Sauce: https://nurseslabs.

com/nclex-exam-respiratory-disorders-1-60-items/

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 patient’s history. Because of
ephedrine’s 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
patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation
are initiated. When the high-pressure alarm on the mechanical ventilator, alarm sounds, the
nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

A. Kinking of the ventilator 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-Fowler’s position
C. Using a high-flow venture mask to deliver oxygen as prescribe
D. Administering a sedative, as prescribe

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

A. Cardiogenic pulmonary 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 client’s 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 it’s too low.

B. Question the order because it’s too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the theophylline measurement.

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 doesn’t differentiate between active and dormant tuberculosis infection.
C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
D. Test stimulates a reddened response in some clients and requires a second test in 3 months.

43. A female adult client has a tracheostomy but doesn’t require continuous mechanical
ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug
the opening in the tube for:

A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.

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 client’s 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 client’s 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 client’s 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 client’s history and
physical findings, the physician suspects legionnaires’ disease. While awaiting diagnostic test
results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of
choice for treating legionnaires’ disease?

A. Erythromycin (Erythrocin)
B. Rifampin (Rifadin)
C. Amantadine (Symmetrel)
D. Amphotericin B (Fungizone)

50. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a
myocardial infarction. Because the client is extremely weak and can’t produce an effective
cough, the nurse should monitor closely for:

A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.

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
client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical
ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the
nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

A. Kinking of the ventilator 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 lung’s 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-Barré syndrome develops respiratory acidosis as a result of reduced
alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory
acidosis?

A. pH, 5.0; PaCO2 30 mm 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 client’s history includes chronic obstructive
pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the
nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication
may arise if the client receives a high oxygen concentration?

A. 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. He’s anxious, and wheezes are audible. The client is immediately given
oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s
arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to
administer:

A. Alprazolam (Xanax).
B. Propranolol (Inderal)
C. Morphine.
D. Albuterol (Proventil).
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.
Source:​ ​https://quizlet.com/99768096/respiratory-system-nclex-questions-flash-cards/

The most important action the nurse should do before and after suctioning a client is:
a. Placing the client in a supine position
b. Making sure that suctioning takes only 10-15 seconds
c. Evaluating for clear breath sounds
d. Hyperventilating the client with 100% oxygen

The position of a conscious client during suctioning is​:

a. Fowler's
b. Supine position
c. Side-lying
d. Prone
Position a conscious person who has a functional gag reflex in the semi fowler's position
with the head turned to one side for oral suctioning or with the neck hyper extended for nasal
suctioning. If the client is unconscious place the patient a lateral position facing you.

Presence of overdistended and non-functional alveoli is a condition called:

a. Bronchitis
b. Emphysema
c. Empyema
d. Atelectasis
An overdistended and non-functional alveoli is a condition called emphysema.
Atelectasis is the collapse of a part or the whole lung. Empyema is the presence of pus in the
lung.

The accumulation of fluids in the pleural space is called:

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

The nurse caring for a male client with a chest tube turns the client to the side, and the
chest tube accidentally disconnects. The initial nursing action is to:
a. Call the physician.
b. Place the tube in a bottle of sterile water.
c. Immediately replace the chest tube system.
d. Place the sterile dressing over the disconnection site.
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.

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

A nurse is caring for a male client immediately after removal of the endotracheal tube. The
nurse reports which of the following signs immediately if experienced by the client?
a. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate of 24 breaths/min
Answer A: The nurse reports stridor to the physician immediately. This is a high-pitched,
coarse sound that is heard with the stethoscope over the trachea. Stridor indicates airway
edema and places the client at risk for airway obstruction

An emergency room nurse is assessing a female client who has sustained a blunt injury
to the chest wall. Which of these signs would indicate the presence of a pneumothorax in
this client
a. A low respiratory
b. Diminished breathe sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury
Answer B. This client has sustained a blunt or a closed chest injury. Basic symptoms of
a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may
cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema.
Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would
be noted with an open chest injury.

A nurse is caring for a male client hospitalized with acute exacerbation of chronic
obstructive pulmonary disease. Which of the following would the nurse expect to note on
assessment of this client?
a. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
c. Increase oxygen saturation with exercise
d. A widened diaphragm noted on the chest x-ray
Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include
hypoxemia, - hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise
and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and
a flattened diaphragm if the disease is advanced.
A community health nurse is conducting an educational session with community
members regarding tuberculosis. The nurse tells the group that one of the first
symptoms associated with tuberculosis is:
a. Dyspnea
b. Chest pain
c. A bloody, productive cough
d. A cough with the expectoration of mucoid sputum
Answer D. One of the first pulmonary symptoms is a slight cough with the expectoration
of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive
lung involvement.

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse
assesses the oxygen flow rate to ensure that it does not exceed:
a. 1 L/min
b. 2 L/min
c. 6 L/min
d. 10 L/min
Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Because of the
long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low
oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory
system.

A nurse instructs a female client to use the pursed-lip method of breathing and the client
asks the nurse about the purpose of this type of breathing. The nurse responds, knowing
that the primary purpose of pursed-lip breathing is to​:
a. Promote oxygen intake.
b. Strengthen the diaphragm.
c. Strengthen the intercostal muscles.
d. Promote carbon dioxide elimination.
Answer D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive
lung disease. This type of breathing allows better expiration by increasing airway pressure that
keeps air passages open during exhalation. Options A, B, and C are not the purposes of this
type of breathing.
Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the
following nursing actions will facilitate obtaining the specimen?
a. Limiting fluids
b. Having the clients take three deep breaths
c. Asking the client to split into the collection container
d. Asking the client to obtain the specimen after eating
Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce
contamination, breathe deeply, and then cough into a sputum specimen container. The client
should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by
fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal
time to obtain a specimen is on arising in the morning

A nurse is caring for a female client after a bronchoscope and biopsy. Which of the
following signs, if noted in the client, should be reported immediately to the physicians?
a. Dry cough
b. Hematuria
c. Bronchospasm
d. Blood-streaked sputum
Answer C. If a biopsy was performed during a bronchoscopy, blood-streaked sputum is
expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected.
The client should be assessed for signs of complications, which would include cyanosis,
dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
Hematuria is unrelated to this procedure.

A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning,
the nurse must limit the suctioning time to a maximum of:
a. 1 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds
Answer C. Hypoxemia can be caused by prolonged suctioning, which stimulates the
pacemaker cells in the heart. A vasovagal response may occur, causing bradycardia. The nurse
must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.
A nurse is suctioning fluids from a female client through an endotracheal tube. During
the suctioning procedure, the nurse notes on the monitor that the heart rate is
decreasing. Which of the following is the appropriate nursing intervention?
a. Continue to suction.
b. Notify the physician immediately.
c. Stop the procedure and reoxygenate the client​.
d. Ensure that the suction is limited to 15 seconds.
Answer C. During suctioning, the nurse should monitor the client closely for side effects,
including hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal
stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side effects develop,
especially cardiac irregularities, the procedure is stopped and the client is reoxygenated.

An unconscious male client is admitted to an emergency room. Arterial blood gas

measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level,
a normal oxygen level, and an elevated potassium level. These results indicate the
presence of:
a. Metabolic acidosis
b. Respiratory acidosis
c. Overcompensated respiratory acidosis
d. Combined respiratory and metabolic acidosis
Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In
addition, a low bicarbonate level along with the low pH would indicate a metabolic state.
Therefore, options B, C, and D are incorrect.

A female client is suspected of having a pulmonary embolus. A nurse assesses the

client, knowing that which of the following is a common clinical manifestation of
pulmonary embolism?
a. Dyspnea
b. Bradypnea
c. Bradycardia
d. Decreased respiratory
Answer A. The common clinical manifestations of pulmonary embolism are tachypnea,
tachycardia, dyspnea, and chest pain.
A nurse teaches a male client about the use of a respiratory inhaler. Which action by the
client indicates a need for further teaching?
a. Inhales the mist and quickly exhales
b. Removes the cap and shakes the inhaler well before use
c. Presses the canister down with the finger as he breathes in
d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed
Answer A. The client should be instructed to hold his or her breath for at least 10 to 15
seconds before exhaling the mist. Options B, C, and D are accurate instructions regarding the
use of the inhaler.

A female client has just returned to a nursing unit following bronchoscopy. A nurse
would implement which of the following nursing interventions for this client?
a. Administering atropine intravenously
b. Administering small doses of midazolam (Versed)
c. Encouraging additional fluids for the next 24 hours
d. Ensuring the return of the gag reflex before offering food or fluids
Answer D. After bronchoscopy, the nurse keeps the client on NPO status until the gag
reflex returns because the preoperative sedation and local anesthesia impair swallowing and
the protective laryngeal reflexes for a number of hours. Additional fluids are unnecessary
because no contrast dye is used that would need flushing from the system. Atropine and
midazolam would be administered before the procedure, not after.

A nurse is assessing the respiratory status of a male client who has suffered a fractured
rib. The nurse would expect to note which of the following?
a. Slow deep respirations
b. Rapid deep respirations
c. Paradoxical respirations
d. Pain, especially with inspiration
Answer D. Rib fractures are a common injury, especially in the older client, and result from a
blunt injury or a fall. Typical signs and Sx include
- pain and tenderness localized at the fracture site and exacerbated by inspiration and
palpation
- shallow respirations
 - splinting or guarding the chest protectively to minimize chest movement, and possible
bruising at the fracture site. Paradoxical respirations are seen with flail chest.

A male client has been admitted with chest trauma after a motor vehicle accident and has
undergone subsequent intubation. A nurse checks the client when the high-pressure
alarm on the ventilator sounds, and notes that the client has absence of breathe sounds
in right upper lobe of the lung. The nurse immediately assesses for other signs of:
a. Right pneumothorax
b. Pulmonary embolism
c. Displaced endotracheal tube
d. Acute respiratory distress syndrome
Answer A. Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain
with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the
affected side. Pneumothorax can cause increased airway pressure because of resistance to
lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not
characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause
absent breath sounds, but the lack of breath sounds most likely would be on the left side
because of the degree of curvature of the right and left main stem bronchi.

A nurse is teaching a male client with chronic respiratory failure how to use a
metered-dose inhaler correctly. The nurse instructs the client to:
a. Inhale quickly
b. Inhale through the nose
c. Hold the breath after inhalation
d. Take two inhalations during one breath
Answer C. Instructions for using a metered-dose inhaler include
- shaking the canister,
- holding it right side up,
- inhaling slowly and evenly through the mouth,
- delivering one spray per breath,
- and holding the breath after inhalation.
A nurse is assessing a female client with multiple trauma who is at risk for developing
acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute
respiratory distress syndrome?
a. Bilateral wheezing
b. Inspiratory crackles
c. Intercostal retractions
d. Increased respiratory rate
Answer D. The earliest detectable sign of acute respiratory distress syndrome is an
increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body.
This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and
cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse
crackles.

A nurse is assessing a male client with chronic airflow limitations and notes that the
client has a "barrel chest." The nurse interprets that this client has which of the following
forms of chronic airflow limitations?
a. Emphysema
b. Bronchial asthma
c. Chronic obstructive bronchitis
d. Bronchial asthma and bronchitis
Answer A. The client with emphysema has hyperinflation of the alveoli and flattening of
the diaphragm. These lead to increased anteroposterior diameter, referred to as "barrel chest."
The client also has dyspnea with prolonged expiration and has hyperresonant lungs to
percussion.

A nurse is caring for a female client diagnosed with tuberculosis. Which assessment, if
made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis
and may indicate the development of a concurrent problem?
a. Cough
b. High-grade fever
c. Chills and night sweats
d. Anorexia and weight loss
 Answer B. The client with tuberculosis USUALLY experiences cough (productive or
nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain,
chills and sweats (which may occur at night), and a low-grade fever

How often should a nurse assess the skin and nares of the patient with a nasal cannula?
The nurse should assess the client's nares and ears for skin breakdown every 6 hours.

What does central cyanosis indicate?

Hypoexmia

Describe the clinical signs of RIGHT sided heart failure.

weight gain, distended neck veins, hepatomegaly and splenomegaly, dependent
peripheral edema

What does FIO2 stand for?

Fraction of Inspired oxygen concentration

What is atelectasis?
collapse of the alveoli in the lung prevents normal exchange of O2 and co2
hypoventilation occurs

Identify what is included during the assessment phase of the nursing process for a
cardiopulmonary focus.
Assessment
• In-depth history of the client's normal and present cardiopulmonary function
• Past impairments in circulatory or respiratory functioning
• Patient history including a review of drug, food, and other allergies
• Physical examination of the client's cardiopulmonary status reveals the extent of
existing signs and symptoms.
• Use PQRST for pain / HPI for other symptoms
• Review of laboratory and diagnostic test results

Describe Tachypnea
respirations > 35
 clinical significance/contributing factors:
- respiratory failure
- response to fever
- anemia
- pain
- respiratory infection
- anxiety
(emergencies SNS system kicks in)

Identify initial assessment findings for a patient with EARLY STAGE LEFT sided heart
failure
- fatigue
- breathlessness
- dizziness
- confusion as a result of tissue hypoxia from the diminished CO

A seven-month-pregnant female is sitting quietly in the waiting room, and her respiratory
rate is 20 and shallow. What does this finding suggest to the nurse?
a. She has a history of smoking.
b. She is using accessory muscles to breathe.
c. She is in pending respiratory failure.
d. Nothing. This is normal.

The nurse is planning to assess the apex of a client's lungs. Which area of the body will
the nurse be assessing?
a. Left of the sternum, third intercostal space
b. Above the clavicles
c. Below the scapula
d. Right of the sternum, sixth intercostal space
b. Above the clavicles The apex of each lung is slightly superior to the inner third of the
clavicle.
A client with a strained trapezius muscle complains of having occasional shortness of breath.
What might be the reason for this symptom?
a. The strained muscle is an accessory muscle of respiration.
b. The diaphragm muscle is also injured.
c. There is an undiagnosed heart problem.
d. There is a blood clot in his lung.
Answer A.

During a physical assessment, the nurse documents eupnea on the client's medical record.
What does this finding suggest?
a. Normal respirations
b. Slow respirations
c. Irregular respirations
d. Rapid respirations

Prior to listening to a client's lung sounds, the nurse palpates the sternum and feels a
horizontal bump on the bone. What does this finding suggest to the nurse?
a. This is the angle of Louis.
b. The manubrium is damaged.
c. The costal angle is greater than normal.
d. The xiphoid process is misshaped.

The nurse is assessing the client's lung bases posteriorly. At which area can the nurse
assess this portion of the lung?
a. Right anterior axillary line
b. Scapular line
c. Midsternal line
d. Left midclavicular line
The mother of a four-year-old child tells the nurse, "I think there's something wrong with
him; his chest is round like a ball." Which of the following would be an appropriate
response for the nurse to make to the mother?
a. I see what you mean. That seems odd.
b. The chest of a child appears round and is normal.
c. I wouldn't worry about that.
d. Did you tell the doctor about this?

After examining a 75-year-old male client, the nurse writes down "barrel chest." What
does this finding suggest?
a. The client has a history of smoking.
b. The client has osteoporosis.
c. The client has long-standing respiratory disease.
d. This is a change associated with aging.

A 57-year-old client tells the nurse, "I need two to three pillows to sleep." How should
this information be documented?
a. Two to three pillow orthopnea
b. Dyspnea on excursion
c. Resting apnea
d. Dyspnea at rest

The client tells the nurse he sometimes coughs up "thick yellow mucous." What does
this information suggest to the nurse?
a. He might have an allergy.
b. He might have a fungal infection.
c. He might have episodic lung infections.
d. He might have tuberculosis.
Answer C. Rationale: The color and odor of any mucus is associated with specific
diseases or problems. Green or yellow mucus often signals a lung infection.
a 48-year-old client doesn't smoke cigarettes yet is demonstrating signs of lung irritation.
Which of the following questions could help with the assessment of this client?
a. Do you smoke or inhale marijuana or other herbal products?
b. Have you had allergy testing?
c. Have you received a flu or pneumonia vaccination?
d. Have you tried to stop smoking?

After inspecting a client's thorax, the nurse writes "AP:T 1:2, bilateral symmetrical
movements, sternum midline, respiratory rate 16 and regular." What do these findings
suggest?
a. Nothing. These findings are normal.
b. The client has pneumonia.
c. The client has a respiratory illness.
d. The client has allergies.

While palpating the posterior thorax of a client, the nurse notes increased fremitus. What
does this finding suggest to the nurse?
a. The client needs to speak up.
b. The client has a thick chest wall.
c. The client could either have fluid in the lungs or have an infection.
d. Nothing. This is a normal finding.

The nurse sees that the client will breathe deeply and then stop breathing for a short
while. Which of the following does this observation suggest?
a. This client is hyperventilating.
b. This client is in a diabetic coma.
c. This client has pneumonia.
d. This is seen in aging people, people with heart failure, and people who have suffered
brain damage.

In planning a patient education session, the nurse sees one area of focus for Healthy
People 2010 is chronic obstructive pulmonary disease (COPD). Which of the following
information should the nurse include in the education session to address this focus
area?
a. Screening for environmental triggers
b. Smoking cessation
c. Develop action plans
d. Identify those at risk
Source:https://quizlet.com/123402166/respiratory-nclex-questions-flash-cards/
Which of these clients will the charge nurse on the medical unit assign to an RN who has
floated from the postanesthesia care unit (PACU)?
A. Client with allergic rhinitis scheduled for skin testing
B. Client with emphysema who needs teaching about pulmonary function testing
C. Client with pancreatitis who needs a preoperative chest x-ray
D. Client with pleural effusion who has had 1200 mL removed by thoracentesis
D) A nurse working in the PACU would be familiar with assessing vital signs and
respiratory status after procedures such as thoracentesis.

An RN and an LPN/LVN are working together to provide care for a client hospitalized with
dyspnea who requires all of these nursing actions. Which of these actions is best
accomplished by the RN?
A. Administer the purified protein derivative (PPD) for tuberculosis testing.
B. Assess vital signs and the puncture site after thoracentesis.
C. Monitor oxygen saturation using pulse oximetry every 4 hours.
D. Plan client and family teaching regarding upcoming pulmonary function testing.
D) Developing the teaching plan is the most complex of the skills listed and requires RN
education and licensure.

A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy.
Which of these nursing tasks is best for the charge nurse to delegate to the experienced
nursing assistant working in PACU?
A. Assess breath sounds.
B. Check gag reflex.
C. Determine level of consciousness.
D. Monitor blood pressure and pulse.
D) A nursing assistant working in the PACU would have experience in taking client vital
signs after the client has had conscious sedation or anesthesia.

The RN has received report about all of these clients. Which client needs the most
immediate assessment?
A. Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry
B. Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes
C. Client with bronchogenic lung cancer who returned from bronchoscopy 3 hours ago
D. Client with pleural effusion who has decreased breath sounds at the right base
A) An oxygen saturation level less than 91% indicates hypoxemia and requires
immediate assessment and intervention to improve blood and tissue oxygenation.

The home health nurse is assigned to visit all of these clients when a change in agency
staffing requires that one of the clients should be rescheduled for a visit on the following
day. Which of these clients would be best to reschedule?
A. Client with emphysema who has been on home oxygen for a month and has SPO2
levels of 91% to 93%
B. Client with history of a cough, weight loss, and night sweats who has just had a positive
Mantoux test
C. Client with newly diagnosed pleural effusion who needs an admission visit and an initial
intake assessment
D. Client with percutaneous lung biopsy yesterday who called in to report increased dyspnea
A) This client has an appropriate Spo2 for home oxygen use.

Which of these assessment findings will be of greatest concern when the nurse is
assessing a client with emphysema?
A. Barrel-shaped chest
B. Bronchial breath sounds heard at the bases
C. Hyperresonance to percussion of the chest
D. Ribs lying horizontal
B) Bronchial breath sounds are not normally heard in the periphery and may indicate
increased lung density, as in a tumor or an infective process such as pneumonia.

People involved in which occupations or activities are encouraged to wear masks and to
have adequate ventilations? Select all that apply.
A. Bakers
B. Coal miners
C. Electricians
D. Furniture refinishers
E. Plumbers
F. Potters
 A) Being exposed to flour as a baker for prolonged periods of time may cause a
condition called occupational asthma. B) Coal miners are at risk to develop pneumoconiosis as
the result of inhalation of coal dust. D) Owing to the chemicals used to refinish furniture (paint
strippers, solvents), masks and adequate ventilation are essential for furniture refinishers. One
of the main solvents involved will metabolize in the body to carbon monoxide and will impair the
ability of the tissue to extract oxygen. F) Silicosis or inhalation of silica dust is a hazard for
professional and recreational potters.

Which nursing intervention is the priority in preparing the client for pulmonary function
testing (PFT)?
A. Administer bronchodilator medication on call.
B. Encourage clear fluid intake 12 hours before the procedure.
C. Ensure no smoking 6 hours before the test.
D. Provide supplemental oxygen as testing begins.
C) If the client has been smoking, this may alter parts of the PFT (diffusing capacity
[DlCO]), yielding inaccurate results.

The nurse is performing a client assessment for the client's potential employer. The
client reports dyspnea when climbing stairs but is not dyspneic at rest. Which dyspnea
classification does the nurse assign to this client in the report to the employer?
A. Class I, can perform perform manual labor
B. Class II, can perform desk job
C. Class III, minimally employable
D. Class IV, must remain at home
B) This client is dyspneic when climbing stairs or walking on an incline but not on level
walking. Therefore, this client is employable only for a sedentary job or under special
circumstances.

A client comes to the emergency department with a productive cough. Which symptom
does the nurse look for that will require immediate attention?
A. Blood in the sputum
B. Mucoid sputum
C. Pink frothy sputum
D. Yellow sputum
 C) Pink frothy sputum is common with pulmonary edema and requires immediate
attention and intervention to prevent the client's condition from getting worse.

A client with asthma reports shortness of breath. What is the nurse assessing when
auscultating this client's chest?
A. Adventitious breath sounds
B. Fremitus
C. Oxygenation status
D. Respiratory excursion
A) Adventitious sounds are additional breath sounds superimposed on normal sounds.
They indicate pathologic changes in the lung.

Four clients are sent back to the emergency department from triage at the same time.
Which client requires the nurse's immediate attention?
A. Client with acute allergic reaction
B. Client with dyspnea on exertion
C. Client with lung cancer with cough
D. Client with sinus infection with fever
A) An acute allergic reaction can lead to immediate respiratory distress. This is an
emergent situation that requires the immediate attention of the nurse.

The nurse auscultates popping, discontinuous sounds over the client's anterior chest.
How does the nurse classify these sounds?
A. Crackles
B. Rhonchi
C. Pleural friction rub
D. Wheeze
A) Crackles are described as a popping, discontinuous sound caused by air moving into
previously deflated airways. The airways have been deflated due to the presence of fluids in the
lungs, and crackles should be considered to be a sign of fluid overload.

In the older adult client, which respiratory change does not require further assessment
by the nurse?
A. Increased anteroposterior (AP) diameter
B. Increased respiratory rate
C. Shortness of breath
D. Sputum production
A) Increased AP diameter is normal with aging.

In assessing the client's respiratory status, blood gas test results reveal pH of 7.50, PaO2
of 99, PaCO2 of 29, and HCO of 22. What action does the nurse need to take first?
A. Call the physician.
B. Encourage the client to slow his breathing rate​.
C. Nothing. These results are within the normal range.
D. Provide oxygen support.
B) The arterial blood gases (ABGs) indicate respiratory alkalosis, which is commonly
caused by hyperventilation. Encouraging the client to slow down his breathing rate may help
him return to normal breathing and may correct this abnormality.

The client returns to the medical unit after a therapeutic bronchoscopy. Which
intervention does the nurse apply first?
A. Assess the puncture site for drainage.
B. Implement NPO (nothing by mouth) status.
C. Monitor for signs of anaphylaxis.
D. Perform aggressive chest physiotherapy
B) Until the client has a gag reflex and is fully alert, he should be maintained on NPO
status to prevent aspiration.

Why are the turbinates important?

A. They decrease the weight of the skull on the neck.
B. They increase the surface area of the nose for heating and filtering​.
C. They move inspired particles from nose to throat for removal.
D. They separate two nasal passages down the middle.
B) The turbinates increase the surface area of the nose, so that more heating, filtering,
and humidifying of inspired air can occur before air passes into the nasopharynx.

A client is having surgery. He asks his nurse, "When they put that tube in my throat,
where does it really go?" What is the name of the opening of the vocal cords?
A. Arytenoid cartilage
B. Epiglottis
C. Glottis
D. Palatine tonsils
C) The glottis is the opening of the vocal cords into which the endotracheal tube is
passed during intubation for surgery.

Where does gas exchange occur?

A. Acinus
B. Alveolus
C. Bronchus
D. Carina
B) The alveolus is the structural unit of the lung where gas exchange occurs.

The client has a fever of 104° F (40° C). In which direction, if any, will this shift the
oxyhemoglobin dissociation curve?
A. Down
B. To the left
C. To the right
D. Will not shift
C) A client with fever has a higher demand for oxygen, so the curve will shift to the right
for easier dissociation.

Which of the components of a client's family history are of particular importance to the
home health nurse who is assessing a new client with asthma?
A. Brother is allergic to peanuts.
B. Father is obese.
C. Mother is diabetic.
D. Sister is pregnant.
A) Clients with asthma often have a family history of allergies. It will be important to
assess whether this client has any allergies that may serve as triggers for an asthma attack.

Four clients arrive in the emergency department simultaneously with chest pain. The
client with which type of chest pain requires immediate attention by the nurse?
A. Client with pain on deep inspiration
B. Client with pain on palpation
C. Client with pain radiating to the shoulder
D. Client with pain that is rubbing in nature
C) Chest pain radiating to the shoulder should be assumed to be cardiac in origin until
proven otherwise; this requires the immediate attention of the nurse.

The nurse is working in an urgent clinic. Which of these four clients needs to be
evaluated first by the nurse?
A. Client who is short of breath after walking up two flights of stairs
B. Client with soreness of the arm after receiving purified protein derivative (PPD) (Mantoux)
skin test
C. Client with sore throat and fever of 39° C oral
D. Client who is speaking in three-word sentences and has SaO2 of 90% by pulse
oximetry
D) A client should be able to speak in sentences of more than three words, and Sao2 of
90% indicates hypoxemia that requires intervention on the part of the nurse.

A client is admitted to the medical floor with a new diagnosis of lung cancer. How can the
nurse assist the client initially with the anxiety associated with the new diagnosis?
A. Encourage client to ask questions and verbalize concerns.
B. Leave client alone to deal with his own feelings.
C. Medicate client with diazepam (Valium) for anxiety every 8 hours.
D. Provide journals about cancer treatment.
A) Anxiety causes increased oxygen consumption. Oxygen availability is limited in lung
cancer. The availability of the nurse to answer questions and listen to the client's concerns will
decrease anxiety.

A client is admitted to the surgical floor with chest pain, shortness of breath, and
hypoxemia after having a knee replacement. What diagnostic test will the nurse teach the
client about to help confirm the diagnosis?
A. Bronchoscopy
B. Chest x-ray
C. Computed tomography (CT) scan
D. Thoracoscopy
C) CT scans, especially spiral or helical CT scans, with injected contrast can detect
pulmonary emboli.

You are a charge nurse on a surgical floor. The LPN/LVN informs you that a new client
who had an earlier bronchoscopy has the following vital signs: heart rate 132, respiratory
rate 26, and blood pressure 98/50. The client is anxious and his skin is cyanotic. What
will be your first action?
A. Call the Rapid Response Team.
B. Give methylene blue 1% 1 to 2 mg/kg by IV injection
C. Administer oxygen.
D. Notify the physician immediately.
C) Administering oxygen and reassessing vital signs to observe for improvement is the
first action. Administration of oxygen by itself may help relieve the client's anxiety.

A client had a thoracentesis 1 day ago. He calls the home health agency and tells the
nurse that he is very short of breath and anxious. What is the major concern of the
nurse?
A. Abscess
B. Pneumonia
C. Pneumothorax
D. Pulmonary embolism
C) A pneumothorax would be the complication of thoracentesis that causes the greatest
concern, along with these symptoms.

The nursing assistant has taken vital signs of the ventilated postoperative client who has
had radical neck surgery. What does the nurse tell the assistant to be especially vigilant
for?
A. Bright red blood rapidly seeping through the dressing
B. Decreased level of consciousness
C. Effective pain management
D. Heart rate and blood pressure trending up over several hours
 A) Bright red blood indicates a rupture in the carotid artery and requires immediate
attention.

The nurse answers the client's call light and realizes that the client has an upper airway
obstruction. What is the nurse's first action?
A. Attempts to remove the obstruction
B. Calls the Rapid Response Team to intubate immediately
C. Calls the Rapid Response Team to perform an emergency cricothyroidotomy
D. Determines the cause of obstruction
D) The first step the nurse will take is to determine the cause of the obstruction. After the
cause has been determined (e.g., tongue, food, inflammation), the nurse can decide the next
course of action.

Which two factors in combination are the greatest risk factors for head and neck cancer?
A. Alcohol and tobacco use
B. Chronic laryngitis and voice abuse
C. Marijuana use and exposure to industrial chemicals
D. Poor oral hygiene and use of chewing tobacco
A) The combination of alcohol and tobacco use is one of the greatest risk factors for
head and neck cancer.

The nurse is planning care for the non-English-speaking client who is on complete voice
rest. What alternative method of communication does the nurse implement?
A. Alphabet board
B. Picture board
C. Translator at the bedside
D. Word board
B) A picture board overcomes language barriers and can be used to communicate with
clients who do not speak English as well as their family members if a translator or a translation
phone is not readily available.

Which clinical manifestation requires immediate action by the nurse for the client with
laryngeal trauma?
A. Aphonia
B. Hemoptysis
C. Hoarseness
D. Tachypnea
D) Tachypnea is a sign of respiratory distress that may accompany laryngeal trauma.
This requires immediate action on the part of the nurse.

Which finding in the postoperative client after nasoseptoplasty requires immediate

intervention by the nurse?
A. Ecchymosis
B. Edema
C. Excessive swallowing
D. Sore throat
C) Excessive swallowing in a client who has undergone a nasoseptoplasty may indicate
posterior nasal bleeding and requires immediate attention.

The client has received packing for a posterior nosebleed. In reviewing the client's
orders, which order does the nurse question?
A. "Give ibuprofen 800 mg every 8 hours as needed for pain."
B. "Encourage bed rest, with the head of the bed elevated 45 to 60 degrees."
C. "Provide humidified air."
D. "Suction at the bedside."
A) Ibuprofen is contraindicated in a client with a nosebleed because NSAIDs inhibit
clotting.

Which clinical manifestation in the client with facial trauma is the nurse's first priority?
A. Bleeding
B. Decreased visual acuity
C. Pain
D. Stridor
D) Stridor is an indication of a partial airway obstruction and requires immediate
attention.

The client admitted for sleep apnea asks the nurse, "Why does it seem like I wake up
every 5 minutes?" What is the nurse's best response?
A. "Because your body isn't getting rid of carbon dioxide. This is what stimulates your
body to wake up and breathe."
B. "Because your body isn't getting enough oxygen. Not getting enough oxygen is what
stimulates you to wake up and breathe."
C. "Because your tongue may be blocking your throat, and you wake up because you are
choking."
D. "It isn't really that often. It just feels that way."
A) During sleep, the muscles relax and the tongue and neck structures are displaced
with the tongue falling back, causing an upper airway obstruction. This obstruction leads to
apnea and increased levels of carbon dioxide. Respiratory acidosis stimulates neural centers in
the brain, and the client awakens, takes a deep breath, and goes back to sleep. After the client
returns to sleep, the cycle may be repeated as often as every 5 minutes as the airway is
re-obstructed.

Which statement by the client with a laryngectomy indicates the need for further
discharge teaching?
A. "I must avoid swimming."
B. "I can clean the stoma with soap and water."
C. "I can project mucus when I laugh or cough."
D. "I can't put anything over my stoma to cover it."
D) Loose clothing or a covering such as a scarf can be used to cover the stoma if the
client desires.

When suctioning a client with an endotracheal tube for the first time, what does the nurse
do first?
A. Briefly explains the procedure
B. Preoxygenates the client
C. Sets up a sterile field
D. Suctions for 10 to 15 seconds
A) Suctioning can be anxiety producing for the client. Explaining the procedure can
decrease the client's anxiety level and, in doing so, can decrease oxygen consumption. Each
time the client is suctioned, reinforcement of how the procedure is completed can decrease
anxiety.
The client is scheduled for a total laryngectomy. Which statement by the client indicates
the need for further teaching about the procedure?
A. "I hope I can learn esophageal speech."
B. "I really will miss the taste of my favorite food."
C. "I won't be able to breathe through my nose anymore."
D. "It is hard to believe that I will never hear my own voice again."
B) A laryngectomy does not involve the taste buds, so the client will still be able to taste
foods. However, laryngectomies do affect the sense of smell, and this has an effect on taste.

A newly hired RN with no previous emergency department (ED) experience has just
completed a 1-month orientation. Which of these clients would be most appropriate to
assign to this nurse?
A. Client with epistaxis with profuse bleeding on warfarin (Coumadin)
B. Client with facial burns caused by a mattress fire while sleeping
C. Client with possible facial fractures after a motor vehicle collision (MVC)
D. Client with suspected bilateral vocal cord paralysis and stridor
A) The initial treatment for epistaxis is upright positioning with direct lateral pressure to
the nose. A nurse with minimal ED experience could be expected to safely provide care for this
client. In addition, laboratory work should be obtained to assess the client's ability to clot, given
that he is on warfarin (Coumadin)

The nurse manager at a long-term care facility is planning care for a client who is
receiving radiation therapy for laryngeal cancer. Which of these tasks will be best to
delegate to a nursing assistant?
A. Administering throat-numbing lozenges
B. Assessing the mouth for inflammation and infection
C. Teaching about skin care while receiving radiation
D. Washing the skin with soap and water
D) Personal hygiene is within the scope of practice of the nursing assistant.

A client with laryngeal cancer is admitted to the medical-surgical unit the morning before
a scheduled total laryngectomy. Which of these preoperative interventions can be
accomplished by an LPN/LVN working on the unit?
A. Administering preoperative antibiotics and anxiolytics
B. Assessing the client's nutritional status and need for nutrition supplements
C. Having the client sign the operative consent form
D. Teaching the client about the need for tracheal suctioning after surgery
A) Administering medication is a skill within the LPN/LVN scope of practice. As a
reminder, anxiolytics must be administered AFTER the operative consent has been signed, or
the consent will be invalid.

A client who has fallen off a roof arrives in the emergency department with possible
head, neck, and chest trauma. All of these physician requests are received. Which action
will the nurse take first?
A. Give oxygen to keep O2 saturation greater than 93%.
B. Immobilize the neck with a cervical collar.
C. Infuse normal saline by large-bore IV catheter.
D. Obtain CT scan of head, neck, and chest.
B) If the cervical spine has not already been stabilized by EMS (emergency medical
services), this is the nurse's top priority. The neck should be held in place manually until a
properly fitted cervical collar can be applied. Innervation of the diaphragm is between cervical
spine levels 3 and 5.

The standard laryngectomy plan of care for a client admitted with laryngeal cancer
includes these interventions. Which intervention will be most important for the nurse to
accomplish before the surgery?
A. Educate the client about ways to avoid aspiration when swallowing after the surgery.
B. Establish a means for communication during the immediate postoperative period,
such as a Magic Slate or an alphabet board.
C. Discuss appropriate clothing to wear that will help cover the laryngectomy stoma and
decrease social isolation after surgery.
D. Teach the client and significant others about how to suction and do wound care of the stoma.
B) In the immediate postoperative period, relieving pain and anxiety is going to be a
major priority. Because the client will be unable to communicate verbally, establishing a way to
communicate before the surgery will help by having a plan in place.
A client's mother asks what is the most important thing she will need to know to care for
her son who is having an inner maxillary fixation (IMF) completed as an outpatient. What
does the RN tell her?
A. "Give him Phenergan (promethazine) by rectum around the clock so he does not vomit."
B. "He can only drink milk and eat ice cream until the wires come off."
C. "He must brush his teeth every 2 hours."
D. "Make sure he always has wire cutters with him."
D) It is extremely important that the client always have wire cutters in the event of
emesis, so the wires can be cut to prevent aspiration. Remind the client to contact the surgeon
as soon as possible if the wires have been cut, so that fixation can be re-established.

A client with sleep apnea who has a new order for continuous positive airway pressure
(CPAP) with a facemask returns to the outpatient clinic after 2 weeks with a report of
ongoing daytime sleepiness. Which action should the nurse take first?
A. Ask the client whether CPAP has been used consistently at night.
B. Discuss the use of autotitrating positive airway pressure (APAP).
C. Plan to teach the client about treatment with modafinil (Provigil).
D. Suggest that a nasal mask be used instead of a full facemask.
A) The nurse should assess whether the client has actually consistently been using
CPAP at night because clients may have difficulty with the initial adjustment to this therapy.

Your client has been diagnosed with oral and laryngeal cancer. He completed a course of
radiation, and it is 2 days since he underwent a total laryngectomy. The client had been
very anxious about his surgery. Which of the following medications would you expect to
find on his home medication list?
A. Amitriptyline (Elavil)
B. Diazepam (Valium)
C. Ketorolac (Toradol)
D. Lorazepam (Ativan)
D) Lorazepam is a short-acting antianxiety medication that would be the most
appropriate choice for this client.
The client is 1 day postoperative from a total laryngectomy for cancer. He has indicated
to you that he is experiencing pain. Pain management for him is best achieved with
which medication?
A. IV ketorolac (Toradol)
B. IV midazolam (Versed)
C. IV morphine sulfate (Morphine)
D. Oral acetaminophen (Tylenol)
C) Morphine or other opioids are the best choice for this client in the immediate
postoperative period. They can be given both as a bolus dose and continuously by
patient-controlled analgesia (PCA). The client's airway and respiratory status must be carefully
observed.

A client who has had a recent laryngectomy continues to report pain. Which of the
following medications would be best used as an adjunct to a narcotic once he can take
oral nutrition?
A. Liquid NSAIDs
B. Liquid steroids
C. Opioid antagonists
D. Oral diazepam
A) NSAIDs are an excellent adjunct when used with narcotics or opioid analgesia.

Your client is the football coach at a local high school. His chief problem is hoarseness.
Which of the following is the best recommendation the nurse can make regarding his
care?
A. Complete voice rest
B. Drinking hot tea with lemon
C. Prescription for antibiotics
D. Whispering instead of using full voice
A) Nodules on the vocal cords from overuse may cause hoarseness. Complete voice
rest is the best recommendation.

What is the purpose of wearing fluoride gel trays during radiation therapy of the mouth?
A. Keep the mouth moist during treatments
B. Keep the teeth from turning yellow after treatment
C. Prevent radiation scatter when the beam hits metal in the mouth
D. Protect the taste buds on the tongue
C) The gel trays help prevent radiation scatter when the beam hits metal in the mouth.

A new client arrives in the medical-surgical unit with a flap. The flap appears dusky in
color. What is the nurse's first action?
A. Apply a hot pack over the flap site.
B. Massage the flap site vigorously.
C. Place a tight dressing over the flap.
D. Use a Doppler to assess flow to the area.
D) A complete assessment of the area including Doppler activity of major feeding
vessels needs to be completed and the surgeon needs to be notified because the client may
have to be returned to the operating room immediately.

All of these clients are being cared for on the intensive care step-down unit. Which client
should the charge nurse assign to an RN who has floated from the pediatric unit?
A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by
non-rebreather mask.
B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour.
C. Client with emphysema who requires instruction about correct use of oxygen at home.
D. Client with lung cancer who has just been transferred from the ICU after having a left lower
lobectomy the previous day.
A) Because asthma is a common pediatric diagnosis, the pediatric nurse would be
familiar with the assessment and care needed for a client with this diagnosis.

The RN and the nursing assistant are working together to provide care for a group of
clients. Which of these nursing activities could the RN delegate to the nursing assistant?
A. Auscultate for improvement in breath sounds in a client who has had a right lower lobectomy.
B. Document discharge instructions for a client being discharged with new asthma medications.
C. Monitor the effectiveness of oxygen therapy for a client admitted with chronic bronchitis.
D. Reinforce the use of slow expiration through pursed lips to maximize gas exchange
for a client with sarcoidosis.
D) Client education is an RN level skill, but reinforcement of previously taught material
can be delegated to unlicensed personnel who are caring for the client.
A client has just been admitted to the intensive care unit (ICU) after having a left lower
lobectomy with a video-assisted thoracoscopic surgery (VATS). Which of these requests
will the nurse implement first?
A. Adjust oxygen flow rate to keep O2 saturation at 93% to 100%.
B. Administer 2 g of cephalothin (Keflin) IV now.
C. Give morphine sulfate 4 to 6 mg IV for pain.
D. Infuse 1 unit of packed red blood cells (PRBCs) over the next 2 hours.
A) Airway and oxygenation are main priorities in the immediate postoperative period.
The client will likely be intubated, so coordination of care with Respiratory Therapy will be
important.

The change-of-shift report has just been completed on the medical-surgical unit. Which
of the following clients will the oncoming nurse plan to assess first?
A. Client with COPD who is ready for discharge but is not able to pay for prescribed home
medications.
B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate
of 38.
C. Hospice client with terminal pulmonary fibrosis and an oxygen saturation level of 89%.
D. Client with lung cancer who needs an IV antibiotic administered before going to surgery.
B) The client with cystic fibrosis, an elevated temperature, and an elevated respiratory
rate is exhibiting signs of an exacerbation and needs to be assessed first.

A client with asthma has pneumonia, is reporting increased shortness of breath, and has
inspiratory and expiratory wheezes. All of these medications are prescribed. Which
medication should the nurse administer first?
A. Albuterol (Proventil) 2 inhalations
B. Fluticasone (Flovent) 2 inhalations
C. Ipratropium (Atrovent) 2 inhalations
D. Salmeterol (Serevent) 2 inhalations
A) Albuterol is a beta2 agonist that acts rapidly as a bronchodilator.

Your client has been diagnosed with chronic bronchitis and started on a mucolytic. What
is the rationale for ordering a mucolytic for this client?
A. Mucolytics decrease secretion production.
B. Mucolytics increase gas exchange in the lower airways.
C. Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease
(COPD).
D. Mucolytics thin secretions, making them easier to expectorate.
D) The term mucolytic means "breaking down mucus." Mucolytics cause secretions to
thin and make them easier to be expectorated. This is important for a client with chronic
bronchitis.

The client has asthma that only gets worse during the summer. She tells the nurse she
will be taking a medicine every day so she does not get short of breath when she walks
to work. About which medicine does the nurse need to educate the client?
A. Albuterol (Proventil) inhaler
B. Guaifenesin (Organidin)
C. Montelukast (Singulair)
D. Omalizumab (Xolair)
C) Montelukast is a leukotriene antagonist that works well for asthma that occurs during
certain seasons. It is taken on a daily basis as a preventive medication.

The client is a marathon runner who has asthma. Which category of medication is used
as a rescue inhaler?
A. Corticosteroids
B. Long-acting beta agonists
C. NSAIDs
D. Short-acting beta agonists
D) Short-acting beta agonist medications have a rapid onset and cause bronchodilation.
These medications would be excellent for marathon running because some types of asthma
may be exercise induced.

A client has been diagnosed with asthma. Which statement below indicates that he
correctly understands how to use an inhaler with a spacer correctly?
A. "I don't have to wait between the two puffs if I use a spacer."
B. "If the spacer makes a whistling sound, I am breathing in too rapidly."
C. "I should rinse my mouth and then swallow the water to get all of the medicine."
D. "Shake the inhaler only if you want to see whether it is empty."
B) Slow and deep breaths ensure that the medication is reaching deeply into the lungs.
The whistling noise serves as a reminder to the client of which technique needs to be used.

What does the nurse do first when setting up a safe environment for the new client on
oxygen?
A. Ensures that staff wear protective clothing
B. Ensures that no combustion hazards are present in the room
C. Sets the oxygen delivery to maintain no fewer than 16 breaths per minute
D. Uses a pulse oximetry unit
B) Oxygen is highly flammable. The nurse needs to ensure that no open flames or
combustion hazards are present in a room where oxygen is in use.

For relief of hypoxemia in the newly admitted client with chronic obstructive pulmonary
disease (COPD), what does the client most likely need?
A. Oxygen flow rate of 1 to 2 L/min via nasal cannula
B. Oxygen flow rate of 2 to 4 L/min via nasal cannula
C. Oxygen flow rate of up to 60% via Venturi mask
D. 100% non-rebreather mask
A) The client who is hypoxemic and also has chronic hypercarbia requires lower levels of
oxygen delivery, usually 1 to 2 L/min via nasal cannula. A low arterial oxygen level is this client's
primary drive for breathing.

Because clients with cystic fibrosis (CF) are at increased risk for infection, what does the
nurse advise the client with CF to do?
A. Avoid Cystic Fibrosis Foundation-sponsored events.
B. Avoid the hospital.
C. Stay at home most of the time.
D. Use an antiseptic hand gel.
A) A serious bacterial infection for clients with CF is Burkholderia cepacia, which is
spread by casual contact from one CF client to another. For this reason, the Cystic Fibrosis
Foundation bans infected clients (those who have had a positive sputum culture) from
participating in any foundation-sponsored events.
While the nurse is talking with the postoperative thoracic surgery client, the client
coughs and the chest tube collection water seal chamber bubbles. What does the nurse
do?
A. Calmly continues talking
B. Checks the tube for blocks or kinks
C. Immediately calls the physician
D. Strips the chest tube
A) Gentle bubbling in the water seal chamber is normal during the client's exhalation,
forceful cough, or position changes.

An environmental assessment of a factory is conducted, and inhalation exposure with a

high level of particulate matter is found. What does the factory nurse do to generate the
quickest compliance?
A. Encourages proper building ventilation
B. Refers workers to a tobacco cessation program
C. Suggests that workers find another job
D. Teaches workers how to use a mask
D) Teaching everyone to use a mask when working in areas with high levels of
particulate matter can reduce individual exposure.

After receiving education on the correct use of emergency drug therapy for asthma,
which statement by the client indicates understanding of the nurse's instructions?
A. "Asthma drugs help everybody breathe better."
B. "I must carry my emergency inhaler only when activity is anticipated."
C. "I must have my emergency inhaler with me at all times."
D. "Preventive drugs can stop an attack."
C) Because asthma attacks cannot always be predicted, clients with asthma must
always carry a rescue inhaler such as a short-acting beta agonist (SABA) like albuterol
(Proventil).

The client says, "I hate this stupid COPD." What is the best response by the nurse?
A. "Then you need to stop smoking."
B. "What is bothering you?"
C. "Why do you feel this way?"
D. "You will get used to it."
B) Encourage the client and the family to express their feelings about limitations on their
lifestyle and about disease progression.

Which statement by the client with chronic obstructive pulmonary disease (COPD) indicates the
need for additional follow-up instruction?
A. "I don't need to use my oxygen all the time."
B. "I don't need to get the flu shot."
C. "I need to eat more protein."
D. "It is normal to feel more tired than I use to."
B) An annual influenza vaccine (flu shot) is important for all clients with COPD. At the
same time, a pneumonia vaccine could be offered since pneumonia is one of the most common
complications of COPD.

A client is admitted with asthma. How is this disease differentiated from other chronic
lung disorders?
A. It affects only young people.
B. The client has dyspnea.
C. The client is coughing.
D. The client is symptom free between exacerbations.
D) The client may be completely symptom free between exacerbations.

In a presentation to middle school students, what does the nurse teach as the major risk
factor for lung cancer?
A. Alcohol consumption
B. Asbestos exposure
C. Cigarette smoking
D. Smoking marijuana
C) Cigarette smoking is the number one risk factor for lung cancer and COPD.

The nurse has been teaching improved airflow techniques to the client, who has
continued to have restrictive breathing problems. Which is the best indicator of success?
A. Peak flowmeter readings that are yellow after the third reading
B. Productive cough
C. SpO2 level of 92% after ambulating 50 feet
D. Stable arterial blood gases (ABGs)
C) Maintaining a baseline Spo2 of 92% after ambulating 50 feet is an excellent indicator
that the client has achieved better airflow, and that the nurse's teaching has been effective.

A newly diagnosed client with asthma says that his peak flow meter is reading 82% of his
personal best. What does the nurse do?
A. Nothing. This is in the green zone.
B. Provides the rescue drug and reassesses
C. Provides the rescue drug and seeks emergency help
D. Repeats the peak flow test
D) The client is newly diagnosed with asthma. This would be an excellent opportunity for
the nurse to observe the client using the peak flow meter to ensure that the client is using it
properly, so readings are accurate and in the green zone, at least 80% of the client's personal
best.

The nurse is teaching the client who has been newly diagnosed with cancer. For which
side effect specific to radiation does the nurse teach prevention techniques?
A. Hair loss
B. Increased risk for sunburn
C. Loss of appetite
D. Pain at site of treatment
B) Skin in the path of radiation is more sensitive to sun damage; therefore clients must
avoid direct skin exposure to the sun during treatment and for at least 1 year after radiation is
completed.

After surgery for placement of a chest tube, the client reports burning in the chest. What
does the nurse do first?
A. Assesses airway, breathing, and circulation
B. Calls for the Rapid Response Team
C. Checks the patency of the chest tubes
D. Listens for breath sounds
A) Assessing the ABCs is the priority to determine possible causes of burning in the
client's chest.
The nurse is caring for a group of clients. Which person does the nurse identify as
having the highest risk for pulmonary embolism (PE)?
A. A client with diabetes and cellulitis of the leg
B. A client receiving IV fluids through a peripheral line
C. A client returning from an open reduction and internal fixation of the tibia
D. A client with hypokalemia receiving potassium supplements
C) Surgery and immobility are risks for deep vein thrombosis (DVT) and PE.

Which client has a higher risk for developing a pulmonary embolism (PE)?
A. 25-year-old woman who frequently flies to different countries
B. 67-year-old man who works on a farm
C. 45-year-old man admitted for a heart attack
D. 23-year-old woman with a bleeding disorder
A) People who engage in prolonged and frequent air travel are at higher risk for PE.

The nurse is assessing a client with possible pulmonary embolism. For which symptoms
should the nurse assess? Select all that apply.
A. Dizziness and fainting
B. Shortness of breath (SOB) worsening over the last 2 weeks
C. Inspiratory chest pain
D. Productive cough
E. Pink, frothy sputum
A) Syncope, hypotension, and fainting are symptoms associated with pulmonary
embolism. C) Sharp, pleuritic, inspiratory chest pain is characteristic of PE.

The nurse is developing the plan of care for the client with pulmonary embolism (PE).
Which client problem does the nurse establish as the priority?
A. Inadequate nutrition related to food-drug interactions and anticoagulant therapy
B. Potential for infection related to leukocytosis
C. Hypoxemia related to ventilation-perfusion mismatch
D. Insufficient knowledge related to the cause of pulmonary
C) Restoring adequate oxygenation and tissue perfusion takes priority when a client
presents with a PE.
The registered nurse is overseeing a nursing student who is administering medications
to a group of clients with pulmonary disorders. Under which circumstance does the
nurse NOT correct the student?
A. "You will receive enoxaparin (Lovenox) through the intravenous line for 3 days."
B. "Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3."
C. "Once the physician orders warfarin (Coumadin), we will discontinue the intravenous
heparin."
D. "If bleeding develops, we will give you aminocaproic acid to reverse the anticoagulant."
B) The international normalized ratio (INR), a measurement of anticoagulation with
Coumadin, is in the therapeutic range between 2 and 3.
-------
A) Enoxaparin (Lovenox) is a low-molecular weight heparin that must be given by the
subcutaneous route. C) Heparin and Coumadin are overlapped until the INR is in the
therapeutic range, then the heparin can be discontinued. D) Aminocaproic acid (Amicar) is used
as an antidote for thrombolytic therapy and in the treatment of subarachnoid hemorrhage.

When caring for a client with pulmonary embolism, which blood gas result does the
nurse anticipate early in the course of the disease?
A. pH 7.24, PCO2 55, HCO 26, PO2 56
B. pH 7.46, PCO2 30, HCO 26, PO2 68
C. pH 7.35, PCO2 45, HCO 24, PO2 80
D. pH 7.47, PCO2 35, HCO 30, PO2 75
B) Hyperventilation triggered by hypoxia and pain first leads to respiratory alkalosis,
indicated by low partial pressure of arterial carbon dioxide (Paco2) and high pH. No
compensation is present as the HCO3 is normal, and hypoxemia is present, consistent with PE.

Which intervention will be most effective in reducing anxiety in the client with a
pulmonary embolism (PE)?
A. Remain with the client, and provide oxygen in a calm manner.
B. Have the client breathe into a brown paper bag using pursed lips.
C. Offer the client a mild sedative.
D. Allow a family member to remain in the room
 A) The underlying cause for anxiety with a PE is hypoxemia, which will be alleviated by
oxygen. Remaining with a client in distress is appropriate.

The nurse is caring for a client who was discharged 3 weeks ago after a diagnosis of
pulmonary embolism (PE). He is currently admitted with gastrointestinal bleeding and an
international normalized ratio (INR) of 6.9. For which of the following should the nurse
assess this client?
A. Consumption of green leafy vegetables
B. Prolonged exhalation
C. Client has massaged his calves.
D. Use of aspirin or salicylates
D) Use of aspirin and salicylates will prolong the INR and cause gastric irritation.

The medical-surgical unit nurse should call the Rapid Response Team to assess which of
these clients?
A. The client with a diagnosed pulmonary embolism who is receiving IV heparin and has
bright red hemoptysis
B. The client with deep vein thrombosis who is receiving low-molecular weight heparin and has
ongoing calf pain
C. The client with a right pneumothorax who is being treated with a chest tube and has a pulse
oximetry of 94%
D. The client who was extubated 3 days ago and has decreased breath sounds at the posterior
bases of both lungs
A) This client is showing signs of possible pulmonary infarction or bleeding abnormality
secondary to heparin. This indicates a significant decline in status and warrants activation of the
Rapid Response Team.

The nurse is caring for a group of clients. Which clients should be monitored closely for
respiratory failure? Select all that apply.
A. Client with a brainstem tumor
B. Client with acute pancreatitis
C. Client with a T3 spinal cord injury
D. Client using patient-controlled analgesia
E. Client experiencing cocaine intoxication
 A) Pressure on the brainstem may depress respiratory function. B) Acute pancreatitis is
a risk factor for acute respiratory distress syndrome (ARDS); abdominal distention also ensues,
which can limit respiratory excursion. D) Opiates, which can depress the brainstem, present risk
factors for respiratory failure.

Which client needs immediate attention by the RN?

A. 40-year-old who is receiving continuous positive airway pressure (CPAP) and has intermittent
wheezing
B. 54-year-old who is mechanically ventilated and has tracheal deviation
C. 57-year-old who was recently extubated and is reporting a sore throat
D. 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24
B) This client is showing signs of a tension pneumothorax that could lead to decreased
cardiac output and shock if not addressed promptly.

The nurse is caring for a client who is receiving mechanical ventilation and hears the
high-pressure alarm. Which action should the nurse take first?
A. Check the ventilator alarm settings.
B. Assess the set tidal volume.
C. Listen to the client's breath sounds.
D. Call the respiratory therapist
C) A typical reason for the high pressure alarm to sound is the need for suctioning with
tension pneumothorax.

All of these nursing actions are included in the plan of care for a client who has just been
extubated. Which action should the RN delegate to unlicensed assistive personnel
(UAP)?
A. Keep the head of the bed elevated.
B. Teach about incentive spirometer use.
C. Monitor vital signs every 5 minutes.
D. Adjust the nasal oxygen flow rate.
A) Positioning of clients is included in UAP education and the job description and can be
delegated to UAP.
The nurse coming on shift prepares to perform an initial assessment of the sedated
ventilated client. Which are priorities for the nurse to carry out? Select all that apply.
A. Ask visitors to leave.
B. Assess the client's color and respirations.
C. Confirm alarms and ventilator settings.
D. Ensure that the tube cuff is inflated and is in the proper position.
E. Listen for bilateral chest sounds.
F. Provide routine tracheotomy and endotracheotomy and mouth care.
B) The first priority when caring for the critically ill client is to assess airway and
breathing. C) Alarm settings should be confirmed each shift, more frequently if necessary. D)
Ensuring that the client cannot speak ensures that air is going through the endotracheal tube
and not around it. E) Auscultating for equal bilateral breath sounds assists in confirming that the
tube is above the carina.

The client has been admitted for a pulmonary embolism and is receiving heparin
infusion. What safety priority does the nurse include in the plan of care?
A. Teach the client to avoid using dental floss.
B. Monitor the platelet count daily.
C. Ensure adequate staffing for the unit.
D. Notify radiology of an impending scan.
B) Daily platelet counts are a safety priority in assessing for thrombocytopenia.
Heparin-induced thrombocytopenia is a possible side effect.

The ventilated client in the intensive care unit begins to pick at the bedcovers. Which
action should the nurse take next?
A. Increase the sedation,
B. Assess for adequate oxygenation,
C. Explain to the client that he has a tube in his throat to help him breathe,
D. Request that the family leave to decrease the client's agitation,
B) Restlessness, agitation, anxiety, and tachycardia are early symptoms of hypoxemia.

The nurse is caring for a group of clients. The client with which condition is in greatest
need of immediate intubation?
A. Difficulty swallowing oral secretions
B. Hypoventilation and decreased breath sounds
C. O2 saturation of 90%
D. Thick, purulent secretions and crackles
B) Intubation may be indicated for the client who is hypoventilating and has decreased
breath sounds.

Which intervention for the client in the intensive care unit will decrease the incidence of
"ICU psychosis"?
A. Decreasing nighttime disruptions
B. Keeping the lights on to promote orientation
C. Administering sedation
D. Providing television or radio for stimulation
A) ICU psychosis can be minimized not only by encouraging sleep, but also by keeping
to a regular routine.

The nurse is assessing a client who is receiving mechanical ventilation with positive
end-expiratory pressure (PEEP). Which findings would cause the nurse to suspect a
left-sided tension pneumothorax?
A. Chest caves in on inspiration and "puffs out" on expiration.
B. Trachea is deviated to the right side and cyanosis is present.
C. The left lung field is dull to percussion with crackles present on auscultation.
D. Client has bloody sputum and wheezes.
B) Symptoms of tension pneumothorax include chest asymmetry, tracheal deviation
toward the unaffected side, dyspnea, absent breath sounds, JVD (jugular venous distention),
cyanosis, and hyperresonance to percussion over the affected area.

The nurse is caring for a group of critically ill clients. Which client has the greatest risk
for developing acute respiratory distress syndrome (ARDS)?
A. A client with diabetic ketoacidosis (DKA)
B. A client with atrial fibrillation
C. A client with aspiration pneumonia
D. A client with acute renal failure
C) Aspiration of acidic gastric contents is a risk for ARDS.
The nurse is teaching the family of a client who is receiving mechanical ventilation.
Which statement reflects appropriate information that the nurse should communicate?
A. Sedation is needed so your loved one does not rip the breathing tube out.
B. Suctioning is important to remove organisms from the lower airway.
C. Paralysis and sedatives help decrease the demand for oxygen.
D. We are encouraging oral and intravenous fluids to keep your loved one hydrated.
C) Paralytics and sedation decrease oxygen demand.

The nurse is caring for a client with impending respiratory failure who refuses intubation
and mechanical ventilation. Which method provides an alternative to mechanical
ventilation?
A. Oropharyngeal airway
B. Bi-level positive airway pressure (BiPAP)
C. Non-rebreathing mask with 100% oxygen
D. Positive end-expiratory pressure (PEEP)
B) Bi-level positive-pressure ventilation is a noninvasive method that may provide
short-term ventilation without intubation.

Which of these clients would be appropriate to assign to the new nurse working on the
unit?
A. A client with diabetic ketoacidosis and change in mental status who has a pH of 7.18
B. A client with emphysema and cellulitis with a PaCO2 level of 58 mm Hg
C. A client with reactive airway disease, wheezing, and a PaO2 level of 62 mm Hg
D. A client with a small bowel obstruction and vomiting with a bicarbonate level of 40 mEq/L
B) This finding, although abnormal, is anticipated for a client with chronic obstructive
pulmonary disease (COPD) and is stable for a new graduate.

A new nurse graduate is caring for a postoperative client with the following arterial blood
gases (ABGs): pH, 7.30; PCO2, 60 mm Hg; PO2, 80 mm Hg; bicarbonate, 24 mEq/L; and
O2 saturation, 96%. Which of these actions by the new graduate is indicated?
A. Encourage the client to use the incentive spirometer and to cough.
B. Administer oxygen by nasal cannula.
C. Request a prescription for sodium bicarbonate from the health care provider.
D. Inform the charge nurse that no changes in therapy are needed.
 A) Respiratory acidosis is caused by CO2 retention and impaired chest expansion
secondary to anesthesia. The nurse takes steps to promote CO2 elimination, including
maintaining a patent airway and expanding the lungs through breathing techniques.

The nurse is caring for a client with hypoxemia and metabolic acidosis. Which of these
tasks can be delegated to the nursing assistant who is helping with the client's care?
A. Assess the client's respiratory pattern.
B. Increase the IV normal saline to 120 mL/hr.
C. Titrate O2 to maintain an O2 saturation of 95% to 100%.
D. Apply the pulse oximeter for continuous readings.
D) Placing a peripheral pulse oximeter is a standardized nursing skill that is within the
scope of practice for unlicensed personnel.

Which nursing intervention takes priority for a client admitted with severe metabolic
acidosis?
A. Perform medication reconciliation.
B. Assess the client's strength in the extremities.
C. Obtain a diet history for the past 3 days.
D. Initiate cardiac monitoring.
D) The nurse follows the ABCs and initiates cardiac monitoring to observe for signs of
hyperkalemia or cardiac arrest.

The nurse is caring for a critically ill client with septic shock. The serum lactate level is
6.2. For which of the following acid-base disturbances should the nurse assess?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
A) Increased lactate levels are associated with hypoxia and metabolic acidosis
secondary to anaerobic metabolism.

The nurse is caring for a client who has taken a large quantity of furosemide (Lasix) to
promote weight loss. The nurse anticipates the finding of which acid-base imbalance?
A. PO2 of 78 mm Hg
B. HCO of 34 mEq/L
C. PCO2 of 56 mm Hg
D. pH of 7.31
B) Diuretics (non-potassium sparing) cause metabolic alkalosis.

The nurse is caring for a client with an oxygen saturation of 88% and accessory muscle
use. The nurse provides oxygen and anticipates which of these physician orders?
A. Administration of IV sodium bicarbonate
B. Computed tomography (CT) of the chest, stat
C. Intubation and mechanical ventilation
D. Administration of concentrated potassium chloride solution
C) Support with mechanical ventilation may be needed for clients who cannot keep their
oxygen saturation at 90% or who have respiratory muscle fatigue.

The nurse is caring for a group of clients with acidosis. The nurse recognizes that
Kussmaul respirations are consistent with which situation?
A. Client receiving mechanical ventilation
B. Use of hydrochlorothiazide
C. Aspirin overdose
D. Administration of sodium bicarbonate
C) If acidosis is metabolic in origin, the rate and depth of breathing increase as the
hydrogen ion level rises; this is known as Kussmaul respirations. Metabolic acidosis is caused
by alcoholic beverages, methyl alcohol, and acetylsalicylic acid (aspirin).

Which action should the nurse take first for the client who is admitted to the emergency
department (ED) with a panic attack and whose blood gases indicate respiratory
alkalosis?
A. Encourage the client to take slow breaths.
B. Obtain a prescription for a fluid and electrolyte infusion.
C. Administer oxygen using ED standard orders.
D. Place an emergency cart close to the client's room.
A) Because respiratory alkalosis is caused by hyperventilation, the nurse's first action
should be to assist the client in slowing the respiratory rate.
To decrease the risk of acid-base imbalance, what goal must the client with diabetes
mellitus strive for?
A. Checking blood glucose levels once daily
B. Drinking 3 L of fluid per day
C. Eating regularly, every 4 to 8 hours
D. Maintaining blood glucose level within normal limits
D) Maintaining blood glucose levels within normal limits is the best way to decrease the
risk of acid-base imbalance.

Which client is most likely to exhibit the following ABG results: pH, 7.30; PaCO2, 49; HCO
, 26; PO2, 76?
A. Client with kidney failure
B. Client taking hydromorphone (Dilaudid)
C. Client with anxiety disorder
D. Client with hyperkalemia
B) Hydromorphone (Dilaudid), a narcotic analgesic, can cause respiratory depression,
hypoventilation, and respiratory acidosis, as this blood gas reading demonstrates.

When caring for a group of clients at risk for respiratory acidosis, the nurse identifies
which person as at highest risk?
A. An athlete in training
B. Pregnant woman with hyperemesis gravidarum
C. Person with uncontrolled diabetes
D. Client who smokes cigarettes
D) Cigarette smoking worsens gas exchange, leading to disorders that contribute to
hypoventilation and respiratory acidosis.

Which acid-base disturbance does the nurse anticipate the client with morbid obesity
may develop?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
 C) Respiratory acidosis is related to CO2 retention secondary to respiratory depression,
inadequate chest expansion, airway obstruction, and reduced alveolar-capillary diffusion,
common in the morbidly obese, who experience inadequate chest expansion owing to their size
and work of breathing.

When caring for a client with a pulse oximetry level of 89%, which action should the
nurse take first?
A. Get the client out of bed.
B. Apply oxygen as prescribed.
C. Notify the client's physician.
D. Auscultate breath sounds.
B) Applying oxygen is the first priority for a client with hypoxemia.

The nurse is caring for a client who is taking a first-generation antihistamine. What is the
most important fact for the nurse to teach the client?
A. "Do not drive after taking this medication."
B. "Make sure you drink a lot of liquids while on this medication."
C. "Take this medication on an empty stomach."
D. "Do not take this medication for more than 2 days."
A) First-generation antihistamines cause drowsiness.

The nurse is caring for a client in the clinic who states that he is afraid of taking
antihistamines because he is a truck driver. What is the best information for the nurse to
give this client?
A. "Take the medication only when you are not driving."
B. "Take a lower dose than normal when you have to drive."
C. "You are correct, you should not take antihistamines."
D. "You may be able to safely take a second-generation antihistamine."
D) Second-generation antihistamines are often called nonsedating antihistamines.
These may be safer for the client to take, but the client should still monitor for signs of excessive
sedation.

The client tells the nurse that she has a bad cold, is coughing, and feels like she has
"stuff" in her lungs. What should the nurse do?
A. Administer dextromethorphan.
B. Administer guaifenesin.
C. Encourage the client to drink fluids hourly.
D. Administer fluticasone (Flonase).
B) The client needs an expectorant. This medication will help the client cough the "stuff"
out of her lungs. Dextromethorphan and fluticasone will not help the client expectorate. There is
no information about the client's fluid intake, so hourly fluids may be too much.

What is the most important thing for the nurse to teach a client who is switching allergy
medications from diphenhydramine (Benadryl) to loratadine (Claritin)?
A. This medication can potentially cause dysrhythmias.
B. This medication has fewer sedative effects.
C. This medication has increased bronchodilating effects.
D. This medication causes less gastrointestinal upset.
B) Loratadine (Claritin) does not affect the central nervous system and therefore is
nonsedating.

A client complains of worsening nasal congestion despite the use of oxymetazoline

(Afrin) nasal spray every 2 hours. What is the nurse's best response?
A. "Oxymetazoline is not an effective nasal decongestant."
B. "Overuse of nasal decongestants results in rebound congestion."
C. "Oxymetazoline should be administered every hour for severe congestion."
D. "You are probably displaying an idiosyncratic reaction to oxymetazoline."
B) Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in
worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid
future rebound congestion with nasal sprays, it is recommended that they be used for no more
than 3 to 5 days.

Which statement indicates that the client understands the teaching about
beclomethasone diproprionate (Beconase)?
A. "I will need to taper off the medication to prevent acute adrenal crisis."
B. "This medication will help prevent the inflammatory response of my allergies."
C. "I will need to monitor my blood sugar more closely because it may increase."
D. "I need to take this medication only when my symptoms get bad."
 B) Beclomethasone diproprionate (Beconase) is a steroid spray administered nasally. It
is used to prevent allergy symptoms. Its effect is localized, and therefore the client does not
have systemic side effects with normal use and does not have to worry about weaning off the
medication as with oral corticosteroids.

A client is prescribed an antitussive medication. What is the most important thing for the
nurse to teach the client?
A. "This medication may cause drowsiness and dizziness."
B. "Watch out for diarrhea and abdominal cramping."
C. "This may cause tremors and anxiety."
D. "Headache and hypertension are common side effects."
A) Antitussive medications also affect the CNS, thus causing drowsiness and dizziness.

Which is the best instruction for the nurse to include when teaching a client about the
use of expectorants?
A. Restrict fluids in order to decrease mucus production.
B. Take the medication once a day only, at bedtime.
C. Increase fluid intake in order to decrease viscosity of secretions.
D. Increase fiber and fluid intake to prevent constipation.
C) Expectorant drugs are used to decrease viscosity of secretions and allow them to be
more easily expectorated. Increasing fluid intake helps this action.

The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the
priority nursing intervention?
a. Increase the IV drip rate.
b. Monitor the client for toxicity.
c. Continue to assess the client's oxygenation.
d. Stop the IV for an hour then restart at lower rate.
C) The therapeutic theophylline level is 10 to 20 mcg/mL. The nurse should continue
interventions and monitor oxygenation.
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize
reporting which side effect?
a. Hypoglycemia
b. Nonproductive cough
c. Sedation
d. Tachycardia
D) A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic
nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and
alertness.

The nurse is instructing a client about the advantages of salmeterol (Serevent) over other
beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the
difference in these two medications?
a. Salmeterol has a shorter onset of action.
b. Salmeterol does not have any side effects.
c. Albuterol has a longer onset of action.
d. Salmeterol has a longer duration of action.
D) Salmeterol (Serevent) has a longer duration of action, requiring the client to use it
only twice a day instead of four times a day with albuterol (Proventil).

A client with a history of asthma is short of breath and says, "I feel like I'm having an
asthmatic attack." What is the nurse's best action?
a. Call a code.
b. Ask the client to describe the symptoms.
c. Administer a beta2 adrenergic agonist.
d. Administer a long-acting glucocorticoid.
C) In an acute asthmatic attack, the short-acting sympathomimetics are the first line of
defense.

A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do

what?
a. Take two puffs to treat an acute asthma attack.
b. Rinse his mouth with water after each use.
c. Immediately stop taking his oral prednisone when he starts using AeroBid.
d. Not use his albuterol inhaler while he is taking AeroBid.
B) Flunisolide (AeroBid) is an inhaled corticosteroid. Rinsing the mouth will help prevent
oral candidal infections. It is not used to treat an acute asthma attack and should be taken with
the client's bronchodilator medications. If the client is taking oral prednisone, it needs to be
tapered off to prevent acute adrenal crisis because flunisolide is minimally absorbed
systemically.

The nurse is caring for a young child who has been prescribed an inhaler for control of
her asthma. The child is having difficulty using the inhaler. What is the nurse's best
action?
a. Tell the parent to hold the inhaler for the child.
b. Ask the health care provider to switch to oral medications.
c. Tell the parent that young children should not use inhalers.
d. Teach the child to use a spacer.
D) If a child is unable to use the inhaler, the medication will be trapped in the mouth.
Using a spacer helps the medication to be deposited to the lungs.

The nurse is caring for clients on the pulmonary unit. Which client should not receive
epinephrine if ordered?
a. The client with a history of emphysema
b. The client with a history of type 2 diabetes
c. The client who is 16 years old
d. The client with atrial fibrillation with a rate of 100
D) The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations.
This client should not receive epinephrine.

The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and
beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action?
a. Question the order; three inhalers should not be given at one time.
b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide,
followed by beclomethasone several minutes later.
c. Administer each inhaler at 30-minute intervals.
d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide,
followed by the albuterol several minutes later.
 B) Administering the bronchodilator albuterol (Proventil) first allows the other drugs to
reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium
bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as
beclomethasone (Vanceril) do not dilate and are therefore given last.

Which instruction will the nurse include when teaching a client about the proper use of
metered-dose inhalers?
a. "After you inhale the medication once, repeat until you obtain relief."
b. "Make sure that you puff out air repeatedly after you inhale the medication."
c. "Hold your breath for 10 seconds if you can after you inhale the medication."
d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
C) Holding the breath for 10 seconds allows the medication to be absorbed in the
bronchial tree rather than be immediately exhaled.

What will the nurse expect to find that would indicate a therapeutic effect of
acetylcysteine (Mucomyst)?

a. Decreased cough reflex

b. Decreased nasal secretions
c. Liquefying and loosening of bronchial secretions
d. Relief of bronchospasms
C) Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in
order to enhance their expectoration.

What is the most important thing for the nurse to teach the client with a history of
diabetes and asthma who has started on albuterol PRN?
a. Take Tylenol for headaches when taking albuterol.
b. Monitor for orthostatic hypotension every 2 hours when taking albuterol.
c. Monitor blood glucose levels every 4 hours when taking albuterol.
d. An antianxiety agent may be prescribed to help with nervousness.
C) Beta2 agonists may increase blood glucose levels. Clients with diabetes should
monitor serum glucose levels frequently while taking this medication.
A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the
client?

a. "Do not take these medications within 4 hours of each other."

b. "Take the ipratropium at least 5 minutes before the cromolyn."
c. "Administer both medications together in a metered-dose inhaler."
d. "Take the ipratropium only in the mornings."
B) When using an anticholinergic in conjunction with an inhaled glucocorticoid or
cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the
bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
____________________________________________________________________________

Source:https://quizlet.com/72088724/medsurg-exam-1-pneumonia-tb-asthma-copd-flash-
cards/

Are men or women more at risk for asthmas?

Before puberty males are more affected. Following puberty women are more affected
and are more likely to be hospitalized or die from complications.

What are some risk factors for asthma?

Genetics, immune response, allergens, air pollutant exposure/occupational exposure

What are some triggers of asthma attacks?

Exercise, respiratory infections, nose and sinus problems, food/drug additives, GERD,
psychologic factors

Which medications could be given to manage asthma exacerbation?

anti-inflammatory agents/corticosteroids (prednisone)
anticholinergics (ipratropium/atrovent, tiotrpium/spiriva)
leukotriene modifiers (montelukast/singulair)
beta-adrenergics agonists (albuterol)
methylxanthines (theophylline)

What teaching should be included for a patient using an inhaler?

 Oral hygiene, count number of uses, clean inhaler following uses, shake before use,
inhale while activating the inhaler, hold breath for 10 seconds following inspiration

What are the two types of obstructive airways diseases included in COPD?
Chronic Bronchitis and Emphysema

Select which patients are at risk for developing COPD

1: Patient has a long history of smoking
2: Patient worked in a dusty factory for 25 years before retiring
3: Patient lived in a city which extremely high levels of pollution for many years
4: An adult with a history of many childhood respiratory diseases
All of these patients are at risk for developing COPD
What is the genetic factor which can determine COPD risk?
alpha antitrypsin (AAT) deficiency

Chronic Bronchitis is characterized by:

A) loss of lung elasticity
B) Alveolar problems
C) Inflammation of bronchi and bronchioles
D)hyperinflation of lungs
Answer C. In chronic bronchitis, inflammation and thickened mucous leads to a
productive cough lasting for more than 3 months. The alveoli are unaffected.

Select all symptoms which are characteristics of emphysema:

1: loss of lung elasticity
2: productive cough lasting more than 3 months
3: bulla formation
4: small airway collapse
5: alveolar problems

Which ABG finding would not be a sign of COPD?

A) Low PaO2
B) Normal HCO3
C) Elevated PaCO2
D) Low pH
E) Increased HCO3
B HCO3 would be elevated

A patient with COPD has been started on O2 therapy and ceases to breath, this is called:
A) Carbon Dioxide Narcosis
B) Hypoxemia
C) End-stage COPD
D) Hypercarbia
A) CO2 narcosis. This is when a patient has a high CO2 tolerence, in order to avoid CO2
narcosis O2 therapy should be started at the lowest effective dose.

What dietary changes should a patient with COPD make?

High protien, high calorie meals

Which is not a physical change associated with COPD?

A) Barrel chest
B) Clubbed fingers and toe nails
C) Decreased hair growth in lower extremities
D) Weight loss
C) Decreased hair growth in lower extremities. This is a physical change associated with
peripheral vascular disease

A patient with COPD presents with jugular distension, weight gain, venous edema, and
increased lung pressure what is a serious concern?
A) Hypoxemia
B) Anxiety
C) Respiratory infection
D) Cor pulmonale
D) Cor pulmonale

Patient reports difficulty sleeping due to nightly asthma exacerbations, this patient would
be described as having ______ persistent symptoms.
 Severe, symptoms occur continually with frequent exacerbations that limit physical
activity and quality of life

Select which nursing interventions would be most appropriate for a patient with asthma:
1) Position the patient in high-Fowler's
2) Initiate and maintain IV access
3) Avoid administering O2 therapy until you're certain the patient is not faking
4) Monitor cardiac rate and rhythm
5) Allow patient work through any anxiety alone
Answer 1,2 and 4. 3) You should administer O2 according to facility policy/as prescribed
to all patients who are in distress, withholding O2 therapy can be dangerous 5) Reassure
patient and maintain a calm demeanor to reduce patient's anxiety

When a patient is given albuterol, the nurse should observe for:

A) black, tarry stools
B) tremors and tachycardia
C) blurred vision
D) oral thrush
B) tremors and tachycardia. Other AEs are nervousness, insomnia, nausea, vomiting

Which medication is not an anti-inflammatory used to treat symptoms of asthma?

A) fluticasone (flovent)
B) prednisone (deltasone)
C) montelukast (singulair)
D) ipratropium (atrovent)
D) ipratropium (atrovent). This is a bronchodilator.

A patient is taking a corticosteroid for asthma, what should you monitor for?
Decreased immune function, hyperglycemia, black stools, fluid retention/weight gain, dry
mouth, and mouth sores

A patient with COPD should be discouraged from exercising:

A) True
B) False
 B) False. Exercise can improve a client's pulmonary status: the patient should walk until
they experience dyspnea and then rest before resuming activity. Rest and exercise should be
carefully balanced.

A patient with COPD should be encouraged to drink ___ L of fluids per day.
2-3

A patient is taught to breath deeply from the diaphragm while lying on back with bent
knees with hands on abdomen. The patient should aim to have their hand rise and fall
with each breath, this technique is called _____
Diaphragmatic/abdominal breathing

Patient should position lips as if they were about to whistle, breath slowly in through
nose and out through mouth without puffing the cheeks, this technique is called _______
Pursed lip breathing

____________________________________________________________________________
Source: https://www.registerednursern.com/copd-nclex-questions/

1. True or False: COPD is reversible and tends to happens gradually.

True
False
The answer is FALSE. COPD IRREVERSIBLE and tends to happens gradually.

2. A patient is presenting with chronic obstructive pulmonary disease. The patient has a
chronic productive cough with dyspnea on excretion. Arterial blood gases show a low
oxygen level and high carbon dioxide level in the blood. On assessment, the patient has
cyanosis in the lips and edema in the abdomen and legs. Based on your nursing
knowledge and the patient's symptoms, you suspect the patient suffers from what type
of COPD?
A. Emphysema
B. Pneumonia
C. Chronic bronchitis
D. Pneumothorax
The answer is C. The key words to let you know the patient is experiencing chronic
bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is
sometimes referred to as "blue bloaters".

3. A patient with emphysema may present with all of the following symptoms EXCEPT?
A. Barrel chest
B. Hyperinflation of the lungs
C. Hypoventilation
D. Hypercapnia
The answer is C. Patients with emphysema present with HYPERventilation. The body
will try to compensate for the low oxygen blood levels and will cause the patient to
hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will
have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the
lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high
carbon dioxide levels).

4. The term" blue bloaters" is used to describe patients with?

A. Pulmonary hypertension
B. Left-sided heart failure
C. Chronic Bronchitis
D. Emphysema
The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and
the term "pink puffers" is used to describe patients with emphysema.

5. A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing
education to the patient about this disease process. Which statement by the patient
indicates they understood your teaching about this condition?
A. "If I stop smoking, it will cure my condition."
B. "Complications from this condition can lead to pulmonary hypertension and
right-sided heart failure."
C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions
during acute illnesses."
D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than
low oxygen levels.
The answer is B. This is the only correct statement. Option A is wrong because smoking
cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong
because the patient may develop HIGH LEVELS of red blood cells due to the body trying to
compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to
breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.

6. An alarm beeps notifying you that one of your patient's oxygen saturation is reading
89%. You arrive to the patient's room, and see the patient comfortably resting in bed
watching television. The patient is already on 2 L of oxygen via nasal cannula. The
patient is admitted for COPD exacerbation. Your next nursing action would be:
A. Continue to monitor the patient
B. Increase the patient's oxygen level to 3 L
C. Notify the doctor for further orders
D. Turn off the alarm settings
The answer is A. This patient is not in any distress from the description
provided...therefore, you would continue to monitor the patient. Patients with COPD are
stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.
Therefore, it is normal for patients who have COPD to have an oxygen saturation between
88-93%.....any higher would decrease the stimulation to breathe and they may stop breathing.
Therefore, you would not increase the oxygen level to 3 L, notify the doctor, or turn off the alarm
settings.

7. You are providing teaching to a patient with chronic COPD on how to perform
diaphragmatic breathing. This technique helps do the following:
A. Increase the breathing rate to prevent hypoxemia
B. Decrease the use of the abdominal muscles
C. Encourages the use of accessory muscles to help with breathing
D. Strengthen the diaphragm
The answer is D. Diaphragmatic breathing helps strengthen the diaphragm because it
has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm,
the body is unable to breathe with ease and must use the accessory muscles to compensate.
Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia,
INCREASES the use of the abdominal muscles RATHER than accessory muscles and
strengthens the diaphragm.

8. A patient with severe COPD is having an episode of extreme shortness of breath and
requests their inhaler. Which type of inhaler ordered by the physician would provide the
FASTEST relief for the patient based on this particular situation?
A. Spiriva
B. Salmeterol
C. Symbicort
D. Albuterol
The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator
to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol.
Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator
and corticosteroid. Salmeterol is a long-acting bronchodilator.

9. Which of the following statements are incorrect about discharge teaching that you
would provide to a patient with COPD? Select-all-that-apply:
A. "It is best to eat three large meals a day that are relatively low in calories."
B. "Avoid going outside during extremely hot or cold days."
C. "It is important to receive the Pneumovax vaccine annually."
D. "Smoking cessation can help improve your symptoms."
The answers are A and C. The patient needs to eat high calorie and protein rich meals
that are small but frequent. The Pneumovax is definitely recommended for patients with COPD
but is given every 5 years (not annually).

10. A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How
should the patient take this medication?
A. The patient should use the medications every 2 hours for acute episodes of shortness of
breath.
B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
D. The patient should use the medications at the same exact time, regardless of the order.
The answer is B. The patient should use the bronchodilator first which is the Spiriva to
open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this
order will allow the corticosteroid to work properly after the lung fields are opened due to
bronchodilation.

11. In regards to question 10, which action by the patient demonstrates they know how to
properly use this medication?
A. The patient rinses their mouth after using the Spiriva inhaler.
B. The patient rinses their mouth after using the Pulmicort inhaler.
C. The patient dispenses of the inhalers.
D. The patient coughs 2 times after using the Pulmicort inhaler.
The answer is B. The patient should rinse the mouth after using any type of
corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the medication
from the mouth. If left in the mouth, the patient can develop thrush.

12. A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I
just feel like ending it all." You assess the patient’s health history and note that the patient was
recently started on which medication that could cause this side effect:
A. Atrovent
B. Prednisone
C. Roflumilast
D. Theophylline
The answer is C. Roflumilast is a phosphodiestrace-4 inhibitor that is used in the
treatment of patients with severe COPD due to chronic bronchitis. This medication can caused
increased suicidal thoughts, and the patient should be monitored for this while taking
Roflumilast.

13. A patient is ordered at 1400 to take Theophylline. You're assessing the patient’s
morning lab results and note that the Theophylline level drawn this morning reads: 15
mcg/mL. You're next nursing action is to?
A. Administer the dose at 1400 as ordered
B. Notify the physician for further orders
C. Hold the 1400 dose
D. Collect another blood sample to confirm the level
The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is
normal and the nurse should administer the dose at 1400 as ordered.

14. You are providing care to a patient with COPD who is receiving medical treatment for
exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia.
The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple
areas of bruising on the arms and legs. Which medication ordered for this patient can
cause hyperglycemia and bruising?
A. Prednisone
B. Atrovent
C. Flagyl
D. Levaquin
The answer is A. Prednisone is a corticosterioid and can cause hyperglycemia and
brusing.

Source:https://www.registerednursern.com/chronic-bronchitis-vs-emphysema-quiz/

1. Select ALL the options that are TRUE about chronic bronchitis and emphysema:
A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow.
B. Emphysema and chronic bronchitis are irreversible.
C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema.
D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while
patients with emphysema are sometimes referred to as "pink puffers".
The answers are B and D. Option A is wrong because patients with chronic bronchitis
DON'T have the ability to fully exhale AND have limited airflow as well. Option C is wrong
because SPRIOMETRY (NOT an incentive spirometer) is used to diagnose chronic bronchitis
and emphysema.
2. True or False: Patients with emphysema experience hypoventilation as a
compensatory mechanism to help increase oxygen levels and decrease carbon dioxide
levels in the body.
True
False
The answer is FALSE. Patients with emphysema experience HYPERventilation as a
compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in
the body.

3. Which of the following is most commonly found in a patient with emphysema?

A. Barrel chest
B. Cyanosis
C. V/Q mismatch
D. Excessive productive cough
The answer is A. Cyanosis, V/Q mismatch, and excessive productive cough are found in
chronic bronchitis.

4. In which of the following conditions below is there a matched V/Q defect?

A. Chronic Bronchitis
B. Emphysema
The answer is B. Emphysema patients have a matched V/Q defect mainly due to a
damaged capillary bed where there is poor ventilation (V) and poor perfusion (Q)...hence there
is matched ventilation and perfusion.

5. True or False: V/Q mismatch is found in chronic bronchitis.

True
False
The answer is TRUE. Patients with chronic bronchitis have a mismatched V/Q because
the capillary bed works properly (this is not the case in emphysema) however ventilation is poor
due to obstruction from mucous and inflammed bronchioles. So, there is poor ventilation but
sufficient perfusion.....hence it is mismatched.
6. Which of the following is NOT a treatment for chronic bronchitis or emphysema?
A. Albuterol
B. Spirvia
C. Theophylline
D. Metoprolol
The answer is D. Metoprolol is a beta blocker used to treat heart conditions. Albuterol,
Spirvia, and Theophylline are types of bronchodilators which are used to treat chronic bronchitis
& emphysema.

7. In which of the following conditions below do the alveolar sacs lose elasticity which
can lead to "air-trapping":
A. Chronic Bronchitis
B. Emphysema
The answer is B.

8. Patients with chronic bronchitis and emphysema can MOST COMMONLY experience
what type of acid-base imbalance?
A. High oxygen level and high carbon dioxide level
B. Low oxygen level and low carbon dioxide level
C. High oxygen level and low carbon dioxide level
D. Low oxygen level and high carbon dioxide level
The answer is D. Low oxygen levels and high carbon dioxide levels (respiratory acidosis)
are found in patients with chronic bronchitis and emphyesma.

9. Which of the following is NOT a sign and symptom of chronic bronchitis?

A. Productive cough
B. Shortness of breath
C. Cyanosis
D. Barrel chest
The answer is D. Barrel chest is most commonly found in patients with emphysema.

10. True or False: Hyperinflation of the lungs leads to diaphragm flattening.

True
False
The answer is TRUE.

____________________________________________________________________________
Source: https://www.registerednursern.com/ards-nclex-questions/

1.) You're providing care to a patient who is being treated for aspiration pneumonia. The
patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and
symptom that the patient is developing acute respiratory distress syndrome (ARDS)?
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96.
The answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia.
This is where that although the patient is receiving a high amount of oxygen (here a 100%
non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the
patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating
patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused
from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

2. You're teaching a class on critical care concepts to a group of new nurses. You're
discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of
the lecture, you assess the new nurses understanding about this condition. Which
statement by a new nurse demonstrates he understands the condition?
A. "This condition develops because the exocrine glands start to work incorrectly leading to
thick, copious mucous to collect in the alveoli sacs."
B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the
lungs."
C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has
accumulated in the pleural space."
D. "This condition develops because alveolar capillary membrane permeability has
changed leading to fluid collecting in the alveoli sacs."
The answer is D. ARDS is a type of respiratory failure that occurs when the capillary
membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the
alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C
describes a pneumothorax.

3. During the exudative phase of acute respiratory distress syndrome (ARDS), the
patient's lung cells that produce surfactant have become damaged. As the nurse you
know this will lead to?
A. bronchoconstriction
B. atelectasis
C. upper airway blockage
D. pulmonary edema
The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the
alveoli sacs will stay stable when a person exhales (hence the sac won’t collapse). If there is a
decrease in surfactant production this creates an unpredictable alveoli sac that can easily
collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when
there is a decrease production in surfactant.

4. A patient has been hospitalized in the ICU for a near drowning event. The patient's
respiratory function has been deteriorating over the last 24 hours. The physician
suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What
finding on the chest x-ray is indicative of ARDS?
A. infiltrates only on the upper lobes
B. enlargement of the heart with bilateral lower lobe infiltrates
C. white-out infiltrates bilaterally
D. normal chest x-ray
The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates
bilaterally.

5. You're providing care to a patient who was just transferred to your unit for the
treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial
blood gases. The results are back. Which results are expected during this early phase of
acute respiratory distress syndrome that correlates with this diagnosis?
A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23
B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26
C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29
D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19
The answer is A. This option demonstrates respiratory alkalosis. In the early stages of
ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have
tachypnea (the body’s way of trying to increase the oxygen level but it can’t). They will have a
very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is
7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.

6. Which patient below is at MOST risk for developing ARDS and has the worst
prognosis?
A. A 52-year-old male patient with a pneumothorax.
B. A 48-year-old male being treated for diabetic ketoacidosis.
C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
D. A 30-year-old female with cystic fibrosis.
The answer is C. Sepsis is the MOST common cause of ARDS because of systemic
inflammation experienced. This is also true if the cause of the sepsis is a gram-negative
bacterium (this also makes the infection harder to treat…hence poor prognosis). With sepsis,
the immune cells that are present with the inflammation travel to the lungs and damage the
alveolar capillary membrane leading to fluid to leak in the alveolar sacs.

7. As the nurse you know that acute respiratory distress syndrome (ARDS) can be
caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS:
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
E. Pneumonia
F. Pancreatitis
The answers are: C, D, F Indirect causes are processes that can cause inflammation
OUTSIDE of the lungs….so the issue arises somewhere outside the lungs. Therefore, sepsis
(infection…as long as it is outside the lungs), blood transfusion, and pancreatitis are INDIRECT
causes. Drowning, aspiration, and pneumonia are issues that arise in the lungs (therefore, they
are DIRECT causes of lung injury).
8. A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure).
Which finding below indicates the patient is developing a complication related to their
therapy and requires immediate treatment?
A. HCO3 26 mmHg
B. Blood pressure 70/45
C. PaO2 80 mmHg
D. PaCO2 38 mmHg
The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic
pressure and decrease the cardiac output (watch out for a low blood pressure) along with
hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that
escapes into the skin because the lungs are leaking air).

9. You are caring for a patient with acute respiratory distress syndrome. As the nurse you
know that prone positioning can be beneficial for some patients with this condition.
Which findings below indicate this type of positioning was beneficial for your patient with
ARDS?
A. Improvement in lung sounds
B. Development of a V/Q mismatch
C. PaO2 increased from 59 mmHg to 82 mmHg
D. PEEP needs to be titrated to 15 mmHg of water
The answers are A and C. Prone positioning helps improve PaO2 (82 mmHg is a good
finding) without actually giving the patient high concentrations of oxygen. It helps improves
perfusion and ventilation (hence correcting the V/Q mismatch). In this position, the heart is no
longer laying against the posterior part of the lungs (improves air flow...hence improvement of
lung sounds) and it helps move secretions from other areas that were fluid filled and couldn’t
move in the supine position, hence helping improve atelectasis.

10. A patient is experiencing respiratory failure due to pulmonary edema. The physician
suspects ARDS but wants to rule out a cardiac cause. A pulmonary artery wedge
pressure is obtained. As the nurse you know that what measurement reading obtained
indicates that this type of respiratory failure is NOT cardiac related?
A. >25 mmHg
B. <10 mmHg
C. >50 mmHg
D. <18 mmHg
The answer is D. A pulmonary artery wedge pressure measures the left atrial pressure.
A pulmonary catheter is "wedged" with a balloon in the pulmonary arterial branch to measure
the pressure. If the reading is less than 18 mmHg it indicates this is NOT a cardiac issue but
most likely ARDS. Therefore, the pulmonary edema is due to damage to the alveolar capillary
membrane leaking fluid into the alveolar sac....NOT a heart problem ex: heart failure.

11. You’re precepting a nursing student who is assisting you care for a patient on
mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the
PEEP setting is at 10 mmHg. Your response is:
A. "This pressure setting assists the patient with breathing in and out and helps improve air
flow."
B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the
lungs."
C. "This pressure setting helps prevent fluid from filling the alveoli sacs."
D. "This pressure setting helps open the alveoli sacs that are collapsed during
exhalation."
The answer is D. This setting of PEEP (it can range between 10 to 20 mmHg of water)
and it helps to open the alveoli sacs that are collapsed, especially during exhalation.
KALAT MARIE
SOURCE:
https://quizlet.com/144158223/respiratory-disorders-nclex-flash-cards/?fbclid=IwAR10V8
VYfF_UXyt9Fy2nWsNnI6q8MPeTBPKO-ZKNTzhKY1aoftnlfNCHuYM

Which factor will most contribute to a client's development of pneumonia in conjunction with a
chronic illness?
a. Dehydration
b. Group living
c. Malnutrition
d. Severe periodontal disease

RATIONALE:​ b. Clients with chronic illnesses generally have poor immune systems. Often,
residing in group living situations increases the chance of disease transmission.

Which pathophysiological mechanism will be expected to develop as a secondary response to

pneumonia after development of the primary causative organism?
a. Atelectasis
b. Bronchiectasis
c. Effusion
d. Inflammation

RATIONALE: ​d. The common feature of all types of pneumonia is an inflammatory pulmonary
response to the offending organism or agent.

The nurse is reviewing the chart of a 58-year-old male client with community-acquired
pneumonia. Which of the following will most likely be reported as a causative organism?
a. Haemophilus influenza
b. Klebsiella pneumoniae
c. Streptococcus pneumoniae
d. Staphylococcus aureus

RATIONALE: ​c. Pneumococcal or streptococcal pneumonia, caused by streptococcus

pneumonia, is the most common cause of community-acquried pneumonia.

An elderly client with pneumonia may appear with which symptoms first?
a. Altered mental status and dehydration
b. Fever and chills
c. Hemoptysis and dyspnea
d. Pleuritic chest pain and cough
RATIONALE: ​a. 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.

When auscultating the chest of a client with pneumonia, the nurse should expect to hear which
type of sounds over areas of consolidation?
a. Bronchial
b. Bronchovesicular
c. Tubular
d. Vesicular

RATIONALE: ​a. Chest auscultation reveals bronchial breath sounds over areas of consolidation.
Bronchovesicular breath sounds are normal over midlobe lung regions, tubular sounds are
commonly heard over large airways, and vesicular breath sounds are commonly heard in bases
of the lung fields.

A diagnosis of pneumonia is typically achieved by which diagnostic test?

a. Arterial blood gas analysis (ABG)
b. Chest X-ray
c. Blood cultures
d. Sputum culture and sensitivity

RATIONALE: ​d. Sputum culture and sensitivity is the best way to identify the organism causing
the pneumonia.

A 78-year-old client is admitted with a diagnosis of dehydration and change in mental status.
He's being hydrated with IV fluids. When the nurse teaks his vital signs, she notes he has a
fever of 103F, a cough producing yellow sputum, and pleuritic chest pain. The nurse suspects
this client may have which condition?
a. Acute respiratory distress syndrome (ARDS)
b. Myocardial infarction (MI)
c. Pneumonia
d. Tuberculosis (TB)

RATIONALE: ​c. Fever, productive cough, and pleuritic chest pain are common signs and
symptoms of pneumonia.

A client with pneumonia develops dyspnea with a respiratory rate of 32 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 treatment first?
a. Antibiotics
b. Bed rest
c. Oxygen
d. Nutritional intake
RATIONALE: ​c. The client is having difficulty breathing and is probably becoming hypoxic. As
an emergency measure, the nurse can provide oxygen without waiting for a physician's order.

A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and
will be discharged today. Which physical finding would lead the nurse to believe it's appropriate
to discharge this client?
a. Continued dyspnea
b. Fever of 102F
c. Respiratory rate of 32
d. Vesicular breath sounds in right base

RATIONALE: ​d. If the client still has pneumonia, the breath sounds in the right base will be
bronchial, not the normal vesicular breath sounds.

A 20-year-old client is being treated for pneumonia. He has a persistent cough and complains of
severe pain on coughing. What type of instruction should be given to help the client reduce the
discomfort he's having?
a. "Hold in your cough as much as possible"
b. "Place the head of your bed flat to help with coughing"
c. "Restrict fluids to help decrease the amount of sputum"
d. "Splint your chest wall with a pillow for comfort"

RATIONALE: ​d. Showing this client how to splint his chest wall will help decrease discomfort
when coughing.

A client in a long-term care facility has been receiving tube feedings around the clock. The
nurse notices he has a cough producing sputum, much like the content of his tube feedings, and
is now febrile to 102F. The nurse auscultates his lung fields and hears bronchial breath sounds
in his right middle lobe. The nurse suspects he may have developed which condition?
a. Atelectasis
b. Bronchitis
c. Pneumonia
d. Pulmonary embolism

RATIONALE: ​c. The client probably has aspirated the contents of his tube feedings and
developed aspiration pneumonia. This is the most common cause of pneumonia in clients with
tube feedings.

A nurse is working in a walk-in clinic. She has been alerted that there is an outbreak of
tuberculosis (TB). Which client is most at risk for developing TB?
a. A 16-year-old female high school student
b. A 33-year-old day-care worker
c. A 43-year-old homeless man with a history of alcoholism
d. A 54-year-old businessman
RATIONALE: ​c. Clients who are economically disadvantaged, malnourished, and have reduced
immunity, such as a client with a history of alcoholism, are at extremely high risk for developing
TB

The nurse is conducting a class for family members of clients diagnosed with TB. Which of the
following should the nurse teach family members regarding transmission of the disease?
a. It is transmitted by sexual contact
b. It is transmitted by contaminated needles
c. It is transmitted through contaminated eating utensils
d. It is transmitted by droplets exhaled from an infected person

RATIONALE: ​d. The TB bacillus is airborne and carried in droplets exhaled by an infected
person who is coughing, sneezing, laughing, or singing.

An adult client is being screened in the clinic today for TB. He reports having negative PPD test
results in the past. The nurse performs a PPD test on his right forearm today. When should he
return to have the test read?
a. Immediately after performing the test
b. 24 hours after performing the test
c. 48 hours after performing the test
d. 1 week after performing the test

RATIONALE: ​c. PPD tests should be read in 48-72 hours. If read too early or too late, the
results won't be accurate

The right forearm of a client who had a PPD test for TB is reddened and raised about 3mm
where the test was given. This PPD should be read as having which result?
a. Indeterminate
b. Needs to be redone
c. Negative
d. Positive

RATIONALE: ​c. This test would be classes as negative. A 3mm raised area would be a positive
result if the client had recent close contact with someone diagnosed with or suspected of having
infectious TB. Follow-up should be done with this client, and a chest X-ray should be ordered.

A client with a primary TB infection can expect to develop:

a. Activate TB within 2 weeks
b. Activate TB within 1 month
c. A fever that requires hospitalization
d. A positive skin test
RATIONALE: ​d. 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.

A client was infected with TB bacillus 10 years ago but never developed the disease. He's now
being treated for cancer. The client begins to develop signs of TB. This is known as which type
of infection?
a. Active infection
b. Latent infection
c. Superinfection
d. Tertiary infection

RATIONALE: ​a. Some people carry dormant TB infections that may develop into active disease.

A client has active TB. Which symptoms will he exhibit?

a. Chest and lower back pain
b. Chills, fever, night sweats, and hemoptysis
c. Fever of more than 104F and nausea
d. Headache and photophobia

RATIONALE: ​b. Typical signs and symptoms are chills, fever, night sweats, and hemoptysis.
Chest pain may be present from coughing.

A client has received a preliminary diagnosis of TB. In order to obtain a definitive diagnosis,
which test will the nurse expect to see ordered?
a. Chest X-ray
b. Mantoux test
c. Sputum culture
d. Tuberculin test

RATIONALE: ​c. The sputum culture for mycobacterium tuberculosis is the only method of
confirming the diagnosis.

A client with a positive Mantoux test result will be sent for a chest x-ray. For which reason is this
done?
a. To confirm the diagnosis
b. To determine if a repeat skin test is needed
c. To determine the extent of lesions
d. To determine if this is a primary or secondary infection

RATIONALE: ​c. If the lesions are large enough, the chest x-ray will show their presence in the
lungs.
A chest X-ray shows a client's lungs to be clear. His Mantoux test is positive, with 10mm of
induration. His previous test was negative. These test results are possible 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

RATIONALE: ​d. A tuberculin converter's skin test will be positive, meaning he has been
exposed to and infected with TB and now has a cell-mediated immune response to the skin test.
The client's blood and X-ray results may stay negative.

A client with a positive skin test of TB isn't showing signs of active disease. To help prevent the
development of active TB, the client should be treated with isoniazid, 300mg daily, for how
long?
a. 10-14 days
b. 2-4 weeks
c. 3-6 months
d. 9-12 months

RATIONALE: ​d. Because of the increasing incidence of resistant strains of TB, the disease must
be treated for up to 24 months in some cases, but treatment typically lasts from 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.

A client with a productive cough, chills, and night sweats is suspected of having active TB. The
physician should take which action?
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 to have it read
d. Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home

RATIONALE: ​a. This client is showing signs and symptoms of active TB and, because of the
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.

A client is diagnosed with active TB and started on triple antibiotic therapy. What sign or
symptom should 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
RATIONALE: ​d. Continuing to have acid-fast bacilli in the sputum after 2 months indicates
continued infection. The other choices would all indicate improvement with therapy.
Which instruction should the nurse give a client about his active TB?
a. "It's ok to miss a dose every day or two"
b. "If side effects occur, stop taking the medication"
c. "Only take the medication until you feel better"
d. "You must comply with the medication regimen to treat TB"

RATIONALE: ​d. The regimen may last up to 24 months. It's essential that the client comply with
therapy during that time or resistance will develop. At no time should he stop taking the
medications before his physician tells him to.

A client diagnosed with active TB would be hospitalized primarily for which reason?
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

RATIONALE: ​c. The client with active TB is highly contagious until three consecutive sputum
cultures are negative, so he's put in respiratory isolation in the hospital.

A 7-year-old is brought to the emergency department. He's tachypneic and afebrile and has a
respiratory rate of 36 and a nonproductive cough. He recently had a cold. From this history, the
child may have which condition?
a. Acute asthma
b. Bronchial pneumonia
c. COPD
d. Emphysema

RATIONALE: ​a. Based on the child's history and symptoms, acute asthma is the most likely
diagnosis.

Which assessment finding helps confirm a diagnosis of asthma in a client suspected of having
the disorder?
a. Circumoral cyanosis
b. Increased forced expiratory volume
c. Inspiratory and expiratory wheezing
d. Normal breath sounds

RATIONALE: ​c. Inspiratory and expiratory wheezes are typical findings in asthma.

The client has recently had a common cold and subsequently experiences an asthma attack.
Which type of asthma is the client most likely experiencing?
a. Emotional
b. Allergic
c. Non-allergic
d. Mediated

RATIONALE: ​c. Non-allergic asthma doesn't have an easily identifiable allergen and can be
triggered by the common cold.

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased forced
expiratory volume should be treated with which class of medication right away?
a. Beta-adrenergic blockers
b. Bronchodilators
c. Inhaled steroids
d. Oral steroids

RATIONALE: ​b. Bronchodilators are the first line of treatment for asthma because
bronchoconstriction is the cause of reduced airflow.

A 19-year-old client comes to the ER with acute asthma. His respiratory rate is 44, and he
appears in acute respiratory distress. Which action should be taken first?
a. Take a full medical history
b. Give a bronchodilator by nebulizer
c. Apply a cardiac monitor to the client
d. Provide emotional support to the client

RATIONALE: ​b. The client having an acute asthma attack needs to increase oxygen delivery

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes per day has
a chronic cough producing thick sputum and peripheral edema. He also has cyanotic nail beds.
Based on this information, he most likely has which condition?
a. Acute respiratory distress syndrome
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema

RATIONALE: ​c. Because of his extensive smoking history and symptoms, the client most likely
has chronic obstructive bronchitis.

The term "blue bloater" refers to which condition?

a. Acute respiratory distress syndrome
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema
RATIONALE: ​c. Clients with chronic obstructive bronchitis appear bloated, they have large
barrel chests and peripheral edema, cyanotic nail beds, and, at times, circumoral cyanosis

The term "pink puffer" refers to a client with which condition?

a. ARDS
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema

RATIONALE: ​d. Because of the large amount of energy it takes to breathe, clients with
emphysema are usually cachectic. They're pink and usually breath through pursed lips, hence
the term "puffer"

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to
breathe. He's tachypneic, with a prolonged expiratory phase. He has no cough and leans
forward with his arms braced on his knees to support his chest and shoulders for breathing. The
client has symptoms of which respiratory disorder?
a. ARDS
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema

RATIONALE: ​d. These are classic signs and symptoms of emphysema

It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have
Pneumovax and flu vaccinations for which reason?
a. These vaccines are recommended for all clients
b. These vaccines produce bronchodilation and improve oxygenation
c. These vaccines help reduce the tachypnea these clients experience
d. Respiratory infections can cause severe hypoxia and possibly death in these clients

RATIONALE: ​d. It's 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.

Exercise has which effect on clients with asthma, chronic bronchitis, and emphysema?
a. It enhances cardiovascular fitness
b. It improves respiratory muscle strength
c. It reduces the number of acute attacks
d. It worsens respiratory function and is discouraged

RATIONALE: ​a. Exercise can improve cardiovascular fitness and help the client tolerate periods
of hypoxia better, perhaps reducing the risk of heart attack.
Clients with chronic obstructive bronchitis are given diuretic therapy. Which reason best explains
why?
a. Reducing fluid volume reduces oxygen demand
b. Reducing fluid volume improves clients' mobility
c. Reducing fluid volume reduces sputum production
d. Reducing fluid volume improves respiratory function

RATIONALE: ​a. Reducing fluid volume reduces the workload of the heart, which reduces
oxygen demand and, in turn, reduces the respiratory rate.

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 with condition?
a. ARDS
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema

RATIONALE: ​d. In emphysema, the wall integrity of the individual air sacs is damaged, reducing
the surface area available for gas exchange.

A client with emphysema should receive only 1-3 L/minute of oxygen, if needed, or he may lose
his hypoxic drive. Which statement 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

RATIONALE: ​c. Clients with emphysema breath when their oxygen levels drop to a certain level

Teaching for a client with chronic obstructive pulmonary disease should include which topic?
a. How to listen to his own lungs
b. How to change 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

RATIONALE: ​d. Respiratory infection in clients with a respiratory disorder can be fatal. It's
important that the client understands how to recognize the signs and symptoms of an impending
respiratory infection.

Which respiratory disorder is most common in the first 24-48 hours after surgery?
a. Atelectasis
b. Bronchitis
c. Pneumonia
d. Pneumothorax
RATIONALE: ​a. Atelectasis develops when there's 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.

Which measure can reduce or prevent the incidence of atelectasis in a postoperative client?
a. Chest physiotherapy
b. Mechanical ventilation
c. Reducing oxygen requirements
d. Use of an incentive spirometer

RATIONALE: ​d. Using an incentive spirometer requires the client to take deep breaths and
promotes lung expansion.

Initial emergency treatment of a client in status asthmaticus includes which medications?

a. Inhaled beta-adrenergic agents
b. Inhaled corticosteroids
c. IV beta-adrenergic agents
d. Oral corticosteroids

RATIONALE: ​a. Inhaled beta-adrenergic agents help promote bronchodilation, which improves
oxygenation.

Which treatment goal is best for a client with status asthmaticus?

a. Avoiding intubation
b. Determining the cause of the attack
c. Improving exercise tolerance
d. Reducing secretions

RATIONALE: ​a. Inhaled beta-adrenergic agents, IV corticosteroids, and supplemental oxygen

are used to reduce bronchospasm, improve oxygenation, and avoid intubation.

A client was given morphine for pain. He's sleeping and his respiratory rate is 4. If action isn't
taken quickly, he might have which reaction?
a. Asthma attack
b. Respiratory arrest
c. Seizure
d. Wake up on his own

RATIONALE: ​b. Opioids such as morphine can cause respiratory arrest if given in large
quantities.
----------------------------------
Source:
1. During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing
and dyspnea. The nurse interprets that these symptoms are related to what
pathophysiologic change?
1. Laryngospasm
2. Pulmonary edema
3. Narrowing of the airway
4. Overdistention of the alveoli
Narrowing of the airway. Narrowing of the airway by persistent but variable inflammation
leads to reduced airflow, making it difficult for the patient to breathe and producing the
characteristic wheezing. Laryngospasm, pulmonary edema, and overdistention of the alveoli do
not produce wheezing.

A 45-year-old man with asthma is brought to the emergency department by automobile.

He is short of breath and appears frightened. During the initial nursing assessment,
which clinical manifestation might be present as an early manifestation during an
exacerbation of asthma?
1. Anxiety
2. Cyanosis
3. Bradycardia
4. Hypercapnia
Anxiety. An early manifestation during an asthma attack is anxiety because the patient is
acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with
decreased PaCO2 and increased pH as he is hyperventilating. If cyanosis occurs, it is a later
sign. The pulse and blood pressure will be increased.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of
asthma. What is the primary reason for the nurse to carefully inspect the chest wall of
this patient?
1. Allow time to calm the patient.
2. Observe for signs of diaphoresis.
3. Evaluate the use of intercostal muscles.
4. Monitor the patient for bilateral chest expansion.
 Evaluate the use of intercostal muscles. The nurse physically inspects the chest wall to
evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of
respiratory distress experienced by the patient. The other options may also occur, but they are
not the primary reason for inspecting the chest wall of this patient.

Which position is most appropriate for the nurse to place a patient experiencing an
asthma exacerbation?
1. Supine
2. Lithotomy
3. High Fowler's
4. Reverse Trendelenburg
High Fowler's. The patient experiencing an asthma attack should be placed in high
Fowler's position and may need to lean forward to allow for optimal chest expansion and enlist
the aid of gravity during inspiration. The supine, lithotomy, and reverse Trendelenburg positions
will not facilitation ventilation.

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial
treatment, what finding indicates to the nurse that the patient's respiratory status is
improving?
1. Wheezing becomes louder.
2. Cough remains nonproductive.
3. Vesicular breath sounds decrease.
4. Aerosol bronchodilators stimulate coughing.
Wheezing becomes louder. The primary problem during an exacerbation of asthma is
narrowing of the airway and subsequent diminished air exchange. As the airways begin to
dilate, wheezing gets louder because of better air exchange. Vesicular breath sounds will
increase with improved respiratory status. After a severe asthma exacerbation, the cough may
be productive and stringy. Coughing after aerosol bronchodilators may indicate a problem with
the inhaler or its use.

The nurse identifies the nursing diagnosis of activity intolerance for a patient with
asthma. In patients with asthma, the nurse assesses for which etiologic factor for this
nursing diagnosis?
1. Work of breathing
2. Fear of suffocation
3. Effects of medications
4. Anxiety and restlessness
Work of breathing. When the patient does not have sufficient gas exchange to engage in
activity, the etiologic factor is often the work of breathing. When patients with asthma do not
have effective respirations, they use all available energy to breathe and have little left over for
purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are
not etiologies for activity intolerance for a patient with asthma.

The nurse is assigned to care for a patient in the emergency department admitted with an
exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and
supplemental oxygen. If the patient's condition does not improve, the nurse should
anticipate what as the most likely next step in treatment?
1. IV fluids
2. Biofeedback therapy
3. Systemic corticosteroids
4. Pulmonary function testing
Systemic corticosteroids. Systemic corticosteroids speed the resolution of asthma
exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is
insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and
pulmonary function testing may be used after recovery to assist the patient and monitor the
asthma.

A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)

needs to receive precise amounts of oxygen. Which equipment should the nurse prepare
to use?
1. Oxygen tent
2. Venturi mask
3. Nasal cannula
4. Oxygen-conserving cannula
Venturi mask. The Venturi mask delivers precise concentrations of oxygen and should
be selected whenever this is a priority concern. The other methods are less precise in terms of
amount of oxygen delivered.
While teaching a patient with asthma about the appropriate use of a peak flow meter,
what should the nurse instruct the patient to do?
1. Keep a record of the peak flow meter numbers if symptoms of asthma are getting
worse.
2. Use the flow meter each morning after taking medications to evaluate their effectiveness.
3. Increase the doses of the long-term control medication if the peak flow numbers decrease.
4. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can
be inhaled.
Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse.
It is important to keep track of peak flow readings daily, especially when the patient's symptoms
are getting worse. The patient should have specific directions as to when to call the physician
based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter
and should be assessed before and after medications to evaluate their effectiveness.

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In
reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should
the nurse provide?
1. "Close lips tightly around the mouthpiece and breathe in deeply and quickly."
2. "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale
it."
3. "You will know you have correctly used the DPI when you taste or sense the medicine going
into your lungs."
4. "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the
medicine as long as possible."
"Close lips tightly around the mouthpiece and breathe in deeply and quickly." The patient
should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and
quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not
require spacer devices. The patient may not taste or sense the medicine going into the lungs.

The nurse determines that a patient is experiencing common adverse effects from the
inhaled corticosteroid beclomethasone (Beclovent) after what occurs?
1. Hypertension and pulmonary edema
2. Oropharyngeal candidiasis and hoarseness
3. Elevation of blood glucose and calcium levels
4. Adrenocortical dysfunction and hyperglycemia
Oropharyngeal candidiasis and hoarseness. Oropharyngeal candidiasis and hoarseness
are common adverse effects from the use of inhaled corticosteroids because the medication can
lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth
following each dose

The nurse determines that the patient understood medication instructions about the use
of a spacer device when taking inhaled medications after hearing the patient state what
as the primary benefit?
1. "I will pay less for medication because it will last longer."
2. "More of the medication will get down into my lungs to help my breathing."
3. "Now I will not need to breathe in as deeply when taking the inhaler medications."
4. "This device will make it so much easier and faster to take my inhaled medications."
"More of the medication will get down into my lungs to help my breathing." A spacer
assists more medication to reach the lungs, with less being deposited in the mouth and the back
of the throat. It does not affect the cost or increase the speed of using the inhaler.

Which test result identifies that a patient with asthma is responding to treatment?
1. An increase in CO2 levels
2. A decreased exhaled nitric oxide
3. A decrease in white blood cell count
4. An increase in serum bicarbonate levels
A decreased exhaled nitric oxide. Nitric oxide levels are increased in the breath of people with
asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may
be decreasing the lung inflammation associated with asthma and adherence to treatment. An
increase in CO2levels, decreased white blood cell count, and increased serum bicarbonate
levels do not indicate a positive response to treatment in the asthma patient.

The nurse determines that the patient is not experiencing adverse effects of albuterol
(Proventil) after noting which patient vital sign?
1. Pulse rate of 72/minute
2. Temperature of 98.4° F
3. Oxygen saturation 96%
4. Respiratory rate of 18/minute
 Pulse rate of 72/minute. Albuterol is a β2-agonist that can sometimes cause adverse
cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72
indicates that the patient did not experience tachycardia as an adverse effect.

The patient has an order for each of the following inhalers. Which one should the nurse
offer to the patient at the onset of an asthma attack?
1. Albuterol (Proventil)
2. Salmeterol (Serevent)
3. Beclomethasone (Qvar)
4. Ipratropium bromide (Atrovent)
Albuterol (Proventil). Albuterol is a short-acting bronchodilator that should be given
initially when the patient experiences an asthma attack. Salmeterol (Serevent) is a long-acting
β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone (Qvar) is a
corticosteroid inhaler and not recommended for an acute asthma attack. Ipratropium bromide
(Atrovent) is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may
be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists
(SABAs).

The nurse, who has administered a first dose of oral prednisone to a patient with asthma,
writes on the care plan to begin monitoring for which patient parameters?
1. Apical pulse
2. Daily weight
3. Bowel sounds
4. Deep tendon reflexes
Daily weight. Corticosteroids such as prednisone can lead to weight gain. For this
reason, it is important to monitor the patient's daily weight. The drug should not affect the apical
pulse, bowel sounds, or deep tendon reflexes.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess
for what potential triggers (select all that apply)?
1. Exercise
2. Allergies
3. Emotional stress
4. Decreased humidity
5. Upper respiratory infections
Exercise; Allergies; Emotional stress; Upper respiratory infections. Although the exact
mechanism of asthma is unknown, there are several triggers that may precipitate an attack.
These include allergens, exercise, air pollutants, upper respiratory infections, drug and food
additives, psychologic factors, and gastroesophageal reflux disease (GERD).

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs

inhaled every 6 hours. What should the nurse explain as the best way to prevent oral
infection while taking this medication?
1. Chew a hard candy before the first puff of medication.
2. Rinse the mouth with water before each puff of medication.
3. Ask for a breath mint following the second puff of medication.
4. Rinse the mouth with water following the second puff of medication.
Rinse the mouth with water following the second puff of medication. Because
beclamethosone is a corticosteroid, the patient should rinse the mouth with water following the
second puff of medication to reduce the risk of fungal overgrowth and oral infection.

The nurse is evaluating if a patient understands how to safely determine whether a

metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands
this important information to prevent medication underdosing when the patient describes
which method to check the inhaler?
1. Place it in water to see if it floats.
2. Keep track of the number of inhalations used.
3. Shake the canister while holding it next to the ear
4. Check the indicator line on the side of the canister.
Keep track of the number of inhalations used. It is no longer appropriate to see if a
canister floats in water or not since this is not an accurate way to determine the remaining
inhaler doses. The best method to determine when to replace an inhaler is by knowing the
maximum puffs available per MDI and then replacing it after the number of days when those
inhalations have been used. (100 puffs/2 puffs each day = 50 days)

When planning teaching for the patient with chronic obstructive pulmonary disease
(COPD), the nurse understands that what causes the manifestations of the disease?
1. An overproduction of the antiprotease α1-antitrypsin
2. Hyperinflation of alveoli and destruction of alveolar walls
3. Hypertrophy and hyperplasia of goblet cells in the bronchi
4. Collapse and hypoventilation of the terminal respiratory unit
Hyperinflation of alveoli and destruction of alveolar walls. In COPD there are structural
changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of
alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal
recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess
mucus production by the increased number of goblet cells.

A male patient with COPD becomes dyspneic at rest. His baseline blood gas results are
PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment
requires the nurse's priority intervention?
1. Arterial pH 7.26
2. PaCO2 50 mm Hg
3. Patient in tripod position
4. Increased sputum expectoration
Arterial pH 7.26. The patient's pH shows acidosis that supports an exacerbation of
COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod
position helps the patient's breathing, and the increase in sputum expectoration will improve the
patient's ventilation.

The nurse evaluates that nursing interventions to promote airway clearance in a patient
admitted with COPD are successful based on which finding?
1. Absence of dyspnea
2. Improved mental status
3. Effective and productive coughing
4. PaO2 within normal range for the patient
Effective and productive coughing. Airway clearance is most directly evaluated as
successful if the patient can engage in effective and productive coughing. Absence of dyspnea,
improved mental status, and PaO2within normal range for the patient show improved respiratory
status but do not evaluate airway clearance.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse
identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after
noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care
for this patient?
1. Order fruits and fruit juices to be offered between meals.
2. Order a high-calorie, high-protein diet with six small meals a day.
3. Teach the patient to use frozen meals at home that can be microwaved.
4. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.
Order a high-calorie, high-protein diet with six small meals a day. Because the patient
with COPD needs to use greater energy to breathe, there is often decreased oral intake
because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during
inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD
should eat six small meals per day taking in a high-calorie, high-protein diet, with non-protein
calories divided evenly between fat and carbohydrate. The other interventions will not increase
the patient's caloric intake.

The nurse teaches pursed lip breathing to a patient who is newly diagnosed with chronic
obstructive pulmonary disease (COPD). The nurse reinforces that this technique will
assist respiration by which mechanism?
1. Loosening secretions so that they may be coughed up more easily
2. Promoting maximal inhalation for better oxygenation of the lungs
3. Preventing bronchial collapse and air trapping in the lungs during exhalation
4. Increasing the respiratory rate and giving the patient control of respiratory patterns
Preventing bronchial collapse and air trapping in the lungs during exhalation. The
purpose of pursed lip breathing is to slow down the exhalation phase of respiration, which
decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. It does
not affect secretions, inhalation, or increase the rate of breathing.

Nursing assessment findings of jugular venous distention and pedal edema would be
indicative of what complication of chronic obstructive pulmonary disease (COPD)?
1. Acute respiratory failure
2. Secondary respiratory infection
3. Fluid volume excess resulting from cor pulmonale
4. Pulmonary edema caused by left-sided heart failure
Fluid volume excess resulting from cor pulmonale. Cor pulmonale is a right-sided heart
failure caused by resistance to right ventricular outflow resulting from lung disease. With failure
of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed,
leading to jugular venous distention and pedal edema.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The
patient asks the nurse whether oxygen use will be needed at home. What is the most
appropriate response by the nurse?
1. "Long-term home oxygen therapy should be used to prevent respiratory failure."
2. "Oxygen will not be needed until or unless you are in the terminal stages of this disease."
3. "Long-term home oxygen therapy should be used to prevent heart problems related to
COPD."
4. "You will not need oxygen until your oxygen saturation drops to 88% and you have
symptoms of hypoxia."
"You will not need oxygen until your oxygen saturation drops to 88% and you have
symptoms of hypoxia.". Long-term oxygen therapy in the home will not be considered until the
oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such
as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also
allow home oxygen therapy to be considered.

Before discharge, the nurse discusses activity levels with a 61-year-old patient with
chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is
most appropriate once the patient is fully recovered from this episode of illness?
1. Slightly increase activity over the current level.
2. Swim for 10 min/day, gradually increasing to 30 min/day.
3. Limit exercise to activities of daily living to conserve energy.
4. Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.
Walk for 20 min/day, keeping the pulse rate less than 130 beats/min. The patient will benefit
from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should
be encouraged to walk for 20 min/day, keeping the pulse rate less than 75% to 80% of
maximum heart rate (220 - patient's age).

The nurse evaluates that a patient is experiencing the expected beneficial effects of
ipratropium (Atrovent) after noting which assessment finding?
1. Decreased respiratory rate
2. Increased respiratory rate
3. Increased peak flow readings
4. Decreased sputum production
Increased peak flow readings. Ipratropium is a bronchodilator that should result in
increased peak expiratory flow rates (PEFRs).

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a

metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to
help the patient learn the proper inhalation technique?
1. "Avoid shaking the inhaler before use."
2. "Breathe out slowly before positioning the inhaler."
3. "Using a spacer should be avoided for this type of medication."
4. "After taking a puff, hold the breath for 30 seconds before exhaling."
"Breathe out slowly before positioning the inhaler." It is important to breathe out slowly
before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the
medication, thus enhancing the effectiveness of the dose. The inhaler should be shaken well. A
spacer may be used. Holding the breath after the inhalation of medication helps keep the
medication in the lungs, but 30 seconds will not be possible for a patient with COPD.

Which statement made by the patient with chronic obstructive pulmonary disease
(COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler?
1. "I can rinse my mouth following the two puffs to get rid of the bad taste."
2. "I should wait at least 1 to 2 minutes between each puff of the inhaler."
3. "Because this medication is not fast-acting, I cannot use it in an emergency if my breathing
gets worse."
4. "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can
breathe more easily."
"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can
breathe more easily." The patient should not just keep taking extra puffs of the inhaler to make
breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would
worsen the patient's respiratory status. Rinsing the mouth after the puffs will eliminate a bad
taste. Waiting 1 to 2 minutes between each puff will facilitate the effectiveness of the
administration. Ipratropium is not used in an emergency for COPD.
When teaching the patient with chronic obstructive pulmonary disease (COPD) about
smoking cessation, what information should be included related to the effects of
smoking on the lungs and the increased incidence of pulmonary infections?
1. Smoking causes a hoarse voice.
2. Cough will become nonproductive.
3. Decreased alveolar macrophage function
4. Sense of smell is decreased with smoking.
Decreased alveolar macrophage function. The damage to the lungs includes alveolar
macrophage dysfunction that increases the incidence of infections and thus increases patient
discomfort and cost to treat the infections. Other lung damage that contributes to infections
includes cilia paralysis or destruction, increased mucus secretion, and bronchospasms that lead
to sputum accumulation and increased cough. The patient may already be aware of respiratory
mucosa damage with hoarseness and decreased sense of smell and taste, but these do not
increase the incidence of pulmonary infection.

When teaching the patient with cystic fibrosis about the diet and medications, what is the
priority information to be included in the discussion?
1. Fat soluble vitamins and dietary salt should be avoided.
2. Insulin may be needed with a diabetic diet if diabetes mellitus develops.
3. Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed.
4. Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.
Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. The
patient must take pancreatic enzymes before each meal and snack and adequate fat, calories,
protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are
malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but
there is no longer a diabetic diet, and this is not priority information at this time. DIOS develops
in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution
(MiraLAX) to thin bowel contents.

When teaching the patient with bronchiectasis about manifestations to report to the
health care provider, which manifestation should be included?
1. Increasing dyspnea
2. Temperature below 98.6° F
3. Decreased sputum production
4. Unable to drink 3 L low-sodium fluids
Increasing dyspnea. The significant clinical manifestations to report to the health care
provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum,
and chest pain. Although drinking at least 3 L of low-sodium fluid will help liquefy secretions to
make them easier to expectorate, the health care provider does not need to be notified if the
patient cannot do this one day.

____________________________________________________________________________
Source: https://quizlet.com/220792904/respi-flash-cards/
Rhinits
group of disorders characterized by inflammation and irritation of the mucus membrane

Allergic and Nonallergic

Classification of Rhinitis

Atelectasis
closure or collapse of the alveoli

Acute atelectasis
most common in post op patients and immobilize and have shallow monotonous breathing
pattern

Obstructive Atelectasis
seen in pt with chronic airway obstruction

Posoperative
patients high risk for atelectasis

Lobar atelectasis
acute atelectasis involving large amount of lung tissue

Atelectasis
difficulty of breathing in suping position
Tachypnea, Dyspnea, Hypoxia
hallmarks of severity of atelectasis

Early mobilization
Prevention of atelectasis

Positive end-expiratory pressure

PEEP

Continuous Positive pressure breathing

CPPB

Thoracentesis
compression of lung tissue

Acute Tracheobronchitis
acute inflammation of the mucous membrane of the trachea and bronchial tree

ISEW
manner of breathing in acute Tracheobronchitis

Blood streak secretions

severe Tracheobronchitis secretions

Pneumonia
inflammation of the lung parenchyma caused by various organisms

Pneumonitis
general term and the inflammatory process of the lung tissue

CAP, HAP, Pneumonia in Immunocompromised host, Aspiration Pneumonia

Classification of Pneumonia
ANO GINAGAWA M
Community acquired pneumonia
occurs in community setting or within the first 48 hours after hospitalizations

Hospital acquired pneumonia

more than 48 hours after admission

Consolidation
found in x-ray and the most significant sign of Pneumonia

Aspiration pneumonia
pulmonary consequence resulting from entry of endogenous and exogenous substances into
the lower airway

Oxygen Transport
oxygen is supplied and carbon dioxide is removed from cells by way of circulating blood.

Respiration
Process of gas exchange between atmospheric air and the blood between the cells of the body

Mechanical process
accomplished by pulmonary ventilation

Air flow variances

air flow from a region of higher pressure to a region of lower pressure

CTOL
causes of airway resistance

Low V/Q ratio

SHUNT

High V/Q ratio

Dead space
Absence of ventilation and perfusion
SILENT UNIT

Hering Breuer reflex

when the lungs are distended; inspiration is inhibited; as a result, lungs do not become
overdistended

pulmonary embolism
Sudden dyspnea in immobilized patients may indicate

Orthopnea
inability to breathe unless in an upright or straight position

Noisy breathing
results from narrowing of the airway or localized obstruction

High pitched sound

partially blocked upper airway

URTI
dry irritative cough

laryngotracheitis
Irritative, high-pitched cough

Tracheal lesion
brassy

Bronchogenic Carcinoma
severe or changing cough

Bronchitis
morning with sputum production
Cheyne-Stokes
regular cycles where rate and depth of breathing increase, then decrease until apnea occurs

Biot's respirations
periods of normal breathing followed by a varying period of apnea (10sec-1min)

Allens test
test the patency of ulnar and radial artery

Radiolucent
normal pulmonary tissue

after full inspiration

Chest x-ray is taken

Pulmonary Angiography
most commonly used to investigate thromboembolic disease of the lungs

Gallium scan
detects inflammatory conditions, abscess, adhesions and presence, location and size of a tumor

PET
evaluate lung nodules for malignancy

Chronic Bronchitis
productive cough last for 3mos a year for 2 consecutive years

Clindamycin
standard treatment for anaerobic lung infection

Pulmonary Edema
accumulation of fluid in the lung tissue or alveoli
frothy, blood-tinged sputum
Pulmonary edema sputum characteristics

Morphine
given to reduce anxiety and dyspnea in pulmonary edema pts

____________________________________________________________________________
Source:
https://quizlet.com/79548540/nclex-rn-practice-questions-chapter-42-respiratory-disorder
s-pediatric-flash-cards/

A 10 year old child with asthma is treated for acute exacerbation in the emergency
department. The nurse caring for the child should monitor for which sign, knowing that it
indicates a worsening of the condition?
1. Warm, dry skin
2. Decreased wheezing
3. Pulse rate of 90 beats/minute
4. Respirations of 18 breaths/minute

The mother of an 8 year old child being treated for right lower lobe pneumonia at home
calls the clinic nurse. The mother tells the nurse that the child complains of discomfort
on the right side and that ibuprofen (Motrin IB) is not effective. Which instruction should
the nurse provide to the mother?
1. Increase the dose of ibuprofen.
2. Increase the frequency of ibuprofen.
3. Encourage the child to lie on the left side.
4. Encourage the child to lie on the right side.

A new parent expresses concern to the nurse regarding sudden infant death syndrome
(SIDS). She asks the nurse how to position her new infant for sleep. In which position
should the nurse tell the parent to place the infant?
1. Side or prone
2. Back or prone
3. Stomach with the face turned
4. Back rather than on the stomach

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the
immunization schedule for the child. Which statement should the nurse make to the parent?
1. "The immunization schedule will need to be altered."
2. "The child should not receive any hepatitis vaccines."
3. "The child will receive all the immunizations except for the polio series."
4. "The child will receive the recommended basic series of immunizations along with a
yearly influenza vaccination."

The emergency department nurse is caring for a child diagnosed with epiglottitis. In
assessing the child, the nurse should monitor for which indication that the child may be
experiencing airway obstruction?
1. The child exhibits nasal flaring and bradycardia.
2. The child is leaning forward, with the chin thrust out.
3. The child has a low-grade fever and complains of a sore throat.
4. The child is leaning backward, supporting himself or herself with the hands and arms.

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother
becomes concerned because the child is frightened, consistently crying and trying to
climb out of the tent. Which is the MOST APPROPRIATE nursing action?

1.Tell the mother that the child must stay in the tent.
2. Place a toy in the tent to make the child feel more comfortable.
3. Call the health care provider and obtain a prescription for a mild sedative.
4. Let the mother hold the child and direct the cool mist over the child's face.

The clinic nurse reads the results of a tuberculin skin test (TST) on a 3 year old child. The
results indicate an area of induration measuring 10mm. The nurse should interpret these
results as which finding?
1. Positive
2. Negative
3. Inconclusive
4. Definitive and requiring a repeat test

The mother of a hospitalized 2 year old child with viral laryngotracheobronchitis (croup)
asks the nurse why the health care provider did not prescribe antibiotics. Which
response should the nurse make?
1. "The child may be allergic to antibiotics."
2. "The child is too young to receive antibiotics."
3. "Antibiotics are not indicated unless a bacterial infection is present."
4. "The child still has the maternal antibodies from birth and does not need antibiotics."

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed
respiratory syncytial virus (RSV). On the basis of this finding, which is the MOST
APPROPRIATE nursing action?

1. Initiate strict enteric precautions.

2. Move the infant to a room with another child with RSV.
3. Leave the infant in the present room because RSV is not contagious.
4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis
caused by respiratory syncytial virus (RSV). Which interventions should the nurse
include in the plan of care? SELECT ALL THAT APPLY.

1. Place the infant in a private room.

2. Ensure that the infant's head is in a flexed position.
3. Wear mask at all times when in contact with the infant.
4. Place the infant in a tent that delivers warm humidified air.
5. Position the infant on the side, with the head lower than the chest.
6. Ensure that nurses caring for the infant with RSV do not care for other high-risk
children.
Sauce​:​https://quizlet.com/105673864/med-surg-chapter-26-lewis-respiratory-system-nclex-flash
-cards/

A patient with acute shortness of breath is admitted to the hospital. Which action should
the nurse take during the initial assessment of the patient?

a. Ask the patient to lie down to complete a full physical assessment.

b. Briefly ask specific questions about this episode of respiratory distress.
c. Complete the admission database to check for allergies before treatment.
d. Delay the physical assessment to first complete pulmonary function tests.

~ When a patient has severe respiratory distress, only information pertinent to the current episode is
obtained, and a more thorough assessment is deferred until later. Obtaining a comprehensive health
history or full physical examination is unnecessary until the acute distress has resolved. Brief
questioning and a focused physical assessment should be done rapidly to help determine the cause
of the distress and suggest treatment. Checking for allergies is important, but it is not appropriate to
complete the entire admission database at this time. The initial respiratory assessment must be
completed before any diagnostic tests or interventions can be ordered.

The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How
should the nurse position the patient?

a. Supine with the head of the bed elevated 30 degrees

b. In a high-Fowler's position with the left arm extended
c. On the right side with the left arm extended above the head
d. Sitting upright with the arms supported on an over bed table

~ The upright position with the arms supported increases lung expansion, allows fluid to collect
at the lung bases, and expands the intercostal space so that access to the pleural space is
easier. The other positions would increase the work of breathing for the patient and make it
more difficult for the health care provider performing the thoracentesis

A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2
85 mm Hg; HCO3- 18 mEq/L. The nurse would expect which finding?
a. Intercostal retractions
b. Kussmaul respirations
c. Low oxygen saturation (SpO2)
d. Decreased venous O2 pressure

~Kussmaul (deep and rapid) respirations are a compensatory mechanism for metabolic
acidosis. The low pH and low bicarbonate result indicate metabolic acidosis. Intercostal
retractions, a low oxygen saturation rate, and a decrease in venous O2 pressure would not be
caused by acidosis.

On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds

during inhalation in the lower third of both lungs. How should the nurse document this
finding?

a. Inspiratory crackles at the bases

b. Expiratory wheezes in both lungs
c. Abnormal lung sounds in the apices of both lungs
d. Pleural friction rub in the right and left lower lobes

~Crackles are low-pitched, bubbling sounds usually heard on inspiration. Wheezes are
high-pitched sounds. They can be heard during the expiratory or inspiratory phase of the
respiratory cycle. The lower third of both lungs are the bases, not apices. Pleural friction rubs
are grating sounds that are usually heard during both inspiration and expiration

The nurse palpates the posterior chest while the patient says "99" and notes absent
fremitus. Which action should the nurse take next?

a. Palpate the anterior chest and observe for barrel chest.

b. Encourage the patient to turn, cough, and deep breathe.
c. Review the chest x-ray report for evidence of pneumonia.
d. Auscultate anterior and posterior breath sounds bilaterally.
~ To assess for tactile fremitus, the nurse should use the palms of the hands to assess for
vibration when the patient repeats a word or phrase such as "99." After noting absent fremitus,
the nurse should then auscultate the lungs to assess for the presence or absence of breath
sounds. Absent fremitus may be noted with pneumothorax or atelectasis. The vibration is
increased in conditions such as pneumonia, lung tumors, thick bronchial secretions, and pleural
effusion. Turning, coughing, and deep breathing is an appropriate intervention for atelectasis,
but the nurse needs to first assess breath sounds. Fremitus is decreased if the hand is farther
from the lung or the lung is hyperinflated (barrel chest).The anterior of the chest is more difficult
to palpate for fremitus because of the presence of large muscles and breast tissue.

A patient with a chronic cough has a bronchoscopy. After the procedure, which
intervention by the nurse is most appropriate?

a. Elevate the head of the bed to 80 to 90 degrees.

b. Keep the patient NPO until the gag reflex returns.
c. Place on bed rest for at least 4 hours after bronchoscopy.
d. Notify the health care provider about blood-tinged mucus.

~ Risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic
is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for
the return of these reflexes before allowing the patient to take oral fluids or food. Blood-tinged
mucus is not uncommon after bronchoscopy. The patient does not need to be on bed rest, and
the head of the bed does not need to be in the high-Fowler's position.

The nurse completes a shift assessment on a patient admitted in the early phase of heart
failure. When auscultating the patient's lungs, which finding would the nurse most likely
hear?

a. Continuous rumbling, snoring, or rattling sounds mainly on expiration

b. Continuous high-pitched musical sounds on inspiration and expiration
c. Discontinuous, high-pitched sounds of short duration heard on inspiration
d. A series of long-duration, discontinuous, low-pitched sounds during inspiration
~ Fine crackles are likely to be heard in the early phase of heart failure. Fine crackles are
discontinuous, high-pitched sounds of short duration heard on inspiration. Rhonchi are
continuous rumbling, snoring, or rattling sounds mainly on expiration. Course crackles are a
series of long-duration, discontinuous, low-pitched sounds during inspiration. Wheezes are
continuous high-pitched musical sounds on inspiration and expiration.

While caring for a patient with respiratory disease, the nurse observes that the patient's
SpO2 drops from 93% to 88% while the patient is ambulating in the hallway. What is the
priority action of the nurse?

a. Notify the health care provider.

b. Document the response to exercise.
c. Administer the PRN supplemental O2.
d. Encourage the patient to pace activity.

~ The drop in SpO2 to 85% indicates that the patient is hypoxemic and needs supplemental
oxygen when exercising. The other actions are also important, but the first action should be to
correct the hypoxemia.

The nurse teaches a patient about pulmonary function testing (PFT). Which statement, if
made by the patient, indicates teaching was effective?

a. "I will use my inhaler right before the test."

b. "I won't eat or drink anything 8 hours before the test."
c. "I should inhale deeply and blow out as hard as I can during the test."
d. "My blood pressure and pulse will be checked every 15 minutes after the test."

~ For PFT, the patient should inhale deeply and exhale as long, hard, and fast as possible. The
other actions are not needed with PFT. The administration of inhaled bronchodilators should be
avoided 6 hours before the procedure.

The nurse observes a student who is listening to a patient's lungs who is having no
problems with breathing. Which action by the student indicates a need to review
respiratory assessment skills?
a. The student starts at the apices of the lungs and moves to the bases.
b. The student compares breath sounds from side to side avoiding bony areas.
c. The student places the stethoscope over the posterior chest and listens during
inspiration.
d. The student instructs the patient to breathe slowly and a little more deeply than normal
through the mouth.

~ Listening only during inspiration indicates the student needs a review of respiratory
assessment skills. At each placement of the stethoscope, listen to at least one cycle of
inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a
little deeper than normal through the mouth. Auscultation should proceed from the lung apices
to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress
or will tire easily. If so, start at the bases (see Fig. 26-7). Place the stethoscope over lung tissue,
not over bony prominences.

A patient who has a history of chronic obstructive pulmonary disease (COPD) was
hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of
89% to 90%). In planning for discharge, which action by the nurse will be most effective
in improving compliance with discharge teaching?

a. Start giving the patient discharge teaching on the day of admission.

b. Have the patient repeat the instructions immediately after teaching.
c. Accomplish the patient teaching just before the scheduled discharge.
d. Arrange for the patient's caregiver to be present during the teaching​.

~ Hypoxemia interferes with the patient's ability to learn and retain information, so having the
patient's caregiver present will increase the likelihood that discharge instructions will be
followed. Having the patient repeat the instructions will indicate that the information is
understood at the time, but it does not guarantee retention of the information. Because the
patient is likely to be distracted just before discharge, giving discharge instructions just before
discharge is not ideal. The patient is likely to be anxious and even more hypoxemic than usual
on the day of admission, so teaching about discharge should be postponed.
A patient is admitted to the emergency department complaining of sudden onset shortness of
breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the
patient for diagnostic testing to confirm the diagnosis?

a. Start an IV so contrast media may be given.

b. Ensure that the patient has been NPO for at least 6 hours.
c. Inform radiology that radioactive glucose preparation is needed.
d. Instruct the patient to undress to the waist and remove any metal objects.

~ Spiral computed tomography (CT) scans are the most commonly used test to diagnose
pulmonary emboli, and contrast media may be given IV. A chest x-ray may be ordered but will
not be diagnostic for a pulmonary embolus. Preparation for a chest x-ray includes undressing
and removing any metal. Bronchoscopy is used to detect changes in the bronchial tree, not to
assess for vascular changes, and the patient should be NPO 6 to 12 hours before the
procedure. Positron emission tomography (PET) scans are most useful in determining the
presence of malignancy, and a radioactive glucose preparation is used.

The nurse admits a patient who has a diagnosis of an acute asthma attack. Which
statement indicates that the patient may need teaching regarding medication use?

a. "I have not had any acute asthma attacks during the last year."
b. "I became short of breath an hour before coming to the hospital."
c. "I've been taking Tylenol 650 mg every 6 hours for chest-wall pain."
d. "I've been using my albuterol inhaler more frequently over the last 4 days."

~ The increased need for a rapid-acting bronchodilator should alert the patient that an acute
attack may be imminent and that a change in therapy may be needed. The patient should be
taught to contact a health care provider if this occurs. The other data do not indicate any need
for additional teaching.

A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan.
Which information obtained by the nurse is a priority to communicate to the health care
provider before the CT?
a. Allergy to shellfish
b. Apical pulse of 104
c. Respiratory rate of 30
d. Oxygen saturation of 90%

~ Because iodine-based contrast media is used during a spiral CT, the patient may need to
have the CT scan without contrast or be premedicated before injection of the contrast media.
The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further
assessment or intervention but do not indicate a need to modify the CT procedure.

The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding
would require immediate action?

a. The bicarbonate level (HCO3-) is 31 mEq/L.

b. The arterial oxygen saturation (SaO2) is 92%.
c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg.
d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg.

~ All the values are abnormal, but the low PaO2 indicates that the patient is at the point on the
oxyhemoglobin dissociation curve where a small change in the PaO2 will cause a large drop in
the O2 saturation and a decrease in tissue oxygenation. The nurse should intervene
immediately to improve the patient's oxygenation.

When assessing the respiratory system of an older patient, which finding indicates that
the nurse should take immediate action?

a. Weak cough effort

b. Barrel-shaped chest
c. Dry mucous membranes
d. Bilateral crackles at lung bases

~ ​Crackles in the lower half of the lungs indicate that the patient may have an acute problem
such as heart failure. The nurse should immediately accomplish further assessments, such as
oxygen saturation, and notify the health care provider. A barrel-shaped chest, hyperresonance
to percussion, and a weak cough effort are associated with aging. Further evaluation may be
needed, but immediate action is not indicated. An older patient has a less forceful cough and
fewer and less functional cilia. Mucous membranes tend to be drier.

A patient in metabolic alkalosis is admitted to the emergency department, and pulse

oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse
take next?

a. Administer bicarbonate.
b. Complete a head-to-toe assessment.
c. Place the patient on high-flow oxygen.
d. Obtain repeat arterial blood gases (ABGs).

~ Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation curve
will decrease the amount of oxygen delivered to tissues, so high oxygen concentrations should
be given. Bicarbonate would worsen the patient's condition. A head-to-toe assessment and
repeat ABGs may be implemented. However, the priority intervention is to give high-flow
oxygen.

After the nurse has received change-of-shift report, which patient should the nurse
assess first?

a. A patient with pneumonia who has crackles in the right lung base
b. A patient with possible lung cancer who has just returned after bronchoscopy
c. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing
d. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing
(PFT) that indicates low forced vital capacity

~ Because the cough and gag are decreased after bronchoscopy, this patient should be
assessed for airway patency. The other patients do not have clinical manifestations or
procedures that require immediate assessment by the nurse.
The laboratory has just called with the arterial blood gas (ABG) results on four patients.
Which result is most important for the nurse to report immediately to the health care
provider?

a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%

b. pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95%
c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%
d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%
~ These ABGs indicate uncompensated respiratory acidosis and should be reported to the
health care provider. The other values are normal or close to normal.

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who
has been admitted with increasing dyspnea over the last 3 days. Which finding is most
important for the nurse to report to the health care provider?

a. Respirations are 36 breaths/minute.

b. Anterior-posterior chest ratio is 1:1.
c. Lung expansion is decreased bilaterally.
d. Hyperresonance to percussion is present.

~ The increase in respiratory rate indicates respiratory distress and a need for rapid
interventions such as administration of oxygen or medications. The other findings are common
chronic changes occurring in patients with COPD.

Which action is appropriate for the nurse to delegate to unlicensed assistive personnel
(UAP)?

a. Listen to a patient's lung sounds for wheezes or rhonchi.

b. Label specimens obtained during percutaneous lung biopsy.
c. Instruct a patient about how to use home spirometry testing.
d. Measure induration at the site of a patient's intradermal skin test.

~ Labeling of specimens is within the scope of practice of UAP. The other actions require
nursing judgment and should be done by licensed nursing personnel.
A patient is scheduled for a computed tomography (CT) of the chest with contrast media.
Which assessment findings should the nurse immediately report to the health care
provider (select all that apply)?

a. Patient is claustrophobic.
b. Patient is allergic to shellfish.
c. Patient recently used a bronchodilator inhaler.
d. Patient is not able to remove a wedding band.
e. Blood urea nitrogen (BUN) and serum creatinine levels are elevated.

~ Because the contrast media is iodine-based and may cause dehydration and decreased renal
blood flow, asking about iodine allergies (such as allergy to shellfish) and monitoring renal
function before the CT scan are necessary. The other actions are not contraindications for CT of
the chest, although they may be for other diagnostic tests, such as magnetic resonance imaging
(MRI) or pulmonary function testing (PFT).

Sauce:https://quizlet.com/275210591/pulmonary-embolism-patients-nclex-flash-cards/?fb
clid=IwAR2TQLVnhAcX5rm0ZiFhGT13TWBAkJ5V8ZBv75KuKNEs3Z3e_lonF_YaaIU

A nurse answers a call light and finds a client anxious, short of breath, reporting chest
pain, and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action
by the nurse takes priority?

a. Assess the client's lung sounds.

b. Notify the Rapid Response Team.
c. Provide reassurance to the client.
d. Take a full set of vital signs.

B
This client has manifestations of a pulmonary embolism, and the most critical action is to notify
the Rapid Response Team for speedy diagnosis and treatment. The other actions are
appropriate also but are not the priority.
A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and
active and has no known risk factors for PE. What action by the nurse is most
appropriate?

a. Encourage the client to walk 5 minutes each hour.

b. Refer the client to smoking cessation classes.
c. Teach the client about factor V Leiden testing.
d. Tell the client that sometimes no cause for disease is found.

C
Factor V Leiden is an inherited thrombophilia that can lead to abnormal clotting events,
including PE. A client with no known risk factors for this disorder should be referred for testing.
Encouraging the client to walk is healthy, but is not related to the development of a PE in this
case, nor is smoking. Although there are cases of disease where no cause is ever found, this
assumption is premature.

A client has a pulmonary embolism and is started on oxygen. The student nurse asks
why the client's oxygen saturation has not significantly improved. What response by the
nurse is best?

a. Breathing so rapidly interferes with oxygenation.

b. Maybe the client has respiratory distress syndrome.
c. The blood clot interferes with perfusion in the lungs.
d. The client needs immediate intubation and mechanical ventilation.

C
A large blood clot in the lungs will significantly impair gas exchange and oxygenation. Unless
the clot is dissolved, this process will continue unabated. Hyperventilation can interfere with
oxygenation by shallow breathing, but there is no evidence that the client is hyperventilating,
and this is also not the most precise physiologic answer. Respiratory distress syndrome can
occur, but this is not as likely. The client may need to be mechanically ventilated, but without
concrete data on FiO2 and SaO2, the nurse cannot make that judgment.
A client is on intravenous heparin to treat a pulmonary embolism. The clients most
recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse
anticipate?

a. Decrease the heparin rate.

b. Increase the heparin rate.
c. No change to the heparin rate.
d. Stop heparin; start warfarin (Coumadin).

B
For clients on heparin, a PTT of 1.5 to 2.5 times the normal value is needed to demonstrate the
heparin is working. A normal PTT is 25 to 35 seconds, so this client's PTT value is too low. The
heparin rate needs to be increased. Warfarin is not indicated in this situation.

A client is hospitalized with a second episode of pulmonary embolism (PE). Recent

genetic testing reveals the client has an alteration in the gene CYP2C19. What action by
the nurse is best?

a. Instruct the client to eliminate all vitamin K from the diet.

b. Prepare preoperative teaching for an inferior vena cava (IVC) filter.
c. Refer the client to a chronic illness support group.
d. Teach the client to use a soft-bristled toothbrush.

B
Often clients are discharged from the hospital on warfarin (Coumadin) after a PE. However,
clients with a variation in the CYP2C19 gene do not metabolize warfarin well and have higher
blood levels and more side effects. This client is a poor candidate for warfarin therapy, and the
prescriber will most likely order an IVC filter device to be implanted. The nurse should prepare to
do preoperative teaching on this procedure. It would be impossible to eliminate all vitamin K
from the diet. A chronic illness support group may be needed, but this is not the best
intervention as it is not as specific to the client as the IVC filter. A soft-bristled toothbrush is a
safety measure for clients on anticoagulation therapy.

A nurse is caring for four clients on intravenous heparin therapy. Which laboratory value
possibly indicates that a serious side effect has occurred?

a. Hemoglobin: 14.2 g/dL

b. Platelet count: 82,000/L
c. Red blood cell count: 4.8/mm3
d. White blood cell count: 8.7/mm3

B
This platelet count is low and could indicate heparin-induced thrombocytopenia. The other
values are normal for either gender.

What is a NORMAL platelet count value?

150,000 - 450,000

A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is
best?

a. Assess for other manifestations of hypoxia.

b. Change the sensor on the pulse oximeter.
c. Obtain a new oximeter from central supply.
d. Tell the client to take slow, deep breaths.

A
Pulse oximetry is not always the most accurate assessment tool for hypoxia as many factors
can interfere, producing normal or near-normal readings in the setting of hypoxia. The nurse
should conduct a more thorough assessment. The other actions are not appropriate for a
hypoxic client.
A nurse is assisting the health care provider who is intubating a client. The provider has
been attempting to intubate for 40 seconds. What action by the nurse takes priority?

a. Ensure the client has adequate sedation.

b. Find another provider to intubate.
c. Interrupt the procedure to give oxygen.
d. Monitor the client's oxygen saturation.

C
Each intubation attempt should not exceed 30 seconds (15 is preferable) as it causes hypoxia.
The nurse should interrupt the intubation attempt and give the client oxygen. The nurse should
also have adequate sedation during the procedure and monitor the client's oxygen saturation,
but these do not take priority. Finding another provider is not appropriate at this time.

An intubated client's oxygen saturation has dropped to 88%. What action by the nurse
takes priority?
a. Determine if the tube is kinked.
b. Ensure all connections are patent.
c. Listen to the clients lung sounds.
d. Suction the endotracheal tube.

When an intubated client shows signs of hypoxia, check for DOPE: displaced tube (most
common cause), obstruction (often by secretions), pneumothorax, and equipment problems.
The nurse listens for equal, bilateral breath sounds first to determine if the endotracheal tube is
still correctly placed. If this assessment is normal, the nurse would follow the mnemonic and
assess the patency of the tube and connections and perform suction.

A client is on a ventilator and is sedated. What care may the nurse delegate to the
unlicensed assistive personnel (UAP)?

a. Assess the client for sedation needs.

b. Get family permission for restraints.
c. Provide frequent oral care per protocol.
d. Use nonverbal pain assessment tools.

C
The client on mechanical ventilation needs frequent oral care, which can be delegated to the
UAP. The other actions fall within the scope of practice of the nurse.

A client is on mechanical ventilation and the client's spouse wonders why ranitidine
(Zantac) is needed since the client only has lung problems. What response by the nurse
is best?
a. It will increase the motility of the gastrointestinal tract.
b. It will keep the gastrointestinal tract functioning normally.
c. It will prepare the gastrointestinal tract for enteral feedings.
d. It will prevent ulcers from the stress of mechanical ventilation.

D
Stress ulcers occur in many clients who are receiving mechanical ventilation, and often
prophylactic medications are used to prevent them. Frequently used medications include
antacids, histamine blockers, and proton pump inhibitors. Zantac is a histamine blocking agent.

A client is being discharged soon on warfarin (Coumadin). What menu selection for
dinner indicates the client needs more education regarding this medication?
a. Hamburger and French fries
b. Large chef’s salad and muffin
c. No selection; spouse brings pizza
d. Tuna salad sandwich and chips

B
Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors. Foods high in
vitamin K thus interfere with its action and need to be eaten in moderate, consistent amounts.
The chef's salad most likely has too many leafy green vegetables, which contain high amounts
of vitamin K. The other selections, while not particularly healthy, will not interfere with the
medications mechanism of action.

A nurse is teaching a client about warfarin (Coumadin). What assessment finding by the
nurse indicates a possible barrier to self-management?

a. Poor visual acuity

b. Strict vegetarian
c. Refusal to stop smoking
d. Wants weight loss surgery

B
Warfarin works by inhibiting the synthesis of vitamin K dependent clotting factors. Foods high in
vitamin K thus interfere with its action and need to be eaten in moderate, consistent amounts. A
vegetarian may have trouble maintaining this diet. The nurse should explore this possibility with
the client. The other options are not related.

A student nurse is preparing to administer enoxaparin (Lovenox) to a client. What action

by the student requires immediate intervention by the supervising nurse?

a. Assessing the clients platelet count

b. Choosing an 18-gauge, 2-inch needle
c. Not aspirating prior to injection
d. Swabbing the injection site with alcohol

B
Enoxaparin is given subcutaneously, so the 18-gauge, 2-inch needle is too big. The other
actions are appropriate.
A client has been diagnosed with a very large pulmonary embolism (PE) and has a
dropping blood pressure. What medication should the nurse anticipate the client will
need as the priority?

a. Alteplase (Activase)
b. Enoxaparin (Lovenox)
c. Unfractionated heparin
d. Warfarin sodium (Coumadin)
A
Activase is a clot-busting agent indicated in large PEs in the setting of hemodynamic instability.
The nurse knows this drug is the priority, although heparin may be started initially. Enoxaparin
and warfarin are not indicated in this setting.

A student nurse asks for an explanation of refractory hypoxemia. What answer by the
nurse instructor is best?

a. It is chronic hypoxemia that accompanies restrictive airway disease.

b. It is hypoxemia from lung damage due to mechanical ventilation.
c. It is hypoxemia that continues even after the client is weaned from oxygen.
d. It is hypoxemia that persists even with 100% oxygen administration.

D
Refractory hypoxemia is hypoxemia that persists even with the administration of 100% oxygen.
It is a cardinal sign of acute respiratory distress syndrome. It does not accompany restrictive
airway disease and is not caused by the use of mechanical ventilation or by being weaned from
oxygen.

A nurse is caring for five clients. For which clients would the nurse assess a high risk for
developing a pulmonary embolism (PE)? (Select all that apply.)

a. Client who had a reaction to contrast dye yesterday

b. Client with a new spinal cord injury on a rotating bed
c. Middle-aged man with an exacerbation of asthma
d. Older client who is 1-day post hip replacement surgery
e. Young obese client with a fractured femur

B, D, E
Conditions that place clients at higher risk of developing PE include prolonged immobility,
central venous catheters, surgery, obesity, advancing age, conditions that increase blood
clotting, history of thromboembolism, smoking, pregnancy, estrogen therapy, heart failure,
stroke, cancer (particularly lung or prostate), and trauma. A contrast dye reaction and asthma
pose no risk for PE.

When working with women who are taking hormonal birth control, what health promotion
measures should the nurse teach to prevent possible pulmonary embolism (PE)? (Select
all that apply.)

a. Avoid drinking alcohol.

b. Eat more omega-3 fatty acids.
c. Exercise on a regular basis.
d. Maintain a healthy weight.
e. Stop smoking cigarettes.

C, D, E
Health promotion measures for clients to prevent thromboembolic events such as PE include
maintaining a healthy weight, exercising on a regular basis, and not smoking. Avoiding alcohol
and eating more foods containing omega-3 fatty acids are heart-healthy actions but do not
relate to the prevention of PE.

A client with a new pulmonary embolism (PE) is anxious. What nursing actions are most
appropriate? (Select all that apply.)
a. Acknowledge the frightening nature of the illness.
b. Delegate a back rub to the unlicensed assistive personnel (UAP).
c. Give simple explanations of what is happening.
d. Request a prescription for anti anxiety medication.
e. Stay with the client and speak in a quiet, calm voice.

A, B, C, E
Clients with PEs are often anxious. The nurse can acknowledge the clients fears, delegate
comfort measures, give simple explanations the client will understand, and stay with the client.
Using a calm, quiet voice is also reassuring. Sedatives and anti anxiety medications are not
used routinely because they can contribute to hypoxia. If the client's anxiety is interfering with
diagnostic testing or treatment, they can be used, but there is no evidence that this is the case.

Following heparin treatment for a pulmonary embolism, a client is being discharged with
a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse
advises the client to have which diagnostic test monitored regularly after discharge.
A. Perfusion scan.
B. Prothrombin Time (PT/INR).
C. Activated partial thromboplastin (APTT).
D. Serum Coumadin level (SCL).

SOURCE:
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clid=IwAR0O5cr7NC1OwOYDCUp3SHKBjZG-A0UXL2c-kl9c4AsD4DHLpO-jZ1hD9SA

An RN performed an ABG sampling at 0930 on a client who is receiving heparin by

continuous IV infusion. The LPN working with the RN was asked to maintain pressure on
the puncture site. At which time should the LPN remove pressure?

~ 0950

A nurse is caring for a client who had an ABG sampling obtained from the left wrist an
hour ago. For which of the following potential complications should the nurse report?

~ loss of pulse in the left radial artery

change in color of the left hand

Which of the following can cause a low pulse ox reading?

~ Nail Polish
Inadequate peripheral circulation
Edema
A nurse is caring for a client following a bronchoscopy. Which of the following client
findings should the nurse report to the charge nurse?

~ Bronchospasms

A newly licensed nurse has set up the clients room for thoracentesis. Which pieces of
equipment should the nurse include?

~ Oxygen Equipment
Pulse Oximeter
Thoracentesis Tray

A nurse is preparing to receive a client from surgery who has a chest tube inserted.
Which of the following items should the nurse have available in the clients room?

~ Pulse OX
Sterile saline
rubber-tipped clamps
suction source

A nurse is caring for a client with a chest tube When she notices the chest tube has been
removed. Which of the following is the FIRST action the nurse should take?

~ Cover the insertion site with a dry sterile gauze

A nurse is checking the functioning of a chest drainage system. Which are expected
finding?
~ Gentle constant bubbling in the suction control chamber
Rise and fall in the level of water in the water seal chamber
Fluid level is marked in drainage chamber with date and time

A nurse is providing instructions to a hospitalized client with a diagnosis of emphysema

about positions that will enhance the effectiveness of breathing during dyspneic periods.
Which position will the nurse instruct to assume?

~ Sitting on the side of bed, leaning on a overbed table

Which test confirms TB dx?

~ Sputum Culture

Which of the following identifies the route of transmission of TB?

~ Airborne
A nurse is caring for a client with emphyema who is receiving O2. The nurse checks the
flow rate to ensure it does not exceed.

~ 2L/min

A nurse is instructing a client about pursed lip breathing. The purpose of this breathing
is?

~ Promote CO2 elimination

The low pressure alarm sounds on the ventilator. The nurse checks for the cause but is
unsuccessful. Which initial action will the nurse take?

~ Ventilate the client manually

A nurse is assigned to care for a client after a left pneumonectomy. Which one of the
follow positions would be contraindicated for this client?

~ On the side

A nurse is caring for a client after pulmonary angiography via catheter insertion into the
left groin. The nurse monitors for an allergic reaction to the contrast by the presence of
=>

~ Respiratory distress

A nurse is providing discharge instructions to the client with pulmonary sarcoidosis. The
client understands the early sign of exacerbation as?

~ Shortness of breath

Which client is a least risk for TB infection

~ A man who is an inspector the USPS

The nurse is reading a Mantoux skin test. The site has no induration and a 1 mm area of
ecchymosis this result is considered?

~ Negative

After a positive reaction to a Mantoux Skin test What is the nurses priority?

~ Report the finding

A client with TB would get more reassurance from the knowledge that?

~ The family will receive prophylactic therapy and the client will not be contagious after 2-3
consecutive weeks of med

A client that has TB has been on meds for 1and a half weeks. The client understood the
information if the client makes which statement?

~ I should not be contagious after 2-3 weeks of meds

The nurse is preparing home instructions for a client with TB. Which should be included?

~Activities should resume gradually

A sputum culture is needed every 2-4 weeks once meds are started

Resp. Isolation is not necessary because family members have already been exposed
Cover the mouth and nose when coughing and sneezing and confine tissues to plastic bags

Sauce
https://nurseslabs.com/nclex-exam-asthma-copd-2-50-items/?fbclid=IwAR3Txb30lQAMXS8wgh
DXxLgcr7QlfpghFmKWWB3ZNWDk8W8WEyXhDKnPd4k

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
3. Relax smooth muscles of the bronchial airway
Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the
bronchial airway.

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
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.

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.

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.
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?”

1. “Is there any possibility that you could be pregnant?”

The most important item to ask about is the client’s 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.

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).

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.

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.
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 Allen’s
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.

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?
1. Chronic obstructive bronchitis
2. Emphysema
3. Bronchial asthma
4. Bronchial asthma and bronchitis
2. Emphysema
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.

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
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.

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.
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.

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
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.

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.”
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 client’s symptoms; in fact, walking outdoors
may increase them if the client is allergic to pollen.

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.

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.
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

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

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.

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.

1. Altered nutrition: Less than body requirements related to fatigue.

The client’s problem is altered nutrition—specifically, 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 client’s 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.

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.

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.

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.

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.

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

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.

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

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.

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

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 client’s 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.

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?

1. Cyanosis

2. Flushed skin

3. Irritability

4. Anxiety

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.

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.

2. While exhaling through pursed lips

Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and
reduces 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.

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

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.

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

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.

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

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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.

---contributor=soap : ​bold=answers; ​italics=rationale-​ --

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.

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.

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.

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.”

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.

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.

Physical exercise is beneficial and should be incorporated as tolerated into the client’s
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 client’s
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.

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

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.

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:

1. Begin mechanical ventilation

2. Place the client on oxygen

3. Give the client sodium bicarbonate

4. Monitor for pulmonary embolism.

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.

Basilar crackles are present in a client’s 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.

Basilar crackles are usually heard during inspiration and are caused by sudden opening of the
alveoli.
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 client’s 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 client’s nail beds.

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.

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

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.

If a client continues to hypoventilate, the nurse will continually assess for a complication of:

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

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.
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:

1. Respiratory acidosis

2. A build-up of carbon dioxide

3. A build-up of oxygen without adequate expelling of carbon dioxide.

4. An acute respiratory infection.

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.

Auscultation of a client’s 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 client’s ankles and sacrum for the presence of edema

4. Place the client on bedrest in a semi-Fowlers position.

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 weren’t there to smack her).
Inspection for edema (3) would be appropriate after re-auscultation.

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.

To check for breathing, the nurse places her ear and cheek next to the client’s 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.

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.

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.

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.

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.

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.

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.

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

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.

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.

Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.

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.

The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated from the
oxyhemoglobin molecule.

The BEST method of oxygen administration for client with COPD uses:

1. Cannula

2. Simple Face mask

3. Non-rebreather mask

4. Venturi mask

Venturi delivers controlled oxygen.

NATAPOS MO NA BA? ETO SI JOSE KAKANTAHAN KA