NCLEX Respiratory Questions

Extract:

Question 1 of 5

Select all the following that can trigger an asthma attack:

Correct Answer: A,B,D,E,G

Rationale: Triggers include sulfites, smoke, GERD, cold weather, and cockroaches. Caffeine and beta agonists are not typical triggers; beta agonists are treatments.

Question 2 of 5

You're caring for a patient with pneumonia. The patient has just started treatment for pneumonia and is still experiencing hypoxemia. You know that respiratory acidosis is very common with patients with pneumonia. Which arterial blood gases below represent respiratory acidosis that is NOT compensated?

A. pH 7.29, PaCO2 55, HCO3 23, PO2 85 B. pH 7.48, PaCO2 35, HCO3 22, PO2 85 C. pH 7.20, PaCO2 20, HCO3 28, PO2 85 D. pH 7.55, PaCO 63, HCO3 19, PO2 85

Correct Answer: A

Rationale: Respiratory acidosis is characterized by low pH (<7.35) and high PaCO2 (>45). Option A (pH 7.29, PaCO2 55, HCO3 23) shows uncompensated respiratory acidosis, as HCO3 is normal, indicating no renal compensation. Other options show normal pH, respiratory alkalosis, or invalid data.

Question 3 of 5

The male client has had a radial neck dissection for cancer of the larynx. Which action by the client indicates a disturbance in body image?

A. The client requests a consultation by the speech therapist. B. The client has a towel placed over the mirror. C. The client is attempting to shave himself. D. The client practices neck and shoulder exercises.

Correct Answer: B

Rationale: Placing a towel over the mirror (choice 2) suggests the client is avoiding looking at their altered appearance due to the radical neck dissection, indicating a disturbance in body image. This surgery often results in visible changes, such as scarring or a tracheostomy, which can impact self-perception. Requesting a speech therapist (choice 1) focuses on communication, attempting to shave (choice 3) shows engagement in self-care, and practicing exercises (choice 4) indicates recovery efforts, none of which directly reflect body image issues.

Question 4 of 5

Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV Heparin. Select all the nursing interventions that are appropriate for this patient:

A. Apply cool compresses to affected extremity B. Measure leg circumference C. Massage affected extremity D. Elevate affected extremity above heart level E. Encourage frequent ambulation F. Monitor the patient's INR level G. Monitor the patient's aPTT level

Correct Answer: B,D,G

Rationale: Nursing interventions for this patient include: measuring leg circumference, elevating affected extremity above heart level, and monitoring aPTT level (for Heparin therapy). Why are the other options wrong? Option A: WARM compresses should be used, NOT cool (this will help with pain and circulation), Option C: this could dislodge the clot (NEVER massage or rub the site), Option E: the patient needs bed rest...ambulation could dislodge the clot, Option F: INR level is used to monitor Warfarin NOT Heparin, Option H: SCDs are NOT applied to an extremity with a clot because it could dislodge the clot...they are used to PREVENT blood clots.

Question 5 of 5

The client has been diagnosed with chronic sinusitis. Which sign/symptom alerts the nurse to a potentially life-threatening complication?

A. Muscle weakness. B. Purulent sputum. C. Nuchal rigidity. D. Intermittent loss of muscle control.

Correct Answer: C

Rationale: Nuchal rigidity (
C) suggests meningitis, a life-threatening sinusitis complication. Muscle weakness (
A) and loss of control (
D) are unrelated, and purulent sputum (
B) is more typical of respiratory infections.

NCLEX Respiratory Questions | Nurselytic

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