ATI RN
NCLEX RN Questions on Respiratory System Questions
Question 1 of 5
The nurse on the intermediate care unit received a change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
Correct Answer: A
Rationale: The correct answer is A. The nurse should assess the 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain first because chest pain can be a sign of a cardiac issue, which could be life-threatening. Assessing this patient first is crucial to rule out any acute cardiac events. Leg cramping (choice B) is a common symptom in hypertensive patients but is not as urgent as chest pain. High creatinine levels (choice C) may indicate kidney issues but do not require immediate assessment compared to chest pain. Microalbuminuria (choice D) is a sign of kidney damage in hypertension but does not pose an immediate threat like chest pain.
Question 2 of 5
O2 dissociation curve shift to R) by all of the following except
Correct Answer: D
Rationale: The correct answer is D: Carbon monoxide. Carbon monoxide does not shift the O2 dissociation curve to the right (R) because it binds to hemoglobin with a higher affinity than oxygen, causing a leftward shift (L). Increased [H+], pCO2, and temperature all shift the curve to the right by decreasing hemoglobin's affinity for oxygen.
Question 3 of 5
The organs of the respiratory zone of the respiratory system include all the following EXCEPT:
Correct Answer: A
Rationale: The correct answer is A: trachea. The trachea is not part of the respiratory zone, which is where gas exchange occurs. The respiratory zone includes the small bronchioles, alveoli ducts, and alveoli. The trachea is part of the conducting zone, which is responsible for transporting air to and from the respiratory zone. Therefore, the trachea is not directly involved in gas exchange, making it the correct answer. The other choices, B: small bronchioles, C: alveoli ducts, and D: alveoli, are all part of the respiratory zone and play a crucial role in gas exchange.
Question 4 of 5
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?
Correct Answer: B
Rationale: The correct answer is B: Continue to monitor the client. Fluctuation of fluid level in the water seal chamber post chest tube insertion indicates proper functioning of the chest tube system. This signifies that the tube is effectively draining fluid or air from the pleural space. It is essential to continue monitoring the client to ensure ongoing proper functioning of the chest tube. Informing the physician (Choice A) is not necessary at this point unless there are other concerning symptoms. Reinforcing the occlusive dressing (Choice C) is not indicated unless there is a leak or issue with the dressing. Encouraging the client to deep breathe (Choice D) is unrelated to the assessment of the chest tube system.
Question 5 of 5
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:
Correct Answer: B
Rationale: The correct answer is B: 5 to 20 minutes. Plugging the tracheostomy tube for this duration allows the client to gradually adapt to breathing without the assistance of the tube. Initially, the client may experience increased respiratory effort, which helps improve lung function. Plugging the tube for too short a time (A) may not provide enough challenge for the client, while plugging it for too long (C, D) may cause distress or potential complications due to lack of oxygen. Therefore, the optimal time frame of 5 to 20 minutes ensures a safe and effective weaning process for the client.