NCLEX Respiratory Questions: Comprehensive Guide to Mastering Med-Surg for the NCLEX Exam


I’m Nurse Sarah, and today we’re diving into some Med-Surg respiratory questions to help you prepare for the NCLEX exam. These questions are specifically designed to challenge your understanding and improve your critical thinking skills. Let’s start with our first question, which involves interpreting arterial blood gas (ABG) results—a vital skill in managing respiratory conditions.

Question 1: Uncompensated Respiratory Acidosis

Scenario:
You're caring for a patient diagnosed with pneumonia. Despite starting treatment, the patient continues to experience hypoxemia. Respiratory acidosis is common in such cases, and your task is to identify which arterial blood gas reading indicates uncompensated respiratory acidosis.

ABG Readings Provided:

  1. pH: 7.29, PCO2: 55 mmHg, HCO3-: 23 mEq/L
  2. pH: 7.48, PCO2: 37 mmHg, HCO3-: 27 mEq/L
  3. pH: 7.20, PCO2: 50 mmHg, HCO3-: 30 mEq/L
  4. pH: 7.55, PCO2: 28 mmHg, HCO3-: 24 mEq/L

Answering Strategy:
When tackling this question, it's crucial to first recall the normal values for pH, PCO2, and bicarbonate (HCO3-):

  • Normal pH: 7.35 - 7.45
  • Normal PCO2: 35 - 45 mmHg
  • Normal HCO3-: 22 - 26 mEq/L

We’re looking for a pH that indicates acidity (below 7.35) because respiratory acidosis is an acidic condition. Let’s analyze the options:

  • Option B: pH is 7.48, which is alkalotic (greater than 7.45), so this can be eliminated.
  • Option D: pH is 7.55, also alkalotic, so this can be ruled out as well.

Now, we’re left with options A and C:

  • Option A: pH is 7.29 (acidic), PCO2 is 55 mmHg (elevated, also acidic), and HCO3- is 23 mEq/L (normal). Since the bicarbonate is within the normal range, there’s no compensation occurring. This represents uncompensated respiratory acidosis.

  • Option C: pH is 7.20 (more acidic), PCO2 is 50 mmHg (elevated), and HCO3- is 30 mEq/L (elevated). Here, we see partial compensation since the bicarbonate is trying to correct the pH by increasing its value, but it hasn't fully compensated as the pH remains acidic. This is partial compensation, not uncompensated.

Correct Answer: Option A is the correct answer, as it demonstrates uncompensated respiratory acidosis.

Question 2: Chest Tube Dislodgement

Scenario:
A patient with a chest tube accidentally has the tube dislodged while being repositioned in bed. What is your immediate nursing intervention?

Options:

  1. Stay with the patient and monitor vital signs while another nurse notifies the healthcare provider.
  2. Place a sterile occlusive dressing over the site and tape it on three sides, then notify the healthcare provider.
  3. Attempt to reinsert the tube.
  4. Keep the site open to air and notify the healthcare provider.

Answering Strategy:
Chest tube dislodgement is a medical emergency, and immediate action is required to prevent complications like a pneumothorax or infection.

  • Option 1: Staying with the patient and monitoring their vitals is important, but it lacks immediate intervention to prevent further harm.
  • Option 3: Attempting to reinsert the tube is outside the nurse's scope of practice. Chest tubes must be reinserted by a qualified physician.
  • Option 4: Keeping the site open to air can lead to a pneumothorax and increases the risk of infection, making this an inappropriate response.

Correct Answer: Option 2 is correct because placing a sterile occlusive dressing taped on three sides creates a temporary seal that prevents air from entering the pleural space, reducing the risk of a pneumothorax. While doing this, you should also instruct another nurse to notify the healthcare provider.

Question 3: Inhaler for COPD Exacerbation

Scenario:
A patient with severe Chronic Obstructive Pulmonary Disease (COPD) experiences an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler, as prescribed by the physician, will provide the fastest relief?

Options:

  1. Tiotropium bromide (Spiriva)
  2. Salmeterol (Serevent Diskus)
  3. Budesonide-formoterol (Symbicort)
  4. Albuterol (ProAir, Ventolin, Proventil)

Understanding the Medications:

  • Tiotropium bromide is a long-acting muscarinic antagonist (LAMA), used for maintenance therapy, not for immediate relief.
  • Salmeterol is a long-acting beta-agonist (LABA), again intended for maintenance, not acute exacerbation.
  • Budesonide-formoterol is a combination of a corticosteroid and a LABA, suitable for maintenance but not fast relief.
  • Albuterol is a short-acting beta-agonist (SABA) that works quickly to relax the bronchial muscles, providing immediate relief from bronchoconstriction.

Correct Answer: Option 4 is correct. Albuterol is a SABA that acts quickly to open the airways, making it the best option for immediate relief in a COPD exacerbation.

Question 4: Using a Peak Flow Meter for Asthma Management

Scenario:
You are educating a patient on how to use a peak flow meter to monitor their asthma. Which statement by the patient indicates correct understanding?

Options:

  1. "This device will make my lungs stronger so I don't have another asthma attack."
  2. "I will exhale as hard as I can while using this device."
  3. "I will lie down when I use this device."
  4. "I will notify the doctor if my peak flow rating is 90% or more than my personal best."

Answering Strategy:
A peak flow meter measures how well air moves out of the lungs, which helps in assessing asthma control. Proper use is crucial:

  • Option 1: This is incorrect; the peak flow meter doesn't strengthen lungs, but rather monitors airflow.
  • Option 3: Incorrect again, as the patient should be standing up to get an accurate measurement.
  • Option 4: If the peak flow reading is 90% or more of the patient’s personal best, it indicates good control, not a situation where the doctor needs to be notified.

Correct Answer: Option 2 is correct. Exhaling as hard as possible is the correct technique for using a peak flow meter.

Question 5: Incentive Spirometer Usage for COPD

Scenario:
A patient with COPD is being educated on using an incentive spirometer. Which of the following is the correct way to use this device?

Options:

  1. Use the device twice a day.
  2. Exhale rapidly into the device and then cough.
  3. Inhale slowly from the device until no longer able, then hold breath for 6 seconds and exhale.
  4. Rapidly inhale 10 times from the device, then exhale for 6 seconds.

Understanding the Device:

An incentive spirometer helps keep the lungs clear and improves lung function, especially after surgery or during respiratory therapy.

  • Option 1: Using the device only twice a day is inadequate. It should be used 10 times every 1-2 hours while awake.
  • Option 2: Incorrect technique—patients should inhale slowly, not exhale into the device.
  • Option 4: Rapid inhalation is not the correct method.

Correct Answer: Option 3 is correct. The patient should inhale slowly, hold their breath for 6 seconds, and then exhale.

Question 6: Managing Exercise-Induced Asthma

Scenario:
A patient with exercise-induced asthma needs advice on preventing attacks during exercise. Which actions should the patient take?

Options:

  1. Avoid warming up before exercise.
  2. Administer a short-acting beta-agonist before exercise.
  3. Administer a short-acting beta-agonist after exercise.
  4. Avoid exercise when experiencing a respiratory illness.

Answering Strategy:

  • Option 1: Avoiding a warm-up is incorrect; warming up prepares the airways and can help prevent bronchoconstriction.
  • Option 3: Administering a bronchodilator after exercise won’t prevent an asthma attack during exercise, so this option is incorrect.

Correct Answers: Options 2 and 4 are correct. Administering a short-acting beta-agonist before exercise can prevent an attack, and avoiding exercise during respiratory illness is essential to prevent exacerbation.

Conclusion

These scenarios and questions highlight the importance of critical thinking in nursing practice, particularly in respiratory care. By carefully analyzing patient symptoms and understanding the mechanisms of action behind treatments, you can make informed decisions that improve patient outcomes. Remember, the key to mastering the NCLEX is not just memorization but truly understanding the why behind

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