MEDICAL-SURGICAL NURSING (RESPIRATORY)

1. An elderly client with pneumonia may appear with which
of the following symptoms first?
a. Altered mental status and dehydration
b. fever and chills
c. Hemoptysis and dyspnea
d. Pleuretic chest pain and cough
nail beds. Based on this information, he most likely has
which of the following conditions?
a. Adult respiratory distress syndrome (ARDS)
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema

2. Which of the following pathophysiological mechanisms 9. The term “blue bloater” refers to which of the following
that occurs in the lung parenchyma allows pneumonia to conditions?
develop? a. Adult respiratory distress syndrome (ARDS)
a. Atelectasis b. Asthma
b. Bronchiectasis c. Chronic obstructive bronchitis
c. Effusion d. Emphysema
d. Inflammation
10. The term “pink puffer” refers to the client with which of
3. A 7-year-old client is brought to the E.R. He’s tachypneic the following conditions?
and afebrile and has a respiratory rate of 36 a. ARDS
breaths/minute and a nonproductive cough. He recently b. Asthma
had a cold. From his history, the client may have which of c. Chronic obstructive bronchitis
the following? d. Emphysema
a. Acute asthma
b. Bronchial pneumonia 11. A 66-year-old client has marked dyspnea at rest, is thin,
c. Chronic obstructive pulmonary disease (COPD) and uses accessory muscles to breathe. He’s tachypneic,
d. Emphysema with a prolonged expiratory phase. He has no cough. He
leans forward with his arms braced on his knees to support
4. Which of the following assessment findings would help his chest and shoulders for breathing. This client has
confirm a diagnosis of asthma in a client suspected of symptoms of which of the following respiratory disorders?
having the disorder? a. ARDS
a. Circumoral cyanosis b. Asthma
b. Increased forced expiratory volume c. Chronic obstructive bronchitis
c. Inspiratory and expiratory wheezing d. Emphysema
d. Normal breath sounds
12. It’s highly recommended that clients with asthma, chronic
5. Which of the following types of asthma involves an acute bronchitis, and emphysema have Pneumovax and flu
asthma attack brought on by an upper respiratory vaccinations for which of the following reasons?
infection? a. All clients are recommended to have these
a. Emotional vaccines
b. Extrinsic b. These vaccines produce bronchodilation and
c. Intrinsic improve oxygenation.
d. Mediated c. These vaccines help reduce the tachypnea these
clients experience.
6. A client with acute asthma showing inspiratory and d. Respiratory infections can cause severe hypoxia
expiratory wheezes and a decreased expiratory volume and possibly death in these clients.
should be treated with which of the following classes of
medication right away? 13. Exercise has which of the following effects on clients with
a. Beta-adrenergic blockers asthma, chronic bronchitis, and emphysema?
b. Bronchodilators a. It enhances cardiovascular fitness.
c. Inhaled steroids b. It improves respiratory muscle strength.
d. Oral steroids c. It reduces the number of acute attacks.
d. It worsens respiratory function and is
7. A 19-year-old comes into the emergency department with discouraged.
acute asthma. His respiratory rate is 44 breaths/minute,
and he appears to be in acute respiratory distress. Which 14. Clients with chronic obstructive bronchitis are given
of the following actions should be taken first? diuretic therapy. Which of the following reasons best
a. Take a full medication history explains why?
b. Give a bronchodilator by neubulizer a. Reducing fluid volume reduces oxygen demand.
c. Apply a cardiac monitor to the client b. Reducing fluid volume improves clients’ mobility.
d. Provide emotional support to the client. c. Restricting fluid volume reduces sputum
production.
8. A 58-year-old client with a 40-year history of smoking one d. Reducing fluid volume improves respiratory
to two packs of cigarettes a day has a chronic cough function.
producing thick sputum, peripheral edema, and cyanotic
15. A 69-year-old client appears thin and cachectic. He’s 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?
a. ARDS
b. Asthma
c. Chronic obstructive bronchitis
d. 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?
a. The client doesn’t notice he needs to breathe.
b. The client breathes only when his oxygen levels
climb above a certain point.
c. The client breathes only when his oxygen levels
dip below a certain point.
d. 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?
a. How to have his wife learn to listen to his lungs
with a stethoscope from Wal-Mart.
b. How to increase his oxygen therapy.
c. How to treat respiratory infections without going
to the physician.
d. 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?
a. Atelectasis
b. Bronchitis
c. Pneumonia
d. Pneumothorax
19. Which of the following measures can reduce or prevent
the incidence of atelectasis in a post-operative client?
a. Chest physiotherapy
b. Mechanical ventilation
c. Reducing oxygen requirements
d. Use of an incentive spirometer
20. Emergency treatment of a client in status asthmaticus
includes which of the following medications?
a. Inhaled beta-adrenergic agents
b. Inhaled corticosteroids
c. I.V. beta-adrenergic agents
d. Oral corticosteroids
21. Which of the following treatment goals is best for the
client with status asthmaticus?
a. Avoiding intubation
b. Determining the cause of the attack
c. Improving exercise tolerance
d. Reducing secretions
22. Dani was given dilaudid for pain. She’s sleeping and her
respiratory rate is 4 breaths/minute. If action isn’t taken
quickly, she might have which of the following reactions?
a. Asthma attack
b. Respiratory arrest
c. Be pissed about receiving Narcan
d. 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?
a. Arterial blood gas (ABG) and breath sounds
b. Level of consciousness and a pulse oximetry
value.
c. Breath sounds and reflexes
d. 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?
a. 15 mm Hg
b. 30 mm Hg
c. 40 mm Hg
d. 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?
a. Asthma attack
b. Pulmonary embolism
c. Respiratory failure
d. 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?
a. Administering oxygen
b. Inserting an I.V. catheter
c. Obtaining a complete blood count (CBC)
d. 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?
a. Administer beta-adrenergic blockers
b. Administer bronchodilators
c. Obtain serum electrolyte levels
d. Have the client lie flat in the bed.
28. A client’s 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?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. 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?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
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?
a. Sodium level of 145 mEq/L
b. Potassium level of 3.0 mEq/L
c. Magnesium level of 2.0 mg/L
d. 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:
a. Metabolic acidosis, compensated.
b. Metabolic alkalosis, uncompensated.
c. Respiratory alkalosis, compensated.
d. 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 Allen’s test is performed to determine the
adequacy of the:
a. Popliteal circulation
b. Ulnar circulation
c. Femoral circulation
d. 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?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
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?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
35. A nurse is caring for a client with diabetic ketoacidosis and
documents that the client is experiencing Kussmaul’s
respirations. Based on this documentation, which of the
following did the nurse observe?
a. Respirations that are abnormally deep, regular,
and increased in rate.
b. Respirations that are regular but abnormally
slow.
c. Respirations that are labored and increased in
depth and rate
d. 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?
a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic acidosis
d. Metabolic alkalosis
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?
a. Sodium level of 145 mEq/L
b. Magnesium level of 2.0 mg/dL
c. Potassium level of 5.2 mEq/L
d. 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 Allen’s
test on the client. Number in order of priority the steps for
performing the Allen’s test (#1 is first step).
a. Ask the client to open and close the hand
repeatedly.
b. Apply pressure over the ulnar and radial arteries.
c. Assess the color of the extremity distal to the
pressure point
d. Release pressure from the ulnar artery
e. 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?
a. Limiting fluids
b. Having the client take 3 deep breaths.
c. Asking the client to spit into the collection
container.
d. 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?
a. Blood-streaked sputum
b. Dry cough
c. Hematuria
d. 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:
a. 5 seconds
b. 10 seconds
c. 30 seconds
d. 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?
a. Continue to suction
b. Ensure that the suction is limited to 15 seconds
c. Stop the procedure and reoxyenate the client
d. 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:
a. Metabolic acidosis
 b. Respiratory acidosis
c. Combined respiratory and metabolic acidosis
d. overcompensated 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?
a. Increased oxygen saturation with exercise
b. Hypocapnia
c. A hyperinflated chest on x-ray film
d. 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?
a. Venturi mask
b. Aerosol mask
c. Face tent
d. 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?
a. “I will take the medication on an empty
stomach.”
b. “I will take the medication with food.”
c. “I will continue to take the medication even if I
am feeling better.”
d. “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
a. 1 L/min
b. 2 L/min
c. 6 L/min
d. 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?
a. pH of 7.48
b. PCO2 of 32 mm Hg
c. pH of 7.30
d. 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:
a. Promote oxygen intake
b. Strengthen the diaphragm
c. Strengthen the intercostal muscles
d. 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:
a. Respiratory acidosis uncompensated
b. Respiratory alkalosis uncompensated
c. Metabolic acidosis uncompensated
d. Metabolic acidosis partially compensated.
51. 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:
a. Promote expectoration
b. Suppress the cough
c. Relax smooth muscles of the bronchial airway
d. Prevent infection
52. A client is receiving isoetharine hydrochloride (Bronkosol)
via a nebulizer. The nurse monitors the client for which
side effect of this medication?
a. Constipation
b. Diarrhea
c. Bradycardia
d. Tachycardia
53. A nurse teaches a client about the use of a respiratory
inhaler. Which action by the client indicated a need for
further teaching?
a. Removes the cap and shakes the inhaler well
before use.
b. Presses the canister down with finger as he
breathes in.
c. Inhales the mist and quickly exhales.
d. Waits 1 to 2 minutes between puffs if more than
one puff has been prescribed.
54. 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?
a. “Is there any possibility that you could be
pregnant?”
b. “Are you wearing any metal chains or jewelry?”
c. “Can you hold your breath easily?”
d. “Are you able to hold your arms above your
head?”
55. A client has just returned to a nursing unit following
bronchoscopy. A nurse would implement which of the
following nursing interventions for this client?
a. Encouraging additional fluids for the next 24
hours
b. Ensuring the return of the gag reflex before
offering foods or fluids
c. Administering atropine intravenously
d. Administering small doses of midazolam
(Versed).
56. A client has an order to have radial ABG drawn. Before
drawing the sample, a nurse occludes the:
a. Brachial and radial arteries, and then releases
them and observes the circulation of the hand.
b. Radial and ulnar arteries, releases one, evaluates
the color of the hand, and repeats the process
with the other artery.
c. Radial artery and observes for color changes in
the affected hand.
d. Ulnar artery and observes for color changes in
the affected hand.
57. 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?
a. Chronic obstructive bronchitis
 b. Emphysema
c. Bronchial asthma
d. Bronchial asthma and bronchitis
58. A client has been taking benzonatate (Tessalin Perles) as
prescribed. A nurse concludes that the medication is
having the intended effect if the client experiences:
a. Decreased anxiety level
b. Increased comfort level
c. Reduction of N/V
d. Decreased frequency and intensity of cough
59. Which of the following would be an expected outcome for
a client recovering from an upper respiratory tract
infection? The client will:
a. Maintain a fluid intake of 800ml every 24 hours.
b. Experience chills only once a day
c. Cough productively without chest discomfort.
d. Experience less nasal obstruction and discharge.
60. Which of the following individuals would the nurse
consider to have the highest priority for receiving an
influenza vaccination?
a. A 60-year-old man with a hiatal hernia
b. A 36-year-old woman with 3 children
c. A 50-year-old woman caring for a spouse with
cancer
d. a 60-year-old woman with osteoarthritis
61. 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?
a. “Use your nasal decongestant spray regularly to
help clear your nasal passages.”
b. “Ask the doctor for antibiotics. Antibiotics will
help decrease the secretion.”
c. “It is important to increase your activity. A daily
brisk walk will help promote drainage.”
d. “Keep a diary if when your symptoms occur. This
can help you identify what precipitates your
attacks.”
62. 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?
a. It is likely that the client is developing a
secondary bacterial pneumonia.
b. The assessment findings are consistent with
influenza and are to be expected.
c. The client is getting dehydrated and needs to
increase her fluid intake to decrease secretions.
d. The client has not been taking her decongestants
and bronchodilators as prescribed.
63. 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?
a. 5.0 ml
b. 7.5 ml
c. 9.5 ml
d. 10 ml
64. Pseudoephedrine (Sudafed) has been ordered as a nasal
decongestant. Which of the following is a possible side
effect of this drug?
a. Constipation
b. Bradycardia
c. Diplopia
d. Restlessness
65. 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?
a. Altered nutrition: Less than body requirements
related to fatigue.
b. Activity intolerance related to dyspnea.
c. Weight loss related to COPD.
d. Ineffective breathing pattern related to alveolar
hypoventilation.
66. 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?
a. Develop infections easily
b. Maintain current status
c. Require less supplemental oxygen
d. Show permanent improvement.
67. Which of the following outcomes would be appropriate for
a client with COPD who has been discharged to home? The
client:
a. Promises to do pursed lip breathing at home.
b. States actions to reduce pain.
c. States that he will use oxygen via a nasal cannula
at 5 L/minute.
d. Agrees to call the physician if dyspnea on
exertion increases.
68. Which of the following physical assessment findings would
the nurse expect to find in a client with advanced COPD?
a. Increased anteroposterior chest diameter
b. Underdeveloped neck muscles
c. Collapsed neck veins
d. Increased chest excursions with respiration
69. Which of the following is the primary reason to teach
pursed-lip breathing to clients with emphysema?
a. To promote oxygen intake
b. To strengthen the diaphragm
c. To strengthen the intercostal muscles
d. To promote carbon dioxide elimination
70. Which of the following is a priority goal for the client with
COPD?
a. Maintaining functional ability
b. Minimizing chest pain
c. Increasing carbon dioxide levels in the blood
d. Treating infectious agents
71. A client’s 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?
a. Cyanosis
b. Flushed skin
c. Irritability
 d. Anxiety
72. When teaching a client with COPD to conserve energy, the
nurse should teach the client to lift objects:
a. While inhaling through an open mouth.
b. While exhaling through pursed lips
c. After exhaling but before inhaling.
d. While taking a deep breath and holding it.
73. 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?
a. Clubbing of nail beds
b. Hypertension
c. Peripheral edema
d. Increased appetite
74. 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?
a. Normal breath sounds
b. Prolonged inspiration
c. Normal chest movement
d. Coarse crackles and rhonchi
75. Which of the following ABG abnormalities should the
nurse anticipate in a client with advanced COPD?
a. Increased PaCO2
b. Increased PaO2
c. Increased pH.
d. Increased oxygen saturation
76. Which of the following diets would be most appropriate
for a client with COPD?
a. Low fat, low cholesterol
b. Bland, soft diet
c. Low-Sodium diet
d. High calorie, high-protein diet
77. The nurse is planning to teach a client with COPD how to
cough effectively. Which of the following instructions
should be included?
a. Take a deep abdominal breath, bend forward,
and cough 3 to 4 times on exhalation.
b. Lie flat on back, splint the thorax, take two deep
breaths and cough.
c. Take several rapid, shallow breaths and then
cough forcefully.
d. Assume a side-lying position, extend the arm
over the head, and alternate deep breathing
with coughing.
78. 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?
a. Initiate oxygen therapy and reassess the client in
10 minutes.
b. Draw blood for an ABG analysis and send the
client for a chest x-ray.
c. Encourage the client to relax and breathe slowly
through the mouth
d. Administer bronchodilators
79. The nurse would anticipate which of the following ABG
results in a client experiencing a prolonged, severe asthma
attack?
a. Decreased PaCO2, increased PaO2, and
decreased pH.
b. Increased PaCO2, decreased PaO2, and
decreased pH.
c. Increased PaCO2, increased PaO2, and increased
pH.
d. Decreased PaCO2, decreased PaO2, and
increased pH.
80. A client with acute asthma is prescribed short-term
corticosteroid therapy. What is the rationale for the use of
steroids in clients with asthma?
a. Corticosteroids promote bronchodilation
b. Corticosteroids act as an expectorant
c. Corticosteroids have an anti-inflammatory effect
d. Corticosteroids prevent development of
respiratory infections.
81. 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 us using the
MDI correctly? Select all that apply.
a. The inhaler is held upright.
b. Head is tilted down while inhaling the
medication
c. Client waits 5 minutes between puffs.
d. Mouth is rinsed with water following
administration
e. Client lies supine for 15 minutes following
administration.
82. 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?
a. Irregular heartbeat
b. Constipation
c. Petal edema
d. Decreased heart rate.
83. 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?
a. “This is an anticipated side-effect of your
medication. It should go away in a couple of
weeks.”
b. “You are using your inhaler too much and it has
irritated your mouth.”
c. “You have developed a fungal infection from
your medication. It will need to be treated with
an antibiotic.”
d. “Be sure to brush your teeth and floss daily.
Good oral hygiene will treat this problem.”
84. Which of the following health promotion activities should
the nurse include in the discharge teaching plan for a client
with asthma?
a. Incorporate physical exercise as tolerated into
the treatment plan.
b. Monitor peak flow numbers after meals and at
bedtime.
c. Eliminate stressors in the work and home
environment
d. Use sedatives to ensure uninterrupted sleep at
night.
85. 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?
a. Occupational exposure to toxins
b. Viral respiratory infections
c. Exposure to cigarette smoke
d. Exercising in cold temperatures
86. 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 ABG’s, 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:
a. Begin mechanical ventilation
b. Place the client on oxygen
c. Give the client sodium bicarbonate
d. Monitor for pulmonary embolism.
87. Basilar crackles are present in a client’s lungs on
auscultation. The nurse knows that these are discrete,
noncontinuous sounds that are:
a. Caused by the sudden opening of alveoli
b. Usually more prominent during expiration
c. Produced by airflow across passages narrowed
by secretions
d. Found primarily in the pleura.
88. A cyanotic client with an unknown diagnosis is admitted to
the E.R. In relation to oxygen, the first nursing action
would be to:
a. Wait until the client’s lab work is done.
b. Not administer oxygen unless ordered by the
physician.
c. Administer oxygen at 2 L flow per minute.
d. Administer oxygen at 10 L flow per minute and
check the client’s nailbeds.
89. Immediately following a thoracentesis, which clinical
manifestations indicate that a complication has occurred
and the physician should be notified?
a. Serosanguineous drainage from the puncture
site
b. Increased temperature and blood pressure
c. Increased pulse and pallor
d. Hypotension and hypothermia
90. If a client continues to hypoventilate, the nurse will
continually assess for a complication of:
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
91. A client is admitted to the hospital with acute bronchitis.
While taking the client’s VS, the nurse notices he has an
irregular pulse. The nurse understands that cardiac
arrhythmias in chronic respiratory distress are usually the
result of:
a. Respiratory acidosis
b. A build-up of carbon dioxide
c. A build-up of oxygen without adequate expelling
of carbon dioxide.
d. An acute respiratory infection.
92. Auscultation of a client’s lungs reveals crackles in the left
posterior base. The nursing intervention is to:
a. Repeat auscultation after asking the client to
deep breathe and cough.
b. Instruct the client to limit fluid intake to less than
2000 ml/day.
c. Inspect the client’s ankles and sacrum for the
presence of edema
d. Place the client on bedrest in a semi-Fowlers
position.
93. The most reliable index to determine the respiratory
status of a client is to:
a. Observe the chest rising and falling
b. Observe the skin and mucous membrane color.
c. Listen and feel the air movement.
d. Determine the presence of a femoral pulse.
94. A client with COPD has developed secondary
polycythemia. Which nursing diagnosis would be included
in the plan of care because of the polycythemia?
a. Fluid volume deficit related to blood loss.
b. Impaired tissue perfusion related to thrombosis
c. Activity intolerance related to dyspnea
d. Risk for infection related to suppressed immune
response.
95. The physician has scheduled a client for a left
pneumonectomy. The position that will most likely be
ordered postoperatively for his is the:
a. Unoperative side or back
b. Operative side or back
c. Back only
d. Back or either side.
96. Assessing a client who has developed atelectasis
postoperatively, the nurse will most likely find:
a. A flushed face
b. Dyspnea and pain
c. Decreased temperature
d. Severe cough and no pain.
97. A fifty-year-old client has a tracheostomy and requires
tracheal suctioning. The first intervention in completing
this procedure would be to:
a. Change the tracheostomy dressing
b. Provide humidity with a trach mask
c. Apply oral or nasal suction
d. Deflate the tracheal cuff
98. A client states that the physician said the tidal volume is b. Bed rest
slightly diminished and asks the nurse what this means. c. Oxygen
The nurse explains that the tidal volume is the amount of d. Nutritional intake
air:
a. Exhaled forcibly after a normal expiration 106. A client has been treated with antibiotic therapy for right
b. Exhaled after there is a normal inspiration lower-lobe pneumonia for 10 days and will be discharged
c. Trapped in the alveoli that cannot be exhaled today. Which of the following physical findings would lead
d. Forcibly inspired over and above a normal the nurse to believe it is appropriate to discharge this
respiration. client?
a. Continued dyspnea
99. An acceleration in oxygen dissociation from hemoglobin, b. Fever of 102*F
and thus oxygen delivery to the tissues, is caused by: c. Respiratory rate of 32 breaths/minute
a. A decreasing oxygen pressure in the blood d. Vesicular breath sounds in right base
b. An increasing carbon dioxide pressure in the
blood 107. The right forearm of a client who had a purified protein
c. A decreasing oxygen pressure and/or an derivative (PPD) test for tuberculosis is reddened and
increasing carbon dioxide pressure in the blood. raised about 3mm where the test was given. This PPD
d. An increasing oxygen pressure and/or a would be read as having which of the following results?
decreasing carbon dioxide pressure in the blood. a. Indeterminate
b. Needs to be redone
100. Clients with chronic illnesses are more likely to get c. Negative
pneumonia when which of the following situations is d. Positive
present?
a. Dehydration 108. A client with primary TB infection can expect to develop
b. Group living which of the following conditions?
c. Malnutrition a. Active TB within 2 weeks
d. Severe periodontal disease b. Active TB within 1 month
c. A fever that requires hospitalization
101. Which of the following pathophysiological mechanisms d. A positive skin test
that occurs in the lung parenchyma allows pneumonia to
develop? 109. A client was infected with TB 10 years ago but never
a. Atelectasis developed the disease. He’s now being treated for cancer.
b. Bronchiectasis The client begins to develop signs of TB. This is known as
c. Effusion which of the following types of infection?
d. Inflammation a. Active infection
b. Primary infection
102. Which of the following organisms most commonly causes c. Superinfection
community-acquired pneumonia in adults? d. Tertiary infection
a. Haemiphilus influenza
b. Klebsiella pneumonia 110. A client has active TB. Which of the following symptoms
c. Steptococcus pneumonia will he exhibit?
d. Staphylococcus aureus a. Chest and lower back pain
b. Chills, fever, night sweats, and hemoptysis
103. When auscultating the chest of a client with pneumonia, c. Fever of more than 104*F and nausea
the nurse would expect to hear which of the following d. Headache and photophobia
sounds over areas of consolidation?
a. Bronchial 111. Which of the following diagnostic tests is definitive for TB?
b. Bronchovestibular a. Chest x-ray
c. Tubular b. Mantoux test
d. Vesicular c. Sputum culture
d. Tuberculin test
104. A diagnosis of pneumonia is typically achieved by which of
the following diagnostic tests? 112. A client with a positive Mantoux test result will be sent for
a. ABG analysis a chest x-ray. For which of the following reasons is this
b. Chest x-ray done?
c. Blood cultures a. To confirm the diagnosis
d. sputum culture and sensitivity b. To determine if a repeat skin test is needed
c. To determine the extent of the lesions
105. A client with pneumonia develops dyspnea with a d. To determine if this is a primary or secondary
respiratory rate of 32 breaths/minute and difficulty infection
expelling his secretions. The nurse auscultates his lung
fields and hears bronchial sounds in the left lower lobe. 113. A chest x-ray should a client’s lungs to be clear. His
The nurse determines that the client requires which of the Mantoux test is positive, with a 10mm if induration. His
following treatments first? previous test was negative. These test results are possible
a. Antibiotics because:
 a. He had TB in the past and no longer has it.
b. He was successfully treated for TB, but skin tests
always stay positive.
c. He’s a “seroconverter”, meaning the TB has
gotten to his bloodstream.
d. He’s a “tuberculin converter,” which means he
has been infected with TB since his last skin test.
114. A client with a positive skin test for TB isn’t showing signs
of active disease. To help prevent the development of
active TB, the client should be treated with isonaizid,
300mg daily, for how long?
a. 10 to 14 days
b. 2 to 4 weeks
c. 3 to 6 months
d. 9 to 12 months
115. 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?
a. Admit him to the hospital in respiratory isolation
b. Prescribe isoniazid and tell him to go home and
rest
c. Give a tuberculin test and tell him to come back
in 48 hours and have it read.
d. Give a prescription for isoniazid, 300mg daily for
2 weeks, and send him home.
116. 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?
a. Decreased shortness of breath
b. Improved chest x-ray
c. Nonproductive cough
d. Positive acid-fast bacilli in a sputum sample after
2 months of treatment.
117. A client diagnosed with active TB would be hospitalized
primarily for which of the following reasons?
a. To evaluate his condition
b. To determine his compliance
c. To prevent spread of the disease
d. To determine the need for antibiotic therapy.
118. A high level of oxygen exerts which of the following effects
on the lung?
a. Improves oxygen uptake
b. Increases carbon dioxide levels
c. Stabilizes carbon dioxide levels
d. Reduces amount of functional alveolar surface
area
119. 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?
a. Auscultation of breath sounds
b. Chest x-ray
c. Echocardiogram
d. Electrocardiogram (ECG)
120. 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?
a. Acute asthma
b. Chronic bronchitis
c. Pneumonia
d. Spontaneous pneumothorax
121. Which of the following treatments would the nurse expect
for a client with a spontaneous pneumothorax?
a. Antibiotics
b. Bronchodilators
c. Chest tube placement
d. Hyperbaric chamber
122. Which of the following methods is the best way to confirm
the diagnosis of a pneumothorax?
a. Auscultate breath sounds
b. Have the client use an incentive spirometer
c. Take a chest x-ray
d. stick a needle in the area of decreased breath
sounds
123. A pulse oximetry gives what type of information about the
client?
a. Amount of carbon dioxide in the blood
b. Amount of oxygen in the blood
c. Percentage of hemoglobin carrying oxygen
d. Respiratory rate
124. What effect does hemoglobin amount have on
oxygenation status?
a. No effect
b. More hemoglobin reduces the client’s
respiratory rate
c. Low hemoglobin levels cause reduces oxygen-
carrying capacity
d. Low hemoglobin levels cause increased oxygen-
carrying capacity.
125. Which of the following statements best explains how
opening up collapsed alveoli improves oxygenation?
a. Alveoli need oxygen to live
b. Alveoli have no effect on oxygenation
c. Collapsed alveoli increase oxygen demand
d. Gaseous exchange occurs in the alveolar
membrane.
126. Continuous positive airway pressure (CPAP) can be
provided through an oxygen mask to improve oxygenation
in hypoxic patients by which of the following methods?
a. The mask provides 100% oxygen to the client.
b. The mask provides continuous air that the client
can breathe.
c. The mask provides pressurized oxygen so the
client can breathe more easily.
d. The mask provides pressurized at the end of
expiration to open collapsed alveoli.
127. Which of the following best describes pleural effusion?
a. The collapse of alveoli
b. The collapse of bronchiole
c. The fluid in the alveolar space
d. The accumulation of fluid between the linings of
the pleural space.
128. 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?
 a. Inserting a chest tube
b. Performing thoracentesis
c. Performing paracentesis
d. Allowing the pleural effusion to drain by itself.
129. A comatose client needs a nasopharyngeal airway for
suctioning. After the airway is inserted, he gags and
coughs. Which action should the nurse take?
a. Remove the airway and insert a shorter one.
b. Reposition the airway.
c. Leave the airway in place until the client gets
used to it.
d. Remove the airway and attempt suctioning
without it.
130. 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?
a. Using intermittent suction while advancing the
catheter.
b. Using continuous suction while withdrawing the
catheter.
c. Using intermittent suction while withdrawing the
catheter.
d. Using continuous suction while advancing the
catheter.
131. A client’s 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?
a. Metabolic acidosis
b. Respiratory alkalosis
c. Metabolic alkalosis
d. Respiratory acidosis
132. 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?
a. 5/8” to ½” 25G to 27G needle.
b. 1” to 3” 20G to 25G needle.
c. ½” to 3/8” 26 or 27G needle.
d. 1” 20G needle.
133. 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?
a. Increased elastic recoil of the lungs
b. Increased number of functional capillaries in the
alveoli
c. Decreased residual volume
d. Decreased vital capacity.
134. A 79-year-old client is admitted with pneumonia. Which
nursing diagnosis should take priority?
a. Acute pain related to lung expansion secondary
to lung infection
b. Risk for imbalanced fluid volume related to
increased insensible fluid losses secondary to
fever.
c. Anxiety related to dyspnea and chest pain.
d. Ineffective airway clearance related to retained
secretions.
135. 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:
a. A bloody, productive cough
b. A cough with the expectoration of mucoid
sputum
c. Chest pain
d. Dyspnea
136. 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?
a. 5 mcg/mL
b. 15 mcg/mL
c. 25 mcg/mL
d. 30 mcg/mL
137. 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 client’s
history, would require physician notification?
a. Heart disease
b. Allergy to penicillin
c. Hepatitis B
d. Rheumatic fever
138. 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:
a. Carbon monoxide poisoning
b. Carbon dioxide narcosis
c. Respiratory alkalosis
d. Metabolic acidosis
139. 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:
a. Positive
b. Negative
c. Inconclusive
d. The need for repeat testing.
140. 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?
a. Nonproductive or productive cough
b. Anorexia and weight loss
c. Chills and night sweats
d. High-grade fever
141. 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:
a. Meats and citrus fruits
b. Grains and broccoli
c. Eggs and spinach
d. Potatoes and fish

142. Which of the following would be priority assessment data
to gather from a client who has been diagnosed with
pneumonia? Select all that apply.
a. Auscultation of breath sounds
b. Auscultation of bowel sounds
c. Presence of chest pain.
d. Presence of peripheral edema
e. Color of nail beds
143. 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?
a. Position changes q4h
b. Nasotracheal suctioning to clear secretions
c. Frequent linen changes
d. Frequent offering of a bedpan.
144. The cyanosis that accompanies bacterial pneumonia is
primarily caused by which of the following?
a. Decreased cardiac output
b. Pleural effusion
c. Inadequate peripheral circulation
d. Decreased oxygenation of the blood.
145. Which of the following mental status changes may occur
when a client with pneumonia is first experiencing
hypoxia?
a. Coma
b. Apathy
c. Irritability
d. Depression
146. 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?
a. Maintain complete bedrest
b. Administer oxygen therapy
c. Provide frequent linen changes.
d. Provide fluid intake of 3 L/day
147. Which of the following would be an appropriate expected
outcome for an elderly client recovering from bacterial
pneumonia?
a. A respiratory rate of 25 to 30 breaths per minute
b. The ability to perform ADL’s without dyspnea
c. A maximum loss of 5 to 10 pounds of body
weight
d. Chest pain that is minimized by splinting the
ribcage.
148. Which of the following symptoms is common in clients
with TB?
a. Weight loss
b. Increased appetite
c. Dyspnea on exertion
d. Mental status changes
149. 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?
a. Acid-fast staining
b. Sensitivity testing
c. Agglunitnation testing
d. Dark-field illumination
150. Which of the following antituberculus drugs can cause
damage to the eighth cranial nerve?
a. Streptomycin
b. Isoniazid
c. Para-aminosalicylic acid
d. Ethambutol hydrochloride
151. The client experiencing eighth cranial nerve damage will
most likely report which of the following symptoms?
a. Vertigo
b. Facial paralysis
c. Impaired vision
d. Difficulty swallowing
152. Which of the following family members exposed to TB
would be at highest risk for contracting the disease?
a. 45-year-old mother
b. 17-year-old daughter
c. 8-year-old son
d. 76-year-old grandmother
153. 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.
a. “I will need to dispose of my old clothing when I
return home.”
b. “I should always cover my mouth and nose when
sneezing.”
c. “It is important that I isolate myself from family
when possible.”
d. “I should use paper tissues to cough in and
dispose of them properly.”
e. “I can use regular plate and utensils whenever I
eat.”
154. A client has a positive reaction to the PPD test. The nurse
correctly interprets this reaction to mean that the client
has:
a. Active TB
b. Had contact with Mycobacterium tuberculosis
c. Developed a resistance to tubercle bacilli
d. Developed passive immunity to TB.
155. 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?
a. Adhere to a low cholesterol diet
b. Supplement the diet with pyridoxine (vitamin B6)
c. Get extra rest
d. Avoid excessive sun exposure.
156. The nurse should include which of the following
instructions when developing a teaching plan for clients
receiving INH and rifampicin for treatment for TB?
a. Take the medication with antacids
b. Double the dosage if a drug dose is forgotten
c. Increase intake of dairy products
d. Limit alcohol intake

157. 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?
a. Ask the client’s spouse to supervise the daily
administration of the medications.
b. Visit the clinic weekly to ask him whether he is
taking his medications regularly.
c. Notify the physician of the client’s non-
compliance and request a different prescription.
d. Remind the client that TB can be fatal if not
taken properly.
158. The nurse is caring for a client admitted to the hospital
with the diagnosis of active tuberculosis. The nurse
determines that the diagnosis was confirmed by a:
a. tine test
b. chest x-ray
c. mantoux test
d. sputum culture
159. A client was admitted to the hospital 24 hours ago after
sustaining blunt chest trauma. The nurse monitors for
which earliest clinical manifestation of acute respiratory
distress syndrome (ARDS)?
a. cyanosis and pallor
b. diffuse crackles and rhonchi on chest
auscultation
c. increase respiratory rate from 18 to 30 breaths
per minute
d. haziness or "white-out appearance of lungs on
chest radiograph
160. A nurse is performing a respiratory assessment on a client
being treated for an asthma attack. The nurse determines
that the client's respiratory status is worsening if which of
the following occurs?
a. loud wheezing
b. wheezing on expiration
c. noticeably diminished breath sounds
d. wheezing during inspiration and expiration
161. A home care nurse assesses a client with chronic
obstructive pulmonary disease (COPD) who is complaining
of increased dypsnea. The client is on home oxygen via a
concentrator at 2L per minute, and the client's respiratory
rate is 22 breaths per minute. The appropriate nursing
action is to:
a. determine the need to increase the oxygen
b. reassure the client that there is no need to worry
c. conduct further assessment of the client's
respiratory status
d. call emergency services to take the client to the
emergency department
162. A nurse is admitting a client suspected of having
tuberculosis (TB) to the hospital. The nurse understands
that the most accurate method of confirming the diagnosis
is:
a. a chest radiograph positive for lung lesions
b. a positive purified protein derivative test (PPD)
c. a sputum culture positive for myconbacterium
tuberculosis
d. obtaining data about the client's long history of
hemoptysis
163. A nurse has just administered a purified protein derivative
(PPD) skin test to a client who is at low risk for developing
tuberculosis. The nurse determines that the test is positive
if which of the following occurs?
a. an induration of 15 mm
b. the presence of a wheal
c. a large area of erythema
d. client complains of constant itching
164. A client who has fallen from a ladder and fractured three
ribs has arterial blood gas (ABG) results of pH 7.38, PCO2
38 mmHg, PO2 86 mmHg, and HCO3 23 mEq/L. The nurse
interprets that the client's ABGs indicate which of the
following?
a. normal results
b. metabolic acidosis
c. metabolic alkalosis
d. respiratory acidosis
165. A client at risk for respiratory failure is receiving oxygen via
nasal cannula at 6 L per minute. Arterial blood gas (ABG)
results indicate: pH 7.29, PCO2 49 mmHg, PO2 58 mmHg,
HCO3 18 mEq/L. The nurse anticipates that the physician
will order which of the following for respiratory support?
a. intubation and mechanical ventilation
b. adding a partial rebreather mask to the current
order
c. keeping the oxygen at 6 L per minute via nasal
cannula
d. lowering the oxygen to 4 L per minute via nasal
cannula
166. The nurse assists the physician with the removal of a chest
tube. During removal of the chest tube, the nurse instructs
the client to perform which of the following?
a. breathe in deeply
b. breathe normally
c. breathe out forcefully
d. exhale and bear down
167. The nurse assesses the water seal chamber of a closed
chest drainage system and notes fluctuations in the
chamber. The nurse determines that this finding indicates
that:
a. the tubing is kinked
b. an air leak is present
c. the lung has expanded
d. the system is functioning as expected
168. The nurse evaluates a client following treatment for
carbon monoxide poisoning. The nurse would document
that the treatment was effective if which of the following
were present?
a. client is sleeping soundly
b. client is awake and talking
c. heart monitor shows sinus tachycardia
d. carboxyhemoglobin levels are less than 5%
169. The nurse is determining the need for suctioning in a client
with an endotracheal (ET) tube attached to a mechanical
ventilator. Which observation by the nurse indicates this
need?
 a. clear breath sounds
b. visible mucus bubbling in the ET tube
c. apical pulse rate of 72 beats per minute
d. low peak inspiratory pressure on the ventilator
170. A client is intubated and receiving mechanical ventilation.
The physician has added 7 cm of positive and expiratory
pressure (PEEP) to the ventilator settings of the client. The
nurse assesses for which of the following expected but
adverse effects of PEEP?
a. decreased peak pressure on the ventilator
b. increased temperature from 98F to 100F rectally
c. decreased heart rate from 78 to 63 beats per
minute
d. systolic blood pressure decrease from 122 to 98
mm Hg
171. The nurse is assessing the respiratory status of the client
following thoracentesis. The nurse would become most
concerned with which of the following assessment
findings?
a. equal bilateral chest expansion
b. respiratory rate of 22 breaths per minute
c. diminished breath sounds on affected side
d. few scattered wheezes, unchanged from
baseline
173. The nurse is preparing to administer a Mantoux skin test to
a client. The nurse determines that which area is most
appropriate for injection of the medication?
a. dorsal aspect of the upper arm near a mole
b. inner aspect of the forearm that is close to a
burn scar
c. inner aspect of the forearm that is not heavily
pigmented
d. dorsal aspect of the upper arm that has a small
amount of hair
174. A 14-year old male is to be admitted to the unit due
to high fever related to influenza. With whom among the
following clients should he be placed together in the
room?
a. the 12-year old male client who had undergone
appendectomy
b. the 12-year old female client with flu
c. the 12-year old boy with flu
d. the 12-year old boy with leukemia
175. Why is influenza vaccine given to adults annually?
a. immunity last only for a year
b. some organisms are resistant to the vaccine
c. this is the routine procedure
d. adults have low resistance to flu virus
176. Which of the following nursing interventions should be
implemented for a client with influenza?
a. instructing family members not to visit the client
until the fever declines
b. instructing family members or visitors to
wear surgical mask before entering the client's
room
c. instructing family members that there are no
special precautions needed when caring for the
client
d. instructing family members to wear gown and
gloves before entering the client's room
177. Which of the following should concern the nurse most,
when caring for a client who will undergo bronchoscopy?
a. the client had a glass of orange juice an hour ago
b. the client has yellowish sputum
c. the client complains of thirst and dryness of
mouth
d. the client says, he had removed his dentures
178. The client had undergone decortication of the right lung.
The nurse needs to intervene when the unlicensednursing
assistant does which of the following?
a. instructs the client to lie on the operated side
b. instructs the client to lie on the unoperated side
c. keeps the client on supine with head of the bed
elevated
d. ensures that chest tube with water-seal drainage
functions properly
179. Which of the following findings should concern the nurse
that the oxygen saturation monitor is not working?
a. there is no sensor light on the probe
b. oxygen saturation (Sa O2) is 92%
c. pulse rate= 58/min; Sa is 97%
d. mucous membrane in the mouth appears pinkish
180. The client had left chest injury. The nurse can feel air going
in and out of injured site during breathing. Which ofthe
following should the nurse do initially?
a. apply petrolatum jelly dressing at the site
b. turn the client to right side
c. give oxygen therapy at 2 L/min
d. transport the client to the nearest medical
facility
181. The client had undergone thoracentesis. Which of the
following is a correct action by the LVN
(LicensedVocational Nurse) immediately after
the procedure?
a. she turns the client towards the affected side
b. she turns the client towards the unaffected side
c. she places the client in a supine position
d. she places the client in semi-fowler's position
182. The client is diagnosed to have
advanced chronic obstructive pulmonary
disease (COPD). Which of the following nursing action
would best promote adequate gas exchange?
a. administering sedative as prescribed
b. placing the client in upright position
c. using high-flow venturi mask to deliver oxygen
d. encourage client to drink 6 glasses of fluid daily
183. A 48-year old man with tuberculosis is taking INH with
pyridoxine (Vit. B6). The client asks why it is necessary for
him to take pyridoxine. Which of the following is the most
appropriate response by the nurse?
a. it increases INH absorption
b. it prevents INH-associated neuritis
c. it decreases toxicity of INH
d. it increases the effectiveness of INH
184. The child with croup is in a mist tent. Which of the following toys
will be appropriate for the child? 193. High pressure alarm still alarms after suctioning the client. What
a. stuffed toys should the nurse do next?
b. drawing book a. disconnect the client from mechanical ventilation and
c. plastic ball do manual resuscitation
d. coloring book b. call the respiratory therapist
c. call another nurse to be with the client while the nurse
185. The client had been subjected to thoracentesis without written calls for the physician
consent. What offense are the health care providers liable for? d. turn off the alarm
a. Assault
b. Battery 194. Which of the following community-acquired pneumonias
c. Manslaughter demonstrates the highest occurrence during summer and fall?
d. invasion of privacy a. pneumococcal pneumonia
b. legionaire's pneumonia
186. The client with acute asthmatic attack is receiving Theophylline c. viral pneumonia
(Aminophylline) drip. Which of the following nursing actions d. mycoplasma pneumonia
should be included in the nursing care plan of the client?
a. note for decreased urine output 195. A client is admitted to an acute care facility with a tentative
b. observe for elevated temperature diagnosis of PCP (pneumocystis cariniipneumonia). She had lost
c. be alert for decreased BP 25 lbs. over the past 2 months and complains of anorexia. At this
d. monitor for decreased pulse rate point, the highest priority goal is that the patient will
a. increase nutrient intake
187. Which of the following is the best position for a client who had b. have no further weight loss
undergone lobectomy? c. be free from infection
a. side-lying position d. maintain cardiopulmonary functioning
b. supine position
c. sitting upright, leaning forward position 196. A patient underwent a pneumonectomy and developed tension
d. semi-fowler's position pneumothorax. Which of the following is an early indication of
tension pneumothorax?
188. Which of the following findings should be reported to the a. frothy, blood-tinged sputum
physician? b. trachea shifts toward unaffected side of the chest
a. vesicular breath sounds at the peripheral areas of the c. development of subcutaneous emphysema
lungs d. open, sucking chest wound
b. bronchovesicular breath sounds heard over the
mainstem bronchi 197. The nurse is caring for a client on mechanical ventilator. The low-
c. bronchial breath sounds heard over the trachea pressure alarm of the ventilator turns on. The most important
d. adventitious breath sounds heard all over the lungs nursing action is:
a. prepare to suction the client
189. The client with chronic obstructive pulmonary disease (COPD) is b. check air leak from endotracheal tube
receiving Aminophylline. Which of the following manifestations c. check if the tube is kinked
indicate that the client is experiencing an adverse effect of the d. turn off the alarm
drug?
a. elevated temperature 198. Which of the following assessment findings in a client with a
b. bradycardia closed chest tube drainage should concern the nurse most?
c. restlessness a. continuous, vigorous bubbling in the suction control
d. tachycardia chamber
b. continuous, gentle bubbling in the suction control
190. The client has closed chest drainage. Which of the following chamber
observations need prompt reporting to the physician? c. continuous fluctuations of fluid along the tube in the
a. the water in the water-seal drainage is constantly water-seal chamber
bubbling d. absence of bubbling in the water-seal chamber
b. there is continuous bubbling in the suction control
chamber 199. A 4-year old female client is brought to the emergency room after
c. fluctuation of fluids is noted in the water seal chamber waking up with bark-like cough and stridor. On arrival to the ER,
if suction is not applied she has respiratory distress and is afebrile. The diagnosis is croup.
d. the suction control chamber is filled with 20 cm of What instruction should you give the parents?
sterile NSS a. perform percussion and postural drainage before
putting the child to bed and before meals
191. The client is diagnosed to have COPD (Chronic Obstructive b. run a cool mist vaporizer in patient's room during the
Pulmonary Disease). Which of the followingsigns and day
symptoms needs priority intervention by the nurse? c. encourage the child to do coughing and deep breathing
a. temperature of 37.5 C exercises
b. tachycardia d. bring the child to the bathroom and have the tap run
c. cough with warm water during acute episodes of cough
d. 91% oxygen saturation
200. Which of the following teachings should be given to the mother
192. A client who had vehicular accident was admitted to the when her child is in a mist tent for liquefication of secretions?
emergency department. His trachea is deviated to the left. What a. give the child a stuff toy inside the mist tent
does the nurse anticipate to be done to the client? b. avoid nylon blanket inside the mist tent
a. the client will have endotracheal intubation c. advise mother to let the child stay in the mist tent
b. the client will have emergency tracheotomy d. give the child coloring book inside the mist tent
c. the client will have oxygen by mask
d. the client will have thoracentesis