RESPIRATORY NCLEX STYLE QUESTIONS

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnose asthma. When teaching the patient about this drug, the nurse should explain that it may cause:a. Nasal congestionb. Nervousnessc. Lethargyd. Hyperkalemia

2. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In a acute rhinitis, nasal drainage normally is:a. Yellowb. Greenc. Cleard. Gray

3. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?a. Nausea or vomitingb. Abdominal pain or diarrheac. Hallucinations or tinnitusd. Lightheadedness or paresthesia

4. Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:a. Patients with an acute asthma attackb. Patients with narcolepsyc. Patients under age 6d. Elderly patients

5. A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which condition triggers the high pressure alarm?a. Kinking of the ventilator tubingb. A disconnected ventilator tubec. An endotracheal cuff leakd. A change in the oxygen concentration without resetting the oxygen level alarm

6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?a. Leg movementb. Finger movementc. Lip movementd. Fighting the ventilator

7. On auscultation, which finding suggests a right pneumothorax?a. Bilateral inspiratory and expiratory cracklesb. Absence of breaths sound in the right thoraxc. Inspiratory wheezes in the right thoraxd. Bilateral pleural friction rub.

8. Rhea, confused and short of breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present?a. Acid-base balanceb. Arterial Bloodc. Arterial oxygen saturationd. Alveoli

9. A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?a. Activity intolerance related to fatigueb. Anxiety related to actual threat to health statusc. Risk for infection related to retained secretionsd. Impaired gas exchange related to airflow obstruction

10. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:a. Contralateral side in a simple pneumothoraxb. Affected side in a hemothoraxc. Affected side in a tension pneumothoraxd. Contralateral side in hemothorax

11. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:a. Monitor fluctuations in the water-seal chamberb. Clamp the chest tube once every shiftc. Encourage coughing and deep breathingd. Milk the chest tube every 2 hours

12. When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:a. Encourage oral feeding as soon as possibleb. Develop an alternative communication methodc. Keep the tracheostomy cuff fully inflatedd. Keep the patient flat in bed

13. A male patient has a sucking stab wound to the chest. Which action should the nurse take first?a. Drawing blood for a hematocrit and hemoglobin levelb. Applying a dressing over the wound and taping it on three sidesc. Preparing a chest tube insertion trayd. Preparing to start an I.V. line

14. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?a. Encouraging the patient to drink three glasses of fluid dailyb. Keeping the patient in semi-fowler’s positionc. Using a high-flow venture mask to deliver oxygen as prescribed. Administering a sedative, as prescribe

15. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from:a. Cardiogenic pulmonary edemab. Respiratory alkalosis

c. Increased pulmonary capillary permeabilityd. Renal failure

16. For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?a. Restricting fluid intake to 1,000 ml per dayb. Enforcing absolute bed restc. Teaching the patient how to perform controlled coughingd. Administering prescribe sedatives regularly and in large amounts

17. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate?a. Do nothing, because this is an expected findingb. Immediately clamp the chest tube and notify the physicianc. Check for an air leak because the bubbling should be intermittentd. Increase the suction pressure so that the bubbling becomes vigorous

18. Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?a. Inform the physicianb. Continue to monitor the clientc. Reinforce the occlusive dressingd. Encourage the client to deep-breathe

19. Nurse Ryan caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:a. Call the physicianb. Place the tube in bottle of sterile waterc. Immediately replace the chest tube systemd. Place a sterile dressing over the disconnection site

20. A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:a. Exhale slowlyb. Stay very stillc. Inhale and exhale quicklyd. Perform the Valsalva maneuver

21. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to:a. Call the physician to reinsert the tubeb. Grasp the retention sutures to spread the openingc. Call the respiratory therapy department to reinsert the tracheotomyd. Cover the tracheostomy site with a sterile dressing to prevent infection

22. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?a. Stridorb. Occasional pink-tinged sputumc. A few basilar lung crackles on the rightd. Respiratory rate 24 breaths/min

23. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?a. A low respiratory rateb. Diminished breath soundsc. The presence of a barrel chestd. A sucking sound at the site of injury

24. Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?a. Hypocapniab. A hyperinflated chest noted on the chest x-rayc. Increased oxygen saturation with exercised. A widened diaphragm noted on the chest x-ray

25. An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?a. Face tentb. Venturi maskc. Aerosol maskd. Tracheostomy collar

26. Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:a. Dyspneab. Chest painc. A bloody, productive coughd. A cough with the expectoration of mucoid sputum

27. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?a. Bronchoscopyb. Sputum culturec. Chest x-rayd. Tuberculin skin test

28. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:a. 1 L/minb. 2 L/minc. 6 L/mind. 10 L/min

29. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:a. Promote oxygen intakeb. Strengthen the diaphragmc. Strengthen the intercostal musclesd. Promote carbon dioxide elimination

30. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

a. Pallorb. Low arterial PaO2c. Elevated arterial PaO2d. Decreased respiratory rate

1. Answer B. Albuterol may cause nervousness. The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia. Other adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps.

2. Answer C. Normally, nasal drainage in acute rhinitis is clear. Yellow or green drainage indicates spread of the infection to the sinuses. Gray drainage may indicate a secondary infection.

3. Answer D. The patient with respiratory alkalosis may complain of lightheadedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rare are associated with respiratory alkalosis or any other acid-base imbalance.

4. Answer D. Ephedrine is not recommended for elderly patients, who are particularly susceptible to CNS reactions (such as confusion and anxiety) and to cardiovascular reactions (such as increased systolic blood pressure, coldness in the extremities, and anginal pain). Ephedrine is used for its bronchodilator effects with acute and chronic asthma and occasionally for its CNS stimulant actions for narcolepsy. It can be administered to children age 2 and older.

5. Answer A. Conditions that trigger the high pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on endotracheal tube, and the patient’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an endotracheal cuff leak would trigger the low pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would tigger the oxygen alarm.

6. Answer D. Pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation and paralysis. It assists mechanical ventilation by promoting endotracheal intubation and paralyzing the patient so that the mechanical ventilator can do its work. Fighting the ventilator is a sign that the patient needs another pancuronium dose. The nurse should administer 0.01 to 0.02 mg/kg I.V. every 20 to 60 minutes. Movement of the legs, or lips has no effect on the ventilator and therefore is not used to determine the need for another dose.

7. Answer B. In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation.

8. Answer B. A lowercase “a” in an ABG value represents arterial blood. For instance, the abbreviation PaO2 refers to the partial pressure of oxygen in arterial blood. The pH value reflects the acid base balance in arterial blood. Sa02 indicates arterial oxygen saturation. An uppercase “A” represents alveolar conditions: for example, PA02 indicates the partial pressure of oxygen in the alveoli.

9. Answer D. A patient airway and an adequate breathing pattern are the top priority for any patient, making “impaired gas exchange related to airflow obstruction” the most important nursing diagnosis. The other options also may apply to this patient but less important.

10. Answer D. The trachea will shift according to the pressure gradients within the thoracic cavity. In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. If there is

no significant air or fluid accumulation, the trachea will not shift. Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the release of normal thoracic pressure gradients on the injured side.

11. Answer C. When caring for a patient who is recovering from a pneumonectomy, the nurse should encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. Because the lung has been removed, the water-seal chamber should display no fluctuations. Reinflation is not the purpose of chest tube. Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage.

12. Answer B. A patient with a laryngectomy cannot speak, yet still needs to communicate. Therefore, the nurse should plan to develop an alternative communication method. After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. To prevent injury to the tracheal mucosa, the nurse should deflate the tracheostomy cuff or use the minimal leak technique. To decrease edema, the nurse should place the patient in semi-fowler’s position.

13. Answer B. The nurse immediately should apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound). Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.

14. Answer C. The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowler’s position and should not receive sedatives or other drugs that may further depress the respiratory center.

15. Answer C. ARDS results from increased pulmonary capillary permeability, which leads to noncardiogenic pulmonary edema. In cardiogenic pulmonary edema, pulmonary congestion occurs secondary to heart failure. In the initial stage of ARDS, respiratory alkalosis may arise secondary to hyperventilation; however, it does not cause ARDS. Renal failure does not cause ARDS, either.

16. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the patient’s ability to maintain a patent airway, causing a high risk for infection from pooled secretions.

17. Answer A. Continuous gentle bubbling should be noted in the suction control chamber. Option b is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option c is incorrect. Bubbling should be continuous and not intermittent. Option d is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system.

18. Answer B. The presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspiration and falls with expiration. Fluctuation stops if the tube is obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has reexpanded. Options A, C, and D are incorrect.

19. Answer B. If the chest drainage system is disconnected, the end of the tube is placed in a bottle of sterile water held below the level of the chest. The system is replaced if it breaks or cracks or if the collection chamber is full. Placing a sterile dressing over the disconnection site will not prevent complications resulting from the disconnection. The physician may need to be notified, but this is not the initial action.

20. Answer D. When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative instruction is to ask the client to take a deep breath and hold the breath while the tube is removed. Options A, B, and C are incorrect client instructions.

21. Answer B. If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures and spread the opening. If agency policy permits, the nurse then attempts immediately to replace the tube. Covering the tracheostomy site will block the airway. Options A and C will delay treatment in this emergency situation.

22. Answer A. The nurse reports stridor to the physician immediately. This is a high-pitched, coarse sound that is heard with the stethoscope over the trachea. Stridor indicates airway edema and places the client at risk for airway obstruction. Options B, C, and D are not signs that require immediate notification of the physician.

23. Answer B. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.

24. Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

25. Answer B. The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

26. Answer D. One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement.

27. Answer B. Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy.

28. Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.

29. Answer D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing.

30. Answer B. The earliest clinical sign of acute respiratory distress syndrome is an increased respiratory rate. Breathing becomes labored, and the client may exhibit air hunger, retractions, and cyanosis. Arterial blood gas analysis reveals increasing hypoxemia, with a PaO2 lower than 60 mm Hg.

1. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?a. Limiting fluidb. Having the client take deep breathsc. Asking the client to spit into the collection containerd. Asking the client to obtain the specimen after eating2. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

a. Dry coughb. Hematuriac. Bronchospasmd. Blood-streaked sputum

3. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of:a. 1 minuteb. 5 secondsc. 10 secondsd. 30 seconds

4. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?a. Continue to suctionb. Notify the physician immediatelyc. Stop the procedure and reoxygenate the clientd. Ensure that the suction is limited to 15 seconds

5. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?a. Dyspneab. Bradypneac. Bradycardiad. Decreased respirations

6. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:a. Resonant sounds.b. Hyperresonant sounds.c. Dull sounds.d. Flat sounds.

7. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:a. Question the order because it’s too low.b. Question the order because it’s too high.c. Set the pump at 45 ml/hour.d. Stop the infusion and have the laboratory repeat the theophylline measurement.

8. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?a. Make inhalation longer than exhalation.b. Exhale through an open mouth.c. Use diaphragmatic breathing.d. Use chest breathing.

9. Which phrase is used to describe the volume of air inspired and expired with a normal breath?a. Total lung capacity

b. Forced vital capacityc. Tidal volumed. Residual volume

10. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?a. Simple maskb. Non-rebreather maskc. Face tentd. Nasal cannula

11. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?a. Impaired color discriminationb. Increased urinary frequencyc. Decreased hearing acuityd. Increased appetite

12. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:a. Area of redness is measured in 3 days and determines whether tuberculosis is present.b. Skin test doesn’t differentiate between active and dormant tuberculosis infection.c. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.d. Test stimulates a reddened response in some clients and requires a second test in 3 months.

13. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:a. 15 to 60 seconds.b. 5 to 20 minutes.c. 30 to 40 minutes.d. 45 to 60 minutes.

14. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?a. The system is functioning normallyb. The client has a pneumothorax.c. The system has an air leak.d. The chest tube is obstructed.

15. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:a. Lips.b. Mucous membranes.c. Nail beds.d. Earlobes.

16. For a male client with an endotracheal (ET) tube, which nursing action is most essential?a. Auscultating the lungs for bilateral breath soundsb. Turning the client from side to side every 2 hoursc. Monitoring serial blood gas values every 4 hoursd. Providing frequent oral hygiene17. The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty breathing?

a. Diaphragmatic breathingb. Use of accessory musclesc. Pursed-lip breathingd. Controlled breathing

18. A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:a. Lung vibrations.b. Vocal sounds.c. Breath sounds.d. Chest movements.

19. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating legionnaires’ disease?a. Erythromycin (Erythrocin)b. Rifampin (Rifadin)c. Amantadine (Symmetrel)d. Amphotericin B (Fungizone)

20. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:a. Pleural effusion.b. Pulmonary edema.c. Atelectasis.d. Oxygen toxicity.

21. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?a. It helps prevent early airway collapse.b. It increases inspiratory muscle strength.c. It decreases use of accessory breathing muscles.d. It prolongs the inspiratory phase of respiration.

22. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond?a. In 30 minutesb. In 1 hourc. In 2.5 hoursd. In 4 hours

23. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?a. Kinking of the ventilator tubingb. A disconnected ventilator tubec. An ET cuff leakd. A change in the oxygen concentration without resetting the oxygen level alarm24. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the

mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD?a. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.b. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator.c. It stimulates adenosine receptors, causing bronchodilation.d. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.

25. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?a. Inflamed lung tissueb. Sudden onsetc. Responsiveness to penicillin.d. Elevated white blood cell (WBC) count

26. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?a. pH, 5.0; PaCO2 30 mm Hgb. pH, 7.40; PaCO2 35 mm Hgc. pH, 7.35; PaCO2 40 mm Hgd. pH, 7.25; PaCO2 50 mm Hg

27. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?a. Apneab. Anginal painc. Respiratory alkalosisd. Metabolic acidosis

28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:a. Alprazolam (Xanax).b. Propranolol (Inderal)c. Morphine.d. Albuterol (Proventil).

29. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?a. Heightened alertnessb. Increased heart ratec. Numbness and tingling of the extremitiesd. Respiratory depression

30. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:a. Drinking more than 1,500 ml of fluid daily.

b. Being overweight.c. Eating a high-protein snack at bedtime.d. Eating more than three large meals a day.

1. Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

2. Answer D. If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

3. Answer C. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells in the heart. A vasovagal response may occur, causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.

4. Answer C. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side effects develop, especially cardiac irregularities, the procedure is stopped and the client is reoxygenated.

5. Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.

6. Answer A. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

7. Answer A. A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5 mg/kg/hour of aminophylline. Because the client’s theophylline level is sub-therapeutic, reducing the dose (which is what the physician’s order would do) would be inappropriate. Therefore, the nurse should question the order.

8. Answer C. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

9. Answer C. Tidal volume refers to the volume of air inspired and expired with a normal breath. Total lung capacity is the maximal amount of air the lungs and respiratory passages can hold after a forced inspiration. Forced vital capacity is the vital capacity performed with a maximally forced expiration. Residual volume is the maximal amount of air left in the lung after a maximal expiration.

10. Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other modes — simple mask, face tent, and nasal cannula — deliver lower levels of FIO2.

11. Answer C. Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be prescribed. The other options aren’t associated with streptomycin. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus.

12. Answer B. The Mantoux test doesn’t differentiate between active and dormant infections. If a positive reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2 days doesn’t indicate active tuberculosis.

13. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually lengthen this interval according to the client’s respiratory status. A client who doesn’t require continuous mechanical ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds wouldn’t be long enough to reveal the client’s true tolerance to the procedure. Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally.

14. Answer C. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

15. Answer B. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.

16. Answer A. For a client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral breath sounds to ensure proper tube placement and effective oxygen delivery. Although the other options are appropriate for this client, they’re secondary to ensuring adequate oxygenation.

17. Answer B. The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.

18. Answer D. The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum fracture. The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to say "99," the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse’s palms. The nurse assesses breath sounds during auscultation.

19. Answer A. Erythromycin is the drug of choice for treating legionnaires’ disease. Rifampin may be added to the regimen if erythromycin alone is ineffective; however, it isn’t administered first. Amantadine, an antiviral agent, and amphotericin B, an antifungal agent, are ineffective against legionnaires’ disease, which is caused by bacterial infection.

20. Answer C. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

21. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

22. Answer A. Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours.

23. Answer A. Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

24. Answer A. Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema, they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.

25. Answer A. The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t.

26. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.

27. Answer A. Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.

28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing. Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

29. Answer D. Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension, decreased sensation and movement of the extremities, allergic reactions, and

urine retention. Typically, epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.

30. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?a. Septicemiab. Pneumoniac. Meningitisd. Pulmonary edema

4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?a. Hypoxiab. Deliriumc. Hyperventilationd. Semiconsciousness

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:a. hyperglycemia and glycosuria.b. acute adrenocortical insufficiency.c. GI bleeding.d. restlessness and seizures.

9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?a. Immediately before a mealb. At least 2 hours after a mealc. When bronchospasms occurd. When secretions have mobilized

10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?a. Feverb. Tachypneac. Tachycardiad. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:a. helping him communicate.

b. keeping his airway patent.c. encouraging him to perform activities of daily living.d. preventing him from developing an infection.

12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?a. Restricting fluid intake to 1,000 ml/dayb. Enforcing absolute bed restc. Teaching the client how to perform controlled coughingd. Administering prescribed sedatives regularly and in large amounts

14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:a. 0.21b. 0.35c. 0.5d. 0.7

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?a. A positive reaction indicates that the client has active tuberculosis (TB).b. A positive reaction indicates that the client has been exposed to the disease.c. A negative reaction always excludes the diagnosis of TB.d. The PPD can be read within 12 hours after the injection.

16. Nurse Murphy administers albuterol (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?a. Respiratory rate of 22 breaths/minuteb. Dilated and reactive pupilsc. Urine output of 40 ml/hourd. Heart rate of 100 beats/minute

17. What is the normal pH range for arterial blood?a. 7 to 7.49b. 7.35 to 7.45c. 7.50 to 7.60d. 7.55 to 7.65

18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?a. Fluid intake for the last 24 hoursb. Baseline arterial blood gas (ABG) levelsc. Prior outcomes of weaningd. Electrocardiogram (ECG) results

19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?a. Administer a prescribed decongestant.b. Instruct the client to breathe into a paper bag.c. Offer the client fluids frequently.d. Administer prescribed supplemental oxygen.

20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?a. pHb. Bicarbonate (HCO3–)c. Partial pressure of arterial oxygen (PaO2)d. Partial pressure of arterial carbon dioxide (PaCO2)

21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?a. Endotracheal suctioningb. Encouragement of coughingc. Use of cooling blanketd. Incentive spirometry

22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?a. Measuring and documenting the drainage in the collection chamberb. Maintaining continuous bubbling in the water-seal chamberc. Keeping the collection chamber at chest leveld. Stripping the chest tube every hour

25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?a. 1 to 2 mcg/mlb. 2 to 5 mcg/mlc. 5 to 10 mcg/mld. 10 to 20 mcg/ml

26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:a. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.b. vancomycin may cause irreversible neutropenia.c. vancomycin should be administered rapidly in a large volume of fluid.d. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history. Which condition is a predisposing factor for respiratory alkalosis?a. Myasthenia gravisb. Type 1 diabetes mellitusc. Extreme anxietyd. Narcotic overdose

2. Answer B. Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reye’s syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren’t associated with influenza.

4. Answer A. As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and place. Hyperventilation (respiratory rate greater than that metabolically necessary for

gas exchange) is marked by an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized by limited motor and verbal responses and decreased orientation.

6. Answer B. Administration of a corticosteroid such as prednisone suppresses the body’s natural cortisol secretion, which may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation.

9. Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to reduce the risk of vomiting and aspiration. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn’t available) are a contraindication for postural drainage, another component of chest physiotherapy.

10. Answer D. Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry values by reducing arterial blood flow. Likewise, movement of the finger to which the oximeter is applied may interfere with interpretation of SaO2. All of these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia don’t affect pulse oximetry values directly.

11. Answer B. Maintaining a patent airway is the most basic and critical human need. All other interventions are important to the client’s well-being but not as important as having sufficient oxygen to breathe.

12. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client’s ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

14. Answer C. An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and surfactant activity. The ideal oxygen source is room air F IO 2 0.18 to 0.21.

15. Answer B. A positive reaction means the client has been exposed to TB; it isn’t conclusive of the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In immunosuppressed clients, a negative reaction doesn’t exclude the presence of active disease.

16. Answer A. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

17. Answer B. A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates alkalosis.

18. Answer B. Before weaning a client from mechanical ventilation, it’s most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client’s record, and the nurse can refer to them before the weaning process begins.

19. Answer B. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. All of the other options — such as administering a decongestant, offering fluids frequently, and administering supplemental oxygen — wouldn’t raise the lowered PaCO2 level.

20. Answer C. The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client’s ventilation status, not oxygenation.

21. Answer A. Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and incentive spirometry improves oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn’t be affected.

22. Answer A. The nurse should measure and document the amount of chest tube drainage regularly to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse should not strip chest tubes because doing so may traumatize the tissue or dislodge the tube.

25. Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10 mcg/ml aren’t therapeutic.

26. Answer A. To avoid a hypotensive reaction from rapid I.V. administration, the nurse should infuse vancomycin slowly, over 60 to 90 minutes, in a large volume of fluid. Although neutropenia may occur in approximately 5% to 10% of clients receiving vancomycin, this adverse effect reverses rapidly when the drug is discontinued.

27. Answer C. Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, and injury to the brain’s respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes mellitus may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul’s respirations) don’t cause excessive CO2 loss. Myasthenia gravis and narcotic overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

1. A male client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client’s baseline theophylline level was:a. 10 mcg/mLb. 12 mcg/mLc. 15 mcg/mLd. 18mcg/mL

12. The nursing instructor asks a nursing student to describe the route of transmission of tuberculosis. The instructor concludes that the student understands this information if the student states that the tuberculosis is transmitted by:a. Hand and mouthb. The airborne routec. The fecal-oral routed. Blood and body fluids

19. An unconscious male client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of:a. Metabolic acidosisb. Respiratory acidosis

c. Overcompensated respiratory acidosisd. Combined respiratory and metabolic acidosis

21. A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further teaching?a. Inhales the mist and quickly exhalesb. Removes the cap and shakes the inhaler well before usec. Presses the canister down with the finger as he breathes ind. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

22. A female client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?a. Administering atropine intravenouslyb. Administering small doses of midazolam (Versed)c. Encouraging additional fluids for the next 24 hoursd. Ensuring the return of the gag reflex before offering food or fluids

23. A nurse is assessing the respiratory status of a male client who has suffered a fractured rib. The nurse would expect to note which of the following?a. Slow deep respirationsb. Rapid deep respirationsc. Paradoxical respirationsd. Pain, especially with inspiration

24. A female client with chest injury has suffered flail chest. A nurse assesses the client for which most distinctive sign of flail chest?a. Cyanosisb. Hypotensionc. Paradoxical chest movementd. Dyspnea, especially on exhalation

25. A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:a. Right pneumothoraxb. Pulmonary embolismc. Displaced endotracheal tubed. Acute respiratory distress syndrome

26. A nurse is teaching a male client with chronic respiratory failure how to use a metered-dose inhaler correctly. The nurse instructs the client to:a. Inhale quicklyb. Inhale through the nosec. Hold the breath after inhalationd. Take two inhalations during one breath

27. A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome?a. Bilateral wheezingb. Inspiratory cracklesc. Intercostal retractionsd. Increased respiratory rate

28. A nurse is taking pulmonary artery catheter measurements of a male client with acute respiratory distress syndrome. The pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this readings is:a. High and expectedb. Low and unexpectedc. Normal and expectedd. Uncertain and unexpected

29. A nurse is assessing a male client with chronic airflow limitations and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitations?a. Emphysemab. Bronchial asthmac. Chronic obstructive bronchitisd. Bronchial asthma and bronchitis

30. A nurse is caring for a female client diagnosed with tuberculosis. Which assessment, if made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis and may indicate the development of a concurrent problem?a. Coughb. High-grade feverc. Chills and night sweatsd. Anorexia and weight loss1. Answer A. The therapeutic range for the serum theophylline level is 10 to 20 mcg/mL. If the level is below the therapeutic range, the client may experience frequent exacerbations of the disorder. Although all the options identify values within the therapeutic range, option A is the option that reflects a need for compliance with medication.

12. Answer B. Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis and is spread primarily by the airborne route. Options A, C, and D are incorrect.

19. Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect.

21. Answer A. The client should be instructed to hold his or her breath for at least 10 to 15 seconds before exhaling the mist. Options B, C, and D are accurate instructions regarding the use of the inhaler.

22. Answer D. After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Additional fluids are unnecessary because no contrast dye is used that would need flushing from the system. Atropine and midazolam would be administered before the procedure, not after.

23. Answer D. Rib fractures are a common injury, especially in the older client, and result from a blunt injury or a fall. Typical signs and symptoms include pain and tenderness localized at the fracture site and exacerbated by inspiration and palpation, shallow respirations, splinting or guarding the chest protectively to minimize chest movement, and possible bruising at the fracture site. Paradoxical respirations are seen with flail chest.

24. Answer C. Flail chest results from fracture of two or more ribs in at least two places each. This results in a “floating” section of ribs. Because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical chest movement. This means that the force of inspiration pulls the fractured segment inward, while the rest of the chest expands. Similarly, during exhalation, the segment balloons outward while the rest of the chest moves inward. This is a telltale sign of flail chest.

25. Answer A. Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi.

26. Answer C. Instructions for using a metered-dose inhaler include shaking the canister, holding it right side up, inhaling slowly and evenly through the mouth, delivering one spray per breath, and holding the breath after inhalation.

27. Answer D. The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

28. Answer C. The normal pulmonary capillary wedge pressure (PCWP) is 8 to 13 mm Hg, and the client is considered to have high readings if they exceed 18 to 20 mm Hg. The client with acute respiratory distress syndrome has a normal PCWP, which is an expected finding because the edema is in the interstitium of the lung and is noncardiac.

29. Answer A. The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, referred to as “barrel chest.” The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.

30. Answer B. The client with tuberculosis usually experiences cough (productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.

1. A Mantoux test signifies exposure to Mycobacterium Tubercle Bacilli. The test is read for how many hours after injection?a. 1 hourb. 12-24 hoursc. 48-72 hoursd. 2 hours

2. A nurse is about to perform a Mantoux test. The test is done by using which route?a. Intradermalb. Intramuscularc. Subcutaneousd. IM with the use of Z-track method

3. A client is suspected to have an HIV. The nurse knows that in the Mantoux test result, a client is considered positive with HV if he has an induration of:a. More than 10 mmb. 3mmc. 4 mmd. 5 mm

4. A client is about to undergo a chest x-ray. Which of the following should the nurse do first before the procedure?a. Secure a written consentb. Instruct the client not to eat anything at the night before the procedure

c. Instruct the client to remove metals from the chestd. Administer atropine sulfate and valium before the procedure

5. Mr. Lorenzo is schedule for a bronchography. Before the procedure the nurse least likely performs which of the following?a. Assist the client in a side-lying positionb. Checking for allergiesc. Instructing the client to be on NPO for 6-8 hoursd. Administer atropine sulfate

6. After thoracentesis the client should be placed on which position?a. Affected sideb. Unaffected sidec. Prone positiond. Supine position

7. The most important action the nurse should do before and after suctioning a client is:a. Placing the client in a supine positionb. Making sure that suctioning takes only 10-15 secondsc. Evaluating for clear breath soundsd. Hyperventilating the client with 100% oxygen

8. The position of a conscious client during suctioning is:a. Fowler’sb. Supine positionc. Side-lyingd. Prone

9. A client is on chest tube. A three-way bottle system is used. The nurse expects that the suction bottle will normally have which of the following characteristics.a. Intermittent bubblingb. Continuous bubblingc. No bubblingd. None of the above

10. Before the nurse’s shift ended, the water seal bottle is observed to have an intermittent suctioning. The nurse should do which of the following?a. Check for an air leakb. Check for kinks in the tubec. Inform the physician immediatelyd. Make sure that the bottle is at least 2-3 feet below the level of the chest

11. The physician is going to remove the chest tube from a client. The nurse should least likely prepare which of the following item?a. Sterile gauzeb. Suture removal kitc. Empty bottlesd. Adhesive tape

12. While the chest tube is removed the nurse should instruct the patient to:a. Exhale deeplyb. Inhale deeplyc. Lie at the abdomend. Hyperextend the neck

13. A client is brought to the ER with complaints of stuffy nose, headache, persistent cough, fever and post-nasal drip. Pain is complained by the client above the eyebrows. The diagnosis is sinusitis. Which of the following sinuses is affected?a. Maxillaryb. Frontalc. Ethmoidd. Sphenoid

14. Which of the following medications is avoided in sinusitis to prevent the risk of developing nasal polyps?a. Codeineb. Amoxicillinc. ASAd. Anti-infectives

15. Which intervention is least likely done for sinutis?a. Increase fluid intakeb. Cold wet packsc. Hot wet packsd. Rest

16. A client with sinusitis had undergone Caldwell-Luc Surgery. The nurse should instruct the client to do which of the following after the procedure?a. Chew on the unaffected side only.b. The client can wear dentures 5 days after.c. Sneezing should be avoided for a week after the surgeryd. All of the above

17. A teen ager is diagnosed to have inflamed tonsils (tonsillitis). The patient’s history reveals recurrent tonsillitis episodes for about 6 times of the same year. The most appropriate intervention for the patient is:a. Promoting restb. Increasing fluid intakec. Warm saline gargled. Surgery

18. Before a tonsillectomy is performed, which of the following data is very crucial for the nurse to assess?a. Degree of painb. URTIc. Drainage on the earsd. Respiration pattern

19. Mark underwent a tonsillectomy procedure. To promote comfort the following interventions should be done by the nurse except:a. Application of ice collarb. Assist the client to a semi-fowler’s position with pillow supportc. Assess for frequent swallowing of the patientd. Administration of acetaminophen

20. Two days after tonsillectomy, Mark’s reported that his stool is black. Initially, the nurse should:a. Inform the physicianb. Document the findingsc. Obtain stool for analysisd. Check the client’s vital signs

21. Asthma can be caused by extrinsic and intrinsic factors. Presence of these factors triggers the release of the chemical mediators which does not include:a. Serotoninb. Prostaglandinc. Bradykinind. Adrenaline

22. Presence of overdistended and non-functional alveoli is a condition called:a. Bronchitisb. Emphysemac. Empyemad. Atelectasis

23. The accumulation of fluids in the pleural space is called:a. Pleural effusionb. Hemothoraxc. Hydrothoraxd. Pyothorax

24. A client with COPD is instructed to follow what diet?a. High carbohydrate, low calorie and high protein dietb. High protein, high calorie and low carbohydrate dietc. High carbohydrate, low protein and high calorie dietd. High protein, high carbohydrate and high caloric diet

25. Bronchodilators include the following apart from:a. Theophylineb. Terbutalinec. Metaproterenold. Dipenhydramine

1.    Answer: C. Mantoux test is read 48-72 hours after injection. 2.    Answer: A. Mantoux tests are done intradermally. 3.    Answer: D. Mantoux test is considered positive for Mycobacterium Tubercle Bacilli if the induration is 10 mm or more. For HIV positive clients, induration of 5mm is considered positive. 4.    Answer: C. The client is instructed to remove metals from the chest. Consent, NPO post midnight and atropine sulfate administration are not needed for this procedure. 5.    Answer: A.

Nursing interventions before bronchogram: • Secure written consent • Check for allergies (seafoods and iodine or anesthesia) • NPO 6-8 hours • Pre-op meds: atropine sulfate and valium, topical anesthesia sprayed followed by local anesthetic into the larynx • Have oxygen and antispasmodic agents ready

Nursing Interventions after bronchogram • Side-lying position • NPO until cough and gag reflex returns • Cough and deep breathe clients • Low grade fever common 6.    Answer: D. After thoracentesis the client is placed or turned to the unaffected side to prevent leakage of fluid in the thoracic cavity.

7.    Answer: D. The client should be hyperventilated with 100% oxygen before and after suctioning. 8.    Answer: A. Position a conscious person who has a functional gag reflex in the semi fowler’s position with the head turned to one side for oral suctioning or with the neck hyper extended for nasal suctioning. If the client is unconscious place the patient a lateral position facing you. 9.    Answer: A. Suction bottle will have continuous suctioning while the water seal bottle will have an intermittent suctioning. 10.    Answer: D. A water seal bottle is expected to be observed for intermittent bubbling. Therefore, the nurse should only make sure that bottle is at least 2-3 feet below the chest. Checking for an air leak would be the nurse’s action if the water seal has continuous bubbling. Kinks should be check for possible obstruction if no bubbling is noted in the water seal bottle. 11.    Answer: C. In removal of the chest tube the nurse should prepare the following: • Petrolatum gauze • Suture removal kit • Sterile gauze • Adhesive tape 12.    Answer: A. As the chest tube is removed the client should be instructed to exhale deeply and do valsalva maneuver. The client is placed in a semi-fowler’s position before the chest tube is removed. 13.    Answer: B. Because the pain is felt above the eyebrows the affected sinus is the frontal sinus. Pain assessment in sinusitis • Maxillary: cheek and upper teeth • Frontal: above eyebrows • Ethmoid: in and around the eyes • Sphenoid: behind eye, occiput, top of the head 14.    Answer: C. ASA is avoided in sinusitis as it increases the risk of developing nasal polyps. 15.    Answer: B. Management for sinusitis: • Rest • Increase fluids • Hot wet packs • Codeine • Amoxicillin and other anti-infectives • Nasal decongestants • Irrigation of maxillary sinuses with warm NSS 16.    Answer: A. After a Caldwell-Luc Operation (Radical Antrum Surgery) the following should be instructed to the client: • Do not chew on the affected side • Caution with oral hygiene to prevent trauma of incision • Do not wear dentures for 10 days • Do not blow nose for 2 weeks after the removal of the packing • Avoid sneezing for two weeks after surgery 17.    Answer: D. Surgery is indicated for patients with tonsillitis recurring 5-6 times a year. 18.    Answer: B. The should assess for Upper respiratory tract infection (URTI). Coughing and sneezing postoperatively due to URTI may cause bleeding. 19.    Answer: C. to promote comfort the nurse must administer acetaminophen to alleviate pain from the operation. Also, ice collar can be applied to decrease pain thus, promoting comforting. Assisting the client to the proper position after tonsillectomy (semi-fowler’s) while supporting the position with pillows is also one way to promote comfort. The only choice that does not promote comfort but monitors for hemorrhage is the assessment for frequent swallowing, thus, it is the correct answer (C). 20.    Answer: B. after tonsillectomy, the client’s stool will be black or dark for a few days due to the swallowed blood. 21.    Answer: D. Allergy (extrinsic) and inflammation (intrinsic) triggers the release of chemical mediators that causes narrowing of the airways and spasm. These mediators are: • Serotonin

• Prostaglandin • Bradykinin • Histamine • Leukotrienes 22.    Answer: B. An overdistended and non-functional alveoli is a condition called emphysema. Atelectasis is the collapse of a part or the whole lung. Empyema is the presence of pus in the lung. 23.    Answer: A. The strategy used in this item is the “umbrella effect.” Hemothorax (blood), hydrothorax (water) and pyothirax (pus; also called empyema) are all types of pleural effusion. The three choices are under pleural effusion (umbrella effect), thus the correct answer is A. 24.    Answer: B. Diet for COPD: High calorie, high protein and low carbohydrate diet • High caloric diet provides source of energy. • High protein diet helps maintain integrity of alveolar walls. • Low carbohydrate diet limits carbon dioxide production (natural end product). The client with COPD has difficulty exhaling carbon dioxide. 25.    Answer: D. Benadryl (Dipenhydramine) is an antihistamine not bronchodilator.