electrolyte, respiratory-Questions with
Complete Solutions.
A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure which
action should the nurse take? - Answer position a client in an upright position leaning over the
bedside table
A nurse is reviewing ABG laboratory results of a client who is in respiratory distress the results
are pH 7.47, PaCO2 32MMHG, HCO3 22MMHG. The nurse should recognize that the client is
experiencing which of the following as a base imbalances? - Answer respiratory alkalosis
A nurse is assessing a client following a bronchoscopy. Which of the following findings should
the nurse report to the Provider? - Answer Bronchospasms
A nurse is caring for a client who is scheduled for a thoracentesis. Which of the following
supplies to the nurse ensure are in the clients room? Select all apply - Answer Oxygen
equipment, pulse ox, sterile dressing
A nurse is caring for a client following a thoracentesis. Which of the following manifestations
should the nurse recognize as risk for complications? Select all that apply - Answer dyspnea,
fever, hypotension
Nurse is caring for a group of clients. Which of the following clients are at risk for pulmonary
embolism? - Answer A client who has a BMI of 30,
client who has a femur fracture,
client who has chronic atrial fibrillation
Nurse is assessing a client who has pulmonary embolism. Which of the following manifestations
should the nurse expect to find? - Answer Pleural friction rub, petechiae, tachycardia
A nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. The client
states she is anxious and unable to get enough air. Vital signs are heart rate 117 per minute,
respirations 38/ minute, temperature 38.4°C and blood pressure 100/54. Which of the following
nursing actions is the priority? - Answer administer oxygen therapy
Nurse is caring for a client who has a new prescription for heparin therapy. Which of the
following statements made by the client should indicate an immediate concern for the nurse? -
Answer I take antacids several times a day.
, Nurse is caring for a client who is to receive thrombolytic therapy. Which of the following factors
should the nurse recognize as a contradiction to the therapy? - Answer hip arthroplasty two
weeks ago
Nurse is assessing a client following a gunshot wound to the chest. Which of the following
findings should the nurse monitor to detect a pneumothorax? - Answer tachypnea
deviation of the trachea
pleuritic pain
Nurse is reviewing the prescriptions for a client who has a pneumothorax. Which of the
following actions should the nurse perform first? - Answer Obtain a large bore IV needle for
decompression
Nurse is reviewing discharge instructions for a client who experienced a pneumothorax. Which
of the following statements should the nurse use when teaching a client? - Answer Notify your
provider if you experience a productive cough.
Nurse in the emergency department is assessing a client who has a suspected flail chest. which
of the following findings should the nurse expect? - Answer cyanosis
hypotension
dyspnea
paradoxic chest movement
Nurse and emergency department is assessing a client who was in a motor vehicle crash..
Findings include absent breath sounds in the left lower lobe with dyspnea, blood pressure
118/68, heart rate 124 per minute, respirations 38/minute, temperature 38.6°C and SaO2 92%
on room air. Which of the following actions should the nurse take first? - Answer Administer
oxygen via high flow mask
A nurse is orienting a newly licensed nurse on the purpose of administering vecuronium to a
client who has acute respiratory distress syndrome. Which of the following statements by the
newly licensed nurse indicates understanding of the teaching? - Answer This medication is
given to facilitate ventilation.
Nurse is reviewing the health records of five clients. Which of the following clients are at risk for
developing acute respiratory distress syndrome? select all that apply - Answer A client who
experienced a near drowning incident.
A client following coronary artery bypass graft surgery
client who has dysphagia
client who experienced a drug overdose