100 Respiratory NCLEX questions COMPLETE QUESTIONS AND ANSWERS SOLVED SOLUTION 2021

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100 Respiratory NCLEX questions COMPLETE QUESTIONS AND ANSWERS SOLVED SOLUTION 2021 1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnose asthma. When teaching ... the patient about this drug, the nurse should explain that it may cause: A. Nasal congestion B. Nervousness C. Lethargy D. Hyperkalemia 2. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is: A. Yellow B. Green C. Clear D. Gray 3. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? A. Nausea or vomiting B. Abdominal pain or diarrhea C. Hallucinations or tinnitus D. Lightheadedness or paresthesia 4. Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for: A. Patients with an acute asthma attack B. Patients with narcolepsy C. Patients under age 6 D. Elderly patients 5. A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A. Kinking of the ventilator tubing B. A disconnected ventilator tube C. An endotracheal cuff leak D. A change in the oxygen concentration without resetting the oxygen level alarm 6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose? A. Leg movement B. Finger movement C. Lip movement D. Fighting the ventilator 7. On auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles B. Absence of breaths sound in the right thorax C. Inspiratory wheezes in the right thorax D. Bilateral pleural friction rub. 8. Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present? A. Acid-base balance B. Arterial Blood C. Arterial oxygen saturation D. Alveoli 9. A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? A. Activity intolerance related to fatigue B. Anxiety related to actual threat to health status C. Risk for infection related to retained secretions D. Impaired gas exchange related to airflow obstruction 10. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the: A. Contralateral side in a simple pneumothorax B. Affected side in a hemothorax C. Affected side in a tension pneumothorax D. Contralateral side in hemothorax 11. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must: A. Monitor fluctuations in the water-seal chamber B. Clamp the chest tube once every shift C. Encourage coughing and deep breathing D. Milk the chest tube every 2 hours 12. When caring for a male patient who has just had a total laryngectomy, the nurse should plan to: A. Encourage oral feeding as soon as possible B. Develop an alternative communication method C. Keep the tracheostomy cuff fully inflated D. Keep the patient flat in bed 13. A male patient has a sucking stab wound to the chest. Which action should the nurse take first? A. Drawing blood for a hematocrit and hemoglobin level B. Applying a dressing over the wound and taping it on three sides C. Preparing a chest tube insertion tray D. Preparing to start an I.V. line 14. For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily B. Keeping the patient in semi-Fowler’s position C. Using a high-flow venture mask to deliver oxygen as prescribe D. Administering a sedative, as prescribe 15. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from: A. Cardiogenic pulmonary edema B. Respiratory alkalosis C. Increased pulmonary capillary permeability D. Renal failure 16. For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? A. Restricting fluid intake to 1,000 ml per day B. Enforcing absolute bed rest C. Teaching the patient how to perform controlled coughing D. Administering prescribe sedatives regularly and in large amounts 17. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate? A. Do nothing, because this is an expected finding B. Immediately clamp the chest tube and notify the physician C. Check for an air leak because the bubbling should be intermittent D. Increase the suction pressure so that the bubbling becomes vigorous 18. Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate? A. Inform the physician B. Continue to monitor the client C. Reinforce the occlusive dressing D. Encourage the client to deep breathe 19. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to: A. Call the physician B. Place the tube in bottle of sterile water C. Immediately replace the chest tube system D. Place a sterile dressing over the disconnection site 20. A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to: A. Exhale slowly B. Stay very still C. Inhale and exhale quickly D. Perform the Valsalva maneuver 21. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to: A. Call the physician to reinsert the tube B. Grasp the retention sutures to spread the opening C. Call the respiratory therapy department to reinsert the tracheotomy D. Cover the tracheostomy site with a sterile dressing to prevent infection 22. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? A. Stridor B. Occasional pink-tinged sputum C. A few basilar lung crackles on the right D. Respiratory rate 24 breaths/min 23. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A. A low respiratory rate B. Diminished breath sounds C. The presence of a barrel chest D. A sucking sound at the site of injury 24. Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? A. Hypocapnia B. A hyperinflated chest noted on the chest x-ray C. Increased oxygen saturation with exercise D. A widened diaphragm noted on the chest x-ray 25. An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? A. Face tent B. Venturi mask C. Aerosol mask D. Tracheostomy collar 26. Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: A. Dyspnea B. Chest pain C. A bloody, productive cough D. A cough with the expectoration of mucoid sputum 27. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis? A. Bronchoscopy B. Sputum culture C. Chest x-ray D. Tuberculin skin test 28. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: A. 1 L/min B. 2 L/min C. 6 L/min D. 10 L/min 29. A nurse instructs a female client to use the pursed-lip method of breathing and 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 to: A. Promote oxygen intake B. Strengthen the diaphragm C. Strengthen the intercostal muscles D. Promote carbon dioxide elimination 30. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client? A. Pallor B. Low arterial PaO2 C. Elevated arterial PaO2 D. Decreased respiratory rate 31. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen? A. Limiting fluid B. Having the client take deep breaths C. Asking the client to spit into the collection container D. Asking the client to obtain the specimen after eating 32. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician? A. Dry cough B. Hematuria C. Bronchospasm D. Blood-streaked sputum 33. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of: A. 1 minute B. 5 seconds C. 10 seconds D. 30 seconds 34. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention? A. Continue to suction B. Notify the physician immediately C. Stop the procedure and reoxygenate the client D. Ensure that the suction is limited to 15 seconds 35. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? A. Dyspnea B. Bradypnea C. Bradycardia D. Decreased respirations 36. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit: A. Resonant sounds. B. Hyperresonant sounds. C. Dull sounds. D. Flat sounds. 37. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should: A. Question the order because it’s too low. B. Question the order because it’s too high. C. Set the pump at 45 ml/hour. D. Stop the infusion and have the laboratory repeat the theophylline measurement. 38. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A. Make inhalation longer than exhalation. B. Exhale through an open mouth. C. Use diaphragmatic breathing. D. Use chest breathing. 39. Which phrase is used to describe the volume of air inspired and expired with a normal breath? A. Total lung capacity B. Forced vital capacity C. Tidal volume D. Residual volume 40. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations? A. Simple mask B. Non-rebreather mask C. Face tent D. Nasal cannula 41. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs? A. Impaired color discrimination B. Increased urinary frequency C. Decreased hearing acuity D. Increased appetite 42. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the: A. Area of redness is measured in 3 days and determines whether tuberculosis is present. B. Skin test doesn’t differentiate between active and dormant tuberculosis infection. C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis. D. Test stimulates a reddened response in some clients and requires a second test in 3 months. 43. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: A. 15 to 60 seconds. B. 5 to 20 minutes. C. 30 to 40 minutes. D. 45 to 60 minutes. 44. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? A. The system is functioning normally B. The client has a pneumothorax. C. The system has an air leak. D. The chest tube is obstructed. 45. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the: A. Lips. B. Mucous membranes. C. Nail beds. D. Earlobes. 46. For a male client with an endotracheal (ET) tube, which nursing action is most essential? A. Auscultating the lungs for bilateral breath sounds B. Turning the client from side to side every 2 hours C. Monitoring serial blood gas values every 4 hours D. Providing frequent oral hygiene 47. The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing B. Use of accessory muscles C. Pursed-lip breathing D. Controlled breathing 48. A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess: A. Lung vibrations. B. Vocal sounds. C. Breath sounds. D. Chest movements. 49. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating legionnaires’ disease? A. Erythromycin (Erythrocin) B. Rifampin (Rifadin) C. Amantadine (Symmetrel) D. Amphotericin B (Fungizone) 50. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for: A. Pleural effusion. B. Pulmonary edema. C. Atelectasis. D. Oxygen toxicity. 51. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. It helps prevent early airway collapse. B. It increases inspiratory muscle strength. C. It decreases use of accessory breathing muscles. D. It prolongs the inspiratory phase of respiration. 52. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond? A. In 30 minutes B. In 1 hour C. In 2.5 hours D. In 4 hours 53. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A. Kinking of the ventilator tubing B. A disconnected ventilator tube C. An ET cuff leak D. A change in the oxygen concentration without resetting the oxygen level alarm 54. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive. B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator. C. It stimulates adenosine receptors, causing bronchodilation. D. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange. 55. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature? A. Inflamed lung tissue B. Sudden onset C. Responsiveness to penicillin. D. Elevated white blood cell (WBC) count 56. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A. pH, 5.0; PaCO2 30 mm Hg B. pH, 7.40; PaCO2 35 mm Hg C. pH, 7.35; PaCO2 40 mm Hg D. pH, 7.25; PaCO2 50 mm Hg 57. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration? A. Apnea B. Anginal pain C. Respiratory alkalosis D. Metabolic acidosis 58. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer: A. Alprazolam (Xanax). B. Propranolol (Inderal) C. Morphine. D. Albuterol (Proventil). 59. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia? A. Heightened alertness B. Increased heart rate C. Numbness and tingling of the extremities D. Respiratory depression 60. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include: A. Drinking more than 1,500 ml of fluid daily. B. Being overweight. C. Eating a high-protein snack at bedtime. D. Eating more than three large meals a day. 61. An elderly client with pneumonia may appear with which of the following symptoms first? 1. Altered mental status and dehydration 2. fever and chills 3. Hemoptysis and dyspnea 4. Pleuritic chest pain and cough 62. Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows pneumonia to develop? 1. Atelectasis 2. Bronchiectasis 3. Effusion 4. Inflammation 63. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? 1. Acute asthma 2. Bronchial pneumonia 3. Chronic obstructive pulmonary disease (COPD) 4. Emphysema 64. Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? 1. Circumoral cyanosis 2. Increased forced expiratory volume 3. Inspiratory and expiratory wheezing 4. Normal breath sounds 65. Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection? 1. Emotional 2. Extrinsic 3. Intrinsic 4. Mediated 66. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? 1. Beta-adrenergic blockers 2. Bronchodilators 3. Inhaled steroids 4. Oral steroids 67. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? 1. Take a full medication history 2. Give a bronchodilator by nebulizer 3. Apply a cardiac monitor to the client 4. Provide emotional support to the client. 68. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? 1. Adult respiratory distress syndrome (ARDS) 2. Asthma 3. Chronic obstructive bronchitis 4. Emphysema 69. The term “blue bloater” refers to which of the following conditions? 1. Adult respiratory distress syndrome (ARDS) 2. Asthma 3. Chronic obstructive bronchitis 4. Emphysema 70. The term “pink puffer” refers to the client with which of the following conditions? 1. ARDS 2. Asthma 3. Chronic obstructive bronchitis 4. Emphysema 71. 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 72. It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? 1. All clients are recommended to have these vaccines 2. These vaccines produce bronchodilation and improve oxygenation. 3. These vaccines help reduce the tachypnea these clients experience. 4. Respiratory infections can cause severe hypoxia and possibly death in these clients. 73. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? 1. It enhances cardiovascular fitness. 2. It improves respiratory muscle strength. 3. It reduces the number of acute attacks. 4. It worsens respiratory function and is discouraged. 74. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why? 1. Reducing fluid volume reduces oxygen demand. 2. Reducing fluid volume improves clients’ mobility. 3. Restricting fluid volume reduces sputum production. 4. Reducing fluid volume improves respiratory function. 75. 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 76. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? 1. The client doesn’t notice he needs to breathe. 2. The client breathes only when his oxygen levels climb above a certain point. 3. The client breathes only when his oxygen levels dip below a certain point. 4. The client breathes only when his carbon dioxide level dips below a certain point. 77. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics? 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. 78. Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery? 1. Atelectasis 2. Bronchitis 3. Pneumonia 4. Pneumothorax 79. 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 80. Emergency treatment of a client in status asthmaticus includes which of the following medications? 1. Inhaled beta-adrenergic agents 2. Inhaled corticosteroids 3. I.V. beta-adrenergic agents 4. Oral corticosteroids 81. 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 82. 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 83. Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute? 1. Arterial blood gas (ABG) and breath sounds 2. Level of consciousness and a pulse oximetry value. 3. Breath sounds and reflexes 4. Pulse oximetry value and heart sounds 84. A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be which of the following values? 1. 15 mm Hg 2. 30 mm Hg 3. 40 mm Hg 4. 80 mm Hg 85. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following conditions? 1. Asthma attack 2. Pulmonary embolism 3. respiratory failure 4. Rheumatoid arthritis 86. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first? 1. Administering oxygen 2. Inserting an I.V. catheter 3. Obtaining a complete blood count (CBC) 4. Taking vital signs 87. 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? 1. Administer beta-adrenergic blockers 2. Administer bronchodilators 3. Obtain serum electrolyte levels 4. Have the client lie flat in the bed. 88. 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 89. 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 90. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L 2. Potassium level of 3.0 mEq/L 3. Magnesium level of 2.0 mg/L 4. Phosphorus level of 4.0 mg/dl 91. 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: 1. Metabolic acidosis, compensated. 2. Metabolic alkalosis, uncompensated. 3. Respiratory alkalosis, compensated. 4. Respiratory acidosis, compensated. 92. 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 93. 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 94. 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 95. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. Based on this documentation, which of the following did the nurse observe? 1. Respirations that are abnormally deep, regular, and increased in rate. 2. Respirations that are regular but abnormally slow. 3. Respirations that are labored and increased in depth and rate 4. Respirations that cease for several seconds. 96. A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic acidosis 4. Metabolic alkalosis 97. 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 98. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen’s test on the client. Number in order of priority the steps for performing the Allen’s test (#1 is first step). 1. Ask the client to open and close the hand repeatedly. 2. Apply pressure over the ulnar and radial arteries. 3. Assess the color of the extremity distal to the pressure point 4. Release pressure from the ulnar artery 5. Explain the procedure to the client. 5, 2, 1, 4, 3 99. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? 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. 100. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician? 1. Blood-streaked sputum 2. Dry cough 3. Hematuria 4. Bronchospasm [Show More]

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