Respiratory Conditions

ABG Interpretations

100

A client with chronic obstructive pulmonary disease (COPD) has the following ABG results:

• pH: 7.32
• PaCO₂: 52 mmHg
• HCO₃⁻: 28 mEq/L

Which acid-base imbalance is present?

A. Uncompensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Compensated respiratory acidosis
D. Uncompensated metabolic acidosis

Correct Answer: C. Compensated respiratory acidosis

Rationale:

• pH is slightly low (acidosis), PaCO₂ is high (respiratory acidosis), and HCO₃⁻ is elevated (renal compensation). Since the pH is near normal but slightly acidotic, this is compensated (chronic) respiratory acidosis.

200

A client is anxious and breathing rapidly. ABG results:

• pH: 7.48
• PaCO₂: 30 mmHg
• HCO₃⁻: 24 mEq/L

What is the correct interpretation?

A. Uncompensated respiratory alkalosis
B. Compensated metabolic alkalosis
C. Uncompensated metabolic acidosis
D. Compensated respiratory acidosis

Correct Answer: A. Uncompensated respiratory alkalosis

Rationale:

• pH is high (alkalosis), PaCO₂ is low (respiratory cause), and HCO₃⁻ is normal (no compensation). This is uncompensated respiratory alkalosis.

300

A client with diabetic ketoacidosis has these ABG results:

• pH: 7.25
• PaCO₂: 28 mmHg
• HCO₃⁻: 14 mEq/L

What is the correct interpretation?

A. Uncompensated metabolic acidosis
B. Partially compensated metabolic acidosis
C. Compensated respiratory alkalosis
D. Uncompensated respiratory acidosis

Correct Answer: B. Partially compensated metabolic acidosis

Rationale:

• pH is low (acidosis), HCO₃⁻ is low (metabolic acidosis), PaCO₂ is also low (respiratory system is trying to compensate by blowing off CO₂). Since pH is still abnormal, this is partially compensated metabolic acidosis.

400

A client with severe vomiting has the following ABG results:

• pH: 7.50
• PaCO₂: 48 mmHg
• HCO₃⁻: 36 mEq/L

What is the correct interpretation?

A. Uncompensated metabolic alkalosis
B. Compensated metabolic alkalosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory alkalosis

Correct Answer: C. Partially compensated metabolic alkalosis

Rationale:

• pH is high (alkalosis), HCO₃⁻ is high (metabolic cause), PaCO₂ is also high (respiratory system is trying to compensate by retaining CO₂). Since pH is still abnormal, this is partially compensated metabolic alkalosis.

500

A client with opioid overdose presents with:

• pH: 7.28
• PaCO₂: 60 mmHg
• HCO₃⁻: 25 mEq/L

What is the correct interpretation?

A. Uncompensated respiratory acidosis
B. Compensated metabolic acidosis
C. Partially compensated respiratory acidosis
D. Compensated respiratory alkalosis

Correct Answer: A. Uncompensated respiratory acidosis

Rationale:

• pH is low (acidosis), PaCO₂ is high (respiratory cause), HCO₃⁻ is normal (no compensation). This is uncompensated respiratory acidosis.

Random

100

Loss of taste.

ageusia    

200

 A highly communicable disease caused by infection with Mycobacterium t.

tuberculosis (TB)

300

 Loss of smell.

anosmia    

400

is a genetic disorder that primarily affects the lungs and digestive system. It is caused by mutations in the CFTR gene, leading to abnormal transport of chloride and sodium across epithelial cells.

Cystic fibrosis (CF)

500

A nurse is assessing a client with suspected pneumonia. Which assessment finding is most indicative of pneumonia?

A. Clear breath sounds
B. Crackles heard in the lower lobes
C. Bradycardia
D. Nonproductive cough

Correct Answer:

B. Crackles heard in the lower lobes

Crackles (rales) are a classic finding in pneumonia due to fluid and exudate in the alveoli.

NCLEX Style

100

A nurse is caring for a client who suddenly develops stridor, difficulty speaking, and use of accessory muscles after eating in the hospital cafeteria. The client appears anxious and cyanotic. What is the nurse’s priority action?

A. Obtain a pulse oximetry reading
B. Encourage the client to cough forcefully
C. Begin rescue breathing with a bag-valve mask
D. Call the rapid response team and leave the client to get help

Correct Answer: B. Encourage the client to cough forcefully

Rationale

• B. Encourage the client to cough forcefully:
• The client is showing signs of an upper airway obstruction (stridor, difficulty speaking, accessory muscle use, cyanosis). If the client can still cough or speak, the priority is to encourage forceful coughing to try to expel the obstruction. This is the first step in managing a partial airway obstruction.

200

A nurse is admitting a client for a routine physical examination. Which client statement or assessment finding is most suggestive of obstructive sleep apnea (OSA)?

A. "I wake up several times at night gasping for air."
B. "I have a persistent dry cough during the day."
C. "I drink a cup of coffee every morning."
D. "I exercise for 30 minutes most days of the week."

Correct Answer: A. "I wake up several times at night gasping for air."

Rationale

• A. "I wake up several times at night gasping for air."
• This is a classic cue for OSA. Clients with OSA often experience repeated episodes of apnea during sleep, leading to abrupt awakenings with gasping or choking.

300

A nurse is caring for a client with a history of obstructive sleep apnea (OSA) who is in the immediate postoperative period following abdominal surgery. Which action is the priority to reduce the risk of complications?

A. Place the client in a supine position with the head of bed flat
B. Ensure the client’s CPAP device is applied during sleep
C. Administer opioid pain medication as prescribed
D. Encourage the client to ambulate as soon as possible

Correct Answer: B. Ensure the client’s CPAP device is applied during sleep

Rationale

• B. Ensure the client’s CPAP device is applied during sleep:
• The highest priority for a client with OSA post-surgery is maintaining airway patency and preventing apneic episodes, especially when sedated or sleeping. Using the CPAP device as prescribed is the most effective intervention to prevent airway obstruction and hypoxemia.

400

A nurse is caring for a client in the first 24 hours after surgery. During a routine assessment, the nurse notes increased respiratory effort, stridor, and the client is drooling and unable to swallow oral secretions. What is the priority nursing action?

A. Reassess the client in 30 minutes
B. Suction the client’s oral secretions and continue to monitor
C. Elevate the head of the bed and apply oxygen
D. Activate the Rapid Response Team immediately

Rationale

• D. Activate the Rapid Response Team immediately:
• The client is showing signs of airway narrowing or partial obstruction (increased respiratory effort, stridor, drooling, inability to swallow). These are critical warning signs that can quickly progress to complete airway obstruction. Immediate activation of the Rapid Response Team is necessary to prevent respiratory arrest and ensure advanced airway management.

500

A client diagnosed with obstructive sleep apnea (OSA) has been prescribed continuous positive airway pressure (CPAP) therapy. What intervention would the nurse take to ensure that the therapy is beneficial?

A. Obtain a baseline arterial blood gas (ABG).

B. Clean the mask and tubing system daily.

C. Remove the mask, and teach coughing and deep-breathing exercises.

D. Apply the mask, and ensure a tight fit around the face.

Correct Answer:

D. Apply the mask, and ensure a tight fit around the face.

Rationale

• Ensuring a tight fit of the CPAP mask is the most important intervention to guarantee that the client receives the full therapeutic benefit of CPAP. Air leaks reduce the effectiveness of therapy and can lead to continued apneic episodes.

Random II

100

is a technique that encourages full oxygen exchange by engaging the diaphragm—a large, dome-shaped muscle at the base of the lungs.

Diaphragmatic (Abdominal) Breathing (AKA: Deep breathing)

200

 Is a technique that helps keep airways open longer, improves breathing efficiency, and reduces shortness of breath—especially in people with chronic lung disease.

  “Breathe in slowly through your nose, then breathe out slowly through pursed lips, as if you are blowing out a candle.”

Pursed-Lip Breathing

300

What can a nurse employ to a patient with chronic respiratory disease who is experiencing dyspnea that is simple, quick, and non invasive?

 (Fowler's Position)

Place the client in an upright position with the head of the bed elevated.

400

A collection of pus in the pleural cavity.

empyema    

500

Is the chronic increase in pulmonary vascular pressures above 25 mm Hg, which makes the right side of the heart work much harder for lung perfusion to support proper gas exchange.

Pulmonary Arterial Hypertension (AKA: Pulmonary hypertension)

NCLEX Style II

100

A nurse is caring for a client who is in the immediate postoperative period following nasal surgery. Which assessment finding requires the nurse’s immediate action?

A. The client reports mild nasal discomfort.
B. The client is swallowing repeatedly.
C. The client’s blood pressure is 118/76 mm Hg.
D. The client has dried blood on the external nares.

Rationale

• B. The client is swallowing repeatedly:
• Repeated swallowing after nasal surgery is a classic sign of possible posterior nasal bleeding. Blood can trickle down the back of the throat, and the client may swallow frequently to clear it. This finding requires immediate assessment with a penlight to check for bleeding and prompt notification of the surgeon if bleeding is present.

200

The nurse is caring for a client who has sustained a mandibular fracture requiring inner maxillary fixation (IMF). Which nursing action has the highest priority?

A. Maintain a patent airway.
B. Administer pain medication.
C. Ensure proper nutritional intake.
D. Assess neurovascular status.

Rationale

• A. Maintain a patent airway:
• Highest priority. Clients with IMF have their jaws wired shut, which puts them at significant risk for airway obstruction, especially if they vomit or have secretions. Airway management is always the top priority in any situation where airway compromise is possible.

300

A nurse is providing community education about the warning signs of head and neck cancer. Which client statement indicates a need for further teaching?

A. "A sore in my mouth that doesn’t heal could be a warning sign."
B. "If I have persistent hoarseness, I should get it checked out."
C. "A painless lump in my neck that doesn’t go away is nothing to worry about."
D. "Difficulty swallowing for several weeks could be a sign of cancer."

Rationale

• C. "A painless lump in my neck that doesn’t go away is nothing to worry about.":
• This statement is incorrect and indicates a need for further teaching. A persistent, painless lump in the neck can be a warning sign of head and neck cancer and should always be evaluated by a healthcare provider.

400

A nurse is caring for a client in the first several days after head and neck surgery. During an hourly assessment, the nurse suspects a carotid artery leak. What is the priority nursing action?

A. Apply gentle pressure to the suspected area and notify the surgeon.
B. Initiate the Rapid Response Team and avoid touching the area.
C. Elevate the head of the bed and monitor vital signs.
D. Leave the client briefly to obtain emergency supplies.

Rationale

• B. Initiate the Rapid Response Team and avoid touching the area:
• If a carotid artery leak is suspected, the nurse must immediately call for help (Rapid Response Team) and avoid touching the area, as additional pressure could cause a rupture. This is a critical rescue situation due to the high risk of stroke and death.

500

 A client who underwent a laryngectomy for laryngeal cancer has started oral intake. What is the nurse’s priority action?

A. Weigh the client daily to track weight loss.

B. Examine oral mucosa for mouth sores.

C. Initiate aspiration precautions.

D. Provide complete oral care to this client.

Rationale

• C. Initiate aspiration precautions:
• Priority. After a laryngectomy, the client is at high risk for aspiration due to changes in the anatomy of the airway and swallowing mechanism. Initiating aspiration precautions (such as upright positioning, slow feeding, and monitoring for signs of aspiration) is essential to prevent potentially life-threatening complications like aspiration pneumonia.