Oxygenation/Perfusion NCLEX Questions
with correct answers
The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?
A. Place the end of the chest tube in a container of sterile saline
B. Apply an occlusive dressing and notify the physician.
C. Clamp the chest tube immediately
D. Secure the chest tube with tape - Answer A. Place the end of the chest tube in a container of sterile saline
For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?
A. Restricting fluid intake to 1,000 ml/day
B. Enforcing absolute bed rest
C. Teaching the client how to perform controlled coughing
D. Administering prescribed sedatives regularly and in large amounts - Answer C.
Teaching the client how to perform controlled coughing
Which of the following is true concerning the physiology of the cardiovascular system? A. Stimulating the parasympathetic system would cause the heart rate to go up. B. When a person has heart muscle disease, the heart muscles stretch as far as is necessary to maintain function. C. The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles. D. When stroke volume decreases, there is a resultant decrease in heart rate. - Answer C. The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles.
The client has emphysema from smoking. During a respiratory system assessment the nurse anticipates finding: A. Abnormal palpation signs in the upper thorax B. Dull sounds on percussion C. A depressed sternum on inspection D. Moist breath sounds on auscultation - Answer B. Dull sounds on percussion
A 64-year-old client is seen in the emergency room for palpitations and mild shortness of breath. The ECG reveals a normal P wave, P-R interval, and QRS complex with a regular rhythm and rate of 108. The nurse should recognize this cardiac dysrhythmia as: A. Sinus dysrhythmia B. Sinus tachycardia C. Supraventricular tachycardia D. Ventricular tachycardia - Answer B. Sinus tachycardia
A client recently fractured his spinal cord at the C-3 level and is at great risk for developing pneumonia primarily because: A. The resulting paralysis immobilizes him, and secretions will increase in his lungs B. Innervation to the phrenic nerve is absent, preventing chest expansion C. The resulting abnormal chest shape disallows efficient ventilatory movement D. Trauma decreases the ability of his red blood cells to carry oxygen - Answer B. Innervation to the phrenic nerve is absent, preventing chest expansion
The client has experienced a myocardial infarction damaging the right ventricle. Which of the following is a likely complication he would experience? A. Jugular neck vein distention B. Pulmonary congestion C. Peripheral edema D. Liver enlargement - Answer B. Pulmonary congestion
On admitting a client, the nurse finds that there is a history of myocardial ischemia.
The most disconcerting dysrhythmia for electrocardiography to reveal is: A. Sinus bradycardia B. Paroxysmal supraventricular tachycardia C. Ventricular tachycardia D. Premature ventricular contractions - Answer C. Ventricular tachycardia
A client develops acute renal failure and a resulting metabolic acidosis. The respiratory system compensates by: A. Hypoventilating and increasing the bicarbonate in the bloodstream B. Alternating periods of deep versus shallow breaths to maintain homeostasis of the serum pH C. Hyperventilating to decrease the serum CO2 and thereby raise the pH D. Expanding the lung tissues to their fullest, which increases the inspiratory reserve volumes to provide more oxygen to the tissues - Answer C. Hyperventilating to decrease the serum CO2 and thereby raise the pH
For a client who is having respiratory symptoms of unknown etiology, the diagnostic test that is most invasive is: A. Pulse oximetry to determine oxygen saturation levels B. Throat cultures with sterile swabs C. Bronchoscopy of the bronchial trees D. Computed tomography of the lung fields - Answer C. Bronchoscopy of the bronchial trees
The nurse identifies that the client is unable to cough to produce a sputum specimen and must be suctioned. Which suctioning route is preferred? A. Nasopharyngeal B. Nasotracheal C. Oropharyngeal D. Orotracheal - Answer B. Nasotracheal
To help the client prevent postoperative pulmonary complications preoperatively, the nurse should: A. Ask the physician to order nebulizer treatments B. Teach the client to do leg exercises C. Teach the client to use a flow-oriented incentive spirometer
with correct answers
The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?
A. Place the end of the chest tube in a container of sterile saline
B. Apply an occlusive dressing and notify the physician.
C. Clamp the chest tube immediately
D. Secure the chest tube with tape - Answer A. Place the end of the chest tube in a container of sterile saline
For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?
A. Restricting fluid intake to 1,000 ml/day
B. Enforcing absolute bed rest
C. Teaching the client how to perform controlled coughing
D. Administering prescribed sedatives regularly and in large amounts - Answer C.
Teaching the client how to perform controlled coughing
Which of the following is true concerning the physiology of the cardiovascular system? A. Stimulating the parasympathetic system would cause the heart rate to go up. B. When a person has heart muscle disease, the heart muscles stretch as far as is necessary to maintain function. C. The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles. D. When stroke volume decreases, there is a resultant decrease in heart rate. - Answer C. The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles.
The client has emphysema from smoking. During a respiratory system assessment the nurse anticipates finding: A. Abnormal palpation signs in the upper thorax B. Dull sounds on percussion C. A depressed sternum on inspection D. Moist breath sounds on auscultation - Answer B. Dull sounds on percussion
A 64-year-old client is seen in the emergency room for palpitations and mild shortness of breath. The ECG reveals a normal P wave, P-R interval, and QRS complex with a regular rhythm and rate of 108. The nurse should recognize this cardiac dysrhythmia as: A. Sinus dysrhythmia B. Sinus tachycardia C. Supraventricular tachycardia D. Ventricular tachycardia - Answer B. Sinus tachycardia
A client recently fractured his spinal cord at the C-3 level and is at great risk for developing pneumonia primarily because: A. The resulting paralysis immobilizes him, and secretions will increase in his lungs B. Innervation to the phrenic nerve is absent, preventing chest expansion C. The resulting abnormal chest shape disallows efficient ventilatory movement D. Trauma decreases the ability of his red blood cells to carry oxygen - Answer B. Innervation to the phrenic nerve is absent, preventing chest expansion
The client has experienced a myocardial infarction damaging the right ventricle. Which of the following is a likely complication he would experience? A. Jugular neck vein distention B. Pulmonary congestion C. Peripheral edema D. Liver enlargement - Answer B. Pulmonary congestion
On admitting a client, the nurse finds that there is a history of myocardial ischemia.
The most disconcerting dysrhythmia for electrocardiography to reveal is: A. Sinus bradycardia B. Paroxysmal supraventricular tachycardia C. Ventricular tachycardia D. Premature ventricular contractions - Answer C. Ventricular tachycardia
A client develops acute renal failure and a resulting metabolic acidosis. The respiratory system compensates by: A. Hypoventilating and increasing the bicarbonate in the bloodstream B. Alternating periods of deep versus shallow breaths to maintain homeostasis of the serum pH C. Hyperventilating to decrease the serum CO2 and thereby raise the pH D. Expanding the lung tissues to their fullest, which increases the inspiratory reserve volumes to provide more oxygen to the tissues - Answer C. Hyperventilating to decrease the serum CO2 and thereby raise the pH
For a client who is having respiratory symptoms of unknown etiology, the diagnostic test that is most invasive is: A. Pulse oximetry to determine oxygen saturation levels B. Throat cultures with sterile swabs C. Bronchoscopy of the bronchial trees D. Computed tomography of the lung fields - Answer C. Bronchoscopy of the bronchial trees
The nurse identifies that the client is unable to cough to produce a sputum specimen and must be suctioned. Which suctioning route is preferred? A. Nasopharyngeal B. Nasotracheal C. Oropharyngeal D. Orotracheal - Answer B. Nasotracheal
To help the client prevent postoperative pulmonary complications preoperatively, the nurse should: A. Ask the physician to order nebulizer treatments B. Teach the client to do leg exercises C. Teach the client to use a flow-oriented incentive spirometer
