NCLEX-PN
NCLEX Respiratory Questions Questions
Extract:
Question 1 of 5
Which assessment finding provides the best indication that the nurse needs to suction the client with a tracheostomy?
Correct Answer: C
Rationale: Wet breath sounds indicate mucus accumulation in the tracheostomy, necessitating suctioning to clear the airway.
Question 2 of 5
The client is admitted to emergency department complaining of shortness of breath and fever. The vital signs are T 100.4°F, P 94, R 26, and BP 134/86. Which concept should the nurse identify as a concern for the client? Select all that apply.
Correct Answer: B,C
Rationale: SOB and tachypnea (
B) suggest oxygenation issues, and fever (
C) indicates infection. Clotting (
A), perfusion (
D), and coping (E) are not primary based on data.
Question 3 of 5
The unlicensed assistive personnel (UAP) is bathing the client diagnosed with acute respiratory distress syndrome (ARDS). The bed is in a high position with the opposite side rail in the low position. Which action should the nurse implement?
Correct Answer: B
Rationale: Lowering the bed (
B) prevents falls, critical for ARDS patients. Demonstration (
A), extra help (
C), and praise (
D) are inappropriate given safety concerns.
Question 4 of 5
An adult has a chest drainage system. The client's wife reports to the nurse that her husband is restless. The nurse enters the room just in time to see him pull out his chest tube. The most appropriate initial action for the nurse to take is to:
Correct Answer: B
Rationale: Placing a hand firmly over the wound prevents air from entering the pleural space, which could cause a pneumothorax.
Question 5 of 5
Which statement indicates the client diagnosed with asthma needs more teaching concerning the medication regimen?
Correct Answer: C
Rationale: Daily oral glucocorticoids (
C) are not typically used for asthma maintenance due to significant side effects; they are reserved for severe exacerbations or specific cases. Inhaled corticosteroids or leukotriene modifiers (like Singulair,
A) are preferred for long-term control. Using cromolyn before exercise (
B) is correct to prevent exercise-induced bronchospasm. Albuterol for acute attacks (
D) is appropriate as a rescue inhaler.