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MED Surge Respiratory ATI Exam Questions
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1- A charge nurse receives notification of the admission of a client who is coughing frequently and whose sputum is pink, frothy, and copious. The client has history of night sweats, anorexia, and weight loss. Which of the following actions should the nurse take? (SATA) -Assign the client to a private room with negative- pressure airflow -Wear an N95 respirator when entering the client’s room. 2- A nurse is assisting a provider with a comprehensive physical examination of a client. When the provider uses transillumination, the nurse should explain to the client that this technique help evaluate which of the following structures? -Maxillary sinuses 3- A nurse is caring for a client who smokes cigarettes and has a new diagnosis of emphysema. How should the nurse assist the client with smoking cessation? -Discuss ways the client can reduce the number of cigarettes smoked per day. 4- A nurse is planning care for a client who has chronic obstructive pulmonary disease (COPD) and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan?
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-Eat high-calorie food first. Rational: client who has COPD experience early satiety. Client should eat calorie- dense food first. 5- A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? -Tinnitus. Rational: An adverse effect of cisplatin is ototoxicity, which can cause tinnitus. 6- A nurse in a medical-surgical unit is assessing a client. The nurse should identify that which of the following findings is a manifestation of a pulmonary embolism? -Stabbing chest pain Rational : sudden chest pain that is sharp and stabbing is a manifestation of pulmonary embolism. Other manifestations include dyspnea, coughing, hemoptysis (coughing up blood), tachypnea, tachycardia, diaphoresis, and feeling of impending doom. 7- A nurse in the PACU is assessing a newly admitted client and observes intercostal retractions and a high-pitched inspiratory sound (stridor). The nurse should identify theses findings as manifestations of which of the following complications? -Respiratory obstruction 8- A nurse is reviewing the laboratory results of a client who has metabolic alkalosis. Which of the following laboratory values should the nurse expect?
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-“The lower tube will drain blood, and the higher tube will remove air.” 13- A nurse is providing teaching to a client who will undergo a total laryngectomy. Which of the following statements indicate that the client understands the impact of the surgery?
- “I understands that I will have a permanent tracheostomy after the surgery.” Rational: With a partial laryngectomy, the tracheostomy is temporary. With the total laryngectomy the tracheostomy will be permanent. 14- A nurse is providing discharge instructions to a client who has a new laryngectomy. The nurse tells the client to be careful while bathing to prevent which of the following complications? -Aspiration of water. Rational: This is a client with a tracheostomy, so he will need to use a shower shield over the stoma when bathing or showering to keep water out of the airway. 15- A nurse is caring for a client who is extremely anxious and is hyperventilating. The client’s ABG results are pH 7.50, PaCO2 27 mmHg, and HCO3-25 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? -Respiratory alkalosis. 16- A nurse is planning postoperative education for a client who will undergo a radical neck dissection for cancer of the larynx. The nurse should include which of the following topics? (SATA)
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-NPO status -Alternative methods of communication - Changes in body image -Swallowing exercises. 17- A nurse in a clinic is providing teaching for a client who is scheduled to have a tuberculin skin test. Which of the following pieces of information should the nurse include?
- “You must return to the clinic to have the test read in 2 or 3 days.” 18- A nurse is providing discharge teaching to a client who is postoperative following a rhinoplasty/ Which of the following instructions should the nurse include? “Lie on your back with your head elevated 30 º when resting.” 19- A nurse is preparing to assist provider with an arterial blood withdrawal from a client’s radial artery for ABG measurements. Which of the following actions the nurse plan to take? -Perform an Allen’s test prior to obtaining the specimen. Rational : the nurse should ensure that the circulation of the hands is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery. 20-A nurse is providing teaching to a client about pulmonary function testing. Which of the following tests measures the volume of air the lungs can holds at the end of maximum inhalation? -Total lung capacity
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26-A nurse is caring for a client following a right pleural thoracentesis. The nurse measures a total of 35 ml of purulent drainage. Which of the following findings should the nurse recognize as an indication of tension pneumothorax? (SATA) -Tracheal deviation to the left -Absent breath sounds on the right side -Neck vein distention 27-A nurse is providing discharge teaching to a client who has emphysema. Which of the following instructions should the nurse include? -“Try to drink at least 2 to 3 liters of fluid per day” Rational : clients who have emphysema should drink 2 to 3 L per day to help liquefy secretions. 28-A nurse is caring for a client who had a left lower lobectomy to treat lung cancer. Which of the following factors will have a significant impact on the plan of care for this client? -Lung cancer usually has metastasized before the client present with symptoms. 29-A nurse is assessing a client who has a positive tuberculin skin test. Which of the following findings indicates that the client has active tuberculosis? -Night sweats. Rational: manifestations of active tuberculosis include a fever, coughing, night sweats, anorexia, and fatigue.
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30-A nurse is providing discharge teaching to a client who had a pulmonary embolism. Which of the following statements indicates that the client understands the information? -“I’ll call the doctor if I see any blood in my urine or stool.” Rational : bleeding precautions are essential to clients who had a pulmonary embolism because they taken an anticoagulant. They should report any signs of bleeding immediately. 31-A nurse is caring for a client whom the respiratory therapist has just removed the endotracheal tube. Which of the following actions should the nurse take first? -Evaluate the client for stridor 32-A nurse in a provider’s office is assessing a client who states he was recently exposed to tuberculosis. Which of the following findings is a clinical manifestation of pulmonary tuberculosis? -Night sweats 33-A nurse on a medical-surgical unit is caring for a client who is postoperative following a hip replacement surgery. The client reports feeling apprehensive and restless. Which of the following findings should the nurse recognize as an indication of pulmonary embolism? -Sudden onset of dyspnea. Rationa l: clinical manifestations of pulmonary embolism have a rapid onset. Dyspnea occurs duet o reduced blood flow to the lungs. 34-A client is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation of the right side of the client’s chest. After notifying the provider, the nurse document this finding as which of the following?
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Rational : dry cough is a clinical manifestation of the prodromal stage of inhalation anthrax. During this stage, it is difficult to distinguish the condition from influenza or pneumonia because there is no sore throat or rhinitis. 38-A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of the following findings indicates that the nurse should suction the client airway secretions? -The nurse auscultates coarse crackles in the lung fields. 39-A nurse is planning care for a client following placement of a chest tube 1 hr ago. Which of the following actions should the nurse include in the plan of care? -Tape all connections between the chest tube and drainage system. Rational: the nurse should tape all connections to ensure that the system is airtight and prevent the chest tubing from accidentally disconnecting. 40-A nurse in the emergency department is assessing a client for closed pneumothorax and significant bruising of the left chest following a motor- vehicle crash. The client reports severe left chest pain on inspiration. The nurse should assess the client for which of the following manifestations of pneumothorax? -Absence of breath sounds 41-A nurse is providing discharge teaching about improving gas exchange for client who has emphysema. Which of the following instructions should the nurse include in the teaching? -Use pursed-lip breathing during periods of dyspnea.
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Rational : using pursed-lip breathing during periods of dyspnea will slow expiration, increase airway pressure, and facilitate effective gas exchange. 42-A nurse is caring for a client who is scheduled to have his chest tube removed. Which of the following actions the nurse takes?
- Instruct the client to perform the Valsalva maneuver during removal. Rational : Valsalva maneuver will maintain the appropriate amount of negative pressure in the chest in order to prevent air entry into the pleural space. 43-A nurse is caring for a client who is receiving mechanical ventilation and develops acute respiration distress. Which of the following actions should the nurse take first? -Initiate bag-valve-mask ventilation. 44-A client comes to the emergency department in severe respiratory distress following leftsided blunt chest trauma. The nurse notes absent breath sounds on the client’s left side and a tracheal shift to the right. For which of the following procedures should the nurse prepare the client? -Chest tube insertion. Rational : client manifestations indicate pneumothorax due to blunt chest trauma. The nurse should prepare for the provider to insert a chest tube and connect it to a water seal drainage system. 45-A nurse a caring for a client who is experiencing acute opioid toxicity. Which of the following actions should the nurse identify as the priority? -Ensure an adequate airway.
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-Draining blood and fluid from the pleural space. 52- A nurse is caring for a client who has a 20-year history of COPD and is receiving oxygen at 2 L/min via nasal canula. The client is dyspneic and has an oxygen saturation via pulse oximetry of 85%. Which of the following actions should the nurse take? -Increase the oxygen flow and request an arterial blood gas determination. Rational: the client requires oxygen at a rate that will keep the oxygen saturation between 88% and 92%. The nurse should increase the client’s oxygen and evaluate its effectiveness with ABG results and oxygen saturation via pulse oximetry measurements. 53- A nurse is teaching breathing techniques to a client who has emphysema. Which of the following statements indicates that the client understands the mechanics of pursed-lip breathing?
- “When I breath out through pursed lips, my airway don’t collapse between breath.” 54- A nurse is planning care for a client who is postoperative following a hip arthroplasty. In the client’s medical records, the nurse notes a history of chronic obstructive pulmonary disease (COPD). Which of the following oxygen-delivery methods should the nurse plan to use for this client? -Nasal cannula Rational: the nasal cannula delivers precise concentrations of oxygen; therefore, it is an appropriate device for s client who has COPD and requires a precise percentage of inspired oxygen. 55- A nurse is providing preoperative teaching to a client who has lung cancer and will undergo a pneumonectomy. Which of the following statements should the nurse include?
- “You will have a chest tube in place after surgery”
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- “We’ll frequently help you turn, cough, and breathe deeply after surgery.”
- “we’ll give you oxygen to support your breathing if you need it.” 56- A nurse is providing instructions about pursed-lip breathing for a client who has chronic obstructive pulmonary disease (COPD) with emphysema. This breathing accomplishes which of the following? -Promotes carbon dioxide elimination 57- A nurse is preparing a client for thoracentesis. In which of the following positions should the nurse place the client? -Sitting while leaning forward over the bedside table 58- A nurse is developing a teaching plan for a client about preventing acute asthma attacks. Which of the following points should the nurse plan to discuss first? -Addressing the client’s perception and what might have triggered past attacks 59- A nurse on a medical-surgical unit is assessing a client who recently transferred from the ICU following endotracheal extubation. Which of the following findings should the nurse identify as a possible manifestation of tracheal stenosis and report to the provider? -Increased coughing Rational: the nurse should identify increased coughing as a manifestation of tracheal stenosis. Other manifestations include an inability to cough up secretions and difficulty talking or breathing. 60- A nurse is teaching a client with cystic fibrosis about daily chest physiotherapy. Which of the following is the purpose of these treatments? -To mobilize secretions in the airways.
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4- A nurse in the emergency department is assessing a client admitted to the emergency department who has sustained crushing chest injuries in a car accident. Which of the following signs indicate a possible pneumothorax? -Diminished or absent breath sounds on the affected side 5- A client who had extensive pelvic surgery 24 hr ago becomes cyanotic, is gasping for breath, and complains of right-sided chest pain. What should the nurse do first? -Administer oxygen using a face mask 6- A client is admitted with second degree burns on face, neck, anterior chest, and hands. The nurse’s priority action would be: -Assess for dyspnea and stridor 7- A client who underwent a left lower lobectomy is forty-eight hrs post op. The client is receiving morphine sulfate via a patient-controlled analgesia (PCA) system and report having pain in the left thorax that worsens coughing. The nurse should: -Obtain a more detailed assessment of the client’s pain using a pain scale. 8- A nurse is caring for a client who is undergoing tracheostomy. The nurse understands that which of the following is a complication of this procedure? -Damage to the recurrent laryngeal nerve. 9- A nurse is assessing a client’s arterial blood results. The results are pH 7.50, bicarbonate 32mEq/L, and PaCO2 36 mmHg. Which of the following do these arterial gas results indicate? -Metabolic alkalosis
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10-A nurse is caring for a client on a ventilator who has ventilator settings with a preset tidal volume. Which best describes the tidal volume (VT) in this setting: -The amount of air inhaled with each breath 11-The nurse is caring for a client who has just been intubated for respiratory failure. The physician orders the ventilator to be set SIMV mode. Which best describes SIMV? -A preset number of breaths delivered to the client at certain volume 12-A client with asthma is scheduled for treatment with methylxanthine for nocturnal wheezing. Which of the following drugs are methylxanthine drugs that are appropriate for the treatment of this client? (SATA) -Theophylline -Aminophylline 13-The nurse is administering cromolyn sodium (Intal) for client with asthma. Which of the following are true about this drug? (SATA) -It causes headache -It prevents an attack 14-A nurse caring for a client with hemothorax. The physician plans to insert a right-sided chest tube. ( La pregunta pide ordenar los cuadritos en el orden correcto)
- Check the physician order and gather the chest tube supplies - Assist the client to the correct position for placement.
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17- The nurse is assessing a client with extrapulmonary tuberculosis. Which of the following is true about this type of condition? (SATA) -Genitourinary system is affected -Osteomyelitis occurs 18- Which of the following devices is most appropriate for delivering a predicted oxygen concentration in a client with unstable chronic obstructive pulmonary disease (COPD)? -Venturi mask Rational: this mas allowing delivery of fixed FiO2 that depends on the flow rate and size of the entrainment port. It can delivery oxygen concentration ranging from 24-60 % and flow rates between 4-12 L/min. Used to titrate the oxygen concentration in clients with unstable COPD. 19- A nurse is assessing a client with emphysema. Which assessment findings does the nurse anticipate in this form of COPD? (SATA) -Hyperresonance on percussion of the lung area -Increased respiratory effort -Increased chest diameter when measured anteriorly and posteriorly 20- A nurse is caring for 4 new clients. When receiving reports, the nurse should prioritize assessment of which of the following?
- A 70-year-old client after knee replacement complaining of sudden-onset dyspnea accompanied by chest pain 21- A charge nurse is admitting an elderly client with influenza. Which of the following precautions are necessary for preventing the transmission of influenza virus to other clients? (SATA)
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- The client should wear a face mas when leaving the room
- The client should be assigned to a private room
- Visitor contact with the client should be limited 22- A nurse is caring for a client with a tracheostomy who is conscious and beginning to advance his oral intake. Which of the following actions should the nurse perform to reduce the risk of aspiration? (SATA)
- Deflate the cuff before feeding
- Ask the client to sit upright during feeding. With the chin in flexion 23-When providing instruction to a client newly diagnosed with asthma concerning the correct use of a corticosteroid inhaler and short-acting beta agonist inhaler (albuterol), which of the following should the nurse relay? -“ Use the albuterol inhaler first for symptomatic treatment” 24- A nurse is caring for a client with measles. Which of the following strategies the nurse implements to prevent the spread of infection? -Negative-pressure room -Use of N95 respirator mask
- Use of goggles and a face shield if there is likelihood of splashing of bodily secretions during an intervention. 25- A nurse is providing teaching about an ipratropium MDI that was recently prescribed to a client with COPD. Which of the following
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