NCLEX : Respiratory Conditions

Study concepts, example questions & explanations for NCLEX

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Example Questions

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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:

Assess the client's mental status

Auscultate for breath sounds

Draw blood for arterial blood gasses (ABG's)

Place in Fowler's position

Give oxygen

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 #51 : Conditions And Treatments

What is the final stage of a pertussis infection?

Possible Answers:

The convalescent stage

The paroxysmal stage

The post-infectious 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 #1 : Respiratory Conditions

Which of the following organisms causes whooping cough?

Possible Answers:

Klebsiella pneumoniae

Human respiratory syncytial virus (RSV)

Haemophilus influenzae 

Bordetella pertussis 

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 acute stage

The convalescent 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 #1 : Respiratory Conditions

How long is the incubation period for pertussis?

Possible Answers:

1-3 weeks

2-7 days

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 #6 : 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:

Meningitis

Tuberculosis

Sarcoidosis

Lung cancer

Pharyngitis

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.

Example Question #1 : Respiratory Conditions

What is the "hygiene hypothesis" in asthma? 

Possible Answers:

Keeping children's hands clean will reduce asthma rates

Frequent bathing can reduce the severity of asthma attacks

Exposing children to pathogens at a young age will decrease their risk for asthma

Dirty water is responsible for many cases of asthma in the developing world

Correct answer:

Exposing children to pathogens at a young age will decrease their risk for asthma

Explanation:

Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response. 

Example Question #2 : Respiratory Conditions

All of the following are common triggers for asthma except __________.

Possible Answers:

exercise

emotional stress or excitement

squatting

cold air

Correct answer:

squatting

Explanation:

The most commonly reported triggers for asthma attacks are cold air, emotional stress or excitement, infection, irritants such as pollen or dust mites, and exercise. Other triggers may include lying down, exposure to cigarette smoke, or acid reflux. 

Example Question #9 : Respiratory Conditions

A patient has been administered isoniazid for the treatment of tuberculosis (TB). Which statement made by the nurse would be the most appropriate when teaching the client about this medication?

Possible Answers:

"This medication must be taken twice daily for 9–12 months."

"This medication is associated with color blindness." 

"This medication must be given by DOT – directly observed therapy."

"This medication is expensive and may only be taken subcutaneously."

"This medication is known to cause peripheral neuropathy and therefore it is necessary to give pyridoxine prophylactically."

Correct answer:

"This medication is known to cause peripheral neuropathy and therefore it is necessary to give pyridoxine prophylactically."

Explanation:

Isoniazid is a bactericidal drug that is given for tuberculosis that has several adverse effects including peripheral neuropathy. This drug is usually administered in conjunction to other antitubercular drugs. Pyridoxine (vitamin B6) is recommended to be taken in conjunction with isoniazid to prevent neurotoxicity.

Isoniazid is relatively inexpensive and may be taken orally or intravenously. It is not necessary to be taken under direct observation, and is usually dosed according to type of disease (active versus latent). The typical duration of administration is roughly 26 weeks. Color blindness is not associated with isoniazid treatment.

Example Question #10 : Respiratory Conditions

All of the following changes may be seen in chronic asthma except __________.

Possible Answers:

destruction of alveolar septa and pulmonary capillaries

epithelial desquamation

deposition of subepithelial collagen

hypertrophy and hyperplasia of mucus glands
Correct answer:

destruction of alveolar septa and pulmonary capillaries

Explanation:

Chronic asthma can result in a situation referred to as "airway remodeling," typified by the following changes: increased airway vascularity, epithelial desquamation, deposition of subepithelial collagen, and hypertrophy and hyperplasia of mucus glands and of the underlying muscle layer.

Destruction of alveolar septa and pulmonary capillaries is a common finding in emphysema and does not present in asthma.

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