NCLEX : Identifying Respiratory Conditions

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #1 : Respiratory Conditions

A client had just undergone a total right knee replacement and has just returned from the operating room. Later that evening, the client suddenly begins to complain of shortness or breath and chest pain on inspiration. The nurse caring for this client further notes the coughing up of blood and that he is sweating profusely.

Which of the following nursing interventions should the nurse perform first? 

Possible Answers:

Place in Fowler's position

Auscultate for breath sounds

Give oxygen

Assess the client's mental status

Draw blood for arterial blood gasses (ABG's)

Correct answer:

Place in Fowler's position

Explanation:

The priority for this client is to ensure a patent airway by placing him the Fowler's or semi upright seated position. Giving oxygen is warranted but will be given after the client is positioned correctly. ABG's would be helpful in this situation but it not the priority. Auscultation of breath sounds and assessment of mental status are not indicated.

Example Question #1 : Identifying Respiratory Conditions

What is the final stage of a pertussis infection?

Possible Answers:

The paroxysmal stage

The post-infectious stage

The convalescent stage

The recovery phase

Correct answer:

The convalescent stage

Explanation:

The final stage of a pertussis infection is known as the convalescent phase. This occurs for 2-6 weeks, after the paroxysmal stage of the disease. During this time coughing decreases, and paroxysms are less severe. The infected individual may experience increased susceptibility to upper and lower respiratory conditions for as much as 6 months after resolution of the infection.

Example Question #2 : Identifying Respiratory Conditions

Which of the following organisms causes whooping cough?

Possible Answers:

Human respiratory syncytial virus (RSV)

Bordetella pertussis 

Haemophilus influenzae 

Klebsiella pneumoniae

Correct answer:

Bordetella pertussis 

Explanation:

Whooping cough, a condition that results in severe paroxysmal coughing fits followed by a long wheezing inspiratory gasp (the "whoop") is caused by the bacteria Bordetella pertussis. Haemophilus influenzae and Klebsiella pneumoniae both commonly cause pneumonia, and RSV is a virus that is frequently implicated in lower respiratory infections of infants and children.

Example Question #4 : Respiratory Conditions

In pertussis, what stage follows the incubation (also known as the catarrhal) stage?

Possible Answers:

The whooping stage

The paroxysmal stage

The convalescent stage

The acute stage

Correct answer:

The paroxysmal stage

Explanation:

After the catarrhal stage, an individual with pertussis will progress into the paroxysmal stage. It's during this stage that they will experience uncontrollable fits of 5-15 forceful coughs, followed by a "whoop" or gasp as they struggle to inhale. The force of these coughs can be such that they can result in vomiting, epistaxis, subconjunctival hemorrhage, or even broken ribs. 

Example Question #3 : Identifying Respiratory Conditions

How long is the incubation period for pertussis?

Possible Answers:

2-7 days

1-3 weeks

4-6 weeks

2-3 months

Correct answer:

1-3 weeks

Explanation:

The incubation period for pertussis, also known as the catarrhal stage, can last as little as 4 days or as long as 42 days, but a typical period is 1-3 weeks. During this stage the disease looks like a regular upper respiratory infection, with sneezing, mild cough, and runny nose. The infected individual is highly infectious at this time, with bacteria spread by airborne droplets after sneezing or cough. 

Example Question #5 : Respiratory Conditions

You are the nurse taking care of a 40-year old African-American female who complains of fatigue and shortness of breath. Her physical exam is remarkable for erythema nodosum on the bilateral lower extremities. A chest x-ray is performed that demonstrates bilateral hilar infiltrates. She lives and works in a suburb, has not traveled outside of the United States recently, and does not work in a healthcare setting. Which of the following is the most likely diagnosis?

Possible Answers:

Sarcoidosis

Lung cancer

Meningitis

Pharyngitis

Tuberculosis

Correct answer:

Sarcoidosis

Explanation:

The correct answer is "Sarcoidosis." Sarcoidosis is the correct answer as this inflammatory condition is frequently found in African-American women in their 40's who present with fatigue and shortness of breath among other symptoms, who also have erythema nodosum on the lower extremities, and have bilateral hilar infiltrates on chest x-ray. This constellation of findings is highly suggestive of sarcoidosis. Sarcoidosis results in the formation of numerous non-necrotizing granulomas, most commonly found in the lungs, that can play a role in the symptoms experienced by these patients. Other findings suggestive of sarcoidosis include elevated serum calcium levels with normal serum PTH levels.

Tuberculosis can present in a similar manner to sarcoidosis, however given the patient's suburban living environment, lack of a travel history, and lack of healthcare exposure, the likelihood of being exposed to tuberculosis is very low, making sarcoidosis a more likely etiology.

While lung cancer can present as shortness of breath with hilar infiltration in chest x-ray, in a relatively young otherwise healthy patient who also has erythema nodosum and in whom the hilar infiltrates are bilateral, sarcoidosis would be a more likely etiology.

The patient does not have any findings consistent with meningitis (leg rash in meningitis is petechial, not erythema nodosum) or pharyngitis.

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