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NCLEX Review Respiratory Questions

1. An adult client is admitted for diagnosis and treatment of a left lung lesion. A bronchoscopy was performed under local anesthesia. What nursing action is of highest priority when he returns following the bronchoscopy?
1. Collect all sputum for examination.
2. Assess level of consciousness frequently.
3. Withhold food and fluids until gag reflex has returned.
4. Monitor blood pressure and pulse at 10 minute intervals.

2. A lower left lobectomy was performed on an adult client. He was returned to his room following an uneventful stay in the recovery room. It is most important for the nurse to
1. Encourage him to perform deep breathing and coughing exercises.
2. Assist him with arm exercises to prevent shoulder ankylosis.
3. Help him perform leg exercises to prevent thrombophlebitis.
4. Position him in semi-Fowler’s position on his left side.

3. A client who has had a lobectomy returns to the nursing unit. He has a chest tube attached to portable water seal drainage system and oxygen per nasal cannula. The first nursing measure concerning the water seal drainage is to
1. Milk the tubing to prevent accumulation of fibrin and clots.
2. Raise the drainage apparatus to bed height to accurately assess the meniscus level.
3. Attach the chest tubes to the bed linen to assure that airflow and drainage are unhindered by kinks.
4. Mark the time and level of drainage in the collection chamber.

4. An adult client had a left thoracotomy. He has portable water seal chest drainage. On the first postoperative day the fluid in the water seal chamber stops fluctuating. What does this most likely indicate?
1. The chest tube is clogged by fibrin or a clot.
2. There is an air leak in the system.
3. Pulmonary edema has occurred due to increased blood volumes in remaining lung tissue.
4. The client’s left lung has reexpanded.

5. An adult client had a left lower lobectomy. Passive exercises are started on his left arm after surgery. The exercises are designed to prevent
1. Hyperflexion of the wrist.
2. Ankylosis of the shoulder.
3. Flexion contractures of the elbow.
4. Spasticity of the intercostal muscle

6. An adult client is admitted to the acute care hospital with bacterial pneumonia. On admission she was pale to dusky in color. Her respirations were 32, temperature 1030F and pulse 110. Auscultation revealed decreased or absent lung sounds in both bases and rhonchi in both upper lung fields. She was oriented to person, time and place, but her responses were brief. Oxygen per nasal cannula is started at 7 l / minute. IV antibiotics were started. While checking the client one hour after admission the nurse notes that she is less responsive, answering only yes or no questions. Her respirations are somewhat more shallow and have decreased to 27 per minute. What is the best INITIAL action for the nurse to take?
1. Increase the IV infusion rate to increase the amount of circulating antibiotics.
2. Notify the physician of the client’s changed mental status and await further orders.
3. Increase the oxygen flow rate to 10 liters / minute.
4. Continue to stimulate her until she responds appropriately.

7. A tracheostomy tube is inserted in a patient who is in respiratory distress as a result of pneumonia. The family asks why the tube is inserted. What should the nurse include when explaining to the patient and family? The purpose of a tracheostomy tube is to
1. Decrease the client’s anxiety by increasing the size of the airway.
2. Provide increased cerebral oxygenation thereby preventing further respiratory depression.
3. Facilitate nursing care since tracheal tubes have fewer side effects than nasotracheal tubes.
4. Provide more controlled ventilation and ease removal of secretions the client is unable to handle.

8. An adult is about to have a tracheostomy performed. Which action is of highest priority for the nurse before the procedure is done?
1. Establishing means of postoperative communication.
2. Drawing blood for serum electrolytes and blood gases.
3. Inserting an indwelling catheter and attaching it to dependent drainage.
4. Doing a surgical prep of the neck and upper chest wall.

9. The nurse is performing tracheal suctioning. Which action is essential to prevent hypoxemia during suctioning?
1. Removal of oral and nasal secretions.
2. Encouraging the client to deep breathe and cough.
3. Administer 100% oxygen before suctioning.
4. Auscultate the lungs.

10. An adult is admitted to the hospital with progressive dyspnea on exertion, which has become increasingly severe during the last six months. Physical examination reveals crackles at the base of the lung and clubbing of fingers. The client has asbestosis that has caused fibrosis in the alveoli. Soon after admission, the nurse helps the client to the bathroom. Before he returns to bed, he is very short of breath. Considering the severity of his symptoms, it is essential for the nurse to include which of the following in the plan of care.
1. Give continuous oxygen via nasal catheter.
2. Allow the client to move at his own pace.
3. Give bronchodilators to increase his ability to breathe.
4. Keep the client in bed to prevent further episodes of dyspnea.

11. An order is written for oxygen by nasal cannula at 2 liters per minute. In assessing the adequacy of the oxygen therapy, which of the following is most effective?
1. Checking the respiratory rate.
2. Checking the color of mucous membranes.
3. Measurement of pulmonary functions.
4. Measurement of arterial blood gasses.

12. A client with asbestosis must see his doctor regularly for a check up. What is the primary reason for him to have frequent checkups?
1. Patients with asbestosis are at high risk for developing bronchogenic cancer.
2. His doctor is monitoring him closely to look for signs of improvement.
3. Patients who use low flow oxygen for long periods are at high risk for developing neurological symptoms.
4. Periodic sputum samples are needed to follow the progress of the disease.

13. An adult male has had a hacking cough and shortness of breath for several months. He now has chest pain. His family has pressured him into seeking medical consultation. He continues to say, “It is just a smoker’s cough.” The physician examines the client and arranges for hospital admission for a diagnostic work-up. The nurse is explaining several types of tests that are ordered. Which of these tests is most definitive in the process of ruling out a malignancy?
1. Needle biopsy.
2. Thoracentesis.
3. Bronchogram.
4. Sputum analysis.

14. Preoperative teaching for the client who is to have a pneumonectomy should include all of the following. Which is of highest priority?
1. Management of postoperative pain.
2. Turning, coughing and deep breathing exercises.
3. How to move with the least pain.
4. Leg exercises.
15. An adult client has just arrived in the recovery room following a pneumonectomy. What is the most appropriate initial action for the nurse?
1. Take his vital signs for baseline data.
2. Check the IV solution for rate and correct solution.
3. Administer oxygen through an appropriate device.
4. Auscultate for the presence of breath sounds.

16. What action is essential because the client had a pneumonectomy?
1. Observe the tracheal position.
2. Auscultate bilateral breath sounds.
3. Assess for hypertension.
4. Assess for blood streaked sputum.

17. The nurse is positioning an adult who has just returned to the surgical nursing care unit following a pneumonectomy. What is the most appropriate position in which to place the client?
1. Semi-Fowler’s on the unaffected side.
2. Semi-Fowler’s on the affected side.
3. Sims position on the unaffected side.
4. Semi-Fowler’s on his back.

18. Which of the following nursing interventions should be instituted the day after surgery for the client who has had a pneumonectomy?
1. Provide range of motion exercises to affected arm.
2. Strip chest tubes every hour.
3. Force fluids to 3500 cc / day.
4. Monitor intermittent positive pressure breathing therapy.

19. An adult has been diagnosed as having pulmonary tuberculosis. Which test(s) would the nurse expect to be ordered before the client is started on Isoniazid (INH) therapy?
1. LDH, SGOT (AST)
2. BUN, serum creatinine
3. Skin test for allergy
4. Chest X-ray

20. A patient is admitted with histoplasmosis. Which item in the patient’s history is most likely related to the onset of the disease?
1. He works in a factory.
2. He likes to explore caves.
3. He has three cats.
4. He smokes four packs of cigarettes a week.

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