NCLEX-PN
NCLEX Respiratory Questions Questions
Extract:
Question 1 of 5
The client diagnosed with ARDS is in respiratory distress and the ventilator is malfunctioning. Which intervention should the nurse implement first?
Correct Answer: B
Rationale: Manual ventilation (
B) ensures oxygenation during ventilator failure, a priority. Notification (
A), ABGs (
C), and auscultation (
D) follow.
Question 2 of 5
The client is diagnosed with a pulmonary embolus (PE) and is receiving a heparin drip. The bag hanging is 20,000 units/500 mL of D5W infusing at 22 mL/hr. How many units of heparin is the client receiving each hour?
Correct Answer: 880
Rationale: Heparin rate: (20,000 units ÷ 500 mL) × 22 mL/hr = 40 units/mL × 22 mL/hr = 880 units/hr.
Question 3 of 5
When suctioning the airway of a client with a tracheostomy, the nurse applies suction for no longer than how many seconds?
Correct Answer: B
Rationale: Suctioning for 10 to 12 seconds minimizes the risk of hypoxia and mucosal trauma.
Question 4 of 5
The client has been diagnosed with chronic sinusitis. Which sign/symptom alerts the nurse to a potentially life-threatening complication?
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.
Question 5 of 5
The client diagnosed with respiratory distress has arterial blood gases of pH 7.45, Paco2 54, Hco3 25, Pao2 52. Which should the nurse implement? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: PaO2 52 and PaCO2 54 indicate severe hypoxia; apply nonrebreather (
A), call RRT (
B), elevate HOB (
C), stay with client (
D), and notify HCP (E) are all critical.