Respiratory System:

1. . The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected,
what should the nurse plan to do?
a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.

Answer A. If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a
container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory
pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out not if the system is
disconnected. The nurse shouldnt clamp the chest tube because clamping increases the risk of tension pneumothorax.
The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has
been disconnected.

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. Septicemia
b. Pneumonia
c. Meningitis
d. Pulmonary edema

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 Reyes 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 arent associated with
influenza.

3. A female client has a tracheostomy but doesnt 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.

Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and then
gradually lengthen this interval according to the clients respiratory status. A client who doesnt 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 wouldnt be long enough to reveal the clients 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.
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. Hypoxia
b. Delirium
c. Hyperventilation
d. Semiconsciousness

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.

5. A male client with Guillain-Barr 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 Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg

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.

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.

Answer B. Administration of a corticosteroid such as prednisone suppresses the bodys 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.

7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which
nursing diagnosis is most important for this client?
a. Activity intolerance related to fatigue
b. Anxiety related to actual threat to health status
c. Risk for infection related to retained secretions
d. Impaired gas exchange related to airflow obstruction

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

8. 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 mask
b. Non-rebreather mask
c. Face tent
d. Nasal cannula

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.

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 meal
b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized
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 isnt
available) are a contraindication for postural drainage, another component of chest physiotherapy.


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 clients arterial oxygen saturation (SaO2)
noninvasively. Which vital sign abnormality may alter pulse oximetry values?
a. Fever
b. Tachypnea
c. Tachycardia
d. Hypotension

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 dont
affect pulse oximetry values directly.

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.

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

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/day
b. Enforcing absolute bed rest
c. Teaching the client how to perform controlled coughing
d. Administering prescribed sedatives regularly and in large amounts

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 clients ability to maintain a patent airway, causing a high risk of infection from pooled
secretions.

13. The amount of air inspired and expired with each breath is called:
a. tidal volume.
b. residual volume.
c. vital capacity.
d. dead-space volume.

Answer A. Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air
remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the
lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in the upper airways
that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways.



14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm
Hg. Hes 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. 0.21
b. 0.35
c. 0.5
d. 0.7

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. 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.

Answer B. A positive reaction means the client has been exposed to TB; it isnt 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 doesnt exclude the presence of active disease.


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/minute
b. Dilated and reactive pupils
c. Urine output of 40 ml/hour
d. Heart rate of 100 beats/minute

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

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

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 hours
b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results

Answer B. Before weaning a client from mechanical ventilation, its 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 clients record, and
the nurse can refer to them before the weaning process begins.



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.

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 wouldnt raise the lowered PaCO2 level.
.

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

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 clients ventilation
status, not oxygenation

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 clients arterial blood oxygen saturation?
a. Endotracheal suctioning
b. Encouragement of coughing
c. Use of cooling blanket
d. Incentive spirometry

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 wouldnt be affected.

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 chamber
b. Maintaining continuous bubbling in the water-seal chamber
c. Keeping the collection chamber at chest level
d. Stripping the chest tube every hour
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.


23. Nurse Eve 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.

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 doesnt increase oxygen demands. To help maintain adequate nutritional intake, the client with
chronic bronchitis should eat small, frequent meals (up to six a day).

24. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this clients dark
skin, the nurse should assess for cyanosis by inspecting the:
a. lips.
b. mucous membranes.
c. nail beds.
d. earlobes.

Answer B. Skin color doesnt affect the mucous membranes. The lips, nail beds, and earlobes are less reliable
indicators of cyanosis because theyre affected by skin color.

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 clients serum theophylline level closely. The nurse knows that the
therapeutic theophylline concentration falls within which range?
a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml

Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10
mcg/ml arent therapeutic.


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.

. 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. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the clients
medical history. Which condition is a predisposing factor for respiratory alkalosis?
a. Myasthenia gravis
b. Type 1 diabetes mellitus
c. Extreme anxiety
d. Narcotic overdose

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 brains 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 (Kussmauls respirations) dont 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.

28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44
breaths/minute. Hes 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 clients arterial blood oxygen saturation is 86% and hes
still wheezing. The nurse should plan to administer:
a. alprazolam (Xanax).
b. propranolol (Inderal)
c. morphine.
d. albuterol (Proventil).

Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal
arterial oxygen saturation level. The clients greatest need is bronchodilation, which can be accomplished by
administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. Its
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 clients
breathing. Propranolol is contraindicated in a client whos wheezing because its a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and is contraindicated in this situation.



29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
a. Encouraging the client to drink three glasses of fluid daily
b. Keeping the client in semi-Fowlers position
c. Using a high-flow Venturi mask to deliver oxygen as prescribed
d. Administering a sedative as prescribed

Answer C. The client 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 wouldnt affect gas exchange or be sufficient to liquefy secretions, which are
common in COPD. Clients with COPD and respiratory distress should be placed in high Fowlers position and
shouldnt receive sedatives or other drugs that may further depress the respiratory center.



30. Nurse Joana 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.

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.)

31. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed
to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:
a. Tachypnea
b. Eupnca
c. Orthopnea
d. Hyperventilation
Answers C. Rationale: Orthopnea is difficulty of breathing except in the upright position. Tachypnea is rapid
respiration characterized by quick, shallow breaths. Eupnea is normal respiration quiet, rhythmic, and without effort
32. 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 fluid
b. Having the client take deep breaths
c. Asking the client to spit into the collection container
d. Asking the client to obtain the specimen after eating
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.
33. 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 cough
b. Hermaturia
c. Bronchospasm
d. Blood-streaked sputum
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.
34. 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 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds
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.
35. 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 suction
b. Notify the physician immediately
c. Stop the procedure and reoxygenate the client
d. Ensure that the suction is limited to 15 seconds
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.
36. 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. Dyspnea
b. Bradypnea
c. Bradycardia
d. Decreased respirations
Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea,
and chest pain

37. 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 clients chest wall, the nurse expects to elicit:
a. Resonant sounds.
b. Hyperresonant sounds.
c. Dull sounds.
d. Flat sounds.
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;
theyre 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.
38. 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 its too low.
b. Question the order because its too high.
c. Set the pump at 45 ml/hour.
d. Stop the infusion and have the laboratory repeat the theophylline measurement.
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 clients theophylline level is sub-therapeutic, reducing the dose (which is what the
physicians order would do) would be inappropriate. Therefore, the nurse should question the order.
39. 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.
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.
40. Which phrase is used to describe the volume of air inspired and expired with a normal breath?
a. Total lung capacity
b. Forced vital capacity
c. Tidal volume
d. Residual volume
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.
41. 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 mask
b. Non-rebreather mask
c. Face tent
d. Nasal cannula
Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO
2
) as high as 100%.
Other modes simple mask, face tent, and nasal cannula deliver lower levels of FIO
2
.
42. 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 discrimination
b. Increased urinary frequency
c. Decreased hearing acuity
d. Increased appetite
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 arent associated with streptomycin. Impaired color
discrimination indicates color blindness; increased urinary frequency and increased appetite accompany
diabetes mellitus.

43. 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 doesnt 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.
Answer B. The Mantoux test doesnt 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 doesnt indicate active
tuberculosis.
44.. A female adult client has a tracheostomy but doesnt 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.
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 clients respiratory status. A client who doesnt 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 wouldnt be long enough to reveal the clients 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.

45. 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 normally
b. The client has a pneumothorax.
c. The system has an air leak.
d. The chest tube is obstructed.
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.
46. A black client with asthma seeks emergency care for acute respiratory distress. Because of this clients dark skin,
the nurse should assess for cyanosis by inspecting the:
a. Lips.
b. Mucous membranes.
c. Nail beds.
d. Earlobes.
Answer B. Skin color doesnt affect the mucous membranes. The lips, nail beds, and earlobes are less reliable
indicators of cyanosis because theyre affected by skin color.
47. 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
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, theyre secondary to ensuring adequate oxygenation.
48. The nurse assesses a male clients respiratory status. Which observation indicates that the client is experiencing
difficulty breathing?
a. Diaphragmatic breathing
b. Use of accessory muscles
c. Pursed-lip breathing
d. Controlled breathing
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.
49. A female client is undergoing a complete physical examination as a requirement for college. When checking the
clients respiratory status, the nurse observes respiratory excursion to help assess:
a. Lung vibrations.
b. Vocal sounds.
c. Breath sounds.
d. Chest movements.
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 nurses palms. The nurse assesses breath sounds during
auscultation.
50. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise,
cough, headache, and recurrent chills. Based on the clients 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)
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 isnt administered first. Amantadine, an antiviral agent, and
amphotericin B, an antifungal agent, are ineffective against legionnaires disease, which is caused by bacterial infection
51. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction.
Because the client is extremely weak and cant produce an effective cough, the nurse should monitor closely for:
a. Pleural effusion.
b. Pulmonary edema.
c. Atelectasis.
d. Oxygen toxicity.
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
doesnt 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 isnt one of them. Oxygen toxicity results from prolonged administration of high
oxygen concentrations, not an ineffective cough.
52. 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.
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.)
53. 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 minutes
b. In 1 hour
c. In 2.5 hours
d. In 4 hours
Answer A. Codeines 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.
54. A male client suffers adult respiratory distress syndrome as a consequence of shock. The clients 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 tubing
b. A disconnected ventilator tube
c. An ET cuff leak
d. A change in the oxygen concentration without resetting the oxygen level alarm
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 clients 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.
55. 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 lungs capacity for gas exchange.
Answer A. Anhydrous theophylline and other methylxanthine agents make the central respiratory center more
sensitive to CO
2
and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drugs 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 dont alter diaphragm movement to increase chest expansion and
enhance gas exchange.
56. 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 tissue
b. Sudden onset
c. Responsiveness to penicillin.
d. Elevated white blood cell (WBC) count
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, arent treated with
antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal
pneumonia, dont.
57. A client with Guillain-Barr 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 Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg
Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial
carbon dioxide (PaCO
2
) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO
2
value of
50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO
2
value of 30 mm Hg indicates respiratory
alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.
58. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via
nasal cannula. The clients 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 clients respiratory
status. Which complication may arise if the client receives a high oxygen concentration?
a. Apnea
b. Anginal pain
c. Respiratory alkalosis
d. Metabolic acidosis
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 dont cause metabolic acidosis.
59. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44
breaths/minute. Hes 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 clients arterial blood oxygen saturation is 86% and hes
still wheezing. The nurse should plan to administer:
a. Alprazolam (Xanax).
b. Propranolol (Inderal)
c. Morphine.
d. Albuterol (Proventil).
Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal
arterial oxygen saturation level. The clients greatest need is bronchodilation, which can be accomplished by
administering bronchodilators. Albuterol is a beta
2
adrenergic agonist, which causes dilation of the bronchioles.
Its 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 clients breathing. Propranolol is contraindicated in a client whos wheezing because its a beta
2
adrenergic
antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.
60. 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 alertness
b. Increased heart rate
c. Numbness and tingling of the extremities
d. Respiratory depression
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
61. 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.
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 doesnt increase oxygen demands. To help maintain
adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).
____
62. 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 clients baseline
theophylline level was:
a. 10 mcg/mL
b. 12 mcg/mL
c. 15 mcg/mL
d. 18mcg/mL

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.



63. Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous
gentle bubbling in the suction control chamber. What action is appropriate?
a. Do nothing, because this is an expected finding.
b. Immediately clamp the chest tube and notify the physician.
c. Check for an air leak because the bubbling should be intermittent.
d. Increase the suction pressure so that bubbling becomes vigorous.

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.

64. A nurse has assisted a physician with the insertion of a chest tube. The nurse monitors the adult 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 physician.
b. Continue to monitor the client.
c. Reinforce the occlusive dressing.
d. Encourage the client to deep-breathe.

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.


65. The nurse caring for a male 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 physician.
b. Place the tube in a bottle of sterile water.
c. Immediately replace the chest tube system.
d. Place the sterile dressing over the disconnection site.

. 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.


66. Nurse Paul is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
a. Exhale slowly.
b. Stay very still.
c. Inhale and exhale quickly.
d. Perform the Valsalva maneuver.

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.

67. While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial
nursing action is to:
a. Call the physician to reinsert the tube.
b. Grasp the retention sutures to spread the opening.
c. Call the respiratory therapy department to reinsert the tracheotomy.
d. Cover the tracheostomy site with a sterile dressing to prevent infection.

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 1 and 3 will delay treatment in this emergency situation.
68. A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of
the following signs immediately if experienced by the client?
a. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate of 24 breaths/min

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.


69. An emergency room nurse is assessing a female 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
b. Diminished breathe sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury



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.

70. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish
regulation of pH is that they

a. Secrete hydrogen ions and sodium.
b. Secrete ammonia.
c. Exchange hydrogen and sodium in the kidney tubules.
d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate.

Answer: d Rationale: By decreasing NA+ ions, holding onto hydrogen ions, and secreting sodium bicarbonate,
the kidneys can regulate pH. Therefore, this is the most complete answer, and while this buffer system is the slowest, it
can completely compensate for acid-base imbalance.

71 . A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first
nursing action would be to

a. Wait until the client's lab work is done
b. Not administer oxygen unless ordered by the physician
c. Administer oxygen at 2 liters flow per minute
d. Administer oxygen at 10 liters flow per minute and check the client's nail beds

Answer: c Rationale: Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and
receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function

72 . A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first
nursing action would be to

a. Wait until the client's lab work is done
b. Not administer oxygen unless ordered by the physician
c. Administer oxygen at 2 liters flow per minute
d. Administer oxygen at 10 liters flow per minute and check the client's nail beds

Answer: c Rationale: Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and
receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function

73. An emergency room nurse is assessing a female 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
b. Diminished breathe sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury

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.

74. . A nurse is caring for a male 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. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
c. Increase oxygen saturation with exercise
d. A widened diaphragm noted on the chest x-ray

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.

75. 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. Dyspnea
b. Chest pain
c. A bloody, productive cough
d. A cough with the expectoration of mucoid sputum
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.

76. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the
results of which diagnostic test that will confirm this diagnosis?
a. Bronchoscopy
b. Sputum culture
c. Chest x-ray
d. Tuberculin skin test

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.

78. 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 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds

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.



79. 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 of the following is the appropriate nursing
intervention?
a. Continue to suction.
b. Notify the physician immediately.
c. Stop the procedure and reoxygenate the client.
d. Ensure that the suction is limited to 15 seconds.

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.



80. 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 acidosis
b. Respiratory acidosis
c. Overcompensated respiratory acidosis
d. Combined respiratory and metabolic acidosis

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.



81. A female 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. Dyspnea
b. Bradypnea
c. Bradycardia
d. Decreased respiratory

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


82. 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 exhales
b. Removes the cap and shakes the inhaler well before use
c. Presses the canister down with the finger as he breathes in
d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

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.


83. 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 intravenously
b. Administering small doses of midazolam (Versed)
c. Encouraging additional fluids for the next 24 hours
d. Ensuring the return of the gag reflex before offering food or fluids

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.


84.. 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 respirations
b. Rapid deep respirations
c. Paradoxical respirations
d. Pain, especially with inspiration

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.


85. A female client with chest injury has suffered flail chest. A nurse assesses the client for which most distinctive sign
of flail chest?
a. Cyanosis
b. Hypotension
c. Paradoxical chest movement
d. Dyspnea, especially on exhalation

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.
86. 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 pneumothorax
b. Pulmonary embolism
c. Displaced endotracheal tube
d. Acute respiratory distress syndrome

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.


87. 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 quickly
b. Inhale through the nose
c. Hold the breath after inhalation
d. Take two inhalations during one breath

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.

88. 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 wheezing
b. Inspiratory crackles
c. Intercostal retractions
d. Increased respiratory rate

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.


89. 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 expected
b. Low and unexpected
c. Normal and expected
d. Uncertain and unexpected

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.

90. 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. Emphysema
b. Bronchial asthma
c. Chronic obstructive bronchitis
d. Bronchial asthma and bronchitis

. 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.


91. 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. Cough
b. High-grade fever
c. Chills and night sweats
d. Anorexia and weight loss

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.
__
92. 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 mouth
b. The airborne route
c. The fecal-oral route
d. Blood and body fluids

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.


93. 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/min
b. 2 L/min
c. 6 L/min
d. 10 L/min

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.
94. 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 intake.
b. Strengthen the diaphragm.
c. Strengthen the intercostal muscles.
d. Promote carbon dioxide elimination.

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.

95. Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will
facilitate obtaining the specimen?
a. Limiting fluids
b. Having the clients take three deep breaths
c. Asking the client to split into the collection container
d. Asking the client to obtain the specimen after eating

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.


96. A nurse is caring for a female client after a bronchoscope and biopsy. Which of the following signs, if noted in the
client, should be reported immediately to the physicians?
a. Dry cough
b. Hematuria
c. Bronchospasm
d. Blood-streaked sputum

Answer C. 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.
--------------------------
97. A Mantoux test signifies exposure to Mycobacterium Tubercle Bacilli. The test is read for how many hours after
injection?
a. 1 hour
b. 12-24 hours
c. 48-72 hours
d. 2 hours
Answer: C. Mantoux test is read 48-72 hours after injection.

98. A nurse is about to perform a Mantoux test. The test is done by using which route?
a. Intradermal
b. Intramuscular
c. Subcutaneous
d. IM with the use of Z-track method
Answer: A. Mantoux tests are done intradermally.

99. 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 mm
b. 3mm
c. 4 mm
d. 5 mm
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.
100. 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 consent
b. Instruct the client not to eat anything at the night before the procedure
c. Instruct the client to remove metals from the chest
d. Administer atropine sulfate and valium before the procedure
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.
101. 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 position
b. Checking for allergies
c. Instructing the client to be on NPO for 6-8 hours
d. Administer atropine sulfate
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

102. After thoracentesis the client should be placed on which position?
a. Affected side
b. Unaffected side
c. Prone position
d. Supine position
Answer: D. After thoracentesis the client is placed or turned to the unaffected side to prevent leakage of fluid in
the thoracic cavity.
103. The most important action the nurse should do before and after suctioning a client is:
a. Placing the client in a supine position
b. Making sure that suctioning takes only 10-15 seconds
c. Evaluating for clear breath sounds
d. Hyperventilating the client with 100% oxygen
Answer: D. The client should be hyperventilated with 100% oxygen before and after suctioning.
8. The position of a conscious client during suctioning is:
a. Fowlers
b. Supine position
c. Side-lying
d. Prone
Answer: A. Position a conscious person who has a functional gag reflex in the semi fowlers 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.
104. 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 bubbling
b. Continuous bubbling
c. No bubbling
d. None of the above
Answer: A. Suction bottle will have continuous suctioning while the water seal bottle will have an intermittent
suctioning.

105. Before the nurses 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 leak
b. Check for kinks in the tube
c. Inform the physician immediately
d. Make sure that the bottle is at least 2-3 feet below the level of the chest
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 nurses 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.
106. 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 gauze
b. Suture removal kit
c. Empty bottles
d. Adhesive tape
Answer: C. In removal of the chest tube the nurse should prepare the following:
Petrolatum gauze
Suture removal kit
Sterile gauze
Adhesive tape

107. While the chest tube is removed the nurse should instruct the patient to:
a. Exhale deeply
b. Inhale deeply
c. Lie at the abdomen
d. Hyperextend the neck
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-fowlers position before the chest tube is removed.

108. 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. Maxillary
b. Frontal
c. Ethmoid
d. Sphenoid
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

109. Which of the following medications is avoided in sinusitis to prevent the risk of developing nasal polyps?
a. Codeine
b. Amoxicillin
c. ASA
d. Anti-infectives
Answer: C. ASA is avoided in sinusitis as it increases the risk of developing nasal polyps.

110. Which intervention is least likely done for sinutis?
a. Increase fluid intake
b. Cold wet packs
c. Hot wet packs
d. Rest
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

111. 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 surgery
d. All of the above
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

112. A teen ager is diagnosed to have inflamed tonsils (tonsillitis). The patients history reveals recurrent tonsillitis
episodes for about 6 times of the same year. The most appropriate intervention for the patient is:
a. Promoting rest
b. Increasing fluid intake
c. Warm saline gargle
d. Surgery
Answer: D. Surgery is indicated for patients with tonsillitis recurring 5-6 times a year.

113. Before a tonsillectomy is performed, which of the following data is very crucial for the nurse to assess?
a. Degree of pain
b. URTI
c. Drainage on the ears
d. Respiration pattern
Answer: B. The should assess for Upper respiratory tract infection (URTI). Coughing and sneezing
postoperatively due to URTI may cause bleeding.
114. Mark underwent a tonsillectomy procedure. To promote comfort the following interventions should be done
by the nurse except:
a. Application of ice collar
b. Assist the client to a semi-fowlers position with pillow support
c. Assess for frequent swallowing of the patient
d. Administration of acetaminophen
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-fowlers) 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).

115. Two days after tonsillectomy, Marks reported that his stool is black. Initially, the nurse should:
a. Inform the physician
b. Document the findings
c. Obtain stool for analysis
d. Check the clients vital signs
Answer: B. after tonsillectomy, the clients stool will be black or dark for a few days due to the swallowed blood.

116. 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. Serotonin
b. Prostaglandin
c. Bradykinin
d. Adrenaline
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

117. Presence of overdistended and non-functional alveoli is a condition called:
a. Bronchitis
b. Emphysema
c. Empyema
d. Atelectasis
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.

118. The accumulation of fluids in the pleural space is called:
a. Pleural effusion
b. Hemothorax
c. Hydrothorax
d. Pyothorax
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.
119. A client with COPD is instructed to follow what diet?
a. High carbohydrate, low calorie and high protein diet
b. High protein, high calorie and low carbohydrate diet
c. High carbohydrate, low protein and high calorie diet
d. High protein, high carbohydrate and high caloric diet
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.
120. Bronchodilators include the following apart from:
a. Theophyline
b. Terbutaline
c. Metaproterenol
d. Dipenhydramine
Answer: D. Benadryl (Dipenhydramine) is an antihistamine not bronchodilator

121. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected,
what should the nurse plan to do?
a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.
Answer A. If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a
container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory
pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out not if the system is
disconnected. The nurse shouldnt clamp the chest tube because clamping increases the risk of tension pneumothorax.
The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has
been disconnected.
122. 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. Septicemia
b. Pneumonia
c. Meningitis
d. Pulmonary edema
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 Reyes 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 arent associated with
influenza.
123. A female client has a tracheostomy but doesnt 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.
Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and then
gradually lengthen this interval according to the clients respiratory status. A client who doesnt 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 wouldnt be long enough to reveal the clients 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.
124. 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. Hypoxia
b. Delirium
c. Hyperventilation
d. Semiconsciousness
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.
125. A male client with Guillain-Barr 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 Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg
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.
126. 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.
Answer B. Administration of a corticosteroid such as prednisone suppresses the bodys 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.
127. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which
nursing diagnosis is most important for this client?
a. Activity intolerance related to fatigue
b. Anxiety related to actual threat to health status
c. Risk for infection related to retained secretions
d. Impaired gas exchange related to airflow obstruction
Answer D. A patent airway and an adequate breathing pattern are the top priority for any client, making
impaired gas exchange related to airflow obstruction the most important nursing diagnosis. The other options also may
apply to this client but are less important.
128. 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 mask
b. Non-rebreather mask
c. Face tent
d. Nasal cannula
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.
129. 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 meal
b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized
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 isnt
available) are a contraindication for postural drainage, another component of chest physiotherapy.
130. 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 clients arterial oxygen saturation (SaO2)
noninvasively. Which vital sign abnormality may alter pulse oximetry values?
a. Fever
b. Tachypnea
c. Tachycardia
d. Hypotension
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 dont affect pulse
oximetry values directly.
131. 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.
Answer B. Maintaining a patent airway is the most basic and critical human need. All other interventions are
important to the clients well-being but not as important as having sufficient oxygen to breathe.
132. 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/day
b. Enforcing absolute bed rest
c. Teaching the client how to perform controlled coughing
d. Administering prescribed sedatives regularly and in large amounts
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 clients ability to maintain a patent airway, causing a high risk of infection from pooled
secretions.
133. The amount of air inspired and expired with each breath is called:
a. tidal volume.
b. residual volume.
c. vital capacity.
d. dead-space volume.
Answer A. Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the
amount of air remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be
moved out of the lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in
the upper airways that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower
airways.
134. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm
Hg. Hes 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. 0.21
b. 0.35
c. 0.5
d. 0.7
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.
135. 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.
Answer B. A positive reaction means the client has been exposed to TB; it isnt 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 doesnt exclude the presence of active disease.
136. 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/minute
b. Dilated and reactive pupils
c. Urine output of 40 ml/hour
d. Heart rate of 100 beats/minute
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.
137. What is the normal pH range for arterial blood?
a. 7 to 7.49
b. 7.35 to 7.45
c. 7.50 to 7.60
d. 7.55 to 7.65
Answer B. A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates alkalosis.
138. 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 hours
b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results
Answer B. Before weaning a client from mechanical ventilation, its 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 clients record, and
the nurse can refer to them before the weaning process begins.
139. 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.
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 wouldnt raise the lowered PaCO2 level.

140. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which
arterial blood gas value is most important?
a. pH
b. Bicarbonate (HCO3)
c. Partial pressure of arterial oxygen (PaO2)
d. Partial pressure of arterial carbon dioxide (PaCO2)
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 clients ventilation status, not oxygenation.
141. 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 clients arterial blood oxygen saturation?
a. Endotracheal suctioning
b. Encouragement of coughing
c. Use of cooling blanket
d. Incentive spirometry
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 wouldnt be affected.

142. 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 chamber
b. Maintaining continuous bubbling in the water-seal chamber
c. Keeping the collection chamber at chest level
d. Stripping the chest tube every hour
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.
143. Nurse Eve 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.
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 doesnt increase oxygen demands. To help maintain adequate nutritional intake, the client with
chronic bronchitis should eat small, frequent meals (up to six a day).
144. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this clients dark
skin, the nurse should assess for cyanosis by inspecting the:
a. lips.
b. mucous membranes.
c. nail beds.
d. earlobes.
Answer B. Skin color doesnt affect the mucous membranes. The lips, nail beds, and earlobes are less reliable
indicators of cyanosis because theyre affected by skin color.
145. 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 clients serum theophylline level closely. The nurse knows that the
therapeutic theophylline concentration falls within which range?
a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml
Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10
mcg/ml arent therapeutic.

146. 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.
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.

147. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the clients
medical history. Which condition is a predisposing factor for respiratory alkalosis?
a. Myasthenia gravis
b. Type 1 diabetes mellitus
c. Extreme anxiety
d. Narcotic overdose
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 brains 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 (Kussmauls respirations) dont 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.

148. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44
breaths/minute. Hes 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 clients arterial blood oxygen saturation is 86% and hes still
wheezing. The nurse should plan to administer:
a. alprazolam (Xanax).
b. propranolol (Inderal)
c. morphine.
d. albuterol (Proventil).
Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal
arterial oxygen saturation level. The clients greatest need is bronchodilation, which can be accomplished by
administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. Its
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 clients
breathing. Propranolol is contraindicated in a client whos wheezing because its a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and is contraindicated in this situation.

149. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
a. Encouraging the client to drink three glasses of fluid daily
b. Keeping the client in semi-Fowlers position
c. Using a high-flow Venturi mask to deliver oxygen as prescribed
d. Administering a sedative as prescribed
Answer C. The client 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 wouldnt affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with
COPD and respiratory distress should be placed in high Fowlers position and shouldnt receive sedatives or other drugs
that may further depress the respiratory center.

150. Nurse Joana 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.
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.)

151. 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 congestion
b. Nervousness
c. Lethargy
d. Hyperkalemia
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.
Otther adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension,
heartburn, nausea, vomiting and muscle cramps.
152. 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. Yellow
b. Green
c. Clear
d. Gray
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.
153. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which
clinical findings commonly accompany respiratory alkalosis?
a. Nausea or vomiting
b. Abdominal pain or diarrhea
c. Hallucinations or tinnitus
d. Lightheadedness or paresthesia
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.
154. Before administering ephedrine, Nurse Tony assesses the patients history. Because of ephedrines central
nervous system (CNS) effects, it is not recommended for:
a. Patients with an acute asthma attack
b. Patients with narcolepsy
c. Patients under age 6
d. Elderly patients
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.
155. A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patients 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 tubing
b. A disconnected ventilator tube
c. An endotracheal cuff leak
d. A change in the oxygen concentration without resetting the oxygen level alarm
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 patients 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.
156. 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 movement
b. Finger movement
c. Lip movement
d. Fighting the ventilator
Answer D. Pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation and paralysis. It assists
mechanical ventilation by promoting encdotracheal 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.
157. On auscultation, which finding suggests a right pneumothorax?
a. Bilateral inspiratory and expiratory crackles
b. Absence of breaths sound in the right thorax
c. Inspiratory wheezes in the right thorax
d. Bilateral pleural friction rub.
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.
158. Rhea, confused and short 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 balance
b. Arterial Blood
c. Arterial oxygen saturation
d. Alveoli
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.
159. 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 fatigue
b. Anxiety related to actual threat to health status
c. Risk for infection related to retained secretions
d. Impaired gas exchange related to airflow obstruction
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.
160. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:
a. Contralateral side in a simple pneumothorax
b. Affected side in a hemothorax
c. Affected side in a tension pneumothorax
d. Contralateral side in hemothorax
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.
161. 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 chamber
b. Clamp the chest tube once every shift
c. Encourage coughing and deep breathing
d. Milk the chest tube every 2 hours
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.
162. 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 possible
b. Develop an alternative communication method
c. Keep the tracheostomy cuff fully inflated
d. Keep the patient flat in bed
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-
fowlers position.
163. 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 level
b. Applying a dressing over the wound and taping it on three sides
c. Preparing a chest tube insertion tray
d. Preparing to start an I.V. line
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.
164. 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 daily
b. Keeping the patient in semi-fowlers position
c. Using a high-flow venture mask to deliver oxygen as prescribe
d. Administering a sedative, as prescribe
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-Fowlers position and should not receive
sedatives or other drugs that may further depress the respiratory center.
165. A male patients X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS).
This syndrome results from:
a. Cardiogenic pulmonary edema
b. Respiratory alkalosis
c. Increased pulmonary capillary permeability
d. Renal failure
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.
166. 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 day
b. Enforcing absolute bed rest
c. Teaching the patient how to perform controlled coughing
d. Administering prescribe sedatives regularly and in large amounts
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 patients ability to maintain a patent airway, causing a high risk for infection from pooled
secretions.
167. 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 finding
b. Immediately clamp the chest tube and notify the physician
c. Check for an air leak because the bubbling should be intermittent
d. Increase the suction pressure so that the bubbling becomes vigorous
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.
168. 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 physician
b. Continue to monitor the client
c. Reinforce the occlusive dressing
d. Encourage the client to deep-breathe
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.
169. 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 physician
b. Place the tube in bottle of sterile water
c. Immediately replace the chest tube system
d. Place a sterile dressing over the disconnection site
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.
170. A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
a. Exhale slowly
b. Stay very still
c. Inhale and exhale quickly
d. Perform the Valsalva maneuver
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.
171. 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 tube
b. Grasp the retention sutures to spread the opening
c. Call the respiratory therapy department to reinsert the tracheotomy
d. Cover the tracheostomy site with a sterile dressing to prevent infection
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.
172. 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. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate 24 breaths/min
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.
173. 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 rate
b. Diminished breath sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury
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.
174. 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. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
c. Increased oxygen saturation with exercise
d. A widened diaphragm noted on the chest x-ray
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.
175. 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 tent
b. Venturi mask
c. Aerosol mask
d. Tracheostomy collar
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.
176. 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. Dyspnea
b. Chest pain
c. A bloody, productive cough
d. A cough with the expectoration of mucoid sputum
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.
177. 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. Bronchoscopy
b. Sputum culture
c. Chest x-ray
d. Tuberculin skin test
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.
178. 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/min
b. 2 L/min
c. 6 L/min
d. 10 L/min
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.
179. 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 intake
b. Strengthen the diaphragm
c. Strengthen the intercostal muscles
d. Promote carbon dioxide elimination
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.
180. 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. Pallor
b. Low arterial PaO2
c. Elevated arterial PaO2
d. Decreased respiratory rate
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.
_______________--
181. A Mantoux test signifies exposure to Mycobacterium Tubercle Bacilli. The test is read for how many hours after
injection?
a. 1 hour
b. 12-24 hours
c. 48-72 hours
d. 2 hours
Answer: C. Mantoux test is read 48-72 hours after injection.
182. A nurse is about to perform a Mantoux test. The test is done by using which route?
a. Intradermal
b. Intramuscular
c. Subcutaneous
d. IM with the use of Z-track method

Answer: A. Mantoux tests are done intradermally.
183. 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 mm
b. 3mm
c. 4 mm
d. 5 mm

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.
184. 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 consent
b. Instruct the client not to eat anything at the night before the procedure
c. Instruct the client to remove metals from the chest
d. Administer atropine sulfate and valium before the procedure
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.
185. 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 position
b. Checking for allergies
c. Instructing the client to be on NPO for 6-8 hours
d. Administer atropine sulfate
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

186. After thoracentesis the client should be placed on which position?
a. Affected side
b. Unaffected side
c. Prone position
d. Supine position
Answer: D. After thoracentesis the client is placed or turned to the unaffected side to prevent leakage of fluid in
the thoracic cavity.
187. The most important action the nurse should do before and after suctioning a client is:
a. Placing the client in a supine position
b. Making sure that suctioning takes only 10-15 seconds
c. Evaluating for clear breath sounds
d. Hyperventilating the client with 100% oxygen

Answer: D. The client should be hyperventilated with 100% oxygen before and after suctioning.
188. The position of a conscious client during suctioning is:
a. Fowlers
b. Supine position
c. Side-lying
d. Prone
Answer: A. Position a conscious person who has a functional gag reflex in the semi fowlers 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.
189. 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 bubbling
b. Continuous bubbling
c. No bubbling
d. None of the above

Answer: A. Suction bottle will have continuous suctioning while the water seal bottle will have an intermittent
suctioning.
190. Before the nurses 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 leak
b. Check for kinks in the tube
c. Inform the physician immediately
d. Make sure that the bottle is at least 2-3 feet below the level of the chest

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 nurses
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.

191. 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 gauze
b. Suture removal kit
c. Empty bottles
d. Adhesive tape
Answer: C. In removal of the chest tube the nurse should prepare the following:
Petrolatum gauze
Suture removal kit
Sterile gauze
Adhesive tape
192. While the chest tube is removed the nurse should instruct the patient to:
a. Exhale deeply
b. Inhale deeply
c. Lie at the abdomen
d. Hyperextend the neck

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-fowlers position before the chest tube is removed.
193. 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. Maxillary
b. Frontal
c. Ethmoid
d. Sphenoid

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
194. Which of the following medications is avoided in sinusitis to prevent the risk of developing nasal polyps?
a. Codeine
b. Amoxicillin
c. ASA
d. Anti-infectives
Answer: C. ASA is avoided in sinusitis as it increases the risk of developing nasal polyps
195. Which intervention is least likely done for sinutis?
a. Increase fluid intake
b. Cold wet packs
c. Hot wet packs
d. Rest
.
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
196. 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 surgery
d. All of the above

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

197. A teen ager is diagnosed to have inflamed tonsils (tonsillitis). The patients history reveals recurrent tonsillitis
episodes for about 6 times of the same year. The most appropriate intervention for the patient is:
a. Promoting rest
b. Increasing fluid intake
c. Warm saline gargle
d. Surgery
Answer: D. Surgery is indicated for patients with tonsillitis recurring 5-6 times a year.
198. Before a tonsillectomy is performed, which of the following data is very crucial for the nurse to assess?
a. Degree of pain
b. URTI
c. Drainage on the ears
d. Respiration pattern

Answer: B. The should assess for Upper respiratory tract infection (URTI). Coughing and sneezing
postoperatively due to URTI may cause bleeding.

199. Mark underwent a tonsillectomy procedure. To promote comfort the following interventions should be done
by the nurse except:
a. Application of ice collar
b. Assist the client to a semi-fowlers position with pillow support
c. Assess for frequent swallowing of the patient
d. Administration of acetaminophen
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-fowlers) 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).

200. Two days after tonsillectomy, Marks reported that his stool is black. Initially, the nurse should:
a. Inform the physician
b. Document the findings
c. Obtain stool for analysis
d. Check the clients vital signs
Answer: B. after tonsillectomy, the clients stool will be black or dark for a few days due to the swallowed blood.

201. 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. Serotonin
b. Prostaglandin
c. Bradykinin
d. Adrenaline
. 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
202. Presence of overdistended and non-functional alveoli is a condition called:
a. Bronchitis
b. Emphysema
c. Empyema
d. Atelectasis
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.
203. The accumulation of fluids in the pleural space is called:
a. Pleural effusion
b. Hemothorax
c. Hydrothorax
d. Pyothorax
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.

204. A client with COPD is instructed to follow what diet?
a. High carbohydrate, low calorie and high protein diet
b. High protein, high calorie and low carbohydrate diet
c. High carbohydrate, low protein and high calorie diet
d. High protein, high carbohydrate and high caloric diet
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.

205. Bronchodilators include the following apart from:

a. Theophyline
b. Terbutaline
c. Metaproterenol
d. Dipenhydramine
Answer: D. Benadryl (Dipenhydramine) is an antihistamine not bronchodilator.





__________________________________-
206. Which is not true about Emphysema?
a. leads to a loss of elasticity
b. It literally means "air in the tissues
c. Inhalation is thus made much more difficult
d. aggravated by frequent coughing which damages the air tract walls.
Answer: C- because in emphysema exhalation is more difficult and may require considerable muscular action,
Where degenerative changes occur in the tissue of the bronchioles, alveolar ducts, and alveoli.
207. Is an inherited or genetic disease, meaning it is caused by a defect in a person's genes. It affects the lungs,
digestive system, sweat glands, and male fertility (ability to produce offspring or children)?

a. Cystic Fibrosis
b. Emphysema
c. Croup
d. Bronchitis
Answer: A . Cystic fibrosis In the lungs, the thickened mucus increases irritation and inflammation of
lung tissue. This inflammation swells the passageways, partially closing them down. At the same time,
infection from bacteria or viruses becomes more likely since the mucus is a rich source of nutrients.
Bronchitis and pneumonia frequently develop in individuals with cystic fibrosis.

209. Which is not true about Cystic Fibrosis?
a. The body's response to the infection is to increase mucus production.
b. The body's response to the infection is to decrease mucus production.
c. the thickened mucus increases irritation.
d. infection from bacteria or viruses becomes more likely since the mucus is a rich source of nutrients

Answer: B- The body's response to the infection is to increase mucus production. White blood cells fighting the
infection thicken the mucus even further as they break down and release their cell contents. These white blood
cells also provoke more inflammation. The process is a downward spiral as a person suffering from the disease
experiences ever-increasing shortness of breath and tiredness. Untreated, cystic fibrosis leads to severe lung
infection, which is the primary cause of death.


210. Other causes of lung cancer include except:
a. exposure to asbestos
b. exposure to non - toxic chemicals
c. exposure to radioactive minerals
d. , environmental pollution (such as auto exhaust fumes)
answer: B- it should be toxic materials because it affects the normal breathing pattern of every individual , it is
not a cause of Lung Cancer.

211. What causative agent by inhaling silica dust?
a. Silicosis
b.Anthracosis
c.Asbestosis
d.Byssinosis

ANSWER: A because the Silicosis caused by inhaling silica dust, Anthracosis caused by inhaling coal dust,
Asbestosis caused by inhaling asbestos dust, and Byssinosis caused by inhaling textile fibres.

212. Which is true in Asthma?
a. Asthma cannot be treated but can be controlled
b. Asthma can be treated but cannot be controlled
c. Asthma can be treated and can be controlled
d. Asthma cannot be treated and cannot control

Answer: A. because in asthma patients they use medicines to lessen the risk of the patient then the best would
be Asthma can be controlled and cannot be treated.
__________
213. Exchange of air occurs in _______ which are also known as 'air sacs'.
a. Alveoli
b.Alveolar ducts
c.Bronchi
d. Bronchioles
Answer: A. Alveoli Gaseous exchange occurs in alveoli. Due to the presence of alveoli, surface area of the lungs
for exchange of gases increases to a great extent.
214. Write the correct sequence of the pathway through which air travels after entering the body.

A. Larynx, pharynx, trachea bronchioles
B. Pharynx, larynx, trachea, bronchioles
C. Pharynx, larynx, bronchioles, trachea
D. Pharynx, trachea, larynx, bronchioles

Answer: B
The blue arrows in the following diagram denote the passage of air in the respiratory tract after entering
through the nostrils.
215. Which process does not occur in the nasal cavity?
A. Trapping of large foreign bodies
B. Exchange of gases
C. Humidification of inhaled air
D. Warming of inhaled air

Answer: B
Gaseous exchange occurs in lungs.
216. Normal rate of respiration in an adult human being is _______ times/ minute.

A. 10-12
B. 12-14
C. 16-18
D. 22-24
Answer: C
____________

217. Spirometer measures:

A. Capacity of lungs
B. Volume of air inhaled and exhaled
C. Residual air
D. All of these

Answer: D
Spirometer is an instrument used to measure various lung volumes and lung functions.

218.Complete the equation:
Glucose + Oxygen = _______ + Water + CO
2


A. Energy
B.Sucrose
C. Starch
D. None of these
Answer: Energy
In the tissues, glucose reacts with oxygen to produce energy which is used in various cell activities. Water and CO
2
are
formed as by-products.

219. What is the leaf-like structure which prevents the entry of food into respiratory passages?
A. Epiglottis
B. Larynx
C. Pharynx
D. Tongue

Answer: Epiglottis

220. Which part of the respiratory tract is also known as the voice box?

A. Larynx
B. Pharynx
C. Trachea
D. Epiglottis

Answer: Larynx
Voice is produced in the larynx; therefore it is also known as the voice box.