procedure for weaning a client from a ventilator by using a T-piece. The registered nurse determines that the new nursing graduate nurse states which of the following to be part of the procedure?

a) removing the client from the mechanical ventilator for a short period
b) connecting the T-piece to the client's artificial airway
c) providing supplemental oxygen through the T-piece at an Flo2 that is 10% higher than the ventilator setting
d) gradually decreasing the respiratory rate on the ventilator until the client takes over all of the work of breathing

69. A registered nurse is mentoring a new nurse hired to work in the nursing unit. The registered nurse determines that the new nurse is competent to provide safe effective care for a client on a ventilator when the registered nurse notes that the new nurse:

a) has the ventilator routinely assessed by the respiratory therapist
b) realizes that the ventilator readings provide information without human error
c) teaches family members how to reset controls during their visits if necessary
d) establishes a rest pattern before morning care

70. A nursing student develops a plan of care for a client who will be returning from the operating room after a mastoidectomy. The registered nurse reviews the plan of care and instructs the student to revise the plan if which intervention is listed?

a) assess client for pain, dizziness, or nausea
b) keep the head of the bed elevated to 30 degrees
c) instruct the client to lie on the affected side
d) assess for signs of injury to cranial nerve VII





Nursing Management Styles
Answers and Rationale

66) C
- Restraints should never be applied tightly because they could impair the circulation. A safety (hitch) knot may be used on the restraint because it can easily be released in an emergency. Restraints must be released at least every 2 hours (or per agency policy) to inspect the skin for abnormalities and to provide range-of-motion exercises. The call light must always be at the client's reach in case the client needs assistance.

67) A
- Personal protective equipment, called particulate respirators, is required for all health care workers entering a tuberculosis isolation room. When fitted and used properly, these respirators filter droplet nuclei. It is important that no air escapes around the nose while wearing the respirator. The strap needs to be adjusted if air is escaping. It is important to exhale forcefully while placing both hands over the apparatus. It is necessary to perform a fit check each time the nurse uses the mask.

68) D
- The T-piece or Briggs device requires that the client is removed from the mechanical ventilation for a short time, usually beginning with a 5-minute period. The ventilator is disconnected and the T-piece is connected to the client's artificial airway. Supplemental oxygen is provided through the device, often at a FIo2 that is 10% higher than the ventilator setting. Option 4 describes the process of weaning via synchronized intermittent mandatory ventilation.

69) A
- Ventilators need to be assessed routinely by the respiratory therapist. Ventilators are machines, and machines can fail. Therefore, option B is not a reasonable option. Family members should not reset ventilator controls. Although option D is considered good nursing practice for the comfort of the client, it is not the priority option.

70) C
- Following mastoidectomy, the nurse should monitor vital signs and inspect the dressing for drainage or bleeding. The nurse should assess for signs of facial nerve injury to cranial nerve VII and assess the client for pain, dizziness, or nausea. The head of the bed should be elevated at least 30 degrees, and the client is instructed to lie on the unaffected side. The client would probably have sutures and an outer ear packing and a bulky dressing, which is removed on approximately the sixth postoperative day.



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