NUR2243 RESPIRATORY EAQS STUDY GUIDE
WITH COMPLETE SOLUTION!!
RESPIRATORY & EMERGENCY NURSING Q&A (WITH
RATIONALES)
1. A client arrives with multiple crushing injuries to the chest, abdomen, and legs.
What is the priority nursing assessment?
Answer: Evaluate respiratory quality and check for the presence of pulses.
Rationale: Airway, breathing, and circulation (ABCs) are always the first priority.
Crushing injuries can impair ventilation or compromise blood flow.
2. A client is extubated in the PACU. What early sign of acute respiratory distress
should the nurse look for?
Answer: Restlessness.
Rationale: Restlessness is a classic early indicator of hypoxia before more obvious
symptoms appear.
3. In what order should the nurse assess the pharynx in a client with a respiratory
disorder?
Answer:
Inspect the mouth
, Observe elevation and lowering of the soft palate
Check tonsils for size and symmetry
Inspect neck symmetry
Palpate lymph nodes
Rationale: This sequence progresses from external to internal structures and
ensures a systematic, safe assessment.
4. After a partial pneumonectomy, tissue near the incision feels spongy and
crackles when palpated. How should the nurse document this finding?
Answer: Subcutaneous emphysema.
Rationale: Air leaking into subcutaneous tissue creates a crackling (crepitus)
sensation, indicating possible air escape from the surgical site.
5. Which client is at greatest risk for a pulmonary embolism?
Answer: An obese client with leg trauma.
Rationale: Obesity and immobilization from trauma increase venous stasis and clot
formation.
WITH COMPLETE SOLUTION!!
RESPIRATORY & EMERGENCY NURSING Q&A (WITH
RATIONALES)
1. A client arrives with multiple crushing injuries to the chest, abdomen, and legs.
What is the priority nursing assessment?
Answer: Evaluate respiratory quality and check for the presence of pulses.
Rationale: Airway, breathing, and circulation (ABCs) are always the first priority.
Crushing injuries can impair ventilation or compromise blood flow.
2. A client is extubated in the PACU. What early sign of acute respiratory distress
should the nurse look for?
Answer: Restlessness.
Rationale: Restlessness is a classic early indicator of hypoxia before more obvious
symptoms appear.
3. In what order should the nurse assess the pharynx in a client with a respiratory
disorder?
Answer:
Inspect the mouth
, Observe elevation and lowering of the soft palate
Check tonsils for size and symmetry
Inspect neck symmetry
Palpate lymph nodes
Rationale: This sequence progresses from external to internal structures and
ensures a systematic, safe assessment.
4. After a partial pneumonectomy, tissue near the incision feels spongy and
crackles when palpated. How should the nurse document this finding?
Answer: Subcutaneous emphysema.
Rationale: Air leaking into subcutaneous tissue creates a crackling (crepitus)
sensation, indicating possible air escape from the surgical site.
5. Which client is at greatest risk for a pulmonary embolism?
Answer: An obese client with leg trauma.
Rationale: Obesity and immobilization from trauma increase venous stasis and clot
formation.
