Respiratory NCLEX Test Bank with updated 2022/2023 questions and answers
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Course
Respiratory NCLEX
Institution
Respiratory NCLEX
During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing
and dyspnea. The nurse interprets that these symptoms are related to what
pathophysiologic change?
a. Laryngospasm
b. Pulmonary edema
c. Narrowing of the airway
d. Overdistention of the alveoli Correct answer-...
respiratory nclex test bank with updated 20222023 questions and answers
during an assessment of a 45 year old patient with asthma
the nurse notes wheezing and dyspnea the nurse interprets that thes
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Respiratory NCLEX Test Bank with
updated 2022/2023 questions and
answers
During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing
and dyspnea. The nurse interprets that these symptoms are related to what
pathophysiologic change?
a. Laryngospasm
b. Pulmonary edema
c. Narrowing of the airway
d. Overdistention of the alveoli Correct answer- C
Narrowing of the airway by persistent but variable inflammation leads to reduced airflow,
making it difficult for the patient to breathe and producing the characteristic wheezing.
Laryngospasm, pulmonary edema, and overdistention of the alveoli do not produce
wheezing.
A 45-year-old man with asthma is brought to the emergency department by automobile.
He is short of breath and appears frightened. During the initial nursing assessment,
which clinical manifestation might be present as an early manifestation during an
exacerbation of asthma?
Anxiety
Cyanosis
Bradycardia
Hypercapnia Correct answer- An early manifestation during an asthma attack is anxiety
because the patient is acutely aware of the inability to get sufficient air to breathe. He
will be hypoxic early on with decreased PaCO2 and increased pH as he is
hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will
be increased.
The nurse is assigned to care for a patient who has anxiety and an exacerbation of
asthma. What is the primary reason for the nurse to carefully inspect the chest wall of
this patient?
Allow time to calm the patient.
Observe for signs of diaphoresis.
Evaluate the use of intercostal muscles.
Monitor the patient for bilateral chest expansion. Correct answer- The nurse physically
inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which
gives an indication of the degree of respiratory distress experienced by the patient. The
other options may also occur, but they are not the primary reason for inspecting the
chest wall of this patient.
,Which position is most appropriate for the nurse to place a patient experiencing an
asthma exacerbation?
Supine
Lithotomy
High Fowler's
Reverse Trendelenburg Correct answer- The patient experiencing an asthma attack
should be placed in high Fowler's position and may need to lean forward to allow for
optimal chest expansion and enlist the aid of gravity during inspiration. The supine,
lithotomy, and reverse Trendelenburg positions will not facilitation ventilation.
The nurse is caring for a patient with an acute exacerbation of asthma. Following initial
treatment, what finding indicates to the nurse that the patient's respiratory status is
improving?
Wheezing becomes louder.
Cough remains nonproductive.
Vesicular breath sounds decrease.
Aerosol bronchodilators stimulate coughing. Correct answer- The primary problem
during an exacerbation of asthma is narrowing of the airway and subsequent diminished
air exchange. As the airways begin to dilate, wheezing gets louder because of better air
exchange. Vesicular breath sounds will increase with improved respiratory status. After
a severe asthma exacerbation, the cough may be productive and stringy. Coughing
after aerosol bronchodilators may indicate a problem with the inhaler or its use.
The nurse identifies the nursing diagnosis of activity intolerance for a patient with
asthma. In patients with asthma, the nurse assesses for which etiologic factor for this
nursing diagnosis?
Work of breathing
Fear of suffocation
Effects of medications
Anxiety and restlessness Correct answer- When the patient does not have sufficient
gas exchange to engage in activity, the etiologic factor is often the work of breathing.
When patients with asthma do not have effective respirations, they use all available
energy to breathe and have little left over for purposeful activity. Fear of suffocation,
effects of medications or anxiety, and restlessness are not etiologies for activity
intolerance for a patient with asthma.
The nurse is assigned to care for a patient in the emergency department admitted with
an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and
supplemental oxygen. If the patient's condition does not improve, the nurse should
anticipate what as the most likely next step in treatment?
IV fluids
Biofeedback therapy
Systemic corticosteroids
Pulmonary function testing Correct answer- Systemic corticosteroids speed the
resolution of asthma exacerbations and are indicated if the initial response to the β-
,adrenergic bronchodilator is insufficient. IV fluids may be used, but not to improve
ventilation. Biofeedback therapy and pulmonary function testing may be used after
recovery to assist the patient and monitor the asthma.
A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)
needs to receive precise amounts of oxygen. Which equipment should the nurse
prepare to use?
Oxygen tent
Venturi mask
Nasal cannula
Oxygen-conserving cannula Correct answer- The Venturi mask delivers precise
concentrations of oxygen and should be selected whenever this is a priority concern.
The other methods are less precise in terms of amount of oxygen delivered.
While teaching a patient with asthma about the appropriate use of a peak flow meter,
what should the nurse instruct the patient to do?
Keep a record of the peak flow meter numbers if symptoms of asthma are getting
worse.
Use the flow meter each morning after taking medications to evaluate their
effectiveness.
Increase the doses of the long-term control medication if the peak flow numbers
decrease.
Empty the lungs and then inhale quickly through the mouthpiece to measure how fast
air can be inhaled. Correct answer- It is important to keep track of peak flow readings
daily, especially when the patient's symptoms are getting worse. The patient should
have specific directions as to when to call the physician based on personal peak flow
numbers. Peak flow is measured by exhaling into the flow meter and should be
assessed before and after medications to evaluate their effectiveness.
The physician has prescribed salmeterol (Serevent) for a patient with asthma. In
reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions
should the nurse provide?
"Close lips tightly around the mouthpiece and breathe in deeply and quickly."
"To administer a DPI, you must use a spacer that holds the medicine so that you can
inhale it."
"You will know you have correctly used the DPI when you taste or sense the medicine
going into your lungs."
"Hold the inhaler several inches in front of your mouth and breathe in slowly, holding
the medicine as long as possible." Correct answer- The patient should be instructed to
tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure
the medicine moves down deeply into the lungs. Dry powder inhalers do not require
spacer devices. The patient may not taste or sense the medicine going into the lungs.
The nurse determines that a patient is experiencing common adverse effects from the
inhaled corticosteroid beclomethasone (Beclovent) after what occurs?
Hypertension and pulmonary edema
, Oropharyngeal candidiasis and hoarseness
Elevation of blood glucose and calcium levels
Adrenocortical dysfunction and hyperglycemia Correct answer- Oropharyngeal
candidiasis and hoarseness are common adverse effects from the use of inhaled
corticosteroids because the medication can lead to overgrowth of organisms and local
irritation if the patient does not rinse the mouth following each dose.
The nurse determines that the patient understood medication instructions about the use
of a spacer device when taking inhaled medications after hearing the patient state what
as the primary benefit?
"I will pay less for medication because it will last longer."
"More of the medication will get down into my lungs to help my breathing."
"Now I will not need to breathe in as deeply when taking the inhaler medications."
"This device will make it so much easier and faster to take my inhaled medications."
Correct answer- A spacer assists more medication to reach the lungs, with less being
deposited in the mouth and the back of the throat. It does not affect the cost or increase
the speed of using the inhaler.
Which test result identifies that a patient with asthma is responding to treatment?
An increase in CO2 levels
A decreased exhaled nitric oxide
A decrease in white blood cell count
An increase in serum bicarbonate levels Correct answer- Nitric oxide levels are
increased in the breath of people with asthma. A decrease in the exhaled nitric oxide
concentration suggests that the treatment may be decreasing the lung inflammation
associated with asthma and adherence to treatment. An increase in CO2 levels,
decreased white blood cell count, and increased serum bicarbonate levels do not
indicate a positive response to treatment in the asthma patient.
The nurse determines that the patient is not experiencing adverse effects of albuterol
(Proventil) after noting which patient vital sign?
Pulse rate of 72/minute
Temperature of 98.4° F
Oxygen saturation 96%
Respiratory rate of 18/minute Correct answer- Albuterol is a β2-agonist that can
sometimes cause adverse cardiovascular effects. These would include tachycardia and
angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as
an adverse effect.
The patient has an order for each of the following inhalers. Which one should the nurse
offer to the patient at the onset of an asthma attack?
Albuterol (Proventil)
Salmeterol (Serevent)
Beclomethasone (Qvar)
Ipratropium bromide (Atrovent) Correct answer- Albuterol is a short-acting
bronchodilator that should be given initially when the patient experiences an asthma
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