Respiratory NCLEX Practice Questions (71-75)

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71. Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review?

a) Fluid intake for the past 24 hours
b) Baseline arterial blood gas (ABG) levels
c) Prior outcomes of weaning
d) Electrocardiogram (ECG) results

72. The nurse is assessing the puncture site of the client who has received a purified protein derivative test. Which finding indicates a need for further evaluation?

a) 15-mm induration
b) Reddened area
c) 10-mm induration
d) Blister

73. A client who under went surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first

a) Initiate oxygen therapy.
b) Administer a heparin bolus and begin an infusion at 500 units/hour.
c) Administer analgesics as ordered.
d) Perform nasopharyngeal suctioning.

74. A client with colorectal carcinoma is devastated after learning that the cancer has spread to the liver and lungs and the client has only a 5% chance surviving for 5 years. Which comment by the nurse would best help the client cope with this news?

a) "I've seen clients in your situation who have lived almost 20 years."
b) "It must be hard to hear that prognosis. Would it help you to talk to me or the chaplain?"
c) "This might be a good time to think about an advance directive in case you run into problems while you're here."
d) "Those are just numbers. You have to live each day fully and not worry about dying."

75. Inspiratory and expiratory stridor may be heard in a client who:

a) is experiencing an exacerbation of goiter
b) is experiencing an acute asthmatic attack.
c) has aspirated a piece of meat
d) has severe laryngotracheitis




Respiratory NCLEX Practice Questions
Answers and Rationale

71) B
- Before weaning a client from mechanical ventilation, it's most important to have a baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

72) A
- A 10-mm induration strongly suggests a positive response in this tuberculosis screening test; a 15-mm induration clearly requires further evaluation. The other options aren't positive reactions to the test and require no further evaluation.

73) A
- The client's signs and symptoms suggest pulmonary embolism. therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely prescribe an anticoagulant, such as heparin, or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

74) B
- This response is most therapeutic because it encourages the client to express feelings and concerns. Options A and D offer false hope and reflect the nurse's empirical observations, not statistics. Option C is inappropriate because an informed person who isn't a member of the health care team should discuss (at the client's request) which level of care the client wishes to receive in case of an emergency.

75) C
- Inspiratory and expiratory stridor is a low-pitched crowing sound heard in client who have a foreign body obstructing the trachea or mainstem bronchi. Acute asthmatic attacks are characterized by wheezing. Goiter attacks and severe laryngotracheitis are associated with inspiratory  stridor only.


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Respiratory NCLEX Practice Questions (1-6)


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Respiratory NCLEX Practice Questions (76-80)

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Respiratory NCLEX Practice Questions (66-70)

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

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66. A client with end-stage chronic obstructive pulmonary disease requires bi-level positive airway pressure (BiPAP). While caring for the client, the nurse determines that bilateral wrist restraints are required to prevent compromised care. Which client care outcome is associated with restraint use in the client who requires BiPAP?

a) The client will remain infection-free

b) The client will maintain adequate oxygenation.

c) The client will maintain adequate urine output

d) The client will remain pain-free

67. A 52-year-old client who just emigrated from Mexico is admitted with tuberculosis. The client explains to the nurse through an interpreter that he's concerned about paying for his medications after discharge. The nurse should collaborate with which health care team member about the client's financial concerns?

a) Public health worker

b) Home health nurse

c) Physician

d) Social worker

68. During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect

a) The client's pupils to become dilated

b) The client to experience bronchodilation

c) A decrease in the client's gastric secretions.

d) A drop in the client's heart rate.

69. A client with chronic sinusitis comes to the outpatient department complaining of headache, malaise, and a nonproductive cough. When examining the client's paranasal sinuses, the nurse detects tenderness. To evaluate this finding further, the nurse should transilluminate the:

a) frontal sinuses only

b) sphenoidal sinuses only

c) frontal and maxillary sinuses

d) sphenoidal and ethmoidal sinuses.

70. A client with severe acute respiratory syndrome (SARS) privately informs the nurse that he doesn't want to be placed on a ventilator if his condition worsens. The client's wife and children have repeatedly expressed their desire that everything be done for the client. The most appropriate action by the nurse would be to.

a) inform the family of the client's wishes.

b) assure the family that everything possible will be done.

c) support the client's decision

d) assure the client that everything possible will be done.

Respiratory NCLEX Practice Questions

Answers and Rationale

66) B

- BiPAP is a type of continuous positive airway pressure in which both inspiratory and expiratory pressures are set above atmospheric pressure. This type of ventilatory support assists clients with chronic obstructive pulmonary disease who retain PaCO2. Restrains are necessary in this client to maintain BiPAP therapy if the client attempts to dislodge the mask despite instruction no to do so. Maintaining  oxygenation is the expected outcome in this client. Options A, C, and D aren't direct outcomes of the client requiring BiPAP who needs restraints to maintain client safety.

67) D

- The nurse should collaborate with the social worker about the client's financial concerns. This collaboration can be done independently without a physician's order. The physician must only notify the public health department of the client's diagnoses. The physician and home health nurse are also involved in the client's care but aren't typically involved with the client's financial concerns until after the client is discharged

 68) D

- During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation, Stimulation of the vagus nerve increases gastric secretions.

69) C

- After detecting tenderness of the paranasal sinuses, the nurse should transilluminate both frontal and maxillary sinuses; lack of illumination may indicate sinus congestion and pus accumulation. The sphenoidal and ethmoidal sinuses can't be transilluminated because of their location.

70) C

- The nurse is obligated to act as client advocate. The nurse shouldn't discuss the issue with the client's family unless the client gives permission. Answers B and D oppose the client's wishes and don't demonstrate client advocacy

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Respiratory NCLEX Practice Questions (1-6)


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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 (1-6)


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NCLEX Review Respiratory Questions (66-70)

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NCLEX Review Respiratory Questions (56-60)

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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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NCLEX Review Respiratory Questions (1-6)


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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 Failure NCLEX Practice Questions (1-7)


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Renal Failure NCLEX Practice Questions (76-80)

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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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Renal NCLEX Questions (71-75)

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