Pulmonary System NCLEX-like Critical Thinking Questions

A client admitted with emphysema is on 2L NC. The client becomes agitated and begins to have shallow breathing at a rate of 28 bpm. What should the nurse do FIRST?

Chief Complaint: 76-year-old client admitted to the ED with a history of poor appetite, decreased fluid intake, confusion, productive cough, and fever x 24 hours.

Nursing Assessment: Alert and oriented x 2, moves all extremities equally, bilateral coarse crackles to lung bases. S1 S2 with no murmurs. All peripheral pulses 2+, CFT 3 seconds, skin pale and moist to touch. Bowel sounds active x 4. Abdomen soft. Voided x 1 in the last 24 hours. Poor oral intake.

Vital signs: Temp 101.4 °F, BP 98/55, HR 110, RR 24 labored, Oxygen saturation 89% on room air.

Place an X to specify what intervention takes priority according to body system.

Chief Complaint: 76-year-old client admitted to the ED with a history of poor appetite, decreased fluid intake, confusion, productive cough, and fever x 24 hours.

Nursing Assessment: Alert and oriented x 2, moves all extremities equally, bilateral coarse crackles to lung bases. S1 S2 with no murmurs. All peripheral pulses 2+, CFT 3 seconds, skin pale and moist to touch. Bowel sounds active x 4. Abdomen soft. Voided x 1 in the last 24 hours. Poor oral intake.

Vital signs: Temp 101.4 °F, BP 98/55, HR 110, RR 24 labored, Oxygen saturation 89% on room air.

Physicians orders:

• Tylenol 650 mg PO/PR every 4 hours for temperature > 100.5 °F.
• Labs: CBC, CMP, Sputum culture and sensitivity, & Blood culture x 2
• Oxygen via NC to keep saturations > 92%
• Normal saline bolus 500ml IV over 1 hour
• Foley catheter
• Levofloxacin 500mg IV every 24 hours

The nurse reviews the physician’s orders. Which of the following does the nurse implement first?

Chief Complaint: 76-year-old client admitted to the ED with a history of poor appetite, decreased fluid intake, confusion, productive cough, and fever x 24 hours.

Nursing Assessment: Alert and oriented x 2, moves all extremities equally, bilateral coarse crackles to lung bases. S1 S2 with no murmurs. All peripheral pulses 2+, CFT 3 seconds, skin pale and moist to touch. Bowel sounds active x 4. Abdomen soft. Voided x 1 in the last 24 hours. Poor oral intake.

Vital signs: Temp 101.4 °F, BP 98/55, HR 110, RR 24 labored, Oxygen saturation 89% on room air.

Physicians orders:

• Tylenol 650 mg PO/PR every 4 hours for temperature > 100.5 °F.
• Labs: CBC, CMP, Sputum culture and sensitivity, & Blood culture x 2
• Oxygen via NC to keep saturations > 92%
• Normal saline bolus 500ml IV over 1 hour
• Foley catheter
• Levofloxacin 500mg IV every 24 hours

The nurse carries out the above physician’s orders. With insertion of the foley the nurse obtains only 10 cc of urine.  

Two hour later, the nurse reassesses the client. For each finding, specify with an X whether the client’s condition has improved, not changed, or declined.

Which of the following instructions should the nurse provide to a client who is having his chest tube tube removed by the physician?

A 25-year-old female client is admitted to the ED with deep vein thrombosis and a pulmonary embolism.  The physician writes an order for a heparin drip.  Which of the following should be a major concern for the nurse?

Which of the following teaching points should the nurse include in the teaching plan of a client who will be discharge on Warfarin after a pulmonary embolism?

The client is admitted with COPD exacerbation.  The client is alert and oriented x 3. Labored Respiratory rate at 20 breaths/min. Lungs with bilateral wheezes. The client has thick tan secretions. 

• Vital Signs: BP 130/70,  HR 100,  RR 22 bpm,  Temperature 98°F.
• ABG:
  • pH        7.30    Low
  • pCO2   59 mm Hg    High
  • pO2       62 mm Hg   Low
  • HCO3    22 mEq/L   Normal

Which of the following describes the client’s problem based on the arterial blood gas?

The client is admitted with COPD exacerbation.  The client is alert and oriented x 3. Respiratory rate 22 bpm and labored. Lungs with bilateral wheezes. The client has thick tan secretions. 

• Vital Signs: BP 130/70,  HR 100,  RR 22 bpm,  Temperature 98 °F.
• ABG:
  • pH      7.30  Low
  • pCO2   59 mm Hg  High
  • HCO3  22 mEq/L
  • pO2      62 mm Hg Low

The nurse interprets this ABG as:

The client is admitted with COPD exacerbation.  The client is alert and oriented x 3. Respiratory rate 20 bpm and labored. Lungs with bilateral wheezes. The client has thick tan secretions. 

• Vital Signs: BP 130/70,  HR 100,  RR 20 bpm,  Temperature 98 °F.
• ABG:
  • pH         7.30  Low
  • pCO2     59 mm Hg  High
  • pO2        62 mm Hg Low
  • HCO3     22 mEq/L    Normal

The nurse expects which of the following potential physician’s orders? Select all that apply.

The nurse is developing a teaching plan for the client who will be discharged on a fluticasone inhaler.  Which of the following teaching points should the nurse include?

The client has been diagnosed with active tuberculosis.  The nurse implements a teaching plan on tuberculosis.  Which of the following indicates that the client needs further teaching?

The nurse is caring for a client with the following ABG results:

pH           7.35

pCO2     44  mm Hg

pO2     88 mm Hg

HCO3   24 mm Hg

Which of the following is the priority intervention?

Which of the following statements demonstrates that the client needs further education about the tuberculin (Mantoux) skin test?

A client is admitted with recent weight loss, night sweats, and extreme fatigue. The preliminary diagnosis is Tuberculosis. What type of isolation should the client be placed in while sputum culture for acid fast bacilli (AFB) smear and culture results come back?

Which of the following are the goals for a client who is being discharged with tuberculosis? Select all that apply

Which of the following interventions should the nurse implement for a client on airborne precautions due to tuberculosis? Select all that apply.

The experienced nurse is teaching a new graduate nurse how to properly suction a ventilated client.  Place the following actions in the correct sequence.

The nurse is caring for a client who has a chest tube for a pleural effusion. Which of the following observations require No intervention by the nurse?

What is the priority intervention for a client who is having an asthma attack?

Which of the following teaching points should be included in the teaching of a client with ashma? Select all that apply.

The nurse is caring for a client with COPD.  Which of the following assessment findings should the nurse anticipate? Select all that apply.

The client had an abdominal surgery 2 days ago. Which of the following is the best intervention to prevent atelectasis?

The nurse is caring for a client who had a right chest tube placed due to a traumatic pneumothorax.  Upon entering the client’s room, the nurse notices that the client is in severe respiratory distress.  What is the priority action by the nurse?

The nurse is caring for a septic client who is developing ARDS (Acute Respiratory Distress Syndrome).  Which of the following signs and symptoms should the nurse anticipate? Select all that apply.

The home health nurse receives a call from a client who has the flu.  Which of the following recommendations should the nurse make to this client? Select all that apply.

The nurse provides education to a client with Cystic Fibrosis.  Which of the following statements by the client demonstrates good understanding of the disease? Select all that apply.

Match the problem with the intervention. Choose the best choice.

Match the sign or symptom with the disease/condition. Choose the BEST answer for each.

The nurse is caring for a client with Acute Respiratory Distress Syndrome.  Which of the following signs and symptoms does the nurse anticipate? Select all that apply.

The nurse is caring for a 78-year-old client with respiratory failure due to sepsis.  The client is on the following ventilator settings:

SIMV 14, Peep 5 cm H2O, and FIO2 45%. 

Which of the following interventions should the nurse implement for this client? Select all that apply.

The nurse is caring for a post-open heart surgery client with bilateral mediastinal chest tubes.  The right chest tube put out 50 mL of serosanguineous drainage in the last hour and the left chest tube put out 200 mL of bright red blood in the last hour.  What is the nurse’s priority action?

The nurse is caring for a septic 80-year-old client who is in respiratory distress.

The nurse recognizes that which of the following is a hallmark sign of acute respiratory distress syndrome?

The nurse is caring for a client with following arterial blood gas:

• pH = 7.44
• pCO2 = 31 mm Hg
• pO2 = 85 mm Hg
• HCO3 = 21 mEq/L

The nurse interprets this ABG as:

Which of the following is the best oxygen delivery for a client with chronic obstructive pulmonary disease (COPD)?

The client is starting a 9-month course of Isoniazid.  Which of the following should the nurse include in the teaching plan? Select all that apply.

Asthma Medications

Match the medication with the description.  All choices must be used.

The charge nurse is observing a nurse who is taking care of a client with active tuberculosis.  Which of the following actions by the nurse require intervention?

The nurse is caring for a client who had a chest tube placed in the morning due to a pneumothorax.  Which of the following findings would require intervention by the nurse?

The nurse is assisting the physician in a thoracentesis for a client with a large right pleural effusion.  The nurse should assist the client in which of the following positions for the thoracentesis?

The nurse is preparing a presentation on populations who are at a high risk for developing Tuberculosis.  Which of the following populations should the nurse include? Select all that apply.

The nurse is caring for a client with respiratory failure who was intubated.  Which of the following includes the way endotracheal tube placement is verified?

The nurse is caring for an 18-year-old female client with rule out pneumonia.  The physician orders a chest X-ray.  What is the most important question that the nurse should ask?

The client has a suspected pulmonary embolism and the physician has ordered a pulmonary angiogram.  Which of the following interventions should the nurse implement?

The charge nurse is making safety rounds.  Which of the following, if observed by the charge nurse, requires intervention?

The nurse is caring for a client who is taking a nasal decongestation over-the-counter (phenylephrine or Sudafed).  Which of the following teaching points should the nurse include in the plan of care?

Which of the following is true of a client who received a bacillus-Calmette-Guerin (BCG) vaccine?

The nurse is preparing to draw an arterial blood gas from an arterial line on a client who is intubated.  Which of following actions by the nurse demonstrates knowledge of the procedure?

The client with active tuberculosis is treated with 3 different medications: isoniazid INH, rifampin, & pyrazinamide.  Which of the following is the priority intervention for this client?

 Which of the following interventions does the nurse implement to prevent ventilator-associated pneumonia? Select all that apply.

The ER nurse admits a tall thin 24-year-old male client who works as a receptionist.  The client had sudden and spontaneous chest pain and shortness of  breath.  The client is in acute respiratory distress with oxygen saturations of 90% on room air.  Assessment findings include: asymetrical chest expansion and no audible right lung breath sounds.  Which of the following doctor’s orders should the nurse anticipate? Select all that apply. 

Upon assessment, the nurse notices that a client with a nasal cannula at 5l/min has dry nasal membranes.  The client’s oxygen saturation is 96%.  Which of the following interventions should the nurse implement?

Which of the following statements by the nurse demonstrates knowledge of Cystic Fibrosis?

Which of the following signs and symptoms can a client with cystic fibrosis experience? Select all that apply.

Which of the following should be included in the teaching plan of a client with Chronic Obstructive Respiratory Disease? Select all that apply.

The nurse educates a client with asthma.  Which of the following statements by the client demonstrates understanding? Select all that apply.

The nurse is performing Chest physiotherapy to a client with cystic fibrosis.  The nurse should instruct the client to do which of the following during Chest PT?

Matching

The ICU nurse is caring for a client with Acute Respiratory Distress Syndrome.  Which of the following should the nurse anticipate? Select all that apply.