NCLEX Questions Respiratory

Extract:

Question 1 of 5

Which option below is considered a positive Homan's Sign for the assessment of a deep vein thrombosis (DVT)?

Correct Answer: A

Rationale: Homan's Sign is NOT reliable because of false positives, but know for exams how to elicit a response. It done by manually (forced) dorsiflexing the patient's foot (bending it up towards the shin) and if it causes the patient pain it considered a positive Homan's Sign. However, the MD must further investigate if the patient has a DVT.

Question 2 of 5

When the client asks why the physician chose this particular drug to treat the pneumonia, which response by the nurse is best?

A. The sensitivity report showed the organism is often killed by penicillin. B. Most viral infections respond well when treated with penicillin drugs. C. Penicillin is one of the safest yet most effective antibiotics. D. All antibiotics are similar; the choice of drug is not that important.

Correct Answer: A

Rationale: Penicillin is chosen based on the sensitivity report, indicating that the pneumococcal bacteria are susceptible to it.

Question 3 of 5

When performing the client's tracheostomy care, which nursing action is correct?

A. Cut a gauze square to fit around the client's stoma. B. Secure the ties at the back of the client's neck. C. Attach new ties before removing old ones. D. Replace the cannula after changing the ties.

Correct Answer: C

Rationale: Attaching new ties before removing old ones ensures the tracheostomy tube remains secure, preventing accidental dislodgement.

Question 4 of 5

Which datum requires immediate intervention by the nurse for the client diagnosed with asbestosis?

A. The client develops an S3 heart sound. B. The client has clubbing of the fingers. C. The client is fatigued in the afternoon. D. The client has basilar crackles in all lobes.

Correct Answer: A

Rationale: An S3 heart sound (
A) indicates heart failure, a serious complication in asbestosis due to pulmonary hypertension, requiring immediate intervention. Clubbing (
B) is a chronic finding, not acute. Fatigue (
C) is common but not urgent. Basilar crackles (
D) are expected in asbestosis and less critical than cardiac issues.

Question 5 of 5

The client diagnosed with a pulmonary embolus is in the intensive care department. Which assessment data warrant immediate intervention from the nurse?

A. The client's ABGs are pH 7.36, Pao2 95, Paco2 38, Hco3 24. B. The client's telemetry exhibits occasional premature ventricular contractions (PVCs). C. The client's pulse oximeter reading is 90%. D. The client's urinary output for the 12-hour shift is 800 mL.

Correct Answer: C

Rationale: SpO2 90% (
C) indicates hypoxia in PE, requiring immediate oxygen adjustment. Normal ABGs (
A), occasional PVCs (
B), and urine output (
D) are less urgent.

NCLEX Questions Respiratory | Nurselytic

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