NCM 118 RLE NEURO REVIEW QUESTIONS B.

Place an intravenous line and

administer fluids containing 50%
dextrose in water.
1. An adult client presents to the emergency C. Assess the airway, breathing, and
department with disorientation and slurred circulation (ABC), vital signs, pulse
speech. The provider has acquired a history and oximetry, and cardiac rhythm.
has done an initial neurological exam. The nurse D. Additional bedside report with
has placed the client on the cardiac monitor. paramedics and verify the times that
What additional actions need to be a nursing the client awakened, ate a meal, and
priority? Select all that apply Required to transferred from the home.
answer. Multiple choice. (3 Points)
4. The nurse is transferring a client from the
A. Prepare the client to get a computed Emergency department to the critical care unit
tomography (CT) scan after thrombolytic therapy for an acute stroke.
B. Take a bedside glucose test What is the highest priority when monitoring
C. Review all the client's medications this client? Single choice. (1 Point)
D. Listen to the client's lung sounds
A. To closely monitor for seizures
E. Establish intravenous access
B. To closely monitor for bleeding
2. The nurse is taking care of a client in a long- C. To closely monitor for liver failure after
term care facility who has nearly completed t-PA administration
rehabilitation therapy following a hip surgery D. To provide blood transfusions, which
(ORIF) following a fall at home and is looking can only be done in the critical care unit
forward to returning home. The client suddenly
5. Given the following scenarios, which client is
exhibits signs of a transient ischemic attack
displaying signs of fluent dysphasia? Single
(TIA). Which is the appropriate action for the
choice. (1 Point)
nurse to take related to the client's condition?
Single choice. (1 Point) A. The nurse asks a client What day is it?"
The client responds in a clear voice,
A. Reposition the client to the
"Banana cream pie," and then shakes
Trendelenburg position to increase
their head "no" after speaking.
B. Reevaluate the status of the client every
B. The nurse asks the client. "What is your
hour to watch for any changes.
name?" The client responds by stating
C. Tell the client to remain calm since
their name very slowly and with a
there is no risk of permanent damage.
stutter.
D. Upon discovery of the signs of a TIA,
C. Motioning to a family member at the
seek medical evaluation immediately.
bedside, the nurse asks the client who
3. When the client enters the emergency room this person is. The client appears
with sudden confusion, arm weakness, and confused and does not respond verbally
speech difficulty, what are the urgent initial at all.
nursing priorities? Single choice. (1 Point) D. The nurse asks the client where they
are. The client responds in a slurred
A. Safe transfer from the ambulance to the voice, "hospital."
hospital medical unit.
6. The nurse on the telemetry unit is caring for a
client with a right- sided ischemic stroke that
occurred four days ago. The client has weakness
of the left arm and paralysis of the left leg. The
8. The nurse is educating a client with
client had a busy morning working with therapy
Parkinson's disease about the prescribed
and is declining to get out of bed to sit in a chair
levodopa medication. As part of this education,
to eat lunch. The spouse asks the nurse. "Why
which should be avoided in high amounts?
can't you just let her rest? She needs to rest and
Single choice. (1 Point)
nap to regain her strength, and this getting up
and back to bed tires her out too much." What A. A. Sodium
is an appropriate response from the nurse to B. Protein
provide education to the client and the spouse? C. Carbohydrates
Select all that apply Required to answer. D. Fat
Multiple choice. (2 Points)
9. The client arrives in the emergency room
A. “I am sorry. You are right, and I did not following a motor vehicle accident. The client is
realize that your wife had so much not spontaneously moving arms or legs but is
therapy this morning. After lunch, I will awake and appears to be aware of what is
close the door and let others know that happening. The client is currently being
she needs to sleep until dinner arrives." ventilated with a bag valve mask device. What
B. "It is important to be up and mobile as will be the most critical priority for long-term
much as possible. It helps her to regain future management? Single choice. (1 Point)
strength, prevents pressure on the skin,
and helps blood circulate to prevent A. Supporting the airway and breathing
swelling in the affected leg and arm." B. Encouraging mobility with adaptive
C. After a stroke, there are complications devices
that can occur. Being mobile and out of C. Monitoring bowel and bladder function
bed and wearing compression stockings D. Prevention of pressure sores
are ways to help prevent blood clots 10. The nurse discovers the client supine in the
from forming in the legs." bed with straight arms and legs, the toes
D. "Everyone on this unit needs to get out pointed downwards and an arched neck and
of bed for meals." back Which finding should the nurse expect to
E. "If she does not get out of bed, she will note, and which nursing intervention is
develop a blood clot in her legs. If that appropriate? Select all that apply Required to
breaks off and travels to her lungs, she answer. Multiple choice. (2 Points)
will be in the hospital longer and may
die." A. The nurse determines that the client is
in a decerebrate posture caused by
7. The nurse is caring for a client who knows dysfunction of the brain stem.
what to say but cannot produce the speech to B. The nurse concludes that the patient is
communicate it. Which area of the cerebral in a decorticate posture caused by
cortex is dysfunctional? Single choice. (1 Point) dysfunction of the hypothalamus.
A. Broca's area C. The nurse performs a neurological
B. Wernicke's area assessment to further evaluate the
C. Prefrontal cortex condition of the client.
D. Primary motor cortex
 D. The nurse notifies the health care 14. The nurse is assessing the client with an
provider immediately of this serious acute ischemic stroke who is 6 hours post-
condition. alteplase therapy. Which finding should the
E. The nurse changes the client's nurse be concerned about that could worsen
positioning to a more comfortable the client's brain injury? Single choice. (1 Point)
position and asks if the client is
A. A blood pressure of 178/100 mmHg.
experiencing any pain.
B. blood glucose level of 188 mg/dL.
11. The nurse is assessing a client for signs and C. An abnormal swallow assessment.
symptoms of stroke. The nurse uses a tool to D. A decrease in the client's National
touch the client's leg. The nurse asks the client. Institutes of Health Stroke 0-Scale
"Does this feel dull or sharp? Which area of the (NIHSS) score.
brain is the nurse assessing the performance of?
Single choice. (1 Point)
15. The nurse is caring for a client who had a
A. Visual association area
cerebrovascular accident. The nurse is assessing
B. Primary motor cortex
the plantar reflex as part of the neurological
C. Primary sensory cortex
assessment. What is the best way to elicit this
D. Somatic motor association area
response? Single choice. (1 Point)
12. A nurse is assessing the level of
A. With the reflex hammer, stroke lightly
consciousness of a client who had a head injury
up the lateral side of the u of the foot
after a rock-climbing accident. The client is
and inward across the ball of the foot in
drowsy but responds to stimulation. The client
the shape of an upside-down J.
answers questions and follows commands
B. Instruct the client to dangle their legs at
slowly and inattentively. How will the nurse
the side of the bed while you tap with
categorize this client? Single choice. (1 Point)
the reflex hammer just below the
A. Fully conscious patella
B. Lethargic C. With a blunt instrument, prick the
C. Obtunded client's skin on the bottom of the foot in
D. Stuporous two places.
D. With one hand, grasp the sides of the
13. The client has arrived at the Emergency
client's big toe, and ask the client what
department 30 minutes after developing stroke
position it is in while moving the up and
symptoms. What does the nurse need to
down.
anticipate as the most critical diagnostic test
that needs to be performed? Single choice. (1 16. What critical nursing action is necessary for
Point) the client with an acute ischemic stroke in the
first 24 hours after alteplase therapy
A. Finger-stick test for blood glucose
administered? Single choice. (1 Point)
B. CT scan of brain
C. 12-lead ECG A. Placement of an arterial catheter to
D. Lab draw for hemoglobin and monitor intravascular arterial pressure
hematocrit and clotting studies and blood gas measurements
B. Placement of a urinary catheter to
ensure voiding and monitor fluid output
 C. Electroencephalography to monitor for B. Uncontrolled hypertension
seizures that occur due to an acute C. Massive hemorrhage and shock
stroke D. Brain herniation
D. Close monitoring of cardiac, vascular,
19. A client is hospitalized after an acute spinal
respiratory, glycemic, and neurologic
cord injury and has a neurogenic bladder. How
status in the critical care unit
should the nurse anticipate managing this
17. The nurse is assessing a client for signs and condition? Single choice. (1 Point)
symptoms of a stroke. To assess for a facial
A. Avoid any type of indwelling urinary
droop, the nurse asks the client to smile
catheter due to the risk of infection.
multiple times. In response, the client grasps
B. Teach any client with a spinal cord
the nurse's hand and shakes it while saying
injury how to perform Intermittent
"hello" after each request. What kind of aphasia
catheterization to empty the bladder.
is the client displaying? Single choice. (1 Point)
C. Collaborate with the provider and client
A. Expressive aphasia about how to manage the type of
B. Receptive aphasia neurogenic bladder symptoms that are
C. Global aphasia experienced
D. The client is not displaying aphasia D. Teach the client how to apply pressure
because there is an attempt to interact over the bladder to stimulate the
with the nurse. bladder to empty.

18. The client was standing on a ladder, lost 20. A nurse is assessing the client's ability to
their balance, and fell striking their head on the discriminate sensations. How does the nurse
driveway pavement. Paramedics were called, conduct this assessment? Single choice. (1
and the client required assisted ventilation from Pointy
the paramedics to open and maintain an airway.
A. The nurse will use fingertips: a clean,
The client was brought into the emergency
sharp object and a dull object and
department (ED) with abnormal posturing and
gently touch them to each side of the
was unresponsive, with a Glasgow Coma Scale
client's body to assess responses from
total of 3/15, blood pressure of 205/120, and
the right and left sides.
heart rate of 55. The client was immediately
B. The nurse will move the client's toes up
intubated in the ED and placed on a ventilator.
and down to assess superficial
No other obvious injuries were noted. The initial
sensation
computed tomography (CT) brain scan indicated
C. The nurse will stroke the bottom of the
a closed skull fracture and severe compression
client's foot and observe the movement
of the ventricles, causing midline structures to
D. The nurse will apply a painful stimulus
shift to the left. The client was admitted to the
to a nail bed on both the right and left
intensive care unit, and aggressive attempts
sides of the client's body
were made to monitor and lower the elevated
intracranial pressure. Unfortunately, this client 21. How does a nurse promote optimal bladder
died within 24 hours of admission. What is the function while promoting safety in the client
most likely cause of death in this client? Single with an acute stroke? Single choice. (1 Point)
choice. (1 Point)
A. Use an indwelling catheter to keep the
A. Direct trauma to the brain tissue bladder empty
 B. Encourage hydration with fluids before B. Provide an SBAR report to the provider
bedtime and request arterial blood gases to
C. Avoid an Indwelling catheter or further assess the oxygenation.
discontinue it as soon as possible C. Place an indwelling urinary catheter to
D. Decrease fluid intake to decrease the assess urine output to manage fluid
frequency of voiding volume
D. Increase the IV fluid rate as ordered by
the provider, and anticipate
22. A nurse is performing a neurological motor administration of an Infusion of
function assessment on a postoperative lumbar vasoconstrictive medications if
laminectomy client from the previous day. additional volume does not increase the
Which statements represent an appropriate blood pressure
technique to utilize during a motor function
24. What are the qualifications before starting
assessment? Select all that apply Required to
alteplase therapy? Select all that apply Required
answer. Multiple choice. (3 Points)
to answer. Multiple choice (3 Points)
A. The client presses against the nurse's
A. Age equal to or greater than 12 years
hand while squeezing the
B. Onset of symptoms less than 24 hours
B. The nurse presses down on the client's
from the start of alteplase
thigh while asking the nurse's fingers
C. Clinical diagnosis of acute ischemic
client to lift their leg.
stroke and definite neurologic deficit
C. The nurse asks the client to flex and
D. No signs of hemorrhage on CT or MRI
extend their foot against nurse's hand
E. Hypoglycemia or other stroke mimics
D. The nurse asks the client to flex and
have been ruled out
extend their foot while the standing
E. The nurse asks the client to flex and 25. The client received alteplase therapy for an
extend their arms while the nurse ischemic stroke and is 5 hours post-therapy. The
applies pressure to the forearm and blood pressure is 200/110 mm Hg, the pulse
arm during the assessment. rate is 90min, the respiratory rate is 18min, and
the temperature is 37.2°C (99°F). Which are
23. The nurse is caring for a client admitted to
examples of medications the nurse should be
the Emergency department with a probable C5
prepared to administer based on the health
fracture. The client, who has no motion or
care provider's specific orders according to this
sensation below the level of injury, has
assessment? Select all that apply. Multiple
verbalized feeling too cold. The client has
choice. (3 Points)
received 1 L of IV fluid. The oxygen saturation
readings by continuous pulse oximetry are in A. Prednisone
the 94%- 95% range with oxygen via mask at 6 L B. Labetalol
The nurse notes a pulse rate of 56/min, C. Nicardipine
respirations of 22/min, and blood pressure of D. Clevidipine
88/50 mm Hg. What is the highest priority in E. Norepinephrine
the care of this client at this time? Single choice.
26. The nurse is assessing the orientation of an
(1 Point)
adult client. Which action by the health care
A. Place warm blankets over the client for team member best supports a therapeutic
comfort.
environment during the assessment? Single establishing a therapeutic relationship? Single
choice. (1 Point) choice (1 Point)

A. Stand over the client and ask the A. "Good morning, Mrs. Jones. I need
following orientation questions: "What some information from you about your
is your name, what is the date, and who husband. I hope you have a few minutes
is the president?" to answer some questions for me"
B. Look at your notes or the electronic B. "Good morning, Mr. Jones. Please tell
health record exclusively while me where you are and why you are
interacting with the client to create here."
thorough and detailed charting C. “Hello, my name is John, and I am the
C. Sit down at the bedside, make nurse caring for you today May I sit
consistent eye contact, introduce down and talk to you for a few minutes?
yourself, and start a conversation with I have some questions that may sound
the client to casually assess orientation. strange, but they will only take a few
D. Walk into the client's room, review the minutes
medical record, turn on the overhead D. "I need to ask you some questions, Mr.
light for visibility, and start the head-to- Jones. Please tell me the name of the
toe assessment. current president and what month and
year it is now."
27. The nurse is caring for a client in the
emergency department whose friends bought 29. Which parameter does the nurse recognize
them in after they were injured in a fight. The as an important part of an initial neurological
friends indicate that the client may have briefly assessment for a client? Select all that apply.
lost consciousness after being hit in the face and Multiple choice. (4 Points)
falling. While performing frequent neurological
A. Level of consciousness and orientation
checks on the client, which finding would be of
28%
most concern on the eye examination? Single
B. Pupil response 27%
choice. (1 Point)
C. Cranial nerve function 7%
A. Increased swelling around the orbital D. Vital sign 12%
area of the right eye, making it difficult E. Motor function
for the client to open their eye.
30. A concerned family member observed a
B. The right eye is 7 mm and reacts slowly
client during an autonomic dysreflexia response.
to 4mm. The left eye is 5mm and reacts
The client's overfilled bladder was emptied, and
to 4 mm.
the blood pressure was returned to a normal
C. The sclera of the right eye appears to be
level for the client. Afterward, the family
bloodshot and imitated.
member asked the nurse to explain why the
D. The right and left pupils are 3 mm now
blood pressure was so high and the client was
after initially being recorded as 5 mm
flushed and sweating. What is the best response
on admission.
from the nurse? Single choice. (1 Point)
28. Which communication between a nurse and
A. Because of the spinal cord injury, nerve
a client demonstrates the ability to obtain
signals do not work as they should
needed assessment information while also
when an area below the area of the
spinal cord injury causes pain or some
 other noxious stimuli. The body's
response is to release a chemical that
increases blood pressure. The body tries
to slow the pulse rate and dilate veins
to decrease the blood pressure, but
only the veins above the injury can
receive the signal and respond
B. The blood pressure was elevated
because of the severe headache. The
rise in blood pressure caused the face
to flush and become sweaty, as you
saw."
C. This is called autonomic dysreflexia, and
it happens to anyone with a spinal cord
injury. It resolves quickly, but it can be
frightening to observe."
D. This was a medical emergency that
could happen again. The day before
discharge, you will be taught how to
recognize the signs and how to treat it

31. When a client transfers from the intensive

care unit to the telemetry medical-surgical unit
for acute stroke treatment, what should the
nurse verify with the intensive care unit nurse
during a bedside report? Select all that apply
Multiple choice. (3 Points)

A. The neurological assessment

B. Oxygen requirements
C. IV rate
D. The physical and occupational therapy
assessment

32. Guillain-Barre Syndrome is an autoimmune

disease which attacks the peripheral nerve
myelin, producing ascending wires w dyskinesia,
hyporeflexia and paresthesia. You have been
aged to a 25-year-old woman with GB5. Which
of the following is your priority nursing
diagnosis for this client? Single choice (1 point)

A. Impaired physical mobility

B. Impaired breathing pattern
C. Acute pain
D. Imbalanced nutrition
 cardiologist. The client has been experiencing
peripheral edema over the past few months.
The cardiologist noted there was right ventricle
thickening. Why does right ventricular
hypertrophy, or thickening of the right ventricle,
occur in cor pulmonale?Required to answer.
Single choice.

A. Lower-extremity edema
B. Pulmonary hypertension
C. Congestive heart failure
NCM 118 RESPIRATORY REVIEW QUESTIONS D. Pulmonary edema

4.Which client presentation can result in

respiratory alkalosis?Required to answer. Single
1.The nurse is using a pulse oximeter to assess a
choice.
client in respiratorydistress. What does the
nurse expect this test to evaluate?Required to A. Asthma
answer. Single choice. B. Pneumonia
C. Hyperventilation
A. How much hemoglobin is in the blood
D. Respiratory failure
to carry oxygen
B. How much of the hemoglobin in blood 5.When using supplemental oxygen on a client,
is carrying oxygen what is the most important item for the nurse
C. How much oxygen is in the lungs remember?Required to answer. Single choice:
D. How much oxygen and carbon dioxide
A. oxygen may be utilized by the nurse
are in the blood
using the device preferred by the client.
2.The nurse is assisting a physician with an B. The supplemental oxygen flow rate is
endotracheal intubation. After the intubation, less important than the client's values
the nurse evaluates whether it was successful. demonstrated by pulse oximetry, and
While listening to sounds, the nurse is able to the oxygen flow rate may be adjusted as
auscultate only left-sided lung sounds. Which needed based on the pulse oximetry
complication from the endotracheal intubation readings.
has occurred? Required to answer. Single C. Supplemental oxygen use must specify
choice. the flow rate and device and must be
ordered by the health care provider.
A. The endotracheal tube was placed too
D. Supplemental oxygen must initially be
deep and went into the left bronchus
applied by the respiratory therapist by
B. The endotracheal tube was placed too
following the order of the provider.
deep and went into the right bronchus
C. The endotracheal tube was placed in 6.An adult client is being seen in the Emergency
the trachea. department for shortness of breath. The client's
D. The endotracheal tube was placed in a oxygen saturation is 82% on room air, the client
is tachypneic, and the nurse notes bilateral
3.The nurse is reviewing a client's
opacities on the client's chest X-ray. What would
echocardiogram results interpreted by the
be the next important diagnostic steps
anticipated by the nurse? Select all that apply D. Hyperventilation
Required to answer. Multiple choice.

A. Brain natriuretic peptide lab test

B. Chest CT scan
C. Abdominal X-ray
D. Arterial blood gas lab test
E. Echocardiogram

7.When the client is using a nasal cannula for

oxygen supplementation, what factor
necessitates changing to a Venturi mask?
10.What are the advantages of capnography
A. Discomfort in the nasal cavities monitoring in a client?
B. Inability to maintain prescribed pulse
oximetry levels A. It is a noninvasive measurement of the
C. Preference for mouth-breathing partial pressure of oxygen to assess
D. Contraindication to intubation trends without repeated arterial blood
gas testing.
8.A client is admitted to the intensive care unit B. It measures the partial pressure of CO2
for ARDS. The health care provider (HCP) orders at the beginning of inhalation.
the client to be placed in the prone position for C. It measures the partial pressure of 02 at
10 hours in a 24-hour period. When the nurse is the beginning of exhalation.
reading the orders, a note that the HCP wrote D. It is a noninvasive measurement that
states, "Client to be placed in prone positioning can determine a client's EtCO2 which is
to recruit alveoli and reduce atelectasis. How used to monitor respiratory gas
does prone positioning help reduce the risk of exchange without repeated arterial
atelectasis? Required to answer. Single choice. blood gas testing.
A. It allows the anterior alveoll to be 11.A client comes into urgent care with difficult
drained and recruited. breathing and audible wheezes. The client is
B. It decreases the proliferation of cells. also diaphoretic. The nurse asks the client what
C. It reduces the pressure that the they did prior to these symptoms. Which
mediastinum and heart place on the response explains the cause of the
lungs. bronchospasms?
D. It allows the diaphragm to move more
freely. A. "I went on a walk with my dog 4 hours
ago, which I do every day."
9.A client with emphysema is exhibiting an B. "I took ibuprofen an hour ago for a
extended expiration and shortness of breath. headache."
What type of breathing pattern are these C. "I watched the football game."
symptoms associated with? D. "I ate cereal and I eat the same cereal
A. Kussmaul breathing every morning.”
B. Bradypnea 12.The nurse is writing a plan of care for a client
C. Air trapping with acute bronchitis. The client's sputum is
thick. What is the most effective nursing action A. "The most common cause is fluid
to address this problem? overload in the body due to right
ventricular hypertrophy."
A. The nurse should administer humidified
B. "You could have a leaky mitral valve."
oxygen.
C. "If chronic hypertension is the left side
B. The nurse should place the client in a
of your heart pumps blood inefficiently
lateral position every 2 hours.
and fluid backs up in your lungs."
C. The nurse should offer fluid to the client
D. "Pulmonary edema is edema of the
at regular intervals.
alveoli in the lungs."
D. The nurse should splint the client's
chest with pillows when the client is 15.A nurse is educating nursing students about
coughing. the function of goblet cells. Which statement
describes the main function of goblet cells in
13.A nurse is reviewing the medications for a
the body? Required to answer.
client with chronic obstructive pulmonary
disease (COPD) prior to discharge from the A. Goblet cells help create a protective
hospital. The client was admitted to the hospital layer of mucus.
for a COPD exacerbation. The nurse knows that B. Goblet cells help increase respirations.
which medication is most important for the C. Goblet cells enhance the flow of air.
client to be discharged home with? D. Goblet cells help decrease body
temperature.
A. An oral steroid such as Prednisone
because the nurse knows that 16.A client is diagnosed with pneumonia per
sometimes when an exacerbation their chest X-ray. The health care provider
occurs, the client might need something prescribes an empiric of levofloxacin 750 mg IV
stronger than an inhaled steroid for a every 24 hours. Which options describe empiric
short period of time therapy for community-acquired pneumonia?
B. An inhaler such as albuterol, a short-
acting B2 agonist
C. An inhaled corticosteroid because the A. Treatment of pneumonia acquired in a
nurse knows this is important for long-term care facility
exacerbation prevention B. Treatment of pneumonia acquired in a
D. An inhaled long-acting B2 agonist hospital
C. Treatment of pneumonia not acquired
14.A client comes in complaining of shortness of
in a hospital
breath. The client's pulse oximetry is 91% on
D. Treatment based on a clinical "educated
room air, and the blood pressure is 190/90 mm
guess"
Hg. The client reports not taking their blood
E. Treatment based on a confirmation of a
pressure medication for chronic hypertension.
definitive medical diagnosis and
On exam, the client has crackles when the lungs
pathogenesis
are auscultated, and the chest X-ray shows
pulmonary edema. When the nurse is obtaining 17.A client uses a continuous positive airway
a history from the client, the client states. "The pressure (CPAP) device at home at night. Since
doctor said I have pulmonary edema. What the client has been admitted to the hospital, the
causes this?" How should the nurse respond? client's respiratory status has declined. The
health care provider orders the client to be put
on bilevel positive airway pressure (BIPAP). The B. A client who has bilateral lower
client believes BIPAP will be unsuccessful extremity edema and complains of
because they "wear the same mask at night". shortness of breath while lying flat,
The nurse identifies the need to provide symptoms noticed for the past 7 days
education to this client on the difference C. A client who has symptoms that started
between CPAP and BIPAP. What difference 6 days ago, reports fevers 2 days ago,
between CPAP and BiPAP therapy does the and is in respiratory distress
nurse explain to the client? D. A client who has experienced shortness
of breath over the past 2 weeks and has
A. BIPAP delivers twice the amount of
a pulse oximetry reading of 87%
oxygen as CPAP.
B. BIPAP delivers two different pressures, 20.A client is admitted due to acute
whereas CPAP delivers one constant exacerbations of asthma. The client presents
pressure. with shortness of breath and wheezing. The
C. BIPAP does not have various settings, initial lab result shows a pH of 7.32, a PaCO2 of
whereas CPAP does. 48 mm Hg, and an HCO3 of 22 mEq/L. The client
D. BIPAP is for sleep apnea, and CPAP is was administered an intravenous dose of
the last step before being placed on a methylprednisolone, a nebulized breathing
ventilator. treatment using the bronchodilator, albuterol,
and supplemental oxygen using a Venturi mask.
18.A client who comes into the Emergency
Which point-of-care lab work does the nurse
department has a history of chronic obstructive
anticipate monitoring at frequent intervals after
pulmonary disease and has been experiencing
the initial blood draw testing?
shortness of breath for the past 3 days. The
client is using their accessory muscles to A. Complete blood count
breathe. Their pulse oximetry is 87% on 2 L/min B. Potassium level
of oxygen they usually wear on a daily basis, C. Liver enzymes
and they are bending forward in a tripod D. Arterial blood gas
position. Which medication does the nurse
21.The nurse is caring for a client who is on a
anticipate to be prescribed as a stat medication
ventilator. The nurse is monitoring the client's
and is administered as a nebulized breathing
end-tidal CO2 level and notices it has decreased
treatment?
from 38 mm Hg to 31 mm Hg. What is possibly
A. Methylprednisolone causing this decrease?
B. Vancomycin
A. The respiratory rate on the ventilator
C. Albuterol
being set too high
D. Amlodipine
B. A mucus plug
19.A nurse is working in the trauma emergency C. A pulmonary embolus
center. Which clients seen during the nurse's D. Oversedation
shift would be considered for a diagnosis of E. Hyperthermia
acute respiratory distress syndrome?
22.A client given opiate pain medications is
A. A client who has a cough with bloody oversedated and is breathing slowly. What end-
sputum that started 1 week ago and has tidal carbon dioxide (EtCO2) reading does the
lung nodules noted on the chest X-ray nurse expect to see?
 A. Elevated EtCO2 is due to D. A 39-year-old who has vomited 3 times
hypoventilation. in the last hour
B. Low EtCO2 is due to hypotension.
26.The nurse has entered the client's room,
C. The EtCO2 is not affected, but the
identified themselves to the client, and
oxygen saturation is low.
explained their role in caring for the client.
D. Elevated EtCO2 is due to metabolic
When the client's respiratory status, what key
acidosis.
step does the nurse need to include to detect
23.A client comes into the trauma emergency early signs of fluid buildup in the lungs?
center (TEC) with a severe asthma exacerbation.
A. Accurately count the number of breaths
The nurse starts a stat albuterol treatment and
per minute of the client.
places the client on the cardiac monitor and
B. Assist the client to change position to
continuous pulse oximetry. Which test does the
enable auscultation of the posterior
nurse anticipate for this client that will provide a
lung fields.
precise measurement of the oxygen saturation
C. Observe for symmetrical rise and fall of
in the blood?
the chest wall during inspiration and
A. Pulse oximetry expiration.
B. Complete blood count D. Assess whether the client appears to be
C. Arterial blood gas working hard to breathe
D. Basic metabolic panel
27.A physician orders capnography through
24.A client who has emphysema asks the nurse nasal cannula to monitor end-tidal carbon
how to do pursed-lip breathing. What is the dioxide (EtCO2) and deliver oxygen at 2 L/min
nurse's best teaching response? for a client in the hospital. As seen in the image,
how does the cannula function to achieve both
A. "With your lips pursed like you are
goals?
blowing out a candle, exhale and inhale
for the same amount of time." A. As CO2 exits, oxygen enters the nostrils.
B. "Breathe in twice as long as you B. A barrier allows only oxygen to be
breathe out with pursed lips." delivered or EtCO2 to be measured one
C. "With a fully open mouth, exhale for at a time.
twice as long as you inhale." C. One sensor is able to measure both
D. "With your tips pursed like you are EtCO2 and 02 simultaneously
blowing out a candle, exhale for twice D. Oxygen is delivered to one naris while
as long as you inhale." CO2 is sampled in the other.

25.Which client is at risk for impaired gas 28.A nurse is assessing the lungs of a client who
exchange? is complaining of shortness of breath. What
would a nurse hear on auscultation that would
A. A 98-year-old client who takes
indicate pulmonary edema?
hydrocodone twice a day
B. A 58-year-old who has a medical history A. Rales that clear with coughing
of leukemia B. Rhonchi in the lung bases
C. A 17-year-old who smokes 3 cigarettes a C. Coarse crackles that do not clear with
day coughing
D. Wheezing on expiration
29.A client has severe internal hemorrhaging 32.A client has a new diagnosis of asthma. The
and is in shock. The body is compensating by provider has prescribed formoterol,
diverting blood flow to vital organs. In the budesonide, and albuterol inhalers. The client
capillaries supplying the tissues of nonvital appears to be stressed by multiple medications.
organs, what mechanism will occur to aid the What is the most important topic for the nurse
body in getting blood to vital organs? to teach the client about the management of
asthma symptoms?
A. Constriction of the thoroughfare
channel A. Use all the medications daily to treat
B. Relaxation of the postcapillary venule and prevent asthma symptoms.
C. Relaxation of precapillary sphincters B. During an acute asthma attack, use the
D. Constriction of precapillary sphincters formoterol and budesonide inhalers
immediately.
30.The nurse is taking a client's vital signs at a
C. Use the albuterol inhaler only when
clinic. The client is crying and is emotionally
needed to treat an acute asthma attack.
distraught from having a fight with their
D. During an acute asthma attack, use all
significant other just prior to the appointment.
three inhalers immediately.
The client's initial blood pressure reading is
168/94 mm Hg. What should be the nurse's 33.The nurse has provided instructions to a
next action? client about how to properly use a metered-
dose inhaler (MDI). Which statements by the
A. Document the blood pressure as the
client indicate an understanding of how to use
final reading.
the MDI correctly?
B. Educate the client on lifestyle changes
for blood pressure control. A. "If I have not used my rescue inhaler
C. Walt for the client to calm down and recently, I need to shake it and then
retake the blood pressure. spray it away from me 1 or 2 times to
D. Retake the blood pressure immediately. ensure that I get a full dose."
B. "Before using the inhaler, I need to
31.A client with high blood pressure and taking
exhale as much as possible."
lisinopril, calls the nurse to ask about taking
C. "After I use the inhaler, I need to count
diphenhydramine for allergic rhinitis. Which
to 20 before exhaling."
statement by the nurse is correct?
D. "Because I need to take two puffs of this
A. "Diphenhydramine is a good choice and medication, I need to exhale and then
will rapidly your symptoms." press the inhaler twice while inhaling."
B. "The diphenhydramine works by E. "I need to shake a new canister of
inhibiting bacteria in the nose that medication and spray 1-2 puffs into the
cause inflammation, so you can breathe air the first time I use it."
easier."
34.A client will receive long-term oral
C. "You should avoid antihistamines
corticosteroids to adequately treat severe
because they could worsen your high
airway inflammation that causes frequent
blood pressure."
exacerbations of acute asthma. Which potential
D. "You can stop your antihypertensive
side effects will the nurse need to educate the
drug because diphenhydramine lowers
client about? Select all that apply.
your blood pressure instead."
 A. Changes in fat accumulation around the
client's midsection or upper back
B. Appearance of a rounder face
C. Increased growth of facial hair
D. Mood swings
E. Increased need to urinate

35.After the nurse educates a client about

asthma medications, the client asks why the
glucocorticoid inhaler cannot be replaced with a
pill, which would be easier to take. What would
be the best response from the to this question?

A. "If you would rather take a pill, I can ask

the provider to change your
prescription."
B. "The inhaled route ensures that the
medication gets to the airway to
prevent inflammation and limits the
systemic effects on the rest of your
body."
C. "Using the inhaler should not be
difficult to manage because you will
only use it if you feel an increase in your
asthma symptoms."
D. "The pills are used only if you are in the
hospital for treatment of a severe
asthmatic attack."

36.A client comes into the E.R. with acute

shortness of breath and a cough that produces
pink, frothy sputum. Admission assessment
reveals crackles and wheezes, a BP of 85/46, a
HR of 122 BPM, and a respiratory rate of
38.Breaths/minute. The client's medical history
included HTN, and heart failure. Which of the
following disorders should the nurse suspect?

A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
D. Pulmonary embolism