Respiratory System Disorders

Respiratory System Disorders
1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with

newly diagnose asthma. When teaching the patient about this drug, the
nurse should explain that it may cause:
A. Nasal congestion
B. Nervousness
C. Lethargy
D. Hyperkalemia
2. Miriam, a college student with acute rhinitis sees the campus nurse
because of excessive nasal drainage. The nurse asks the patient about
the color of the drainage. In acute rhinitis, nasal drainage normally is:
A. Yellow
B. Green
C. Clear
D. Gray
3. A male adult patient hospitalized for treatment of a pulmonary

embolism develops respiratory alkalosis. Which clinical findings
commonly accompany respiratory alkalosis?
A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Lightheadedness or paresthesia
4. 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
5. 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
6. A male adult patient on mechanical ventilation is

receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed.
Which assessment finding indicates that the patient needs
another pancuronium dose?
A. Leg movement
B. Finger movement
C. Lip movement
D. Fighting the ventilator
7. 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.
8. 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
9. A male patient is admitted to the healthcare 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
10. 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
11. After undergoing a left pneumonectomy, a female patient has a
chest tube in place for drainage. When caring for this patient, the nurse
must:
A. Monitor fluctuations in the water-seal chamber

B. Clamp the chest tube once every shift
C. Encourage coughing and deep breathing
D. Milk the chest tube every 2 hours
12. When caring for a male patient who has just had a total
laryngectomy, the nurse should plan to:
A. Encourage oral feeding as soon as possible

B. Develop an alternative communication method
C. Keep the tracheostomy cuff fully inflated
D. Keep the patient flat in bed
13. A male patient has a sucking stab wound to the chest. Which action
should the nurse take first?
A. Drawing blood for a hematocrit and hemoglobin 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
14. For a patient with advanced 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
15. 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
16. For a female patient with chronic obstructive pulmonary disease,

which nursing intervention would help maintain a patent airway?
A. Restricting fluid intake to 1,000 ml per day

B. Enforcing absolute bed rest
C. Teaching the patient how to perform controlled coughing
D. Administering prescribe sedatives regularly and in large amounts
17. Nurse Lei caring for a client with a pneumothorax and who has had
a chest tube inserted notes continues gentle bubbling in the suction
control chamber. What action is appropriate?
A. Do nothing, because this is an expected 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
18. Nurse Maureen has assisted a physician with the insertion of a

chest tube. The nurse monitors the client and notes fluctuation of the
fluid level in the water seal chamber after the tube is inserted. Based
on this assessment, which action would be appropriate?
A. Inform the physician

B. Continue to monitor the client
C. Reinforce the occlusive dressing
D. Encourage the client to deep breathe
19. Nurse Reynolds 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
20. 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
21. While changing the tapes on a tracheostomy tube, the male client
coughs and tube is dislodged. The initial nursing action is to:
A. Call the physician to reinsert the 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
22. Nurse Oliver is caring for a client immediately after removal of the
endotracheal tube. The nurse reports which of the following signs
immediately if experienced by the client?
A. Stridor
B. Occasional pink-tinged sputum
C. A few basilar lung crackles on the right
D. Respiratory rate 24 breaths/min
23. An emergency room nurse is assessing a male client who has

sustained a blunt injury to the chest wall. Which of these signs would
indicate the presence of a pneumothorax in this client?
A. A low respiratory rate

B. Diminished breath sounds
C. The presence of a barrel chest
D. A sucking sound at the site of injury
24. Nurse Reese is caring for a client hospitalized with acute

exacerbation of chronic obstructive pulmonary disease. Which of the
following would the nurse expect to note on assessment of this client?
A. 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
25. An oxygen delivery system is prescribed for a male client

with chronic obstructive pulmonary disease to deliver a precise oxygen
concentration. Which of the following types of oxygen delivery systems
would the nurse anticipate to be prescribed?
A. Face tent
B. Venturi mask
C. Aerosol mask
D. Tracheostomy collar
26. Blessy, a community health nurse is conducting an educational
session with community members regarding tuberculosis. The nurse
tells the group that one of the first symptoms associated with
tuberculosis is:
A. Dyspnea
B. Chest pain
C. A bloody, productive cough
D. A cough with the expectoration of mucoid sputum
27. A nurse performs an admission assessment on a female client with

a diagnosis of tuberculosis. The nurse reviews the result of which
diagnosis test that will confirm this diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
28. A nurse is caring for a male client with emphysema who is receiving
oxygen. The nurse assesses the oxygen flow rate to ensure that it does
not exceed:
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
29. A nurse instructs a female client to use the pursed-lip method of

breathing and the client asks the nurse about the purpose of this type
of breathing. The nurse responds, knowing that the primary purpose of
pursed-lip breathing is to:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination
30. A nurse is caring for a male client with acute respiratory distress
syndrome. Which of the following would the nurse expect to note in the
client?
A. Pallor
B. Low arterial PaO2
C. Elevated arterial PaO2
D. Decreased respiratory rate
31. 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
32. 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. Hematuria
C. Bronchospasm
D. Blood-streaked sputum
33. 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
34. 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
35. 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
36. 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.
37. 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.
38. 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.
39. 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
40. 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
41. 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
42. 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.
43. 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.
44. 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.
45. 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.
46. 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
47. 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
48. 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.
49. 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)
50. 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.
51. 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.
52. 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
53. 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
54. 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.
55. 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
56. 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
57. 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
58. 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).
59. 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
60. 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.
Answers and Rationale
1. Answer: B. Nervousness
Albuterol may cause nervousness. The inhaled form of the drug may cause
dryness and irritation of the nose and throat, not nasal congestion; insomnia,
not lethargy; and hypokalemia (with high doses), not hyperkalemia. Other
adverse effects of albuterol include tremor, dizziness, headache, tachycardia,
palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps.
2. Answer: C. Clear
Normally, nasal drainage in acute rhinitis is clear. Yellow or green drainage

indicates spread of the infection to the sinuses. Gray drainage may indicate a
secondary infection.
3. Answer: D. Lightheadedness or paresthesia
The patient with respiratory alkalosis may complain of lightheadedness or

paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting,
abdominal pain, and diarrhea may accompany respiratory acidosis.
Hallucinations and tinnitus rare are associated with respiratory alkalosis or any
other acid-base imbalance.
4. Answer: D. Elderly patients
Ephedrine is not recommended for elderly patients, who are particularly

susceptible to CNS reactions (such as confusion and anxiety) and to
cardiovascular reactions (such as increased systolic blood pressure, coldness in
the extremities, and anginal pain). Ephedrine is used for its bronchodilator
effects with acute and chronic asthma and occasionally for its CNS stimulant
actions for narcolepsy. It can be administered to children age 2 and older.
5. Answer: A. Kinking of the ventilator tubing
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 trigger the
oxygen alarm.
6. Answer: D. Fighting the ventilator
Pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation

and paralysis. It assists mechanical ventilation by promoting endotracheal
intubation and paralyzing the patient so that the mechanical ventilator can do
its work. Fighting the ventilator is a sign that the patient needs
another pancuronium dose. The nurse should administer 0.01 to 0.02 mg/kg
I.V. every 20 to 60 minutes. Movement of the legs, or lips has no effect on the
ventilator and therefore is not used to determine the need for another dose.
7. Answer: B. Absence of breaths sound in the right thorax
In pneumothorax, the alveoli are deflated and no air exchange occurs in the
lungs. Therefore, breath sounds in the affected lung field are absent. None of
the other options are associated with pneumothorax. Bilateral crackles may
result from pulmonary congestion, inspiratory wheezes may signal asthma, and
a pleural friction rub may indicate pleural inflammation.
8. Answer: B. Arterial Blood
A lowercase a in an ABG value represents arterial blood. For instance, the

abbreviation PaO2 refers to the partial pressure of oxygen in arterial blood. The
pH value reflects the acid-base balance in arterial blood. Sa02 indicates arterial
oxygen saturation. An uppercase A represents alveolar conditions: for
example, PA02 indicates the partial pressure of oxygen in the alveoli.
9. Answer: D. Impaired gas exchange related to airflow obstruction
A patient airway and an adequate breathing pattern are the top priority for any
patient, making impaired gas exchange related to airflow obstruction the most
important nursing diagnosis. The other options also may apply to this patient
but less important.
10. Answer: D. Contralateral side in hemothorax
The trachea will shift according to the pressure gradients within the thoracic
cavity. In tension pneumothorax and hemothorax, accumulation of air or fluid
causes a shift away from the injured side. If there is no significant air or fluid
accumulation, the trachea will not shift. Tracheal deviation toward the
contralateral side in simple pneumothorax is seen when the thoracic contents
shift in response to the release of normal thoracic pressure gradients on the
injured side.
11. Answer: C. Encourage coughing and deep breathing
When caring for a patient who is recovering from a pneumonectomy, the nurse
should encourage coughing and deep breathing to prevent pneumonia in the
unaffected lung. Because the lung has been removed, the water-seal chamber
should display no fluctuations. Reinflation is not the purpose of chest tube.
Chest tube milking is controversial and should be done only to remove blood
clots that obstruct the flow of drainage.
12. Answer: B. Develop an alternative communication method
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.
13. Answer: B. Applying a dressing over the wound and taping it on
three sides
The nurse immediately should apply a dressing over the stab wound and tape it
on three sides to allow air to escape and to prevent tension pneumothorax
(which is more life-threatening than an open chest wound). Only after covering
and taping the wound should the nurse draw blood for laboratory tests, assist
with chest tube insertion, and start an I.V. line.
14. Answer: C. Using a high-flow venture mask to deliver oxygen as

prescribe
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.
15. Answer: C. Increased pulmonary capillary permeability
ARDS results from increased pulmonary capillary permeability, which leads to

noncardiogenic pulmonary edema. In cardiogenic pulmonary edema, pulmonary
congestion occurs secondary to heart failure. In the initial stage of ARDS,
respiratory alkalosis may arise secondary to hyperventilation; however, it does
not cause ARDS. Renal failure does not cause ARDS, either.
16. Answer: C. Teaching the patient how to perform controlled coughing

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.
17. Answer: A. Do nothing, because this is an expected finding
Continuous gentle bubbling should be noted in the suction control chamber.

Option b is incorrect. Chest tubes should only be clamped to check for an air
leak or when changing drainage devices (according to agency policy). Option c
is incorrect. Bubbling should be continuous and not intermittent. Option d is
incorrect because bubbling should be gentle. Increasing the suction pressure
only increases the rate of evaporation of water in the drainage system.
18. Answer: B. Continue to monitor the client
The presence of fluctuation of the fluid level in the water seal chamber indicates
a patent drainage system. With normal breathing, the water level rises with
inspiration and falls with expiration. Fluctuation stops if the tube is obstructed, if
a dependent loop exists, if the suction is not working properly, or if the lung has
reexpanded. Options A, C, and D are incorrect.
19. Answer: B. Place the tube in bottle of sterile water
If the chest drainage system is disconnected, the end of the tube is placed in a
bottle of sterile water held below the level of the chest. The system is replaced
if it breaks or cracks or if the collection chamber is full. Placing a sterile dressing
over the disconnection site will not prevent complications resulting from the
disconnection. The physician may need to be notified, but this is not the initial
action.
20. Answer: D. Perform the Valsalva maneuver

When the chest tube is removed, the client is asked to perform the Valsalva
maneuver (take a deep breath, exhale, and bear down). The tube is quickly
withdrawn, and an airtight dressing is taped in place. An alternative instruction
is to ask the client to take a deep breath and hold the breath while the tube is
removed. Options A, B, and C are incorrect client instructions.
21. Answer: B. Grasp the retention sutures to spread the opening
If the tube is dislodged accidentally, the initial nursing action is to grasp the
retention sutures and spread the opening. If agency policy permits, the nurse
then attempts immediately to replace the tube. Covering the tracheostomy site
will block the airway. Options A and C will delay treatment in this emergency
situation.
22. Answer: A. Stridor
The nurse reports stridor to the physician immediately. This is a high-pitched,

coarse sound that is heard with the stethoscope over the trachea. Stridor
indicates airway edema and places the client at risk for airway obstruction.
Options B, C, and D are not signs that require immediate notification of the
physician.
23. Answer: B. Diminished breath sounds
This client has sustained a blunt or a closed chest injury. Basic symptoms of a
closed pneumothorax are shortness of breath and chest pain. A larger
pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and
subcutaneous emphysema. Hyperresonance also may occur on the affected
side. A sucking sound at the site of injury would be noted with an open chest
injury.
24. Answer: B. A hyperinflated chest noted on the chest x-ray

Clinical manifestations of chronic obstructive pulmonary disease (COPD) include
hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation
with exercise, and the use of accessory muscles of respiration. Chest x-rays
reveal a hyperinflated chest and a flattened diaphragm if the disease is
advanced.
25. Answer: B. Venturi mask
The Venturi mask delivers the most accurate oxygen concentration. It is the
best oxygen delivery system for the client with chronic airflow limitation
because it delivers a precise oxygen concentration. The face tent, aerosol mask,
and tracheostomy collar are also high-flow oxygen delivery systems but most
often are used to administer high humidity.
26. Answer: D. A cough with the expectoration of mucoid sputum
One of the first pulmonary symptoms is a slight cough with the expectoration of
mucoid sputum. Options A, B, and C are late symptoms and signify cavitation
and extensive lung involvement.
27. Answer: B. Sputum culture
Tuberculosis is definitively diagnosed through culture and isolation of

Mycobacterium tuberculosis. A presumptive diagnosis is made based on a
tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a
chest x-ray, and histological evidence of granulomatous disease on biopsy.
28. Answer: B. 2 L/min
Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-
standing hypercapnia that occurs in emphysema, the respiratory drive is
triggered by low oxygen levels rather than increased carbon dioxide levels, as is
the case in a normal respiratory system.
29. Answer: D. Promote carbon dioxide elimination
Pursed-lip breathing facilitates maximal expiration for clients with obstructive

lung disease. This type of breathing allows better expiration by increasing
airway pressure that keeps air passages open during exhalation. Options A, B,
and C are not the purposes of this type of breathing.
30. Answer: B. Low arterial PaO2
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.
31. Answer: B. Having the client take deep breaths
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.
32. Answer: C. Bronchospasm
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.
33. Answer: C. 10 seconds

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.
34. Answer: C. Stop the procedure and reoxygenate the client
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.
35. Answer: A. Dyspnea
The common clinical manifestations of pulmonary embolism are tachypnea,

tachycardia, dyspnea, and chest pain.
36. Answer: A. Resonant sounds.
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.
37. Answer: A. Question the order because its too low.

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.
38. Answer: C. Use diaphragmatic breathing.
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.
39. Answer: C. Tidal volume
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.
40. Answer: B. Non-rebreather mask
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.
41. Answer: C. Decreased hearing acuity
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.
42. Answer: B. Skin test doesnt differentiate between active and

dormant tuberculosis infection.
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.
43. Answer: B. B. 5 to 20 minutes.
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.
44. Answer: C. The system has an air leak.
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.
45. Answer: B. Mucous membranes.
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.
46. Answer: A. Auscultating the lungs for bilateral breath sounds
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.
47. Answer: B. Use of accessory muscles
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.
48. Answer: D. Chest movements.
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.
49. Answer: A. Erythromycin (Erythrocin)
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.
50. Answer: C. Atelectasis.
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.
51. Answer: A. It helps prevent early airway collapse.
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.)
52. Answer: A. In 30 minutes

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.
53. Answer: A. Kinking of the ventilator tubing
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.
54. Answer: A. It makes the central respiratory center more sensitive

to carbon dioxide and stimulates the respiratory drive.
Anhydrous theophylline and other methylxanthine agents make the central

respiratory center more sensitive to CO2 and stimulate the respiratory drive.
Inhibition of phosphodiesterase is the 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.
55. Answer: A. Inflamed lung tissue
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.
56. Answer: D. pH, 7.25; PaCO2 50 mm Hg
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.
57. Answer: A. Apnea
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.
58. Answer: D. Albuterol (Proventil).
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.
59. Answer: D. Respiratory depression
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.
60. Answer: B. Being overweight.
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).
Asthma and COPD

1. An elderly client with pneumonia may appear with which of the
following symptoms first?
1. Altered mental status and dehydration

2. fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough
2. Which of the following pathophysiological mechanisms that occur in

the lung parenchyma allows pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation
3. A 7-year-old client is brought to the E.R. Hes tachypneic and afebrile

and has a respiratory rate of 36 breaths/minute and a nonproductive
cough. He recently had a cold. From his history, the client may have
which of the following?
1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema
4. Which of the following assessment findings would help confirm a

diagnosis of asthma in a client suspected of having the disorder?
1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds
5. Which of the following types of asthma involves an

acute asthma attack brought on by an upper respiratory infection?
1. Emotional
2. Extrinsic
3. Intrinsic
4. Mediated
6. A client with acute asthma showing inspiratory and expiratory

wheezes and a decreased expiratory volume should be treated with
which of the following classes of medication right away?
1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids
7. A 19-year-old comes into the emergency department with

acute asthma. His respiratory rate is 44 breaths/minute, and he
appears to be in acute respiratory distress. Which of the following
actions should be taken first?
1. Take a full medication history

2. Give a bronchodilator by nebulizer
3. Apply a cardiac monitor to the client
4. Provide emotional support to the client.
8. A 58-year-old client with a 40-year history of smoking one to two

packs of cigarettes a day has a chronic cough producing thick sputum,
peripheral edema, and cyanotic nail beds. Based on this information, he
most likely has which of the following conditions?
1. Adult respiratory distress syndrome (ARDS)

2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
9. The term blue bloater refers to which of the following conditions?
1. Adult respiratory distress syndrome (ARDS)

2. Asthma
4. Emphysema
10. The term pink puffer refers to the client with which of the
following conditions?
1. ARDS
2. Asthma
4. Emphysema
11. A 66-year-old client has marked dyspnea at rest, is thin, and uses
accessory muscles to breathe. Hes tachypneic, with a prolonged
expiratory phase. He has no cough. He leans forward with his arms
braced on his knees to support his chest and shoulders for breathing.
This client has symptoms of which of the following respiratory
disorders?
1. ARDS
2. Asthma
4. Emphysema
12. Its highly recommended that clients with asthma, chronic

bronchitis, and emphysema have Pneumovax and flu vaccinations for
which of the following reasons?
1. All clients are recommended to have these vaccines

2. These vaccines produce bronchodilation and improve oxygenation.
3. These vaccines help reduce the tachypnea these clients experience.
4. Respiratory infections can cause severe hypoxia and possibly death in these
clients.
13. Exercise has which of the following effects on clients with asthma,
chronic bronchitis, and emphysema?
1. It enhances cardiovascular fitness.

2. It improves respiratory muscle strength.
3. It reduces the number of acute attacks.
4. It worsens respiratory function and is discouraged.
14. Clients with chronic obstructive bronchitis are given diuretic

therapy. Which of the following reasons best explains why?
1. Reducing fluid volume reduces oxygen demand.

2. Reducing fluid volume improves clients mobility.
3. Restricting fluid volume reduces sputum production.
4. Reducing fluid volume improves respiratory function.
15. A 69-year-old client appears thin and cachectic. Hes short of breath
at rest and his dyspnea increases with the slightest exertion. His breath
sounds are diminished even with deep inspiration. These signs and
symptoms fit which of the following conditions?
1. ARDS
2. Asthma
4. Emphysema
16. A client with emphysema should receive only 1 to 3 L/minute of

oxygen, if needed, or he may lose his hypoxic drive. Which of the
following statements is correct about hypoxic drive?
1. The client doesnt notice he needs to breathe.
2. The client breathes only when his oxygen levels climb above a certain point.
3. The client breathes only when his oxygen levels dip below a certain point.
4. The client breathes only when his carbon dioxide level dips below a certain
point.
17. Teaching for a client with chronic obstructive pulmonary

disease (COPD) should include which of the following topics?
1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-
Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the physician.
4. How to recognize the signs of an impending respiratory infection.
18. Which of the following respiratory disorders is most common in the

first 24 to 48 hours after surgery?
1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax
19. Which of the following measures can reduce or prevent the

incidence of atelectasis in a post-operative client?
1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer
20. Emergency treatment of a client in status asthmaticus includes

which of the following medications?
1. Inhaled beta-adrenergic agents
2. Inhaled corticosteroids
3. I.V. beta-adrenergic agents
4. Oral corticosteroids
21. Which of the following treatment goals is best for the client with
status asthmaticus?
1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions
22. Dani was given dilaudid for pain. Shes sleeping and her respiratory
rate is 4 breaths/minute. If action isnt taken quickly, she might have
which of the following reactions?
1. Asthma attack
2. Respiratory arrest
3. Be pissed about receiving Narcan
4. Wake up on her own
23. Which of the following additional assessment data should

immediately be gathered to determine the status of a client with a
respiratory rate of 4 breaths/minute?
1. Arterial blood gas (ABG) and breath sounds

2. Level of consciousness and a pulse oximetry value.
3. Breath sounds and reflexes
4. Pulse oximetry value and heart sounds
24. A client is in danger of respiratory arrest following the

administration of a narcotic analgesic. An arterial blood gas value is
obtained. The nurse would expect to PaCO2 to be which of the following
values?
1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg
25. A client has started a new drug for hypertension. Thirty minutes
after he takes the drug, he develops chest tightness and becomes short
of breath and tachypneic. He has a decreased level of consciousness.
These signs indicate which of the following conditions?
1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis
26. Emergency treatment for a client with

impending anaphylaxis secondary to hypersensitivity to a drug should
include which of the following actions first?
1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs
27. Following the initial care of a client with asthma and

impending anaphylaxis from hypersensitivity to a drug, the nurse
should take which of the following steps next?
1. Administer beta-adrenergic blockers

2. Administer bronchodilators
3. Obtain serum electrolyte levels
4. Have the client lie flat in the bed.
28. A clients ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg;
PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result
represents which of the following conditions?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
29. A nurse plans care for a client with chronic obstructive pulmonary
disease, knowing that the client is most likely to experience what type
of acid-base imbalance?
30. A nurse is caring for a client who is on a mechanical ventilator.

Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The
nurse has determined that the client is experiencing respiratory
alkalosis. Which laboratory value would most likely be noted in this
condition?
1. Sodium level of 145 mEq/L

2. Potassium level of 3.0 mEq/L
3. Magnesium level of 2.0 mg/L
4. Phosphorus level of 4.0 mg/dl
31. A nurse reviews the arterial blood gas results of a patient and notes
the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration
of 22 mEq/L. The nurse analyzes these results as indicating:
1. Metabolic acidosis, compensated.

2. Metabolic alkalosis, uncompensated.
3. Respiratory alkalosis, compensated.
4. Respiratory acidosis, compensated.
32. A client is scheduled for blood to be drawn from the radial artery for
an ABG determination. Before the blood is drawn, an Allens test is
performed to determine the adequacy of the:
1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation
33. A nurse is caring for a client with a nasogastric tube that is attached
to low suction. The nurse monitors the client, knowing that the client is
at risk for which acid-base disorder?
34. A nurse is caring for a client with an ileostomy understands that the
client is most at risk for developing which acid-base disorder?
35. A nurse is caring for a client with diabetic ketoacidosis and

documents that the client is experiencing Kussmauls respirations.
Based on this documentation, which of the following did the nurse
observe?
1. Respirations that are abnormally deep, regular, and increased in rate.

2. Respirations that are regular but abnormally slow.
3. Respirations that are labored and increased in depth and rate
4. Respirations that cease for several seconds.
36. A nurse understands that the excessive use of oral antacids

containing bicarbonate can result in which acid-base disturbance?
37. A nurse is caring for a client with renal failure. Blood gas results
indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate
concentration of 20 mEq/L. The nurse has determined that the client is
experiencing metabolic acidosis. Which of the following laboratory
values would the nurse expect to note?
1. Sodium level of 145 mEq/L

2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL
38. A nurse is preparing to obtain an arterial blood gas specimen from a
client and plans to perform the Allens test on the client. Number in
order of priority the steps for performing the Allens test (#1 is first
step).
1. Ask the client to open and close the hand repeatedly.

2. Apply pressure over the ulnar and radial arteries.
3. Assess the color of the extremity distal to the pressure point
4. Release pressure from the ulnar artery
5. Explain the procedure to the client.
39. A nurse is preparing to obtain a sputum specimen from a client.

Which of the following nursing actions will facilitate obtaining the
specimen?
1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.
40. A nurse is caring for a client after a bronchoscopy and biopsy.

Which of the following signs if noted in the client should be reported
immediately to the physician?
1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm
41. A nurse is suctioning fluids from a client via a tracheostomy tube.

When suctioning, the nurse must limit the suctioning to a maximum of:
1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute
42. A nurse is suctioning fluids from a client through an endotracheal

tube. During the suctioning procedure, the nurse notes on the monitor
that the heart rate decreases. Which of the following is the most
appropriate nursing intervention?
1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxygenated the client
4. Notify the physician immediately.
43. An unconscious 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, and a normal oxygen level. An
elevated potassium level is also present. These results indicate the
presence of:
3. Combined respiratory and metabolic acidosis
4. over compensated respiratory acidosis
44. A nurse is caring for a client hospitalized with acute exacerbation

of COPD. Which of the following would the nurse expect to note on
assessment of this client?
1. Increased oxygen saturation with exercise

2. Hypocapnia
3. A hyperinflated chest on x-ray film
4. A widened diaphragm noted on chest x-ray film
45. An oxygenated delivery system is prescribed for a client with COPD

to deliver a precise oxygen concentration. Which of the following types
of oxygen delivery systems would the nurse anticipate to be
prescribed?
1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar
46. Theophylline (Theo-Dur) tablets are prescribed for a client with

chronic airflow limitation, and the nurse instructs the client about the
medication. Which statement by the client indicates a need for further
teaching?
1. I will take the medication on an empty stomach.

2. I will take the medication with food.
3. I will continue to take the medication even if I am feeling better.
4. Periodic blood levels will need to be obtained.
47. A nurse is caring for a client with emphysema. The client is

receiving oxygen. The nurse assesses the oxygen flow rate to ensure
that it does not exceed
1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min
48. The nurse reviews the ABG values of a client. The results indicate
respiratory acidosis. Which of the following values would indicate that
this acid-base imbalance exists?
1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3- of 20 mEq/L
49. A nurse instructs a client to use the pursed lip method of breathing.
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:
1. Promote oxygen intake

2. Strengthen the diaphragm
3. Strengthen the intercostal muscles
4. Promote carbon dioxide elimination
50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of
30 mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values
as indicating:
1. Respiratory acidosis uncompensated

2. Respiratory alkalosis uncompensated
3. Metabolic acidosis uncompensated
4. Metabolic acidosis partially compensated.
1. Answer: 1. Altered mental status and dehydration

Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the
common symptoms of pneumonia, but elderly clients may first appear with only
an altered mental status and dehydration due to a blunted immune response.
2. Answer: 4. Inflammation
The most common feature of all types of pneumonia is an inflammatory

pulmonary response to the offending organism or agent. Atelectasis and
bronchiectasis indicate a collapse of a portion of the airway that doesnt occur
with pneumonia. An effusion is an accumulation of excess pleural fluid in the
pleural space, which may be a secondary response to pneumonia.
3. Answer: 1. Acute asthma
Based on the clients history and symptoms, acute asthma is the most likely
diagnosis. Hes unlikely to have bronchial pneumonia without a productive
cough and fever and hes too young to have developed COPD or emphysema.
4. Answer: 3. Inspiratory and expiratory wheezing
Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral

cyanosis may be present in extreme cases of respiratory distress. The nurse
would expect the client to have a decreased forced expiratory volume because
asthma is an obstructive pulmonary disease. Breath sounds will be tight
sounding or markedly decreased; they wont be normal.
5. Answer: 3. Intrinsic
Intrinsic asthma doesnt have an easily identifiable allergen and can be

triggered by the common cold. Asthma caused be emotional reasons is
considered to be in the extrinsic category. Extrinsic asthma is caused by dust,
molds, and pets; easily identifiable allergens. Mediated asthma doesnt exist.
6. Answer: 2. Bronchodilators
Bronchodilators are the first line of treatment for asthma because

bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers
arent used to treat asthma and can cause bronchoconstriction. Inhaled or oral
steroids may be given to reduce the inflammation but arent used for
emergency relief.
7. Answer: 2. Give a bronchodilator by nebulizer
The client is having an acute asthma attack and needs to increase

oxygen delivery to the lung and body. Nebulized bronchodilators open airways
and increase the amount of oxygen delivered. First, resolve the acute phase of
the attack ad how to prevent attacks in the future. It may not be necessary to
place the client on a cardiac monitor because hes only 19-years-old, unless he
has a past medical history of cardiac problems.
8. Answer: 3. Chronic obstructive bronchitis
Because of his extensive smoking history and symptoms, the client most likely
has chronic obstructive bronchitis. Clients with ARDS have acute symptoms of
and typically need large amounts of oxygen. Clients with asthma and
emphysema tend not to have a chronic cough or peripheral edema.
9. Answer: 3. Chronic obstructive bronchitis
Clients with chronic obstructive bronchitis appear bloated; they have large
barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral
cyanosis. Clients with ARDS are acutely short of breath and frequently need
intubation for mechanical ventilation and large amounts of oxygen. Clients with
asthma dont exhibit characteristics of chronic disease, and clients with
emphysema appear pink and cachectic (a state of ill health, malnutrition, and
wasting).
10. Answer: 4. Emphysema
Because of the large amount of energy it takes to breathe, clients with

emphysema are usually cachectic. Theyre pink and usually breathe through
pursed lips, hence the term puffer. Clients with ARDS are usually acutely short
of breath. Clients with asthma dont have any particular characteristics, and
clients with chronic obstructive bronchitis are bloated and cyanotic in
appearance.
These are classic signs and symptoms of a client with emphysema. Clients with
ARDS are acutely short of breath and require emergency care; those with
asthma are also acutely short of breath during an attack and appear very
frightened. Clients with chronic obstructive bronchitis are bloated and cyanotic
in appearance.
12. Answer: 4. Respiratory infections can cause severe hypoxia and

possibly death in these clients.
Its highly recommended that clients with respiratory disorders be given

vaccines to protect against respiratory infection. Infections can cause these
clients to need intubation and mechanical ventilation, and it may be difficult to
wean these clients from the ventilator. The vaccines have no effect on
bronchodilation or respiratory care.
13. Answer: 1. It enhances cardiovascular fitness.
Exercise can improve cardiovascular fitness and help the client tolerate periods
of hypoxia better, perhaps reducing the risk of heart attack. Most exercise has
little effect on respiratory muscle strength, and these clients cant tolerate the
type of exercise necessary to do this. Exercise wont reduce the number of
acute attacks. In some instances, exercise may be contraindicated, and the
client should check with his physician before starting any exercise program.
14. Answer: 1. Reducing fluid volume reduces oxygen demand.
Reducing fluid volume reduces the workload of the heart, which reduces oxygen
demand and, in turn, reduces the respiratory rate. It may also reduce edema
and improve mobility a little, but exercise tolerance will still be harder to clear
airways. Reducing fluid volume wont improve respiratory function, but may
improve oxygenation.
In emphysema, the wall integrity of the individual air sacs is damaged, reducing
the surface area available for gas exchange. Very little air movement occurs in
the lungs because of bronchial collapse, as well. In ARDS, the clients condition
is more acute and typically requires mechanical ventilation. In asthma and
bronchitis, wheezing is prevalent.
16. Answer: 3. The client breathes only when his oxygen levels dip
below a certain point.
Clients with emphysema breathe when their oxygen levels drop to a certain
level; this is known as the hypoxic drive. They dont take a breath when their
levels of carbon dioxide are higher than normal, as do those with healthy
respiratory physiology. If too much oxygen is given, the client has little stimulus
to take another breath. In the meantime, his carbon dioxide levels continue to
climb, and the client will pass out, leading to a respiratory arrest.
17. Answer: 4. How to recognize the signs of an impending respiratory

infection.
Respiratory infection in clients with a respiratory disorder can be fatal. Its
important that the client understands how to recognize the signs and symptoms
of an impending respiratory infection. It isnt appropriate for the wife to listen to
his lung sounds, besides, you cant purchase stethoscopes from Wal-Mart. If the
client has signs and symptoms of an infection, he should contact his physician
at once.
18. Answer: 1. Atelectasis
Atelectasis develops when theres interference with the normal negative

pressure that promotes lung expansion. Clients in the postoperative phase often
splint their breathing because of pain and positioning, which causes hypoxia.
Its uncommon for any of the other respiratory disorders to develop.
19. Answer: 4. Use of an incentive spirometer
Using an incentive spirometer requires the client to take deep breaths and
promotes lung expansion. Chest physiotherapy helps mobilize secretions but
wont prevent atelectasis. Reducing oxygen requirements or placing someone on
mechanical ventilation doesnt affect the development of atelectasis.
20. Answer: 1. Inhaled beta-adrenergic agents
Inhaled beta-adrenergic agents help promote bronchodilation, which improves

oxygenation. I.V. beta-adrenergic agents can be used but have to be monitored
because of their greater systemic effects. Theyre typically used when the
inhaled beta-adrenergic agents dont work. Corticosteroids are slow-acting, so
their use wont reduce hypoxia in the acute phase.
21. Answer: 1. Avoiding intubation
Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen

are used to reduce bronchospasm, improve oxygenation, and avoid intubation.
Determining the trigger for the clients attack and improving exercise tolerance
are later goals. Typically, secretions arent a problem in status asthmaticus.
22. Answer: 2. Respiratory arrest
Narcotics can cause respiratory arrest if given in large quantities. Its unlikely
Dani will have an asthma attack or wake up on her own. She may be pissed for
a minute, but then shed be grateful for saving her butt.
23. Answer: 2. Level of consciousness and a pulse oximetry value.
First, the nurse should attempt to rouse the client because this should increase
the clients respiratory rate. If available, a spot pulse oximetry check should be
done and breath sounds should be checked. The physician should be notified
immediately if of the findings. Hell probably order ABG analysis to determine
specific carbon dioxide and oxygen levels, which will indicate the effectiveness
of ventilation. Reflexes and heart sounds will be part of the more extensive
examination done after these initial actions are completed.
24. Answer: 4. 80 mm Hg
A client about to go into respiratory arrest will have inefficient ventilation and
will be retaining carbon dioxide. The value expected would be around 80 mm
Hg. All other values are lower than expected.
25. Answer: 3. Respiratory Failure
The client was reacting to the drug with respiratory signs of

impending anaphylaxis, which could lead to eventual respiratory failure.
Although the signs are also related to an asthma attack or a pulmonary
embolism, consider the new drug first. Rheumatoid arthritis doesnt manifest
these signs.
26. Answer: 1. Administering oxygen
Giving oxygen would be the best first action in this case. Vital signs then should
be checked and the physician immediately notified. If the client doesnt already
have an I.V. catheter, one may be inserted now if anaphylactic shock is
developing. Obtaining a CBC wouldnt help the emergency situation.
27. Answer: 2. Administer bronchodilators
Bronchodilators would help open the clients airway and improve his
oxygenation status. Beta-adrenergic blockers arent indicated in the
management of asthma because they may cause bronchospasm. Obtaining
laboratory values wouldnt be done on an emergency basis, and having the
client lie flat in bed could worsen his ability to breathe.
28. Answer: 3. Respiratory acidosis
You all should know this. Practice some problems if you got this wrong.
Respiratory acidosis is most often due to hypoventilation. Chronic respiratory

acidosis is most commonly caused by COPD. In end-stage disease, pathological
changes lead to airway collapse, air trapping, and disturbance of ventilation-
perfusion relationships.
30. Answer: 2. Potassium level of 3.0 mEq/L
Clinical manifestations of respiratory alkalosis include headache,

tachypnea, paresthesias, tetany, vertigo, convulsions, hypokalemia,
and hypocalcemia. Options 1, 3, and 4 identify normal laboratory
values. Option 2 identifies the presence of hypokalemia.
31. Answer: 3. Respiratory alkalosis, compensated.
The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite (see-saw)

will be seen between the pH and the PCO2. In this situation, the pH is at the
high end of the normal value and the PCO2 is low. In an alkalotic condition, the
pH is up. Therefore, the values identified in the question indicate a respiratory
alkalosis. Compensation occurs when the pH returns to a normal value. Because
the pH is in the normal range at the high end, compensation has occurred.
32. Answer: 2. Ulnar circulation
Before radial puncture for obtaining an ABG, you should perform an Allens test
to determine adequate ulnar circulation. Failure to determine the presence of
adequate collateral circulation could result in severe ischemic injury o the hand
if damage to the radial artery occurs with arterial puncture.
33. Answer: 4. Metabolic alkalosis
Loss of gastric fluid via nasogastric suction or vomiting causes metabolic

alkalosis as a result of the loss of hydrochloric acid.
34. Answer: 3. Metabolic acidosis
Intestinal secretions are high in bicarbonate and may be lost through enteric
drainage tubes or an ileostomy or with diarrhea. These conditions result in
metabolic acidosis.
35. Answer: 1. Respirations that are abnormally deep, regular, and

increased in rate.
Kussmauls respirations are abnormally deep, regular, and increased in rate.
36. Answer: 4. Metabolic alkalosis

Increases in base components occur as a result of oral or parenteral intake of
bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral
antacids containing bicarbonate can cause metabolic alkalosis.
37. Answer: 3. Potassium level of 5.2 mEq/L
Clinical manifestations of metabolic acidosis include hyperpnea with Kussmauls

respirations; headache; N/V, and diarrhea; fruity-smelling breath resulting from
improper fat metabolism; CNS depression, including mental dullness,
drowsiness, stupor, and coma; twitching, and coma. Hyperkalemia will occur.
38. Answer: 5, 2, 1, 4, and then 3.
39. Answer: 2. Having the client take 3 deep breaths.
To obtain a sputum specimen, the client should rinse the mouth to prevent
contamination, breathe deeply, and then cough unto 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.
40. Answer: 4. Bronchospasm
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 arrhythmias. Hematuria is unrelated
to this procedure.
41. Answer: 2. 10 seconds

Hypoxemia can be caused by prolonged suctioning, which stimulates
the pacemaker cells within 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.
42. Answer: 3. Stop the procedure and reoxygenated the client
During suctioning, the nurse should monitor the client closely for side effects,
including hypoxemia, cardiac irregularities such as a decrease in HR resulting
from vagal stimulation, mucosal trauma, hypotension, and paroxysmal
coughing. If side effects develop, especially cardiac irregularities, this procedure
is stopped and the client is reoxygenated.
43. Answer: 1. Metabolic acidosis
In an acidotic condition, the pH would be low, indicating the acidosis. In

addition, a low bicarbonate level along with the pH would indicate a metabolic
state.
44. Answer: 3. A hyperinflated chest on x-ray film
Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on

exertion and at rest, oxygen desaturation with exercise, and the use of
accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest
and a flattened diaphragm is the disease is advanced.
45. Answer: 1. Venturi mask
The venture mask delivers the most accurate oxygen concentration. The Venturi
mask is the best oxygen delivery system for the client with chronic airflow
limitation because it delivers a precise oxygen concentration. The face tent, the
aerosol mask, and the tracheostomy collar are also high-flow
oxygen delivery systems but most often are used to administer high humidity.
46. Answer: 1. I will take the medication on an empty stomach.
Theo-Dur is a bronchodilator. The medication should be administered with food

such as milk and crackers to prevent GI irritation.
47. Answer: 2. 2 L/min
One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to

60 to 80 mm Hg. However, oxygen is used cautiously and should not exceed 2
L/min. Because of the long-standing hypercapnia, the respiratory drive is
triggered by low oxygen levels rather than increased carbon dioxide levels, as is
the case in normal respiratory system.
48. Answer: 3. pH of 7.30
49. Answer: 4. Promote carbon dioxide elimination
Pursed lip breathing facilitates maximum 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.
50. Answer: 2. Respiratory alkalosis uncompensated
In respiratory alkalosis, the pH will be higher than normal and the PCO2 will be
low.
1. Aminophylline (theophylline) is prescribed for a client with acute

bronchitis. A nurse administers the medication, knowing that the
primary action of this medication is to:
1. Promote expectoration
2. Suppress the cough
3. Relax smooth muscles of the bronchial airway
4. Prevent infection
2. A client is receiving isoetharine hydrochloride (Bronkosol) via a

nebulizer. The nurse monitors the client for which side effect of this
medication?
1. Constipation
2. Diarrhea
3. Bradycardia
4. Tachycardia
3. A nurse teaches a client about the use of a respiratory inhaler. Which

action by the client indicated a need for further teaching?
1. Removes the cap and shakes the inhaler well before use.
2. Presses the canister down with finger as he breathes in.
3. Inhales the mist and quickly exhales.
4. Waits 1 to 2 minutes between puffs if more than one puff has been
prescribed.
4. A female client is scheduled to have a chest radiograph. Which of the

following questions is of most importance to the nurse assessing this
client?
1. Is there any possibility that you could be pregnant?

2. Are you wearing any metal chains or jewelry?
3. Can you hold your breath easily?
4. Are you able to hold your arms above your head?
5. A client has just returned to a nursing unit following bronchoscopy. A

nurse would implement which of the following nursing interventions for
this client?
1. Encouraging additional fluids for the next 24 hours
2. Ensuring the return of the gag reflex before offering foods or fluids
3. Administering atropine intravenously
4. Administering small doses of midazolam (Versed).
6. A client has an order to have radial ABG drawn. Before drawing the
sample, a nurse occludes the:
1. Brachial and radial arteries, and then releases them and observes the
circulation of the hand.
2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and
repeats the process with the other artery.
3. Radial artery and observes for color changes in the affected hand.
4. Ulnar artery and observes for color changes in the affected hand.
7. A nurse is assessing a client with chronic airflow limitation and notes

that the client has a barrel chest. The nurse interprets that this client
has which of the following forms of chronic airflow limitation?

2. Emphysema
3. Bronchial asthma
4. Bronchial asthma and bronchitis
8. A client has been taking benzonatate (Tessalon Perles) as

prescribed. A nurse concludes that the medication is having the
intended effect if the client experiences:
1. Decreased anxiety level

2. Increased comfort level
3. Reduction of N/V
4. Decreased frequency and intensity of cough
9. Which of the following would be an expected outcome for a client
recovering from an upper respiratory tract infection? The client will:
1. Maintain a fluid intake of 800 ml every 24 hours.

2. Experience chills only once a day
3. Cough productively without chest discomfort.
4. Experience less nasal obstruction and discharge.
10. Which of the following individuals would the nurse consider to have
the highest priority for receiving an influenza vaccination?
1. A 60-year-old man with a hiatal hernia

2. A 36-year-old woman with 3 children
3. A 50-year-old woman caring for a spouse with cancer
4. a 60-year-old woman with osteoarthritis
11. A client with allergic rhinitis asks the nurse what he should do to
decrease his symptoms. Which of the following instructions would be
appropriate for the nurse to give the client?
1. Use your nasal decongestant spray regularly to help clear your nasal
passages.
2. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.
3. It is important to increase your activity. A daily brisk walk will help promote
drainage.
4. Keep a diary if when your symptoms occur. This can help you identify what
precipitates your attacks.
12. An elderly client has been ill with the flu, experiencing
headache, fever, and chills. After 3 days, she develops a cough
productive of yellow sputum. The nurse auscultates her lungs and hears
diffuse crackles. How would the nurse best interpret these assessment
findings?
1. It is likely that the client is developing a secondary bacterial pneumonia.
2. The assessment findings are consistent with influenza and are to be
expected.
3. The client is getting dehydrated and needs to increase her fluid intake to
decrease secretions.
4. The client has not been taking her decongestants and bronchodilators as
prescribed.
13. Guaifenesin 300 mg four times daily has been ordered as an

expectorant. The dosage strength of the liquid is 200mg/5ml. How
many mL should the nurse administer each dose?
1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml
14. Pseudoephedrine (Sudafed) has been ordered as a nasal

decongestant. Which of the following is a possible side effect of this
drug?
1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness
15. A client with COPD reports steady weight loss and being too tired
from just breathing to eat. Which of the following nursing diagnoses
would be most appropriate when planning nutritional interventions for
this client?
1. Altered nutrition: Less than body requirements related to fatigue.

2. Activity intolerance related to dyspnea.
3. Weight loss related to COPD.
4. Ineffective breathing pattern related to alveolar hypoventilation.
16. When developing a discharge plan to manage the care of a client

with COPD, the nurse should anticipate that the client will do which of
the following?
1. Develop infections easily

2. Maintain current status
3. Require less supplemental oxygen
4. Show permanent improvement.
17. Which of the following outcomes would be appropriate for a client

with COPD who has been discharged to home? The client:
1. Promises to do pursed lip breathing at home.

2. States actions to reduce pain.
3. States that he will use oxygen via a nasal cannula at 5 L/minute.
4. Agrees to call the physician if dyspnea on exertion increases.
18. Which of the following physical assessment findings would the

nurse expect to find in a client with advanced COPD?
1. Increased anteroposterior chest diameter

2. Underdeveloped neck muscles
3. Collapsed neck veins
4. Increased chest excursions with respiration
19. Which of the following is the primary reason to teach pursed-lip

breathing to clients with emphysema?
1. To promote oxygen intake

2. To strengthen the diaphragm
3. To strengthen the intercostal muscles
4. To promote carbon dioxide elimination
20. Which of the following is a priority goal for the client with COPD?
1. Maintaining functional ability

2. Minimizing chest pain
3. Increasing carbon dioxide levels in the blood
4. Treating infectious agents
21. A clients arterial blood gas levels are as follows: pH 7.31; PaO2 80
mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following
signs or symptoms would the nurse expect?
1. Cyanosis
2. Flushed skin
3. Irritability
4. Anxiety
22. When teaching a client with COPD to conserve energy, the nurse
should teach the client to lift objects:
1. While inhaling through an open mouth.

2. While exhaling through pursed lips
3. After exhaling but before inhaling.
4. While taking a deep breath and holding it.
23. The nurse teaches a client with COPD to assess for s/s of right-
sided heart failure. Which of the following s/s would be included in the
teaching plan?
1. Clubbing of nail beds

2. Hypertension
3. Peripheral edema
4. Increased appetite
24. The nurse assesses the respiratory status of a client who is

experiencing an exacerbation of COPD secondary to an upper
respiratory tract infection. Which of the following findings would be
expected?
1. Normal breath sounds

2. Prolonged inspiration
3. Normal chest movement
4. Coarse crackles and rhonchi
25. Which of the following ABG abnormalities should the nurse

anticipate in a client with advanced COPD?
1. Increased PaCO2
2. Increased PaO2
3. Increased pH.
4. Increased oxygen saturation
26. Which of the following diets would be most appropriate for a client
with COPD?
1. Low fat, low cholesterol

2. Bland, soft diet
3. Low-Sodium diet
4. High calorie, high-protein diet
27. The nurse is planning to teach a client with COPD how to cough
effectively. Which of the following instructions should be included?
1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times
on exhalation.
2. Lie flat on back, splint the thorax, take two deep breaths and cough.
3. Take several rapid, shallow breaths and then cough forcefully.
4. Assume a side-lying position, extend the arm over the head, and alternate
deep breathing with coughing.
28. A 34-year-old woman with a history of asthma is admitted to the

emergency department. The nurse notes that the client is dyspneic,
with a respiratory rate of 35 breaths/minute, nasal flaring, and use of
accessory muscles. Auscultation of the lung fields reveals greatly
diminished breath sounds. Based on these findings, what action should
the nurse take to initiate care of the client?
1. Initiate oxygen therapy and reassess the client in 10 minutes.

2. Draw blood for an ABG analysis and send the client for a chest x-ray.
3. Encourage the client to relax and breathe slowly through the mouth
4. Administer bronchodilators
29. The nurse would anticipate which of the following ABG results in a
client experiencing a prolonged, severe asthma attack?
1. Decreased PaCO2, increased PaO2, and decreased pH.

2. Increased PaCO2, decreased PaO2, and decreased pH.
3. Increased PaCO2, increased PaO2, and increased pH.
4. Decreased PaCO2, decreased PaO2, and increased pH.
30. A client with acute asthma is prescribed short-term corticosteroid

therapy. What is the rationale for the use of steroids in clients
with asthma?
1. Corticosteroids promote bronchodilation

2. Corticosteroids act as an expectorant
3. Corticosteroids have an anti-inflammatory effect
4. Corticosteroids prevent development of respiratory infections.
31. The nurse is teaching the client how to use a metered dose inhaler
(MDI) to administer a Corticosteroid drug. Which of the following client
actions indicates that he is using the MDI correctly? Select all that
apply.
1. The inhaler is held upright.

2. Head is tilted down while inhaling the medication
3. Client waits 5 minutes between puffs.
4. Mouth is rinsed with water following administration
5. Client lies supine for 15 minutes following administration.
32. A client is prescribed metaproterenol (Alupent) via a metered dose

inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to
report side effects. Which of the following are potential side effects of
metaproterenol?
1. Irregular heartbeat
2. Constipation
3. Pedal edema
4. Decreased heart rate.
33. A client has been taking flunisolide (Aerobid), two inhalations a

day, for treatment of asthma. He tells the nurse that he has painful,
white patches in his mouth. Which response by the nurse would be the
most appropriate?
1. This is an anticipated side-effect of your medication. It should go away in a

couple of weeks.
2. You are using your inhaler too much and it has irritated your mouth.
3. You have developed a fungal infection from your medication. It will need to
be treated with an antibiotic.
4. Be sure to brush your teeth and floss daily. Good oral hygiene will treat this
problem.
34. Which of the following health promotion activities should the nurse
include in the discharge teaching plan for a client with asthma?
1. Incorporate physical exercise as tolerated into the treatment plan.

2. Monitor peak flow numbers after meals and at bedtime.
3. Eliminate stressors in the work and home environment
4. Use sedatives to ensure uninterrupted sleep at night.
35. The client with asthma should be taught that which of the following
is one of the most common precipitating factors of an
acute asthma attack?
1. Occupational exposure to toxins

2. Viral respiratory infections
3. Exposure to cigarette smoke
4. Exercising in cold temperatures
36. A female client comes into the emergency room complaining of SOB
and pain in the lung area. She states that she started taking birth
control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P
110, R 40. The physician orders ABGs, results are as follows: pH: 7.50;
PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%.
Considering these results, the first intervention is to:
1. Begin mechanical ventilation

2. Place the client on oxygen
3. Give the client sodium bicarbonate
4. Monitor for pulmonary embolism.
37. Basilar crackles are present in a clients lungs on auscultation. The
nurse knows that these are discrete, non continuous sounds that are:
1. Caused by the sudden opening of alveoli

2. Usually more prominent during expiration
3. Produced by airflow across passages narrowed by secretions
4. Found primarily in the pleura.
38. A cyanotic client with an unknown diagnosis is admitted to the E.R.

In relation to oxygen, the first nursing action would be to:
1. Wait until the clients lab work is done.

2. Not administer oxygen unless ordered by the physician.
3. Administer oxygen at 2 L flow per minute.
4. Administer oxygen at 10 L flow per minute and check the clients nail beds.
39. Immediately following a thoracentesis, which clinical

manifestations indicate that a complication has occurred and
the physician should be notified?
1. Serosanguineous drainage from the puncture site

2. Increased temperature and blood pressure
3. Increased pulse and pallor
4. Hypotension and hypothermia
40. If a client continues to hypoventilate, the nurse will continually

assess for a complication of:
41. A client is admitted to the hospital with acute bronchitis. While
taking the clients VS, the nurse notices he has an irregular pulse. The
nurse understands that cardiac arrhythmias in chronic respiratory
distress are usually the result of:
2. A build-up of carbon dioxide
3. A build-up of oxygen without adequate expelling of carbon dioxide.
4. An acute respiratory infection.
42. Auscultation of a clients lungs reveals crackles in the left posterior

base. The nursing intervention is to:
1. Repeat auscultation after asking the client to deep breathe and cough.
2. Instruct the client to limit fluid intake to less than 2000 ml/day.
3. Inspect the clients ankles and sacrum for the presence of edema
4. Place the client on bedrest in a semi-Fowlers position.
43. The most reliable index to determine the respiratory status of a

client is to:
1. Observe the chest rising and falling

2. Observe the skin and mucous membrane color.
3. Listen and feel the air movement.
4. Determine the presence of a femoral pulse.
44. A client with COPD has developed secondary polycythemia. Which

nursing diagnosis would be included in the plan of care because of the
polycythemia?
1. Fluid volume deficit related to blood loss.

2. Impaired tissue perfusion related to thrombosis
3. Activity intolerance related to dyspnea
4. Risk for infection related to suppressed immune response.
45. The physician has scheduled a client for a left pneumonectomy. The
position that will most likely be ordered postoperatively for his is the:
1. Nonoperative side or back

2. Operative side or back
3. Back only
4. Back or either side.
46. Assessing a client who has developed atelectasis postoperatively,

the nurse will most likely find:
1. A flushed face
2. Dyspnea and pain
3. Decreased temperature
4. Severe cough and no pain.
47. A fifty-year-old client has a tracheostomy and requires tracheal

suctioning. The first intervention in completing this procedure would be
to:
1. Change the tracheostomy dressing

2. Provide humidity with a trach mask
3. Apply oral or nasal suction
4. Deflate the tracheal cuff
48. A client states that the physician said the tidal volume is slightly
diminished and asks the nurse what this means. The nurse explains
that the tidal volume is the amount of air:
1. Exhaled forcibly after a normal expiration
2. Exhaled after there is a normal inspiration
3. Trapped in the alveoli that cannot be exhaled
4. Forcibly inspired over and above a normal respiration.
49. An acceleration in oxygen dissociation from hemoglobin, and thus

oxygen delivery to the tissues, is caused by:
1. A decreasing oxygen pressure in the blood

2. An increasing carbon dioxide pressure in the blood
3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure
in the blood.
4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure
in the blood.
50. The BEST method of oxygen administration for client with COPD
uses:
1. Cannula
2. Simple Face mask
3. Non-rebreather mask
4. Venturi mask
1. Answer: 3. Relax smooth muscles of the bronchial airway
Aminophylline is a bronchodilator that directly relaxes the smooth muscles of

the bronchial airway.
2. Answer: 4. Tachycardia
Side effects that can occur from a beta 2 agonist include tremors, nausea,
nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of
the mouth or throat.
3. Answer: 3. Inhales the mist and quickly exhales.
The client should be instructed to hold his or her breath at least 10 to 15

seconds before exhaling the mist.
4. Answer: 1. Is there any possibility that you could be pregnant?
The most important item to ask about is the clients pregnancy status because
pregnant women should not be exposed to radiation. Clients are also asked to
remove any chains or metal objects that could interfere with obtaining an
adequate film. A chest radiograph most often is done at full inspiration, which
gives optimal lung expansion. If a lateral view of the chest is ordered, the client
is asked to raise the arms above the head. Most films are done in posterior-
anterior view.
5. Answer: 2. Ensuring the return of the gag reflex before offering foods
or fluids
After bronchoscopy, the nurse keeps the client on NPO status until the gag
reflex returns because the preoperative sedation and the local anesthesia impair
swallowing and the protective laryngeal reflexes for a number of hours.
Additional fluids is unnecessary because no contrast dye is used that would
need to be flushed from the system. Atropine and Versed would be administered
before the procedure, not after.
6. Answer: 2. Radial and ulnar arteries, releases one, evaluates the

color of the hand, and repeats the process with the other artery.
Before drawing an ABG, the nurse assesses the collateral circulation to the hand
with Allens test. This involves compressing the radial and ulnar arteries and
asking the client to close and open the fist. This should cause the hand to
become pale. The nurse then releases pressure on one artery and observes
whether circulation is restored quickly. The nurse repeats the process, releasing
the other artery. The blood sample may be taken safely if collateral circulation is
adequate.
The client with emphysema has hyperinflation of the alveoli and flattening of
the diaphragm. These lead to increased anteroposterior diameter, which is
referred to as barrel chest. The client also has dyspnea with
prolonged expiration and has hyperresonant lungs to percussion.
8. Answer: 4. Decreased frequency and intensity of cough
Benzonatate is a locally acting antitussive the effectiveness of which is

measured by the degree to which it decreases the intensity and frequency of
cough without eliminating the cough reflex.
9. Answer: 4. Experience less nasal obstruction and discharge.
A client recovering from an URI should report decreasing or no nasal discharge

and obstruction. Daily fluid intake should be increased to more than 1 L every
24 hours to liquefy secretions. The temperature should be below 100*F
(37.8*C) with no chills or diaphoresis. A productive cough with
chest pain indicated pulmonary infection, not an URI.
10. Answer: 3. A 50-year-old woman caring for a spouse with cancer
Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza
to prevent transmission to those who have a decreased capacity to deal with the
disease. The wife who is caring for a husband with cancer has the highest
priority of the clients described.
11. Answer: 4. Keep a diary if when your symptoms occur. This can
help you identify what precipitates your attacks.
It is important for clients with allergic rhinitis to determine the precipitating

factors so that they can be avoided. Keeping a diary can help identify these
triggers. Nasal decongestant sprays should not be used regularly because they
can cause a rebound effect. Antibiotics are not appropriate. Increasing activity
will not control the clients symptoms; in fact, walking outdoors may increase
them if the client is allergic to pollen.
12. Answer: 1. It is likely that the client is developing a secondary

bacterial pneumonia.
Pneumonia is the most common complication of influenza, especially in the

elderly. The development of a purulent cough and crackles may be indicative of
a bacterial infection are not consistent with a diagnosis of influenza. These
findings are not indicative of dehydration. Decongestants and bronchodilators
are not typically prescribed for the flu.
13. Answer: 2. 7.5 ml
14. Answer: 4. Restlessness
Side effects of pseudoephedrine are experienced primarily in the cardiovascular

system and through sympathetic effects on the CNS. The most common CNS
effects include restlessness, dizziness, tension, anxiety, insomnia, and
weakness. Common cardiovascular side effects include tachycardia,
hypertension, palpitations, and arrhythmias. Constipation and diplopia are not
side effects of pseudoephedrine. Tachycardia, not bradycardia, is a side effect of
pseudoephedrine.
15. Answer: 1. Altered nutrition: Less than body requirements related

to fatigue.
The clients problem is altered nutritionspecifically, less than required. The

cause, as stated by the client, is the fatigue associated with the disease
process. Activity intolerance is a likely diagnosis but is not related to the clients
nutritional problems. Weight loss is not a nursing diagnosis. Ineffective
breathing pattern may be a problem, but this diagnosis does not specifically
address the problem of weight loss described by the client.
16. Answer: 1. Develop infections easily
A client with COPD is at high risk for development of respiratory infections.

COPD is a slowly progressive; therefore, maintaining current status and
establishing a goal that the client will require less supplemental oxygen are
unrealistic expectations. Treatment may slow progression of the disease, but
permanent improvement is highly unlikely.
17. Answer: 4. Agrees to call the physician if dyspnea on exertion

increases.
Increasing dyspnea on exertion indicates that the client may be experiencing

complications of COPD, and therefore the physician should be notified.
Extracting promises from clients is not an outcome criterion. Pain is not a
common symptom of COPD. Clients with COPD use low-flow oxygen
supplementation (1 to 2 L/minute) to avoid suppressing the respiratory drive,
which, for these clients, is stimulated by hypoxia.
18. Answer: 1. Increased anteroposterior chest diameter

Increased anteroposterior chest diameter is characteristic of advanced COPD.
Air is trapped in the overextended alveoli, and the ribs are fixed in an
inspiratory position. The result is the typical barrel-chested appearance. Overly
developed, not underdeveloped, neck muscles are associated with COPD
because of their increased use in the work of breathing. Distended, not
collapsed, neck veins are associated with COPD as a symptom of the heart
failure that the client may experience secondary to the increased workload on
the heart to pump into pulmonary vasculature. Diminished, not increased, chest
excursion is associated with COPD.
19. Answer: 4. To promote carbon dioxide elimination
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and
helping the client relax, pursed-lip breathing helps the client learn to control the
rate and depth of respiration. Pursed-lip breathing does not promote the intake
of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.
20. Answer: 1. Maintaining functional ability
A priority goal for the client with COPD is to manage the s/s of the disease
process so as to maintain the clients functional ability. Chest pain is not a
typical sign of COPD. The carbon dioxide concentration in the blood is increased
to an abnormal level in clients with COPD; it would not be a goal to increase the
level further. Preventing infection would be a goal of care for the client with
COPD.
21. Answer: 2. Flushed skin
The high PaCO2 level causes flushing due to vasodilation. The client also
becomes drowsy and lethargic because carbon dioxide has a depressant effect
on the CNS. Cyanosis is a late sign of hypoxia. Irritability and anxiety are not
common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.
22. Answer: 2. While exhaling through pursed lips
Exhaling requires less energy than inhaling. Therefore, lifting while exhaling
saves energy and reduced perceived dyspnea. Pursing the lips
prolongs exhalation and provides the client with more control over breathing.
Lifting after exhalation but before inhaling is similar to lifting with the breath
held. This should not be recommended because it is similar to the Valsalva
maneuver, which can stimulate cardiac dysrhythmias.
23. Answer: 3. Peripheral edema
Right-sided heart failure is a complication of COPD that occurs because of

pulmonary hypertension. Signs and symptoms of right-sided heart
failure include peripheral edema, jugular venous distention, hepatomegaly, and
weight gain due to increased fluid volume. Clubbing of nail beds is associated
with conditions of chronic hypoxia. Hypertension is associated with left-
sided heart failure. Clients with heart failure have decreased appetites.
24. Answer: 4. Coarse crackles and rhonchi
Exacerbations of COPD are frequently caused by respiratory infections. Coarse

crackles and rhonchi would be auscultated as air moves through airways
obstructed with secretions. In COPD, breath sounds are diminished because of
an enlarged anteroposterior diameter of the chest. Expiration, not inspiration,
becomes prolonged. Chest movement is decreased as lungs become
overdistended.
25. Answer: 1. Increased PaCO2
As COPD progresses, the client typically develops increased PaCO2 levels and
decreased PaO2 levels. This results in decreased pH and decreased oxygen
saturation. These changes are the result of air trapping and hypoventilation.
26. Answer: 4. High-calorie, high-protein diet
The client should eat high-calorie, high-protein meals to maintain nutritional

status and prevent weight loss that results from the increased work of
breathing. The client should be encouraged to eat small, frequent meals. A low-
fat, low-cholesterol diet is indicated for clients with coronary artery disease. The
client with COPD does not necessarily need to follow a sodium-restricted diet,
unless otherwise medically indicated.
27. Answer: 1. Take a deep abdominal breath, bend forward, and cough
3 to 4 times on exhalation.
The goal of effective coughing is to conserve energy, facilitate removal of

secretions, and minimize airway collapse. The client should assume a sitting
position with feet on the floor if possible. The client should bend forward slightly
and, using pursed-lip breathing, exhale. After resuming an upright position, the
client should use abdominal breathing to slowly and deeply inhale. After
repeating this process 3 or 4 times, the client should take a deep abdominal
breath, bend forward and cough 3 or 4 times upon exhalation (huff cough).
Lying flat does not enhance lung expansion; sitting upright promotes full
expansion of the thorax. Shallow breathing does not facilitate removal of
secretions, and forceful coughing promotes collapse of airways. A side-lying
position does not allow for adequate chest expansion to promote deep
breathing.
28. Answer: 4. Administer bronchodilators
In an acute asthma attack, diminished or absent breath sounds can be an

ominous sign of indicating lack of air movement in the lungs and impending
respiratory failure. The client requires immediate intervention with inhaled
bronchodilators, intravenous corticosteroids, and possibly intravenous
theophylline. Administering oxygen and reassessing the client 10 minutes later
would delay needed medical intervention, as would drawing an ABG and
obtaining a chest x-ray. It would be futile to encourage the client to relax and
breathe slowly without providing necessary pharmacologic intervention.
29. Answer: 2. Increased PaCO2, decreased PaO2, and decreased pH.
As the severe asthma attack worsens, the client becomes fatigued and
alveolar hypotension develops. This leads to carbon dioxide retention and
hypoxemia. The client develops respiratory acidosis. Therefore, the PaCO2 level
increase, the PaO2 level decreases, and the pH decreases, indicating acidosis.
30. Answer: 3. Corticosteroids have an anti-inflammatory effect
Corticosteroids have an anti-inflammatory effect and act to decrease edema in

the bronchial airways and decrease mucus secretion. Corticosteroids do not
have a bronchodilator effect, act as expectorants, or prevent respiratory
infections.
31. Answer: 1 and 4.
32. Answer: 1. Irregular heartbeat
Irregular heart rates should be reported promptly to the care provider.

Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain
because of its adrenergic effect on the beta-adrenergic receptors in the heart. It
is not recommended for use in clients with known cardiac disorders.
Metaproterenol does not cause constipation, petal edema, or bradycardia.
33. Answer: 3. You have developed a fungal infection from your

medication. It will need to be treated with an antibiotic.
Use of oral inhalant corticosteroids, such as flunisolide, can lead to the

development of oral thrush, a fungal infection. Once developed, thrush must be
treated by antibiotic therapy; it will not resolve on its own. Fungal infections can
develop even without overuse of the Corticosteroid inhaler. Although good oral
hygiene can help prevent the development of a fungal infection, it cannot be
used alone to treat the problem.
34. Answer: 1. Incorporate physical exercise as tolerated into the

treatment plan.
Physical exercise is beneficial and should be incorporated as tolerated into the

clients schedule. Peak flow numbers should be monitored daily, usually in the
morning (before taking medication). Peak flow does not need to be monitored
after each meal. Stressors in the clients life should be modified but cannot be
totally eliminated. Although adequate sleep is important, it is not recommended
that sedatives be routinely taken to induce sleep.
35. Answer: 2. Viral respiratory infections
The most common precipitator of asthma attacks is viral respiratory infection.

Clients with asthma should avoid people who have the flu or a cold and should
get yearly flu vaccinations. Environmental exposure to toxins or heavy
particulate matter can trigger asthma attacks; however, far fewer asthmatics
are exposed to such toxins than are exposed to viruses. Cigarette smoke can
also trigger asthma attacks, but to a lesser extent than viral respiratory
infections. Some asthmatic attacks are triggered by exercising in cold weather.
36. Answer: 2. Place the client on oxygen
The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are
involved. The client should immediately be placed on oxygen via mask so that
the SaO2 is brought up to 95%. Encourage slow, regular breathing to decrease
the amount of CO2 she is losing. This client may have pulmonary embolism, so
she should be monitored for this condition (4), but it is not the first
intervention. Sodium bicarbonate (3) would be given to reverse acidosis;
mechanical ventilation (1) may be ordered for acute respiratory acidosis.
37. Answer: 1. Caused by the sudden opening of alveoli
Basilar crackles are usually heard during inspiration and are caused by sudden
opening of the alveoli.
38. Answer: 3. Administer oxygen at 2 L flow per minute.
Administer oxygen at 2 L/minute and no more, for if the client if emphysemic

and receives too high a level of oxygen, he will develop CO2 narcosis and
the respiratory system will cease to function.
39. Answer: 3. Increased pulse and pallor
Increased pulse and pallor are symptoms associated with shock. A compromised
venous return may occur if there is a mediastinal shift as a result of excessive
fluid removal. Usually, no more than 1 L of fluid is removed at one time to
prevent this from occurring.
Respiratory acidosis represents an increase in the acid component, carbon

dioxide, and an increase in the hydrogen ion concentration (decreased pH) of
the arterial blood.
41. Answer: 2. A build-up of carbon dioxide
The arrhythmias are caused by a build-up of carbon dioxide and not enough
oxygen so that the heart is in a constant state of hypoxia.
42. Answer: 1. Repeat auscultation after asking the client to deep

breathe and cough.
Although crackles often indicate fluid in the alveoli, they may also be related to
hypoventilation and will clear after a deep breath or a cough. It is, therefore,
premature to impose fluid (2) or activity (4) restrictions (which Margaret would
totally do if Dani werent there to smack her). Inspection for edema (3) would
be appropriate after re-auscultation.
43. Answer: 3. Listen and feel the air movement.
To check for breathing, the nurse places her ear and cheek next to the clients
mouth and nose to listen and feel for air movement. The chest rising and falling
(1) is not conclusive of a patent airway. Observing skin color (2) is not an
accurate assessment of respiratory status, nor is checking the femoral pulse.
44. Answer: 2. Impaired tissue perfusion related to thrombosis
Chronic hypoxia associated with COPD may stimulate excessive RBC production
(polycythemia). This results in increased blood viscosity and the risk of
thrombosis. The other nursing diagnoses are not applicable in this situation.
45. Answer: 2. Operative side or back
Positioning the client on the operative side facilitates the accumulation of

serosanguineous fluid. The fluid forms a solid mass, which prevents the
remaining lung from being drawn into the space.
46. Answer: 2. Dyspnea and pain
Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation.

Clients become short of breath, have a high temperature, and usually
experience severe pain but do not have a severe cough (4). The shortness of
breath is a result of decreased oxygen-carbon dioxide exchange at the alveolar
level.
47. Answer: 3. Apply oral or nasal suction
Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction
to the airway to prevent secretions from falling into the lung. Dressing change
(1) and humidity (2) do not relate to suctioning.
48. Answer: 2. Exhaled after there is a normal inspiration
Tidal volume (TV) is defined as the amount of air exhaled after a normal
inspiration.
49. Answer: 3. A decreasing oxygen pressure and/or an increasing

carbon dioxide pressure in the blood.
The lower the PO2 and the higher the PCO2, the more rapidly oxygen
dissociated from the oxyhemoglobin molecule.
50. Answer: 4. Venturi mask
Venturi delivers controlled oxygen.
Pneumonia and Tuberculosis

1. Clients with chronic illnesses are more likely to get pneumonia when
which of the following situations is present?
1. Dehydration
2. Group living
3. Malnutrition
4. Severe periodontal disease
2. Which of the following pathophysiological mechanisms that occurs in

the lung parenchyma allows pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation
3. Which of the following organisms most commonly causes

community-acquired pneumonia in adults?
1. Haemiphilus influenzae
2. Klebsiella pneumoniae
3. Streptococcus pneumoniae
4. Staphylococcus aureus
4. An elderly client with pneumonia may appear with which of the

following symptoms first?
1. Altered mental status and dehydration

2. Fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough
5. When auscultating the chest of a client with pneumonia, the nurse

would expect to hear which of the following sounds over areas of
consolidation?
1. Bronchial
2. Bronchovesicular
3. Tubular
4. Vesicular
6. A diagnosis of pneumonia is typically achieved by which of the

following diagnostic tests?
1. ABG analysis
2. Chest x-ray
3. Blood cultures
4. sputum culture and sensitivity
7. A client with pneumonia develops dyspnea with a respiratory rate of

32 breaths/minute and difficulty expelling his secretions. The nurse
auscultates his lung fields and hears bronchial sounds in the left lower
lobe. The nurse determines that the client requires which of the
following treatments first?
1. Antibiotics
2. Bed rest
3. Oxygen
4. Nutritional intake
8. A client has been treated with antibiotic therapy for right lower-
lobe pneumonia for 10 days and will be discharged today. Which of the
following physical findings would lead the nurse to believe it is
appropriate to discharge this client?
1. Continued dyspnea
2. Fever of 102*F
3. Respiratory rate of 32 breaths/minute
4. Vesicular breath sounds in right base
9. The right forearm of a client who had a purified protein derivative

(PPD) test for tuberculosis is reddened and raised about 3mm where
the test was given. This PPD would be read as having which of the
following results?
1. Indeterminate
2. Needs to be redone
3. Negative
4. Positive
10. A client with primary TB infection can expect to develop which of

the following conditions?
1. Active TB within 2 weeks

2. Active TB within 1 month
3. A fever that requires hospitalization
4. A positive skin test
11. A client was infected with TB 10 years ago but never developed the
disease. Hes now being treated for cancer. The client begins to develop
signs of TB. This is known as which of the following types of infection?
1. Active infection
2. Primary infection
3. Superinfection
4. Tertiary infection
12. A client has active TB. Which of the following symptoms will he
exhibit?
1. Chest and lower back pain

2. Chills, fever, night sweats, and hemoptysis
3. Fever of more than 104*F and nausea
4. Headache and photophobia
13. Which of the following diagnostic tests is definitive for TB?
1. Chest x-ray
2. Mantoux test
3. Sputum culture
4. Tuberculin test
14. A client with a positive Mantoux test result will be sent for a chest
x-ray. For which of the following reasons is this done?
1. To confirm the diagnosis

2. To determine if a repeat skin test is needed
3. To determine the extent of the lesions
4. To determine if this is a primary or secondary infection
15. A chest x-ray should a clients lungs to be clear. His Mantoux test is
positive, with a 10mm if induration. His previous test was negative.
These test results are possible because:
1. He had TB in the past and no longer has it.

2. He was successfully treated for TB, but skin tests always stay positive.
3. Hes a seroconverter, meaning the TB has gotten to his bloodstream.
4. Hes a tuberculin converter, which means he has been infected with TB since
his last skin test.
16. A client with a positive skin test for TB isnt showing signs of active
disease. To help prevent the development of active TB, the client should
be treated with isoniazid, 300 mg daily, for how long?
1. 10 to 14 days
2. 2 to 4 weeks
3. 3 to 6 months
4. 9 to 12 months
17. A client with a productive cough, chills, and night sweats is

suspected of having active TB. The physician should take which of the
following actions?
1. Admit him to the hospital in respiratory isolation
2. Prescribe isoniazid and tell him to go home and rest
3. Give a tuberculin test and tell him to come back in 48 hours and have it read.
4. Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him
home.
18. A client is diagnosed with active TB and started on

triple antibiotic therapy. What signs and symptoms would the client
show if therapy is inadequate?
1. Decreased shortness of breath

2. Improved chest x-ray
3. Nonproductive cough
4. Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
19. A client diagnosed with active TB would be hospitalized primarily

for which of the following reasons?
1. To evaluate his condition

2. To determine his compliance
3. To prevent spread of the disease
4. To determine the need for antibiotic therapy.
20. A high level of oxygen exerts which of the following effects on the
lung?
1. Improves oxygen uptake

2. Increases carbon dioxide levels
3. Stabilizes carbon dioxide levels
4. Reduces amount of functional alveolar surface area
21. A 24-year-old client comes into the clinic complaining of right-sided
chest pain and shortness of breath. He reports that it started suddenly.
The assessment should include which of the following interventions?
1. Auscultation of breath sounds

2. Chest x-ray
3. Echocardiogram
4. Electrocardiogram (ECG)
22. A client with shortness of breath has decreased to absent breath

sounds on the right side, from the apex to the base. Which of the
following conditions would best explain this?
1. Acute asthma
2. Chronic bronchitis
3. Pneumonia
4. Spontaneous pneumothorax
23. Which of the following treatments would the nurse expect for a
client with a spontaneous pneumothorax?
1. Antibiotics
2. Bronchodilators
3. Chest tube placement
4. Hyperbaric chamber
24. Which of the following methods is the best way to confirm the
diagnosis of a pneumothorax?
1. Auscultate breath sounds

2. Have the client use an incentive spirometer
3. Take a chest x-ray
4. stick a needle in the area of decreased breath sounds
25. A pulse oximetry gives what type of information about the client?
1. Amount of carbon dioxide in the blood

2. Amount of oxygen in the blood
3. Percentage of hemoglobin carrying oxygen
4. Respiratory rate
26. What effect does hemoglobin amount have on oxygenation status?
1. No effect
2. More hemoglobin reduces the clients respiratory rate
3. Low hemoglobin levels cause reduces oxygen-carrying capacity
4. Low hemoglobin levels cause increased oxygen-carrying capacity.
27. Which of the following statements best explains how opening up

collapsed alveoli improves oxygenation?
1. Alveoli need oxygen to live

2. Alveoli have no effect on oxygenation
3. Collapsed alveoli increase oxygen demand
4. Gaseous exchange occurs in the alveolar membrane.
28. Continuous positive airway pressure (CPAP) can be provided

through an oxygen mask to improve oxygenation in hypoxic patients by
which of the following methods?
1. The mask provides 100% oxygen to the client.

2. The mask provides continuous air that the client can breathe.
3. The mask provides pressurized oxygen so the client can breathe more easily.
4. The mask provides pressurized at the end of expiration to open collapsed
alveoli.
29. Which of the following best describes pleural effusion?

1. The collapse of alveoli
2. The collapse of bronchiole
3. The fluid in the alveolar space
4. The accumulation of fluid between the linings of the pleural space.
30. If a pleural effusion develops, which of the following actions best

describes how the fluid can be removed from the pleural space and
proper lung status restored?
1. Inserting a chest tube

2. Performing thoracentesis
3. Performing paracentesis
4. Allowing the pleural effusion to drain by itself.
31. A comatose client needs a nasopharyngeal airway for suctioning.

After the airway is inserted, he gags and coughs. Which action should
the nurse take?
1. Remove the airway and insert a shorter one.

2. Reposition the airway.
3. Leave the airway in place until the client gets used to it.
4. Remove the airway and attempt suctioning without it.
32. An 87-year-old client requires long-term ventilator therapy. He has

a tracheostomy in place and requires frequent suctioning. Which of the
following techniques is correct?
1. Using intermittent suction while advancing the catheter.

2. Using continuous suction while withdrawing the catheter.
3. Using intermittent suction while withdrawing the catheter.
4. Using continuous suction while advancing the catheter.
33. A clients ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg,
PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these values
indicate?
34. A police officer brings in a homeless client to the ER. A chest x-ray
suggests he has TB. The physician orders an intradermal injection of 5
tuberculin units/0.1 ml of tuberculin purified derivative. Which needle
is appropriate for this injection?
1. 5/8 to 25G to 27G needle.

2. 1 to 3 20G to 25G needle.
3. to 3/8 26 or 27G needle.
4. 1 20G needle.
35. A 76-year old client is admitted for elective knee surgery. Physical
examination reveals shallow respirations but no signs of respiratory
distress. Which of the following is a normal physiologic change related
to aging?
1. Increased elastic recoil of the lungs

2. Increased number of functional capillaries in the alveoli
3. Decreased residual volume
4. Decreased vital capacity.
36. A 79-year-old client is admitted with pneumonia. Which nursing

diagnosis should take priority?
1. Acute pain related to lung expansion secondary to lung infection
2. Risk for imbalanced fluid volume related to increased insensible fluid losses
secondary to fever.
3. Anxiety related to dyspnea and chest pain.
4. Ineffective airway clearance related to retained secretions.
37. A community health nurse is conducting an educational session

with community members regarding TB. The nurse tells the group that
one of the first symptoms associated with TB is:
1. A bloody, productive cough

2. A cough with the expectoration of mucoid sputum
3. Chest pain
4. Dyspnea
38. A nurse evaluates the blood theophylline level of a client receiving

aminophylline (theophylline) by intravenous infusion. The nurse would
determine that a therapeutic blood level exists if which of the following
were noted in the laboratory report?
1. 5 mcg/mL
2. 15 mcg/mL
3. 25 mcg/mL
4. 30 mcg/mL
39. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a
client with TB. A nurse reviews the medical record of the client. Which
of the following, if noted in the clients history, would require physician
notification?
1. Heart disease
2. Allergy to penicillin
3. Hepatitis B
4. Rheumatic fever
40. A client is experiencing confusion and tremors is admitted to a

nursing unit. An initial ABG report indicates that the PaCO2 level is 72
mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that
the client is most likely experiencing:
1. Carbon monoxide poisoning

2. Carbon dioxide narcosis
41. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-
mm area of induration at the site of the skin test. The nurse interprets
the results as:
1. Positive
2. Negative
3. Inconclusive
4. The need for repeat testing.
42. A nurse is caring for a client diagnosed with TB. Which assessment,
if made by the nurse, would not be consistent with the usual clinical
presentation of TB and may indicate the development of a concurrent
problem?
1. Nonproductive or productive cough

2. Anorexia and weight loss
3. Chills and night sweats
4. High-grade fever
43. A nurse is teaching a client with TB about dietary elements that
should be increased in the diet. The nurse suggests that the client
increase intake of:
1. Meats and citrus fruits

2. Grains and broccoli
3. Eggs and spinach
4. Potatoes and fish
44. Which of the following would be priority assessment data to gather

from a client who has been diagnosed with pneumonia? Select all that
apply.
1. Auscultation of breath sounds

2. Auscultation of bowel sounds
3. Presence of chest pain.
4. Presence of peripheral edema
5. Color of nail beds
45. A client with pneumonia has a temperature of 102.6*F (39.2*C), is

diaphoretic, and has a productive cough. The nurse should include
which of the following measures in the plan of care?
1. Position changes q4h

2. Nasotracheal suctioning to clear secretions
3. Frequent linen changes
4. Frequent offering of a bedpan.
46. The cyanosis that accompanies bacterial pneumonia is primarily

caused by which of the following?
1. Decreased cardiac output

2. Pleural effusion
3. Inadequate peripheral circulation
4. Decreased oxygenation of the blood.
47. Which of the following mental status changes may occur when a
client with pneumonia is first experiencing hypoxia?
1. Coma
2. Apathy
3. Irritability
4. Depression
48. A client with pneumonia has a temperature ranging between 101*

and 102*F and periods of diaphoresis. Based on this information, which
of the following nursing interventions would be a priority?
1. Maintain complete bedrest

2. Administer oxygen therapy
3. Provide frequent linen changes.
4. Provide fluid intake of 3 L/day
49. Which of the following would be an appropriate expected outcome

for an elderly client recovering from bacterial pneumonia?
1. A respiratory rate of 25 to 30 breaths per minute

2. The ability to perform ADLs without dyspnea
3. A maximum loss of 5 to 10 pounds of body weight
4. Chest pain that is minimized by splinting the ribcage.
50. Which of the following symptoms is common in clients with TB?
1. Weight loss
2. Increased appetite
3. Dyspnea on exertion
4. Mental status changes
51. The nurse obtains a sputum specimen from a client with suspected
TB for laboratory study. Which of the following laboratory techniques is
most commonly used to identify tubercle bacilli in sputum?
1. Acid-fast staining
2. Sensitivity testing
3. Agglutination testing
4. Dark-field illumination
52. Which of the following antituberculous drugs can cause damage to

the eighth cranial nerve?
1. Streptomycin
2. Isoniazid
3. Para-aminosalicylic acid
4. Ethambutol hydrochloride
53. The client experiencing eighth cranial nerve damage will most
likely report which of the following symptoms?
1. Vertigo
2. Facial paralysis
3. Impaired vision
4. Difficulty swallowing
54. Which of the following family members exposed to TB would be at

highest risk for contracting the disease?
1. 45-year-old mother
2. 17-year-old daughter
3. 8-year-old son
4. 76-year-old grandmother
55. The nurse is teaching a client who has been diagnosed with TB how
to avoid spreading the disease to family members. Which statement(s)
by the client indicate(s) that he has understood the nurses
instructions? Select all that apply.
1. I will need to dispose of my old clothing when I return home.

2. I should always cover my mouth and nose when sneezing.
3. It is important that I isolate myself from family when possible.
4. I should use paper tissues to cough in and dispose of them properly.
5. I can use regular plate and utensils whenever I eat.
56. A client has a positive reaction to the PPD test. The nurse correctly
interprets this reaction to mean that the client has:
1. Active TB
2. Had contact with Mycobacterium tuberculosis
3. Developed a resistance to tubercle bacilli
4. Developed passive immunity to TB.
57. INH treatment is associated with the development of peripheral

neuropathies. Which of the following interventions would the nurse
teach the client to help prevent this complication?
1. Adhere to a low cholesterol diet

2. Supplement the diet with pyridoxine (vitamin B6)
3. Get extra rest
4. Avoid excessive sun exposure.
58. The nurse should include which of the following instructions when
developing a teaching plan for clients receiving INH and rifampin for
treatment for TB?
1. Take the medication with antacids

2. Double the dosage if a drug dose is forgotten
3. Increase intake of dairy products
4. Limit alcohol intake
59. The public health nurse is providing follow-up care to a client with
TB who does not regularly take his medication. Which nursing action
would be most appropriate for this client?
1. Ask the clients spouse to supervise the daily administration of the

medications.
2. Visit the clinic weekly to ask him whether he is taking his medications
regularly.
3. Notify the physician of the clients non-compliance and request a different
prescription.
4. Remind the client that TB can be fatal if not taken properly.
60. The Causative agent of Tuberculosis is said to be:
1. Mycobacterium Tuberculosis
2. Hansens Bacilli
3. Bacillus Anthracis
4. Group A Beta Hemolytic Streptococcus
1. Answer: 2. Group living

Clients with chronic illnesses generally have poor immune systems. Often,
residing in group living situations increases the chance of disease transmission.
2. Answer: 4. Inflammation
The common feature of all type of pneumonia is an inflammatory pulmonary

response to the offending organism or agent. Atelectasis and bronchiectasis
indicate a collapse of a portion of the airway that doesnt occur in pneumonia.
An effusion is an accumulation of excess pleural fluid in the pleural space, which
may be a secondary response to pneumonia.
3. Answer: 3. Streptococcus pneumoniae
Pneumococcal or streptococcal pneumonia, caused by streptococcus

pneumoniae, is the most common cause of community-acquired pneumonia. H.
influenzae is the most common cause of infection in children. Klebsiella species
is the most common gram-negative organism found in the hospital setting.
Staphylococcus aureus is the most common cause of hospital-acquired
pneumonia.
4. Answer: 1. Altered mental status and dehydration
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common
symptoms of pneumonia, but elderly clients may first appear with only an
altered mental status and dehydration due to a blunted immune response.
5. Answer: 1. Bronchial
Chest auscultation reveals bronchial breath sounds over areas of consolidation.

Bronchovesicular are normal over midlobe lung regions, tubular sounds are
commonly heard over large airways, and vesicular breath sounds are commonly
heard in the bases of the lung fields.
6. Answer: 4. sputum culture and sensitivity
Sputum C & S is the best way to identify the organism causing the pneumonia.
Chest x-ray will show the area of lung consolidation. ABG analysis will
determine the extent of hypoxia present due to the pneumonia, and blood
cultures will help determine if the infection is systemic.
7. Answer: 3. Oxygen
The client is having difficulty breathing and is probably becoming hypoxic. As an

emergency measure, the nurse can provide oxygen without waiting for a
physicians order. Antibiotics may be warranted, but this isnt a nursing decision.
The client should be maintained on bedrest if he is dyspneic to minimize his
oxygen demands, but providing additional will deal more immediately with his
problem. The client will need nutritional support, but while dyspneic, he may be
unable to spare the energy needed to eat and at the same time maintain
adequate oxygenation.
8. Answer: 4. Vesicular breath sounds in right base
If the client still has pneumonia, the breath sounds in the right base will be
bronchial, not the normal vesicular breath sounds. If the client still has
dyspnea, fever, and increased respiratory rate, he should be examined by the
physician before discharge because he may have another source of infection or
still have pneumonia.
9. Answer: 3. Negative
This test would be classed as negative. A 5 mm raised area would be a positive

result if a client was HIV+ or had recent close contact with someone diagnosed
with TB. Indeterminate isnt a term used to describe results of a PPD test. If the
PPD is reddened and raised 10mm or more, its considered positive according to
the CDC.
10. Answer: 4. A positive skin test
A primary TB infection occurs when the bacillus has successfully invaded the
entire body after entering through the lungs. At this point, the bacilli are walled
off and skin tests read positive. However, all but infants and immunosuppressed
people will remain asymptomatic. The general population has a 10% risk of
developing active TB over their lifetime, in many cases because of a break in
the bodys immune defenses. The active stage shows the classic symptoms of
TB: fever, hemoptysis, and night sweats.
11. Answer: 1. Active infection
Some people carry dormant TB infections that may develop into active disease.
In addition, primary sites of infection containing TB bacilli may remain inactive
for years and then activate when the clients resistance is lowered, as when a
client is being treated for cancer. Theres no such thing as tertiary infection, and
superinfection doesnt apply in this case.
12. Answer: 2. Chills, fever, night sweats, and hemoptysis
Typical signs and symptoms are chills, fever, night sweats, and
hemoptysis. Chest pain may be present from coughing, but isnt usual. Clients
with TB typically have low-grade fevers, not higher than 102*F. Nausea,
headache, and photophobia arent usual TB symptoms.
13. Answer: 3. Sputum culture
The sputum culture for Mycobacterium tuberculosis is the only method of

confirming the diagnosis. Lesions in the lung may not be big enough to be seen
on x-ray. Skin tests may be falsely positive or falsely negative.
14. Answer: 3. To determine the extent of the lesions

If the lesions are large enough, the chest x-ray will show their presence in
the lungs. Sputum culture confirms the diagnosis. There can be false-positive
and false-negative skin test results. A chest x-ray cant determine if this is a
primary or secondary infection.
15. Answer: 4. Hes a tuberculin converter, which means he has been

infected with TB since his last skin test.
A tuberculin converters skin test will be positive, meaning he has been exposed
to an infected with TB and now has a cell-mediated immune response to the
skin test. The clients blood and x-ray results may stay negative. It doesnt
mean the infection has advanced to the active stage. Because his x-ray is
negative, he should be monitored every 6 months to see if he develops changes
in his x-ray or pulmonary examination. Being a seroconverter doesnt mean the
TB has gotten into his bloodstream; it means it can be detected by a blood test.
16. Answer: 4. 9 to 12 months
Because of the increased incidence of resistant strains of TB, the disease must
be treated for up to 24 months in some cases, but treatment typically lasts for
9-12 months. Isoniazid is the most common medication used for the treatment
of TB, but other antibiotics are added to the regimen to obtain the best results.
17. Answer: 1. Admit him to the hospital in respiratory isolation
The client is showing s/s of active TB and because of a productive cough is

highly contagious. He should be admitted to the hospital, placed in respiratory
isolation, and three sputum cultures should be obtained to confirm the
diagnosis. He would most likely be given isoniazid and two or three other
antitubercular antibiotics until the diagnosis is confirmed, then isolation and
treatment would continue if the cultures were positive for TB. After 7 to 10
days, three more consecutive sputum cultures will be obtained. If theyre
negative, he would be considered non-contagious and may be sent home,
although hell continue to take the antitubercular drugs for 9 to 12 months.
18. Answer: 4. Positive acid-fast bacilli in a sputum sample after 2

months of treatment.
Continuing to have acid-fast bacilli in the sputum after 2 months indicated

continued infection.
19. Answer: 3. To prevent spread of the disease
The client with active TB is highly contagious until three consecutive sputum
cultures are negative, so hes put in respiratory isolation in the hospital.
20. Answer: 4. Reduces amount of functional alveolar surface area
Oxygen toxicity causes direct pulmonary trauma, reducing the amount of

alveolar surface area available for gaseous exchange, which results in increased
carbon dioxide levels and decreased oxygen uptake.
21. Answer: 1. Auscultation of breath sounds
Because the client is short of breath, listening to breath sounds is a good idea.
He may need a chest x-ray and an ECG, but a physician must order these tests.
Unless a cardiac source for the clients pain is identified, he wont need an
echocardiogram.
22. Answer: 4. Spontaneous pneumothorax
A spontaneous pneumothorax occurs when the clients lung collapses, causing

an acute decrease in the amount of functional lung used in oxygenation. The
sudden collapse was the cause of his chest pain and shortness of breath.
An asthma attack would show wheezing breath sounds, and bronchitis would
have rhonchi. Pneumonia would have bronchial breath sounds over the area of
consolidation.
23. Answer: 3. Chest tube placement
The only way to re-expand the lung is to place a chest tube on the right side so
the air in the pleural space can be removed and the lung re-expanded.
24. Answer: 3. Take a chest x-ray
A chest x-ray will show the area of collapsed lung if pneumothorax is present as
well as the volume of air in the pleural space. Listening to breath sounds wont
confirm a diagnosis. An IS is used to encourage deep breathing. A needle
thoracostomy is done only in an emergency and only by someone trained to do
it.
25. Answer: 3. Percentage of hemoglobin carrying oxygen
The pulse oximeter determines the percentage of hemoglobin carrying oxygen.

This doesnt ensure that the oxygen being carried through the bloodstream is
actually being taken up by the tissue.
26. Answer: 3. Low hemoglobin levels cause reduces oxygen-carrying

capacity
Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is
low, the amount of oxygen-carrying capacity is also low. More hemoglobin will
increase oxygen-carrying capacity and thus increase the total amount of oxygen
available in the blood. If the client has been tachypneic during exertion, or even
at rest, because oxygen demand is higher than the available oxygen content,
then an increase in hemoglobin may decrease the respiratory rate to normal
levels.
27. Answer: 4. Gaseous exchange occurs in the alveolar membrane.
Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse,

no exchange occurs, Collapsed alveoli receive oxygen, as well as other
nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen
demand, though by decreasing the surface area available for gas exchange,
they decrease oxygenation of the blood.
28. Answer: 3. The mask provides pressurized oxygen so the client can
breathe more easily.
The mask provides pressurized oxygen continuously through both inspiration

and expiration. The mask can be set to deliver any amount of oxygen needed.
By providing the client with pressurized oxygen, the client has less resistance to
overcome in taking his next breath, making it easier to breathe. Pressurized
oxygen delivered at the end of expiration is positive end-expiratory pressure
(PEEP), not continuous positive airway pressure.
29. Answer: 4. The accumulation of fluid between the linings of the

pleural space.
The pleural fluid normally seeps continually into the pleural space from the
capillaries lining the parietal pleura and is reabsorbed by the visceral pleural
capillaries and lymphatics. Any condition that interferes with either the secretion
or drainage of this fluid will lead to a pleural effusion.
30. Answer: 2. Performing thoracentesis
Performing thoracentesis is used to remove excess pleural fluid. The fluid is then
analyzed to determine if its transudative or exudative. Transudates are
substances that have passed through a membrane and usually occur in low
protein states. Exudates are substances that have escaped from blood vessels.
They contain an accumulation of cells and have a high specific gravity and a
high lactate dehydrogenase level. Exudates usually occur in response to a
malignancy, infection, or inflammatory process. A chest tube is rarely necessary
because the amount of fluid typically isnt large enough to warrant such a
measure. Pleural effusions cant drain by themselves.
31. Answer: 1. Remove the airway and insert a shorter one.
If a client gags or coughs after nasopharyngeal airway placement, the tube may
be too long. The nurse should remove it and insert a shorter one. Simply
repositioning the airway wont solve the problem. The client wont get used to
the tube because its the wrong size. Suctioning without a nasopharyngeal
airway causes trauma to the natural airway.
32. Answer: 3. Using intermittent suction while withdrawing the

catheter.
Intermittent suction should be applied during catheter withdrawal. To prevent

hypoxia, suctioning shouldnt last more than 10-seconds at a time. Suction
shouldnt be applied while the catheter is being advanced.
34. Answer: 3. to 3/8 26 or 27G needle.
Intradermal injections like those used in TN skin tests are administered in small
volumes (usually 0.5 ml or less) into the outer skin layers to produce a local
effect. A TB syringe with a to 3/8 26G or 27G needle should be inserted
about 1/8 below the epidermis.
35. Answer: 4. Decreased vital capacity.

Reduction in VC is a normal physiologic change in the older adult. Other normal
physiologic changes include decreased elastic recoil of the lungs, fewer
functional capillaries in the alveoli, and an increase is residual volume.
36. Answer: 4. Ineffective airway clearance related to retained

secretions.
Pneumonia is an acute infection of the lung parenchyma. The inflammatory

reaction may cause an outpouring of exudate into the alveolar spaces, leading
to an ineffective airway clearance related to retained secretions.
37. Answer: 2. A cough with the expectoration of mucoid sputum
One of the first pulmonary symptoms includes a slight cough with the
expectoration of mucoid sputum.
38. Answer: 2. 15 mcg/mL
The therapeutic theophylline blood level range from 10-20 mcg/mL.
39. Answer: 3. Hepatitis B
Isoniazid and rifampin are contraindicated in clients with acute liver disease or a
history of hepatic injury.
40. Answer: 2. Carbon dioxide narcosis
Carbon dioxide narcosis is a condition that results from extreme hypercapnia,

with carbon dioxide levels in excess of 70 mm Hg. The client experiences
symptoms such as confusion and tremors, which may progress to convulsions
and possible coma.
41. Answer: 1. Positive

The client with HIV+ status is considered to have positive results on PPD skin
test with an area greater than 5-mm of induration. The client with HIV is
immunosuppressed, making a smaller area of induration positive for this type of
client.
42. Answer: 4. High-grade fever
The client with TB usually experiences cough (non-productive or

productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest
discomfort or pain, chills and sweats (which may occur at night), and a low-
grade fever.
43. Answer: 1. Meats and citrus fruits
The nurse teaches the client with TB to increase intake of protein, iron, and
vitamin C.
44. Answer: 1, 3, 5.
A respiratory assessment, which includes auscultating breath sounds and

assessing the color of the nail beds, is a priority for clients with pneumonia.
Assessing for the presence of chest pain is also an important respiratory
assessment as chest pain can interfere with the clients ability to breathe
deeply. Auscultating bowel sounds and assessing for peripheral edema may be
appropriate assessments, but these are not priority assessments for the patient
with pneumonia.
45. Answer: 3. Frequent linen changes
Frequent linen changes are appropriate for this client because of diaphoresis.
Diaphoresis produces general discomfort. The client should be kept dry to
promote comfort. Position changes need to be done every 2 hours. Nasotracheal
suctioning is not indicated with the clients productive cough. Frequent offering
of a bedpan is not indicated by the data provided in this scenario.
46. Answer: 4. Decreased oxygenation of the blood.
A client with pneumonia has less lung surface available for the diffusion of gases
because of the inflammatory pulmonary response that creates lung exudate and
results in reduced oxygenation of the blood. The client becomes cyanotic
because blood is not adequately oxygenated in the lungs before it enters the
peripheral circulation.
47. Answer: 3. Irritability
Clients who are experiencing hypoxia characteristically exhibit irritability,

restlessness, or anxiety as initial mental status changes. As the hypoxia
becomes more pronounced, the client may become confused and combative.
Coma is a late clinical manifestation of hypoxia. Apathy and depression are not
symptoms of hypoxia.
48. Answer: 4. Provide fluid intake of 3 L/day
A fluid intake of at least 3 L/day should be provided to replace any fluid loss
occurring as a result the fever and diaphoresis; this is a high-priority
intervention.
49. Answer: 2. The ability to perform ADLs without dyspnea
An expected outcome for a client recovering from pneumonia would be the

ability to perform ADLs without experiencing dyspnea. A respiratory rate of 25
to 30 breaths/minute indicates the client is experiencing tachypnea, which
would not be expected on recovery. A weight loss of 5-10 pounds is
undesirable; the expected outcome would be to maintain normal weight. A
client who is recovering from pneumonia should experience decreased or no
chest pain.
50. Answer: 1. Weight loss
TB typically produces anorexia and weight loss. Other signs and symptoms may
include fatigue, low-grade fever, and night sweats.
51. Answer: 1. Acid-fast staining
The most commonly used technique to identify tubercle bacilli is acid-fast

staining. The bacilli have a waxy surface, which makes them difficult to stain in
the lab. However, once they are stained, the stain is resistant to removal, even
with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
52. Answer: 1. Streptomycin
Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity)

is a common side effect from aminoglycosides.
53. Answer: 1. Vertigo
The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for
hearing and equilibrium. Streptomycin can damage this nerve.
54. Answer: 4. 76-year-old grandmother
Elderly persons are believed to be at higher risk for contracting TB because of

decreased immunocompetence. Other high-risk populations in the US include
the urban poor, AIDS, and minority groups.
55. Answer: 2, 4, 5.
56. Answer: 2. Had contact with Mycobacterium tuberculosis
A positive PPD test indicates that the client has been exposed to tubercle bacilli.
Exposure does not necessarily mean that active disease exists.
57. Answer: 2. Supplement the diet with pyridoxine (vitamin B6)
INH competes with the available vitamin B6 in the body and leaves the client at
risk for development of neuropathies related to vitamin deficiency.
Supplemental vitamin B6 is routinely prescribed.
58. Answer: 4. Limit alcohol intake
INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake
of alcohol during drug therapy. Both drugs should be taken on an empty
stomach. If antacids are needed for GI distress, they should be taken 1 hour
before or 2 hours after these drugs are administered. Clients should not double
the dosage of these drugs because of their potential toxicity. Clients taking INH
should avoid foods that are rich in tyramine, such as cheese and dairy products,
or they may develop hypertension.
59. Answer: 1. Ask the clients spouse to supervise the daily

administration of the medications.
Directly observed therapy (DOT) can be implemented with clients who are not
compliant with drug therapy. In DOT, a responsible person, who may be a family
member or a health care provider, observes the client taking the medication.
Visiting the client, changing the prescription, or threatening the client will not
ensure compliance if the client will not or cannot follow the prescribed
treatment.
60. Answer: 1. Mycobacterium Tuberculosis

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Respiratory System Disorders

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with

3. A male adult patient hospitalized for treatment of a pulmonary

4. Before administering ephedrine, Nurse Tony assesses the patients

5. A female patient suffers adult respiratory distress syndrome as a

A. Kinking of the ventilator tubing

6. A male adult patient on mechanical ventilation is

7. On auscultation, which finding suggests a right pneumothorax?

A. Bilateral inspiratory and expiratory crackles

8. Rhea, confused and short breath, is brought to the emergency

9. A male patient is admitted to the healthcare facility for treatment

A. Activity intolerance related to fatigue

10. Nurse Ruth assessing a patient for tracheal displacement should

A. Contralateral side in a simple pneumothorax

A. Monitor fluctuations in the water-seal chamber

A. Encourage oral feeding as soon as possible

A. Drawing blood for a hematocrit and hemoglobin level

14. For a patient with advanced chronic obstructive pulmonary

A. Encouraging the patient to drink three glasses of fluid daily

A. Cardiogenic pulmonary edema

16. For a female patient with chronic obstructive pulmonary disease,

A. Restricting fluid intake to 1,000 ml per day

A. Do nothing, because this is an expected finding

18. Nurse Maureen has assisted a physician with the insertion of a

A. Inform the physician

A. Call the physician

20. A nurse is assisting a physician with the removal of a chest tube.

A. Call the physician to reinsert the tube

23. An emergency room nurse is assessing a male client who has

A. A low respiratory rate

24. Nurse Reese is caring for a client hospitalized with acute

25. An oxygen delivery system is prescribed for a male client

27. A nurse performs an admission assessment on a female client with

29. A nurse instructs a female client to use the pursed-lip method of

31. A nurse is preparing to obtain a sputum specimen from a male

34. A nurse is suctioning fluids from a female client through an

35. A male adult client is suspected of having a pulmonary embolus. A

36. A slightly obese female client with a history of allergy-

37. A male client who weighs 175 lb (79.4 kg) is receiving

A. Question the order because its too low.

A. Make inhalation longer than exhalation.

40. A male client abruptly sits up in bed, reports having difficulty

41. A female client must take streptomycin for tuberculosis. Before

A. Impaired color discrimination

A. Area of redness is measured in 3 days and determines whether tuberculosis

43. A female adult client has a tracheostomy but doesnt require

44. Nurse Oliver observes constant bubbling in the water-seal chamber

A. The system is functioning normally

47. The nurse assesses a male clients respiratory status. Which

48. A female client is undergoing a complete physical examination as a

49. A male client comes to the emergency department complaining of

50. A male client with chronic obstructive pulmonary disease (COPD) is

51. The nurse in charge is teaching a client with emphysema how to

A. It helps prevent early airway collapse.

A. Kinking of the ventilator tubing

54. A female client with chronic obstructive pulmonary disease (COPD)

55. A male client with pneumococcal pneumonia is admitted to an acute

56. A client with Guillain-Barr syndrome develops respiratory acidosis

A. pH, 5.0; PaCO2 30 mm Hg

57. A male client admitted to an acute care facility with pneumonia is

58. At 11 p.m., a male client is admitted to the emergency department.

59. After undergoing a thoracotomy, a male client is receiving epidural

60. The nurse in charge formulates a nursing diagnosis of Activity

A. Drinking more than 1,500 ml of fluid daily.