Respiratory System NCLEX Practice Questions

Respiratory System NCLEX Practice Questions Related

Review Respiratory System NCLEX Practice Questions related questions and content

For a male client with an endotracheal (ET) tube, which nursing action is most essential?

  • A. Auscultating the lungs for bilateral breath sounds.
  • B. Turning the client from side to side every 2 hours.
  • C. Monitoring serial blood gas values every 4 hours.
  • D. Providing frequent oral hygiene.
Correct Answer: A

Rationale: The correct answer is A: Auscultating the lungs for bilateral breath sounds. This is the most essential nursing action for a male client with an endotracheal tube because it ensures proper placement of the tube and adequate ventilation. By auscultating the lungs, the nurse can assess for any potential complications such as tube displacement, pneumothorax, or mucus plugging. This action helps in early detection of respiratory issues and prompt intervention if needed.

Summary:
- Choice B (Turning the client from side to side every 2 hours) is important for preventing pressure ulcers but not as critical as assessing breath sounds.
- Choice C (Monitoring serial blood gas values every 4 hours) is important for evaluating respiratory status but does not provide immediate information on tube placement.
- Choice D (Providing frequent oral hygiene) is important for preventing infections but does not directly assess the client's respiratory status with an ET tube.

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The impulse for voluntary muscles for forced breathing starts in

  • A. Medulla ( pons )
  • B. Vagus nerve
  • C. Cerebral hemispheres
  • D. Spinal cord
Correct Answer: A

Rationale: The correct answer is A: Medulla (pons). The medulla, located in the brainstem, controls involuntary functions like breathing. Specifically, the medulla contains the respiratory center, which regulates breathing rhythm and depth. During forced breathing, the medulla sends impulses to the voluntary muscles involved in breathing, such as the diaphragm and intercostal muscles. The pons, which is closely connected to the medulla, assists in regulating breathing patterns. The vagus nerve (B) is responsible for parasympathetic functions, not voluntary breathing. The cerebral hemispheres (C) are primarily involved in higher brain functions, not breathing regulation. The spinal cord (D) plays a role in transmitting signals between the brain and muscles but does not initiate voluntary breathing impulses.

In the lungs

  • A. PCO2 in the alveoli is the same as that in the capillaries
  • B. PO2 in the alveoli is the same as that in the capillaries
  • C. PCO2 in the alveoli is higher than that in the capillaries
  • D. PCO2 in the alveoli is lower than that in the capillaries
Correct Answer: D

Rationale: The correct answer is D because in the lungs, during gas exchange, carbon dioxide (CO2) is removed from the blood and exhaled. This leads to a lower PCO2 in the alveoli compared to the capillaries. The concentration gradient drives the diffusion of CO2 from the capillaries to the alveoli. Options A and B are incorrect because the partial pressure of CO2 (PCO2) and oxygen (PO2) differ between the alveoli and capillaries due to gas exchange. Option C is also incorrect as PCO2 is lower in the alveoli to facilitate the removal of CO2 from the blood.

Each of the following is true regarding the spleen, except:

  • A. Spleen is located posterolateral to the stomach, and contacts the diaphragm and left kidney.
  • B. Splenic veins, arteries, and lymphatic vessels communicate with the spleen at the hilum.
  • C. The spleen is a primary lymphoid organ, serving to filter lymph fluid.
  • D. Lymphocytes and dendritic cells are concentrated in the white pulp.
Correct Answer: C

Rationale: Rationale:
C is correct because the spleen is a secondary lymphoid organ, not a primary one. The spleen filters blood, not lymph fluid.
A is correct as the spleen is located in the described position.
B is correct as the splenic vessels do communicate with the spleen at the hilum.
D is correct as lymphocytes and dendritic cells are indeed concentrated in the white pulp.

Summary:
A, B, and D are correct statements about the spleen. C is incorrect because the spleen is a secondary lymphoid organ, not a primary one.

Which area represents the work to overcome airway resistance?

  • A. ABCEA
  • B. ABCFA
  • C. AECFA
  • D. ABCDOA
Correct Answer: C

Rationale: The correct answer is C: AECFA. This sequence represents the flow of air through the respiratory system. Airway resistance is primarily overcome by the contraction and relaxation of the smooth muscles in the airways. The correct sequence includes the airway segments that actively participate in regulating airway resistance - the trachea (A), bronchi (E), and bronchioles (C and F). The other choices do not include the correct segments that are involved in overcoming airway resistance.

A patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue, and thick secretions. What is an expected outcome for this patient?

  • A. SpO is 90%
  • B. Lungs clear to auscultation
  • C. Patient tolerates walking in hallway
  • D. Patient takes three or four shallow breaths before coughing to minimize pain
Correct Answer: D

Rationale: The expected outcome for a patient with ineffective airway clearance would be for the patient to take three or four shallow breaths before coughing to minimize pain, which indicates effective clearing of airway secretions. The other options do not directly relate to the nursing diagnosis provided.

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