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Respiratory

2/11/14 9:32 AM

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 a acute rhinitis, nasal drainage normally is:
a. Yellow b. Green c. Clear d. Gray
3. A male adult patient hospitalized for treatment of a pulmonary
embolism develops respiratory alkalosis. Which clinical findings commonly
accompany respiratory alkalosis?
a. Nausea or vomiting b. Abdominal pain or diarrhea c. Hallucinations
or tinnitus d. Lightheadedness or paresthesia
4. Before administering ephedrine, Nurse Tony assesses the patients
history. Because of ephedrines central nervous system (CNS) effects, it is
not recommended for:
a. Patients with an acute asthma attack b. Patients with
narcolepsy c. Patients under age 6 d. Elderly patients
5. A female patient suffers adult respiratory distress syndrome as a
consequence of shock. The patients condition deteriorates rapidly, and
endotracheal intubation and mechanical ventilation are initiated. When the
high pressure alarm on the mechanical ventilator, alarm sounds, the nurse
starts to check for the cause. Which condition triggers the high pressure
alarm?
a. Kinking of the ventilator tubing b. A disconnected ventilator
tube c. An endotracheal cuff leak d. A change in the oxygen
concentration without resetting the oxygen level alarm
6. A male adult patient on mechanical ventilation is receiving pancuronium
bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding
indicates that the patient needs another pancuronium dose?
a. Leg movement b. Finger movement c. Lip movement d. Fighting
the ventilator
7. On auscultation, which finding suggests a right pneumothorax?
a. Bilateral inspiratory and expiratory crackles b. Absence of breaths
sound in the right thorax c. Inspiratory wheezes in the right
thorax d. Bilateral pleural friction rub.

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


department by a family member. The medical history reveals chronic
bronchitis and hypertension. To learn more about the current respiratory
problem, the doctor orders a chest x-ray and arterial blood gas (ABG)
analysis. When reviewing the ABG report, the nurses sees many
abbreviations. What does a lowercase a in ABG value present?
a. Acid-base balance b. Arterial Blood c. Arterial oxygen
saturation d. Alveoli
9. A male patient is admitted to the health care facility for treatment of
chronic obstructive pulmonary disease. Which nursing diagnosis is most
important for this patient?
a. Activity intolerance related to fatigue b. Anxiety related to actual
threat to health status c. Risk for infection related to retained
secretions d. Impaired gas exchange related to airflow obstruction
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 advance chronic obstructive pulmonary disease
(COPD), which nursing action best promotes adequate gas exchange?

a. Encouraging the patient to drink three glasses of fluid daily b. Keeping


the patient in semi-fowlers position c. Using a high-flow venture mask to
deliver oxygen as prescribe d. Administering a sedative, as prescribe
15.
A male patients X-ray result reveals bilateral white-outs, indicating
adult respiratory distress syndrome (ARDS). This syndrome results from:
a. Cardiogenic pulmonary edema b. Respiratory alkalosis c. Increased
pulmonary capillary permeability d. Renal failure
16. For a female patient with chronic obstructive pulmonary disease, which
nursing intervention would help maintain a patent airway?
a. Restricting fluid intake to 1,000 ml per day b. Enforcing absolute bed
rest c. Teaching the patient how to perform controlled
coughing d. Administering prescribe sedatives regularly and in large
amounts
17.
Nurse Lei caring for a client with a pneumothorax and who has had a
chest tube inserted notes continues gentle bubbling in the suction control
chamber. What action is appropriate?
a. Do nothing, because this is an expected finding b. Immediately
clamp the chest tube and notify the physician c. Check for an air leak
because the bubbling should be intermittent d. Increase the suction
pressure so that the bubbling becomes vigorous
18. Nurse Maureen has assisted a physician with the insertion of a chest
tube. The nurse monitors the client and notes fluctuation of the fluid level in
the water seal chamber after the tube is inserted. Based on this assessment,
which action would be appropriate?
a. Inform the physician b. Continue to monitor the client c. Reinforce
the occlusive dressing d. Encourage the client to deep-breathe
19.
Nurse Ryan caring for a client with a chest tube turns the client to the
side, and the chest tube accidentally disconnects. The initial nursing action is
to:
a. Call the physician b. Place the tube in bottle of sterile
water c. Immediately replace the chest tube system d. Place a sterile
dressing over the disconnection site
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 pursedlip 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

Answers to Respiratory

2/11/14 9:32 AM

1. Answer B. Albuterol may cause nervousness. The inhaled form of the


drug may cause dryness and irritation of the nose and throat, not nasal
congestion; insomnia, not lethargy; and hypokalemia (with high doses),
not hyperkalemia. Otther adverse effects of albuterol include tremor,
dizziness, headache, tachycardia, palpitations, hypertension, heartburn,
nausea, vomiting and muscle cramps .
2. Answer C. Normally, nasal drainage in acute rhinitis is clear. Yellow or
green drainage indicates spread of the infection to the sinuses. Gray
drainage may indicate a secondary infection.
3. Answer D. The patient with respiratory alkalosis may complain of
lightheadedness or paresthesia (numbness and tingling in the arms and
legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany
respiratory acidosis. Hallucinations and tinnitus rare are associated with
respiratory alkalosis or any other acid-base imbalance.
4. Answer D. Ephedrine is not recommended for elderly patients, who are
particularly susceptible to CNS reactions (such as confusion and anxiety)
and to cardiovascular reactions (such as increased systolic blood
pressure, coldness in the extremities, and anginal pain). Ephedrine is
used for its bronchodilator effects with acute and chronic asthma and
occasionally for its CNS stimulant actions for narcolepsy. It can be
administered to children age 2 and older.
5. Answer A. Conditions that trigger the high pressure alarm include kinking
of the ventilator tubing, bronchospasm or pulmonary embolus, mucus
plugging, water in the tube, coughing or biting on endotracheal tube, and
the patients being out of breathing rhythm with the ventilator. A
disconnected ventilator tube or an endotracheal cuff leak would trigger
the low pressure alarm. Changing the oxygen concentration without
resetting the oxygen level alarm would trigger the oxygen alarm.
6. Answer D. Pancuronium, a nondepolarizing blocking agent, is used for
muscle relaxation and paralysis. It assists mechanical ventilation by
promoting encdotracheal intubation and paralyzing the patient so that the
mechanical ventilator can do its work. Fighting the ventilator is a sign
that the patient needs another pancuronium dose. The nurse should
administer 0.01 to 0.02 mg/kg I.V. every 20 to 60 minutes. Movement of

the legs, or lips has no effect on the ventilator and therefore is not used
to determine the need for another dose.
7. Answer B. In pneumothorax, the alveoli are deflated and no air exchange
occurs in the lungs. Therefore, breath sounds in the affected lung field
are absent. None of the other options are associated with pneumothorax.
Bilateral crackles may result from pulmonary congestion, inspiratory
wheezes may signal asthma, and a pleural friction rub may indicate
pleural inflammation.
8. Answer B. A lowercase a in an ABG value represents arterial blood. For
instance, the abbreviation PaO2 refers to the partial pressure of oxygen in
arterial blood. The pH value reflects the acid base balance in arterial
blood. Sa02 indicates arterial oxygen saturation. An uppercase A
represents alveolar conditions: for example, PA02 indicates the partial
pressure of oxygen in the alveoli.
9. Answer D. A patient airway and an adequate breathing pattern are the
top priority for any patient, making impaired gas exchange related to
airflow obstruction the most important nursing diagnosis. The other
options also may apply to this patient but less important.
10. Answer D. The trachea will shift according to the pressure gradients
within the thoracic cavity. In tension pneumothorax and hemothorax,
accumulation of air or fluid causes a shift away from the injured side. If
there is no significant air or fluid accumulation, the trachea will not shift.
Tracheal deviation toward the contralateral side in simple pneumothorax
is seen when the thoracic contents shift in response to the release of
normal thoracic pressure gradients on the injured side.
11. Answer C. When caring for a patient who is recovering from a
pneumonectomy, the nurse should encourage coughing and deep
breathing to prevent pneumonia in the unaffected lung. Because the lung
has been removed, the water-seal chamber should display no
fluctuations. Reinflation is not the purpose of chest tube. Chest tube
milking is controversial and should be done only to remove blood clots
that obstruct the flow of drainage.
12. Answer B. A patient with a laryngectomy cannot speak, yet still needs
to communicate. Therefore, the nurse should plan to develop an
alternative communication method. After a laryngectomy, edema
interferes with the ability to swallow and necessitates tube (enteral)

feedings. To prevent injury to the tracheal mucosa, the nurse should


deflate the tracheostomy cuff or use the minimal leak technique. To
decrease edema, the nurse should place the patient in semi-fowlers
position.
13. Answer B. The nurse immediately should apply a dressing over the
stab wound and tape it on three sides to allow air to escape and to
prevent tension pneumothorax (which is more life-threatening than an
open chest wound). Only after covering and taping the wound should the
nurse draw blood for laboratory tests, assist with chest tube insertion,
and start an I.V. line.
14. Answer C. The patient with COPD retains carbon dioxide, which inhibits
stimulation of breathing by the medullary center in the brain. As a result,
low oxygen levels in the blood stimulate respiration, and administering
unspecified, unmonitored amounts of oxygen may depress ventilation. To
promote adequate gas exchange, the nurse should use a Venturi mask to
deliver a specified, controlled amount of oxygen consistently and
accurately. Drinking three glasses of fluid daily would not affect gas
exchange or be sufficient to liquefy secretions, which are common in
COPD. Patients with COPD and respiratory distress should be places in
high-Fowlers position and should not receive sedatives or other drugs
that may further depress the respiratory center.
15. Answer C. ARDS results from increased pulmonary capillary
permeability, which leads to noncardiogenic pulmonary edema. In
cardiogenic pulmonary edema, pulmonary congestion occurs secondary to
heart failure. In the initial stage of ARDS, respiratory alkalosis may arise
secondary to hyperventilation; however, it does not cause ARDS. Renal
failure does not cause ARDS, either.
16. Answer C. Controlled coughing helps maintain a patent airway by
helping to mobilize and remove secretions. A moderate fluid intake
(usually 2 L or more daily) and moderate activity help liquefy and
mobilize secretions. Bed rest and sedatives may limit the patients ability
to maintain a patent airway, causing a high risk for infection from pooled
secretions.
17. Answer A. Continuous gentle bubbling should be noted in the suction
control chamber. Option b is incorrect. Chest tubes should only be
clamped to check for an air leak or when changing drainage devices

(according to agency policy). Option c is incorrect. Bubbling should be


continuous and not intermittent. Option d is incorrect because bubbling
should be gentle. Increasing the suction pressure only increases the rate
of evaporation of water in the drainage system.
18. Answer B. The presence of fluctuation of the fluid level in the water
seal chamber indicates a patent drainage system. With normal breathing,
the water level rises with inspiration and falls with expiration. Fluctuation
stops if the tube is obstructed, if a dependent loop exists, if the suction is
not working properly, or if the lung has reexpanded. Options A, C, and D
are incorrect.
19. Answer B. If the chest drainage system is disconnected, the end of the
tube is placed in a bottle of sterile water held below the level of the chest.
The system is replaced if it breaks or cracks or if the collection chamber is
full. Placing a sterile dressing over the disconnection site will not prevent
complications resulting from the disconnection. The physician may need
to be notified, but this is not the initial action.
20. Answer D. When the chest tube is removed, the client is asked to
perform the Valsalva maneuver (take a deep breath, exhale, and bear
down). The tube is quickly withdrawn, and an airtight dressing is taped in
place. An alternative instruction is to ask the client to take a deep breath
and hold the breath while the tube is removed. Options A, B, and C are
incorrect client instructions.
21. Answer B. If the tube is dislodged accidentally, the initial nursing
action is to grasp the retention sutures and spread the opening. If agency
policy permits, the nurse then attempts immediately to replace the tube.
Covering the tracheostomy site will block the airway. Options A and C will
delay treatment in this emergency situation.
22. Answer A. The nurse reports stridor to the physician immediately. This
is a high-pitched, coarse sound that is heard with the stethoscope over
the trachea. Stridor indicates airway edema and places the client at risk
for airway obstruction. Options B, C, and D are not signs that require
immediate notification of the physician.
23. Answer B. This client has sustained a blunt or a closed chest injury.
Basic symptoms of a closed pneumothorax are shortness of breath and
chest pain. A larger pneumothorax may cause tachypnea, cyanosis,
diminished breath sounds, and subcutaneous emphysema.

Hyperresonance also may occur on the affected side. A sucking sound at


the site of injury would be noted with an open chest injury.
24. Answer B. Clinical manifestations of chronic obstructive pulmonary
disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion
and at rest, oxygen desaturation with exercise, and the use of accessory
muscles of respiration. Chest x-rays reveal a hyperinflated chest and a
flattened diaphragm if the disease is advanced.
25. Answer B. The Venturi mask delivers the most accurate oxygen
concentration. It is the best oxygen delivery system for the client with
chronic airflow limitation because it delivers a precise oxygen
concentration. The face tent, aerosol mask, and tracheostomy collar are
also high-flow oxygen delivery systems but most often are used to
administer high humidity.
26. Answer D. One of the first pulmonary symptoms is a slight cough with
the expectoration of mucoid sputum. Options A, B, and C are late
symptoms and signify cavitation and extensive lung involvement.
27. Answer B. Tuberculosis is definitively diagnosed through culture and
isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made
based on a tuberculin skin test, a sputum smear that is positive for acidfast bacteria, a chest x-ray, and histological evidence of granulomatous
disease on biopsy.
28. Answer B. Oxygen is used cautiously and should not exceed 2 L/min.
Because of the long-standing hypercapnia that occurs in emphysema, the
respiratory drive is triggered by low oxygen levels rather than increased
carbon dioxide levels, as is the case in a normal respiratory system.
29. Answer D. Pursed-lip breathing facilitates maximal expiration for
clients with obstructive lung disease. This type of breathing allows better
expiration by increasing airway pressure that keeps air passages open
during exhalation. Options A, B, and C are not the purposes of this type
of breathing.
30. Answer B. The earliest clinical sign of acute respiratory distress
syndrome is an increased respiratory rate. Breathing becomes labored,
and the client may exhibit air hunger, retractions, and cyanosis. Arterial
blood gas analysis reveals increasing hypoxemia, with a PaO2 lower than
60 mm Hg.

Respi part 2

2/11/14 9:32 AM

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


Which of the following nursing actions will facilitate obtaining the
specimen? a. Limiting 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
2. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which
of the following signs, if noticed in the client, should be reported
immediately to the physician? a. Dry
cough b. Hermaturia c. Bronchospasm d. Blood-streaked sputum
3. A nurse is suctioning fluids from a male client via a tracheostomy tube.
When suctioning, the nurse must limit the suctioning time to a maximum
of: a. 1 minute b. 5 seconds c. 10 seconds d. 30 seconds
4. A nurse is suctioning fluids from a female client through an
endotracheal tube. During the suctioning procedure, the nurse notes on the
monitor that the heart rate is decreasing. Which if the following is the
appropriate nursing intervention? a. Continue to suction b. Notify the
physician immediately c. Stop the procedure and reoxygenate the
client d. Ensure that the suction is limited to 15 seconds
5. A male adult client is suspected of having a pulmonary embolus. A
nurse assesses the client, knowing that which of the following is a common
clinical manifestation of pulmonary
embolism? a. Dyspnea b. Bradypnea c. Bradycardia d. Decreased
respirations
6. A slightly obese female client with a history of allergy-induced asthma,
hypertension, and mitral valve prolapse is admitted to an acute care facility
for elective surgery. The nurse obtains a complete history and performs a
thorough physical examination, paying special attention to the
cardiovascular and respiratory systems. When percussing the clients chest
wall, the nurse expects to elicit: a. Resonant sounds. b. Hyperresonant
sounds. c. Dull sounds. d. Flat sounds.
7. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline
(Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is
reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse
to change the dosage to 0.45 mg/kg/hour. The nurse should: a. Question
the order because its too low. b. Question the order because its too

high. c. Set the pump at 45 ml/hour. d. Stop the infusion and have the
laboratory repeat the theophylline measurement.
8. The nurse is teaching a male client with chronic bronchitis about
breathing exercises. Which of the following should the nurse include in the
teaching? a. Make inhalation longer than exhalation. b. Exhale through
an open mouth. c. Use diaphragmatic breathing. d. Use chest breathing.
9. Which phrase is used to describe the volume of air inspired and expired
with a normal breath? a. Total lung capacity b. Forced vital
capacity c. Tidal volume d. Residual volume
10. A male client abruptly sits up in bed, reports having difficulty
breathing and has an arterial oxygen saturation of 88%. Which mode of
oxygen delivery would most likely reverse the manifestations? a. Simple
mask b. Non-rebreather mask c. Face tent d. Nasal cannula
11. A female client must take streptomycin for tuberculosis. Before
therapy begins, the nurse should instruct the client to notify the physician if
which health concern occurs? a. Impaired color
discrimination b. Increased urinary frequency c. Decreased hearing
acuity d. Increased appetite
12. A male client is asking the nurse a question regarding the Mantoux
test for tuberculosis. The nurse should base her response on the fact that
the: a. Area of redness is measured in 3 days and determines whether
tuberculosis is present. b. Skin test doesnt differentiate between active
and dormant tuberculosis infection. c. Presence of a wheal at the injection
site in 2 days indicates active tuberculosis. d. Test stimulates a reddened
response in some clients and requires a second test in 3 months.
13. A female adult client has a tracheostomy but doesnt require
continuous mechanical ventilation. When weaning the client from the
tracheostomy tube, the nurse initially should plug the opening in the tube
for: a. 15 to 60 seconds. b. 5 to 20 minutes. c. 30 to 40
minutes. d. 45 to 60 minutes.
14. Nurse Oliver observes constant bubbling in the water-seal chamber of
a closed chest drainage system. What should the nurse conclude? a. The
system is functioning normally b. The client has a pneumothorax. c. The
system has an air leak. d. The chest tube is obstructed.
15. A black client with asthma seeks emergency care for acute respiratory
distress. Because of this clients dark skin, the nurse should assess for

cyanosis by inspecting the: a. Lips. b. Mucous membranes. c. Nail


beds. d. Earlobes.
16. For a male client with an endotracheal (ET) tube, which nursing action
is most essential? a. Auscultating the lungs for bilateral breath
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
17. The nurse assesses a male clients respiratory status. Which
observation indicates that the client is experiencing difficulty
breathing? a. Diaphragmatic breathing b. Use of accessory
muscles c. Pursed-lip breathing d. Controlled breathing
18. A female client is undergoing a complete physical examination as a
requirement for college. When checking the clients respiratory status, the
nurse observes respiratory excursion to help assess: a. Lung
vibrations. b. Vocal sounds. c. Breath sounds. d. Chest movements.
19. A male client comes to the emergency department complaining of
sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent
chills. Based on the clients history and physical findings, the physician
suspects legionnaires disease. While awaiting diagnostic test results, the
client is admitted to the facility and started on antibiotic therapy. What is the
drug of choice for treating legionnaires disease? a. Erythromycin
(Erythrocin) b. Rifampin (Rifadin) c. Amantadine
(Symmetrel) d. Amphotericin B (Fungizone)
20. A male client with chronic obstructive pulmonary disease (COPD) is
recovering from a myocardial infarction. Because the client is extremely
weak and cant produce an effective cough, the nurse should monitor closely
for: a. Pleural effusion. b. Pulmonary
edema. c. Atelectasis. d. Oxygen toxicity.
21. The nurse in charge is teaching a client with emphysema how to
perform pursed-lip breathing. The client asks the nurse to explain the
purpose of this breathing technique. Which explanation should the nurse
provide? a. It helps prevent early airway collapse. b. It increases
inspiratory muscle strength. c. It decreases use of accessory breathing
muscles. d. It prolongs the inspiratory phase of respiration.
22. After receiving an oral dose of codeine for an intractable cough, the
male client asks the nurse, How long will it take for this drug to work? How

should the nurse respond? a. In 30 minutes b. In 1 hour c. In 2.5


hours d. In 4 hours
23. A male client suffers adult respiratory distress syndrome as a
consequence of shock. The clients condition deteriorates rapidly, and
endotracheal (ET) intubation and mechanical ventilation are initiated. When
the high-pressure alarm on the mechanical ventilator sounds, the nurse
starts to check for the cause. Which condition triggers the high-pressure
alarm? a. Kinking of the ventilator tubing b. A disconnected ventilator
tube c. An ET cuff leak d. A change in the oxygen concentration without
resetting the oxygen level alarm
24. A female client with chronic obstructive pulmonary disease (COPD)
takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine
clinic visit, the client asks the nurse how the drug works. What is the
mechanism of action of anhydrous theophylline in treating a nonreversible
obstructive airway disease such as COPD? a. It makes the central
respiratory center more sensitive to carbon dioxide and stimulates the
respiratory drive. b. It inhibits the enzyme phosphodiesterase, decreasing
degradation of cyclic adenosine monophosphate, a bronchodilator. c. It
stimulates adenosine receptors, causing bronchodilation. d. It alters
diaphragm movement, increasing chest expansion and enhancing the lungs
capacity for gas exchange.
25. A male client with pneumococcal pneumonia is admitted to an acute
care facility. The client in the next room is being treated for mycoplasmal
pneumonia. Despite the different causes of the various types of pneumonia,
all of them share which feature? a. Inflamed lung tissue b. Sudden
onset c. Responsiveness to penicillin. d. Elevated white blood cell (WBC)
count
26. A client with Guillain-Barr syndrome develops respiratory acidosis as
a result of reduced alveolar ventilation. Which combination of arterial blood
gas (ABG) values confirms respiratory acidosis? a. pH, 5.0; PaCO2 30 mm
Hg b. pH, 7.40; PaCO2 35 mm Hg c. pH, 7.35; PaCO2 40 mm
Hg d. pH, 7.25; PaCO2 50 mm Hg
27. A male client admitted to an acute care facility with pneumonia is
receiving supplemental oxygen, 2 L/minute via nasal cannula. The clients
history includes chronic obstructive pulmonary disease (COPD) and coronary
artery disease. Because of these history findings, the nurse closely monitors

the oxygen flow and the clients respiratory status. Which complication may
arise if the client receives a high oxygen
concentration? a. Apnea b. Anginal pain c. Respiratory
alkalosis d. Metabolic acidosis
28. At 11 p.m., a male client is admitted to the emergency department.
He has a respiratory rate of 44 breaths/minute. Hes anxious, and wheezes
are audible. The client is immediately given oxygen by face mask and
methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the clients arterial
blood oxygen saturation is 86% and hes still wheezing. The nurse should
plan to administer: a. Alprazolam (Xanax). b. Propranolol
(Inderal) c. Morphine. d. Albuterol (Proventil).
29. After undergoing a thoracotomy, a male client is receiving epidural
analgesia. Which assessment finding indicates that the client has developed
the most serious complication of epidural analgesia? a. Heightened
alertness b. Increased heart rate c. Numbness and tingling of the
extremities d. Respiratory depression
30. The nurse in charge formulates a nursing diagnosis of Activity
intolerance related to inadequate oxygenation and dyspnea for a client with
chronic bronchitis. To minimize this problem, the nurse instructs the client to
avoid conditions that increase oxygen demands. Such conditions
include: a. Drinking more than 1,500 ml of fluid daily. b. Being
overweight. c. Eating a high-protein snack at bedtime. d. Eating more
than three large meals a day.

2/11/14 9:32 AM
1. Answer B. To obtain a sputum specimen, the client should rinse the
mouth to reduce contamination, breathe deeply, and then cough into a
sputum specimen container. The client should be encouraged to cough
and not spit so as to obtain sputum. Sputum can be thinned by fluids or
by a respiratory treatment such as inhalation of nebulized saline or water.
The optimal time to obtain a specimen is on arising in the morning.
2. Answer C. If a biopsy was performed during a bronchoscopy, bloodstreaked sputum is expected for several hours. Frank blood indicates
hemorrhage. A dry cough may be expected. The client should be
assessed for signs of complications, which would include cyanosis,
dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia,
and dysrhythmias. Hematuria is unrelated to this procedure.
3. Answer C. Hypoxemia can be caused by prolonged suctioning, which
stimulates the pacemaker cells in the heart. A vasovagal response may
occur, causing bradycardia. The nurse must preoxygenate the client
before suctioning and limit the suctioning pass to 10 seconds.
4. Answer C. During suctioning, the nurse should monitor the client closely
for side effects, including hypoxemia, cardiac irregularities such as a
decrease in heart rate resulting from vagal stimulation, mucosal trauma,
hypotension, and paroxysmal coughing. If side effects develop, especially
cardiac irregularities, the procedure is stopped and the client is
reoxygenated.
5. Answer A. The common clinical manifestations of pulmonary embolism
are tachypnea, tachycardia, dyspnea, and chest pain.
6. Answer A. When percussing the chest wall, the nurse expects to elicit
resonant sounds low-pitched, hollow sounds heard over normal lung
tissue. Hyperresonant sounds indicate increased air in the lungs or pleural
space; theyre louder and lower pitched than resonant sounds. Although
hyperresonant sounds occur in such disorders as emphysema and
pneumothorax, they may be normal in children and very thin adults. Dull
sounds, normally heard only over the liver and heart, may occur over
dense lung tissue, such as from consolidation or a tumor. Dull sounds are
thudlike and of medium pitch. Flat sounds, soft and high-pitched, are
heard over airless tissue and can be replicated by percussing the thigh or
a bony structure.

7. Answer A. A therapeutic theophylline level is 10 to 20 mcg/ml. The client


is currently receiving 0.5 mg/kg/hour of aminophylline. Because the
clients theophylline level is sub-therapeutic, reducing the dose (which is
what the physicians order would do) would be inappropriate. Therefore,
the nurse should question the order.
8. Answer C. In chronic bronchitis the diaphragm is flat and weak.
Diaphragmatic breathing helps to strengthen the diaphragm and
maximizes ventilation. Exhalation should be longer than inhalation to
prevent collapse of the bronchioles. The client with chronic bronchitis
should exhale through pursed lips to prolong exhalation, keep the
bronchioles from collapsing, and prevent air trapping. Diaphragmatic
breathing not chest breathing increases lung expansion.
9. Answer C. Tidal volume refers to the volume of air inspired and expired
with a normal breath. Total lung capacity is the maximal amount of air
the lungs and respiratory passages can hold after a forced inspiration.
Forced vital capacity is the vital capacity performed with a maximally
forced expiration. Residual volume is the maximal amount of air left in
the lung after a maximal expiration.
10. Answer B. A non-rebreather mask can deliver levels of the fraction of
inspired oxygen (FIO2) as high as 100%. Other modes simple mask,
face tent, and nasal cannula deliver lower levels of FIO2.
11. Answer C. Decreased hearing acuity indicates ototoxicity, a serious
adverse effect of streptomycin therapy. The client should notify the
physician immediately if it occurs so that streptomycin can be
discontinued and an alternative drug can be prescribed. The other options
arent associated with streptomycin. Impaired color discrimination
indicates color blindness; increased urinary frequency and increased
appetite accompany diabetes mellitus.
12. Answer B. The Mantoux test doesnt differentiate between active and
dormant infections. If a positive reaction occurs, a sputum smear and
culture as well as a chest X-ray are necessary to provide more
information. Although the area of redness is measured in 3 days, a
second test may be needed; neither test indicates that tuberculosis is
active. In the Mantoux test, an induration 5 to 9 mm in diameter
indicates a borderline reaction; a larger induration indicates a positive

reaction. The presence of a wheal within 2 days doesnt indicate active


tuberculosis.
13. Answer B. Initially, the nurse should plug the opening in the
tracheostomy tube for 5 to 20 minutes, then gradually lengthen this
interval according to the clients respiratory status. A client who doesnt
require continuous mechanical ventilation already is breathing without
assistance, at least for short periods; therefore, plugging the opening of
the tube for only 15 to 60 seconds wouldnt be long enough to reveal the
clients true tolerance to the procedure. Plugging the opening for more
than 20 minutes would increase the risk of acute respiratory distress
because the client requires an adjustment period to start breathing
normally.
14. Answer C. Constant bubbling in the chamber indicates an air leak and
requires immediate intervention. The client with a pneumothorax will
have intermittent bubbling in the water-seal chamber. Clients without a
pneumothorax should have no evidence of bubbling in the chamber. If the
tube is obstructed, the nurse should notice that the fluid has stopped
fluctuating in the water-seal chamber.
15. Answer B. Skin color doesnt affect the mucous membranes. The lips,
nail beds, and earlobes are less reliable indicators of cyanosis because
theyre affected by skin color.
16. Answer A. For a client with an ET tube, the most important nursing
action is auscultating the lungs regularly for bilateral breath sounds to
ensure proper tube placement and effective oxygen delivery. Although
the other options are appropriate for this client, theyre secondary to
ensuring adequate oxygenation.
17. Answer B. The use of accessory muscles for respiration indicates the
client is having difficulty breathing. Diaphragmatic and pursed-lip
breathing are two controlled breathing techniques that help the client
conserve energy.
18. Answer D. The nurse observes respiratory excursion to help assess
chest movements. Normally, thoracic expansion is symmetrical; unequal
expansion may indicate pleural effusion, atelectasis, pulmonary embolus,
or a rib or sternum fracture. The nurse assesses vocal sounds to evaluate
air flow when checking for tactile fremitus; after asking the client to say
99, the nurse palpates the vibrations transmitted from the

bronchopulmonary system along the solid surfaces of the chest wall to


the nurses palms. The nurse assesses breath sounds during auscultation.
19. Answer A. Erythromycin is the drug of choice for treating legionnaires
disease. Rifampin may be added to the regimen if erythromycin alone is
ineffective; however, it isnt administered first. Amantadine, an antiviral
agent, and amphotericin B, an antifungal agent, are ineffective against
legionnaires disease, which is caused by bacterial infection.
20. Answer C. In a client with COPD, an ineffective cough impedes
secretion removal. This, in turn, causes mucus plugging, which leads to
localized airway obstruction a known cause of atelectasis. An
ineffective cough doesnt cause pleural effusion (fluid accumulation in the
pleural space). Pulmonary edema usually results from left-sided heart
failure, not an ineffective cough. Although many noncardiac conditions
may cause pulmonary edema, an ineffective cough isnt one of them.
Oxygen toxicity results from prolonged administration of high oxygen
concentrations, not an ineffective cough.
21. Answer A. Pursed-lip breathing helps prevent early airway collapse.
Learning this technique helps the client control respiration during periods
of excitement, anxiety, exercise, and respiratory distress. To increase
inspiratory muscle strength and endurance, the client may need to learn
inspiratory resistive breathing. To decrease accessory muscle use and
thus reduce the work of breathing, the client may need to learn
diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client
mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with
emphysema may have an I:E ratio as high as 1:4.)
22. Answer A. Codeines onset of action is 30 minutes. Its peak
concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its
duration of action is 4 to 6 hours.
23. Answer A. Conditions that trigger the high-pressure alarm include
kinking of the ventilator tubing, bronchospasm or pulmonary embolus,
mucus plugging, water in the tube, coughing or biting on the ET tube, and
the clients being out of breathing rhythm with the ventilator. A
disconnected ventilator tube or an ET cuff leak would trigger the lowpressure alarm. Changing the oxygen concentration without resetting the
oxygen level alarm would trigger the oxygen alarm.

24. Answer A. Anhydrous theophylline and other methylxanthine agents


make the central respiratory center more sensitive to CO2 and stimulate
the respiratory drive. Inhibition of phosphodiesterase is the drugs
mechanism of action in treating asthma and other reversible obstructive
airway diseases not COPD. Methylxanthine agents inhibit rather than
stimulate adenosine receptors. Although these agents reduce
diaphragmatic fatigue in clients with chronic bronchitis or emphysema,
they dont alter diaphragm movement to increase chest expansion and
enhance gas exchange.
25. Answer A. The common feature of all types of pneumonia is an
inflammatory pulmonary response to the offending organism or agent.
Although most types of pneumonia have a sudden onset, a few (such as
anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an
insidious onset. Antibiotic therapy is the primary treatment for most types
of pneumonia; however, the antibiotic must be specific for the causative
agent, which may not be responsive to penicillin. A few types of
pneumonia, such as viral pneumonia, arent treated with antibiotics.
Although pneumonia usually causes an elevated WBC count, some types,
such as mycoplasmal pneumonia, dont.
26. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH
below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above
45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2
value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a
PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C
represent normal ABG values, reflecting normal gas exchange in the
lungs.
27. Answer A. Hypoxia is the main breathing stimulus for a client with
COPD. Excessive oxygen administration may lead to apnea by removing
that stimulus. Anginal pain results from a reduced myocardial oxygen
supply. A client with COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia; however, administering oxygen at
any concentration dilates blood vessels, easing anginal pain. Respiratory
alkalosis results from alveolar hyperventilation, not excessive oxygen
administration. In a client with COPD, high oxygen concentrations
decrease the ventilatory drive, leading to respiratory acidosis, not
alkalosis. High oxygen concentrations dont cause metabolic acidosis.

28. Answer D. The client is hypoxemic because of bronchoconstriction as


evidenced by wheezes and a subnormal arterial oxygen saturation level.
The clients greatest need is bronchodilation, which can be accomplished
by administering bronchodilators. Albuterol is a beta2 adrenergic agonist,
which causes dilation of the bronchioles. Its given by nebulization or
metered-dose inhalation and may be given as often as every 30 to 60
minutes until relief is accomplished. Alprazolam is an anxiolytic and
central nervous system depressant, which could suppress the clients
breathing. Propranolol is contraindicated in a client whos wheezing
because its a beta2 adrenergic antagonist. Morphine is a respiratory
center depressant and is contraindicated in this situation.
29. Answer D. Respiratory depression is the most serious complication of
epidural analgesia. Other potential complications include hypotension,
decreased sensation and movement of the extremities, allergic reactions,
and urine retention. Typically, epidural analgesia causes central nervous
system depression (indicated by drowsiness) as well as a decreased heart
rate and blood pressure.
30. Answer B. Conditions that increase oxygen demands include obesity,
smoking, exposure to temperature extremes, and stress. A client with
chronic bronchitis should drink at least 2,000 ml of fluid daily to thin
mucus secretions; restricting fluid intake may be harmful. The nurse
should encourage the client to eat a high-protein snack at bedtime
because protein digestion produces an amino acid with sedating effects
that may ease the insomnia associated with chronic bronchitis. Eating
more than three large meals a day may cause fullness, making breathing
uncomfortable and difficult; however, it doesnt increase oxygen
demands. To help maintain adequate nutritional intake, the client with
chronic bronchitis should eat small, frequent meals (up to six a day).