MEDICAL-SURGICAL NURSING (RESPIRATORY)

1. An elderly client with pneumonia may appear with which nail beds. Based on this information, he most likely has
of the following symptoms first? which of the following conditions?
a. Altered mental status and dehydration a. Adult respiratory distress syndrome (ARDS)
b. fever and chills b. Asthma
c. Hemoptysis and dyspnea c. Chronic obstructive bronchitis
d. Pleuretic chest pain and cough d. Emphysema
2. 16.
3. Which of the following pathophysiological mechanisms 17. The term “blue bloater” refers to which of the following
that occurs in the lung parenchyma allows pneumonia to conditions?
develop? a. Adult respiratory distress syndrome (ARDS)
a. Atelectasis b. Asthma
b. Bronchiectasis c. Chronic obstructive bronchitis
c. Effusion d. Emphysema
d. Inflammation 18.
4. 19. The term “pink puffer” refers to the client with which of
5. A 7-year-old client is brought to the E.R. He’s tachypneic the following conditions?
and afebrile and has a respiratory rate of 36 a. ARDS
breaths/minute and a nonproductive cough. He recently b. Asthma
had a cold. From his history, the client may have which of c. Chronic obstructive bronchitis
the following? d. Emphysema
a. Acute asthma 20.
b. Bronchial pneumonia 21. A 66-year-old client has marked dyspnea at rest, is thin,
c. Chronic obstructive pulmonary disease (COPD) and uses accessory muscles to breathe. He’s tachypneic,
d. Emphysema with a prolonged expiratory phase. He has no cough. He
6. leans forward with his arms braced on his knees to support
7. Which of the following assessment findings would help his chest and shoulders for breathing. This client has
confirm a diagnosis of asthma in a client suspected of symptoms of which of the following respiratory disorders?
having the disorder? a. ARDS
a. Circumoral cyanosis b. Asthma
b. Increased forced expiratory volume c. Chronic obstructive bronchitis
c. Inspiratory and expiratory wheezing d. Emphysema
d. Normal breath sounds 22.
8. 23. It’s highly recommended that clients with asthma, chronic
9. Which of the following types of asthma involves an acute bronchitis, and emphysema have Pneumovax and flu
asthma attack brought on by an upper respiratory vaccinations for which of the following reasons?
infection? a. All clients are recommended to have these
a. Emotional vaccines
b. Extrinsic b. These vaccines produce bronchodilation and
c. Intrinsic improve oxygenation.
d. Mediated c. These vaccines help reduce the tachypnea these
10. clients experience.
11. A client with acute asthma showing inspiratory and d. Respiratory infections can cause severe hypoxia
expiratory wheezes and a decreased expiratory volume and possibly death in these clients.
should be treated with which of the following classes of 24.
medication right away? 25. Exercise has which of the following effects on clients with
a. Beta-adrenergic blockers asthma, chronic bronchitis, and emphysema?
b. Bronchodilators a. It enhances cardiovascular fitness.
c. Inhaled steroids b. It improves respiratory muscle strength.
d. Oral steroids c. It reduces the number of acute attacks.
12. d. It worsens respiratory function and is
13. A 19-year-old comes into the emergency department with discouraged.
acute asthma. His respiratory rate is 44 breaths/minute, 26.
and he appears to be in acute respiratory distress. Which 27. Clients with chronic obstructive bronchitis are given
of the following actions should be taken first? diuretic therapy. Which of the following reasons best
a. Take a full medication history explains why?
b. Give a bronchodilator by neubulizer a. Reducing fluid volume reduces oxygen demand.
c. Apply a cardiac monitor to the client b. Reducing fluid volume improves clients’ mobility.
d. Provide emotional support to the client. c. Restricting fluid volume reduces sputum
14. production.
15. A 58-year-old client with a 40-year history of smoking one d. Reducing fluid volume improves respiratory
to two packs of cigarettes a day has a chronic cough function.
producing thick sputum, peripheral edema, and cyanotic 28.
29. A 69-year-old client appears thin and cachectic. He’s short b. Respiratory arrest
of breath at rest and his dyspnea increases with the c. Be pissed about receiving Narcan
slightest exertion. His breath sounds are diminished even d. Wake up on her own
with deep inspiration. These signs and symptoms fit which 44.
of the following conditions? 45. Which of the following additional assessment data should
a. ARDS immediately be gathered to determine the status of a
b. Asthma client with a respiratory rate of 4 breaths/minute?
c. Chronic obstructive bronchitis a. Arterial blood gas (ABG) and breath sounds
d. Emphysema b. Level of consciousness and a pulse oximetry
30. value.
31. A client with emphysema should receive only 1 to 3 c. Breath sounds and reflexes
L/minute of oxygen, if needed, or he may lose his hypoxic d. Pulse oximetry value and heart sounds
drive. Which of the following statements is correct about 46.
hypoxic drive? 47. A client is in danger of respiratory arrest following the
a. The client doesn’t notice he needs to breathe. administration of a narcotic analgesic. An arterial blood gas
b. The client breathes only when his oxygen levels value is obtained. The nurse would expect to PaCO2 to be
climb above a certain point. which of the following values?
c. The client breathes only when his oxygen levels a. 15 mm Hg
dip below a certain point. b. 30 mm Hg
d. The client breathes only when his carbon dioxide c. 40 mm Hg
level dips below a certain point. d. 80 mm Hg
32. 48.
33. Teaching for a client with chronic obstructive pulmonary 49. A client has started a new drug for hypertension. Thirty
disease (COPD) should include which of the following minutes after he takes the drug, he develops chest
topics? tightness and becomes short of breath and tachypneic. He
a. How to have his wife learn to listen to his lungs has a decreased level of consciousness. These signs
with a stethoscope from Wal-Mart. indicate which of the following conditions?
b. How to increase his oxygen therapy. a. Asthma attack
c. How to treat respiratory infections without going b. Pulmonary embolism
to the physician. c. Respiratory failure
d. How to recognize the signs of an impending d. Rheumatoid arthritis
respiratory infection. 50.
34. 51. Emergency treatment for a client with impending
35. Which of the following respiratory disorders is most anaphylaxis secondary to hypersensitivity to a drug should
common in the first 24 to 48 hours after surgery? include which of the following actions first?
a. Atelectasis a. Administering oxygen
b. Bronchitis b. Inserting an I.V. catheter
c. Pneumonia c. Obtaining a complete blood count (CBC)
d. Pneumothorax d. Taking vital signs
36. 52.
37. Which of the following measures can reduce or prevent 53. Following the initial care of a client with asthma and
the incidence of atelectasis in a post-operative client? impending anaphylaxis from hypersensitivity to a drug, the
a. Chest physiotherapy nurse should take which of the following steps next?
b. Mechanical ventilation a. Administer beta-adrenergic blockers
c. Reducing oxygen requirements b. Administer bronchodilators
d. Use of an incentive spirometer c. Obtain serum electrolyte levels
38. d. Have the client lie flat in the bed.
39. Emergency treatment of a client in status asthmaticus 54.
includes which of the following medications? 55. A client’s ABG results are as follows: pH: 7.16; PaCO2 80
a. Inhaled beta-adrenergic agents mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This
b. Inhaled corticosteroids ABG result represents which of the following conditions?
c. I.V. beta-adrenergic agents a. Metabolic acidosis
d. Oral corticosteroids b. Metabolic alkalosis
40. c. Respiratory acidosis
41. Which of the following treatment goals is best for the d. Respiratory alkalosis
client with status asthmaticus? 56.
a. Avoiding intubation 57. A nurse plans care for a client with chronic obstructive
b. Determining the cause of the attack pulmonary disease, knowing that the client is most likely to
c. Improving exercise tolerance experience what type of acid-base imbalance?
d. Reducing secretions a. Respiratory acidosis
42. b. Respiratory alkalosis
43. Dani was given dilaudid for pain. She’s sleeping and her c. Metabolic acidosis
respiratory rate is 4 breaths/minute. If action isn’t taken d. Metabolic alkalosis
quickly, she might have which of the following reactions? 58.
a. Asthma attack
59. A nurse is caring for a client who is on a mechanical 72. A nurse is caring for a client with renal failure. Blood gas
ventilator. Blood gas results indicate a pH of 7.50 and a results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a
PCO2 of 30 mm Hg. The nurse has determined that the bicarbonate concentration of 20 mEq/L. The nurse has
client is experiencing respiratory alkalosis. Which determined that the client is experiencing metabolic
laboratory value would most likely be noted in this acidosis. Which of the following laboratory values would
condition? the nurse expect to note?
a. Sodium level of 145 mEq/L a. Sodium level of 145 mEq/L
b. Potassium level of 3.0 mEq/L b. Magnesium level of 2.0 mg/dL
c. Magnesium level of 2.0 mg/L c. Potassium level of 5.2 mEq/L
d. Phosphorus level of 4.0 mg/dl d. Phosphorus level of 4.0 mg/dL
60. 73.
61. A nurse reviews the arterial blood gas results of a patient 74. A nurse is preparing to obtain an arterial blood gas
and notes the following: pH 7.45; PCO2 30 mm Hg; and specimen from a client and plans to perform the Allen’s
bicarbonate concentration of 22 mEq/L. The nurse analyzes test on the client. Number in order of priority the steps for
these results as indicating: performing the Allen’s test (#1 is first step).
a. Metabolic acidosis, compensated. a. Ask the client to open and close the hand
b. Metabolic alkalosis, uncompensated. repeatedly.
c. Respiratory alkalosis, compensated. b. Apply pressure over the ulnar and radial arteries.
d. Respiratory acidosis, compensated. c. Assess the color of the extremity distal to the
62. pressure point
63. A client is scheduled for blood to be drawn from the radial d. Release pressure from the ulnar artery
artery for an ABG determination. Before the blood is e. Explain the procedure to the client.
drawn, an Allen’s test is performed to determine the 75.
adequacy of the: 76. A nurse is preparing to obtain a sputum specimen from a
a. Popliteal circulation client. Which of the following nursing actions will facilitate
b. Ulnar circulation obtaining the specimen?
c. Femoral circulation a. Limiting fluids
d. Carotid circulation b. Having the client take 3 deep breaths.
64. c. Asking the client to spit into the collection
65. A nurse is caring for a client with a nasogastric tube that is container.
attached to low suction. The nurse monitors the client, d. Asking the client to obtain the specimen after
knowing that the client is at risk for which acid-base eating.
disorder? 77.
a. Respiratory acidosis 78. A nurse is caring for a client after a bronchoscopy and
b. Respiratory alkalosis biopsy. Which of the following signs if noted in the client
c. Metabolic acidosis should be reported immediately to the physician?
d. Metabolic alkalosis a. Blood-streaked sputum
66. b. Dry cough
67. A nurse is caring for a client with an ileostomy understands c. Hematuria
that the client is most at risk for developing which acid- d. Bronchospasm
base disorder? 79.
a. Respiratory acidosis 80. A nurse is suctioning fluids from a client via a tracheostomy
b. Respiratory alkalosis tube. When suctioning, the nurse must limit the suctioning
c. Metabolic acidosis to a maximum of:
d. Metabolic alkalosis a. 5 seconds
68. b. 10 seconds
69. A nurse is caring for a client with diabetic ketoacidosis and c. 30 seconds
documents that the client is experiencing Kussmaul’s d. 1 minute
respirations. Based on this documentation, which of the 81.
following did the nurse observe? 82. A nurse is suctioning fluids from a client through an
a. Respirations that are abnormally deep, regular, endotracheal tube. During the suctioning procedure, the
and increased in rate. nurse notes on the monitor that the heart rate decreases.
b. Respirations that are regular but abnormally Which of the following is the most appropriate nursing
slow. intervention?
c. Respirations that are labored and increased in a. Continue to suction
depth and rate b. Ensure that the suction is limited to 15 seconds
d. Respirations that cease for several seconds. c. Stop the procedure and reoxyenate the client
70. d. Notify the physician immediately.
71. A nurse understands that the excessive use of oral antacids 83.
containing bicarbonate can result in which acid-base 84. An unconscious client is admitted to an emergency room.
disturbance? Arterial blood gas measurements reveal a pH of 7.30, a low
a. Respiratory alkalosis bicarbonate level, a normal carbon dioxide level, and a
b. Respiratory acidosis normal oxygen level. An elevated potassium level is also
c. Metabolic acidosis present. These results indicate the presence of:
d. Metabolic alkalosis a. Metabolic acidosis
 b. Respiratory acidosis 100. Aminophylline (theophylline) is prescribed for a client with
c. Combined respiratory and metabolic acidosis acute bronchitis. A nurse administers the medication,
d. overcompensated respiratory acidosis knowing that the primary action of this medication is to:
85. a. Promote expectoration
86. A nurse is caring for a client hospitalized with acute b. Suppress the cough
exacerbation of COPD. Which of the following would the c. Relax smooth muscles of the bronchial airway
nurse expect to note on assessment of this client? d. Prevent infection
a. Increased oxygen saturation with exercise 101.
b. Hypocapnia 102. A client is receiving isoetharine hydrochloride (Bronkosol)
c. A hyperinflated chest on x-ray film via a nebulizer. The nurse monitors the client for which
d. A widened diaphragm noted on chest x-ray film side effect of this medication?
87. a. Constipation
88. An oxygenated delivery system is prescribed for a client b. Diarrhea
with COPD to deliver a precise oxygen concentration. c. Bradycardia
Which of the following types of oxygen delivery systems d. Tachycardia
would the nurse anticipate to be prescribed? 103.
a. Venturi mask 104. A nurse teaches a client about the use of a respiratory
b. Aerosol mask inhaler. Which action by the client indicated a need for
c. Face tent further teaching?
d. Tracheostomy collar a. Removes the cap and shakes the inhaler well
89. before use.
90. Theophylline (Theo-Dur) tablets are prescribed for a client b. Presses the canister down with finger as he
with chronic airflow limitation, and the nurse instructs the breathes in.
client about the medication. Which statement by the client c. Inhales the mist and quickly exhales.
indicates a need for further teaching? d. Waits 1 to 2 minutes between puffs if more than
a. “I will take the medication on an empty one puff has been prescribed.
stomach.” 105.
b. “I will take the medication with food.” 106. A female client is scheduled to have a chest radiograph.
c. “I will continue to take the medication even if I Which of the following questions is of most importance to
am feeling better.” the nurse assessing this client?
d. “Periodic blood levels will need to be obtained.” a. “Is there any possibility that you could be
91. pregnant?”
92. A nurse is caring for a client with emphysema. The client is b. “Are you wearing any metal chains or jewelry?”
receiving oxygen. The nurse assesses the oxygen flow rate c. “Can you hold your breath easily?”
to ensure that it does not exceed d. “Are you able to hold your arms above your
a. 1 L/min head?”
b. 2 L/min 107.
c. 6 L/min 108. A client has just returned to a nursing unit following
d. 10 L/min bronchoscopy. A nurse would implement which of the
93. following nursing interventions for this client?
94. The nurse reviews the ABG values of a client. The results a. Encouraging additional fluids for the next 24
indicate respiratory acidosis. Which of the following values hours
would indicate that this acid-base imbalance exists? b. Ensuring the return of the gag reflex before
a. pH of 7.48 offering foods or fluids
b. PCO2 of 32 mm Hg c. Administering atropine intravenously
c. pH of 7.30 d. Administering small doses of midazolam
d. HCO3- of 20 mEq/L (Versed).
95. 109.
96. A nurse instructs a client to use the pursed lip method of 110. A client has an order to have radial ABG drawn. Before
breathing. The client asks the nurse about the purpose of drawing the sample, a nurse occludes the:
this type of breathing. The nurse responds, knowing that a. Brachial and radial arteries, and then releases
the primary purpose of pursed lip breathing is: them and observes the circulation of the hand.
a. Promote oxygen intake b. Radial and ulnar arteries, releases one, evaluates
b. Strengthen the diaphragm the color of the hand, and repeats the process
c. Strengthen the intercostal muscles with the other artery.
d. Promote carbon dioxide elimination c. Radial artery and observes for color changes in
97. the affected hand.
98. A nurse reviews the ABG values and notes a pH of 7.50, a d. Ulnar artery and observes for color changes in
PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The nurse the affected hand.
interprets these values as indicating: 111.
a. Respiratory acidosis uncompensated 112. A nurse is assessing a client with chronic airflow limitation
b. Respiratory alkalosis uncompensated and notes that the client has a “barrel chest.” The nurse
c. Metabolic acidosis uncompensated interprets that this client has which of the following forms
d. Metabolic acidosis partially compensated. of chronic airflow limitation?
99. a. Chronic obstructive bronchitis
 b. Emphysema 125. Pseudoephedrine (Sudafed) has been ordered as a nasal
c. Bronchial asthma decongestant. Which of the following is a possible side
d. Bronchial asthma and bronchitis effect of this drug?
113. a. Constipation
114. A client has been taking benzonatate (Tessalin Perles) as b. Bradycardia
prescribed. A nurse concludes that the medication is c. Diplopia
having the intended effect if the client experiences: d. Restlessness
a. Decreased anxiety level 126.
b. Increased comfort level 127. A client with COPD reports steady weight loss and being
c. Reduction of N/V “too tired from just breathing to eat.” Which of the
d. Decreased frequency and intensity of cough following nursing diagnoses would be most appropriate
115. when planning nutritional interventions for this client?
116. Which of the following would be an expected outcome for a. Altered nutrition: Less than body requirements
a client recovering from an upper respiratory tract related to fatigue.
infection? The client will: b. Activity intolerance related to dyspnea.
a. Maintain a fluid intake of 800ml every 24 hours. c. Weight loss related to COPD.
b. Experience chills only once a day d. Ineffective breathing pattern related to alveolar
c. Cough productively without chest discomfort. hypoventilation.
d. Experience less nasal obstruction and discharge. 128.
117. 129. When developing a discharge plan to manage the care of a
118. Which of the following individuals would the nurse client with COPD, the nurse should anticipate that the
consider to have the highest priority for receiving an client will do which of the following?
influenza vaccination? a. Develop infections easily
a. A 60-year-old man with a hiatal hernia b. Maintain current status
b. A 36-year-old woman with 3 children c. Require less supplemental oxygen
c. A 50-year-old woman caring for a spouse with d. Show permanent improvement.
cancer 130.
d. a 60-year-old woman with osteoarthritis 131. Which of the following outcomes would be appropriate for
119. a client with COPD who has been discharged to home? The
120. A client with allergic rhinitis asks the nurse what he should client:
do to decrease his symptoms. Which of the following a. Promises to do pursed lip breathing at home.
instructions would be appropriate for the nurse to give the b. States actions to reduce pain.
client? c. States that he will use oxygen via a nasal cannula
a. “Use your nasal decongestant spray regularly to at 5 L/minute.
help clear your nasal passages.” d. Agrees to call the physician if dyspnea on
b. “Ask the doctor for antibiotics. Antibiotics will exertion increases.
help decrease the secretion.” 132.
c. “It is important to increase your activity. A daily 133. Which of the following physical assessment findings would
brisk walk will help promote drainage.” the nurse expect to find in a client with advanced COPD?
d. “Keep a diary if when your symptoms occur. This a. Increased anteroposterior chest diameter
can help you identify what precipitates your b. Underdeveloped neck muscles
attacks.” c. Collapsed neck veins
121. d. Increased chest excursions with respiration
122. An elderly client has been ill with the flu, experiencing 134.
headache, fever, and chills. After 3 days, she develops a 135. Which of the following is the primary reason to teach
cough productive of yellow sputum. The nurse auscultates pursed-lip breathing to clients with emphysema?
her lungs and hears diffuse crackles. How would the nurse a. To promote oxygen intake
best interpret these assessment findings? b. To strengthen the diaphragm
a. It is likely that the client is developing a c. To strengthen the intercostal muscles
secondary bacterial pneumonia. d. To promote carbon dioxide elimination
b. The assessment findings are consistent with 136.
influenza and are to be expected. 137. Which of the following is a priority goal for the client with
c. The client is getting dehydrated and needs to COPD?
increase her fluid intake to decrease secretions. a. Maintaining functional ability
d. The client has not been taking her decongestants b. Minimizing chest pain
and bronchodilators as prescribed. c. Increasing carbon dioxide levels in the blood
123. d. Treating infectious agents
124. Guaifenesin 300 mg four times daily has been ordered as 138.
an expectorant. The dosage strength of the liquid is 139. A client’s arterial blood gas levels are as follows: pH 7.31;
200mg/5ml. How many mL should the nurse administer PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L.
each dose? Which of the following signs or symptoms would the nurse
a. 5.0 ml expect?
b. 7.5 ml a. Cyanosis
c. 9.5 ml b. Flushed skin
d. 10 ml c. Irritability
 d. Anxiety c. Encourage the client to relax and breathe slowly
140. through the mouth
141. When teaching a client with COPD to conserve energy, the d. Administer bronchodilators
nurse should teach the client to lift objects: 154.
a. While inhaling through an open mouth. 155. The nurse would anticipate which of the following ABG
b. While exhaling through pursed lips results in a client experiencing a prolonged, severe asthma
c. After exhaling but before inhaling. attack?
d. While taking a deep breath and holding it. a. Decreased PaCO2, increased PaO2, and
142. decreased pH.
143. The nurse teaches a client with COPD to assess for s/s of b. Increased PaCO2, decreased PaO2, and
right-sided heart failure. Which of the following s/s would decreased pH.
be included in the teaching plan? c. Increased PaCO2, increased PaO2, and increased
a. Clubbing of nail beds pH.
b. Hypertension d. Decreased PaCO2, decreased PaO2, and
c. Peripheral edema increased pH.
d. Increased appetite 156.
144. 157. A client with acute asthma is prescribed short-term
145. The nurse assesses the respiratory status of a client who is corticosteroid therapy. What is the rationale for the use of
experiencing an exacerbation of COPD secondary to an steroids in clients with asthma?
upper respiratory tract infection. Which of the following a. Corticosteroids promote bronchodilation
findings would be expected? b. Corticosteroids act as an expectorant
a. Normal breath sounds c. Corticosteroids have an anti-inflammatory effect
b. Prolonged inspiration d. Corticosteroids prevent development of
c. Normal chest movement respiratory infections.
d. Coarse crackles and rhonchi 158.
146. 159. The nurse is teaching the client how to use a metered dose
147. Which of the following ABG abnormalities should the nurse inhaler (MDI) to administer a Corticosteroid drug. Which of
anticipate in a client with advanced COPD? the following client actions indicates that he us using the
a. Increased PaCO2 MDI correctly? Select all that apply.
b. Increased PaO2 a. The inhaler is held upright.
c. Increased pH. b. Head is tilted down while inhaling the
d. Increased oxygen saturation medication
148. c. Client waits 5 minutes between puffs.
149. Which of the following diets would be most appropriate d. Mouth is rinsed with water following
for a client with COPD? administration
a. Low fat, low cholesterol e. Client lies supine for 15 minutes following
b. Bland, soft diet administration.
c. Low-Sodium diet 160.
d. High calorie, high-protein diet 161. A client is prescribed metaproterenol (Alupent) via a
150. metered dose inhaler (MDI), two puffs every 4 hours. The
151. The nurse is planning to teach a client with COPD how to nurse instructs the client to report side effects. Which of
cough effectively. Which of the following instructions the following are potential side effects of metaproterenol?
should be included? a. Irregular heartbeat
a. Take a deep abdominal breath, bend forward, b. Constipation
and cough 3 to 4 times on exhalation. c. Petal edema
b. Lie flat on back, splint the thorax, take two deep d. Decreased heart rate.
breaths and cough. 162.
c. Take several rapid, shallow breaths and then 163. A client has been taking flunisolide (Aerobid), two
cough forcefully. inhalations a day, for treatment of asthma. He tells the
d. Assume a side-lying position, extend the arm nurse that he has painful, white patches in his mouth.
over the head, and alternate deep breathing with Which response by the nurse would be the most
coughing. appropriate?
152. a. “This is an anticipated side-effect of your
153. A 34-year-old woman with a history of asthma is admitted medication. It should go away in a couple of
to the emergency department. The nurse notes that the weeks.”
client is dyspneic, with a respiratory rate of 35 b. “You are using your inhaler too much and it has
breaths/minute, nasal flaring, and use of accessory irritated your mouth.”
muscles. Auscultation of the lung fields reveals greatly c. “You have developed a fungal infection from your
diminished breath sounds. Based on these findings, what medication. It will need to be treated with an
action should the nurse take to initiate care of the client? antibiotic.”
a. Initiate oxygen therapy and reassess the client in d. “Be sure to brush your teeth and floss daily.
10 minutes. Good oral hygiene will treat this problem.”
b. Draw blood for an ABG analysis and send the 164.
client for a chest x-ray.
165. Which of the following health promotion activities should d. Metabolic alkalosis
the nurse include in the discharge teaching plan for a client 178.
with asthma? 179. A client is admitted to the hospital with acute bronchitis.
a. Incorporate physical exercise as tolerated into While taking the client’s VS, the nurse notices he has an
the treatment plan. irregular pulse. The nurse understands that cardiac
b. Monitor peak flow numbers after meals and at arrhythmias in chronic respiratory distress are usually the
bedtime. result of:
c. Eliminate stressors in the work and home a. Respiratory acidosis
environment b. A build-up of carbon dioxide
d. Use sedatives to ensure uninterrupted sleep at c. A build-up of oxygen without adequate expelling
night. of carbon dioxide.
166. d. An acute respiratory infection.
167. The client with asthma should be taught that which of the 180.
following is one of the most common precipitating factors 181. Auscultation of a client’s lungs reveals crackles in the left
of an acute asthma attack? posterior base. The nursing intervention is to:
a. Occupational exposure to toxins a. Repeat auscultation after asking the client to
b. Viral respiratory infections deep breathe and cough.
c. Exposure to cigarette smoke b. Instruct the client to limit fluid intake to less than
d. Exercising in cold temperatures 2000 ml/day.
168. c. Inspect the client’s ankles and sacrum for the
169. A female client comes into the emergency room presence of edema
complaining of SOB and pain in the lung area. She states d. Place the client on bedrest in a semi-Fowlers
that she started taking birth control pills 3 weeks ago and position.
that she smokes. Her VS are: 140/80, P 110, R 40. The 182.
physician orders ABG’s, results are as follows: pH: 7.50; 183. The most reliable index to determine the respiratory status
PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; of a client is to:
SaO2 86%. Considering these results, the first intervention a. Observe the chest rising and falling
is to: b. Observe the skin and mucous membrane color.
a. Begin mechanical ventilation c. Listen and feel the air movement.
b. Place the client on oxygen d. Determine the presence of a femoral pulse.
c. Give the client sodium bicarbonate 184.
d. Monitor for pulmonary embolism. 185. A client with COPD has developed secondary
170. polycythemia. Which nursing diagnosis would be included
171. Basilar crackles are present in a client’s lungs on in the plan of care because of the polycythemia?
auscultation. The nurse knows that these are discrete, a. Fluid volume deficit related to blood loss.
noncontinuous sounds that are: b. Impaired tissue perfusion related to thrombosis
a. Caused by the sudden opening of alveoli c. Activity intolerance related to dyspnea
b. Usually more prominent during expiration d. Risk for infection related to suppressed immune
c. Produced by airflow across passages narrowed response.
by secretions 186.
d. Found primarily in the pleura. 187. The physician has scheduled a client for a left
172. pneumonectomy. The position that will most likely be
173. A cyanotic client with an unknown diagnosis is admitted to ordered postoperatively for his is the:
the E.R. In relation to oxygen, the first nursing action would a. Unoperative side or back
be to: b. Operative side or back
a. Wait until the client’s lab work is done. c. Back only
b. Not administer oxygen unless ordered by the d. Back or either side.
physician. 188.
c. Administer oxygen at 2 L flow per minute. 189. Assessing a client who has developed atelectasis
d. Administer oxygen at 10 L flow per minute and postoperatively, the nurse will most likely find:
check the client’s nailbeds. a. A flushed face
174. b. Dyspnea and pain
175. Immediately following a thoracentesis, which clinical c. Decreased temperature
manifestations indicate that a complication has occurred d. Severe cough and no pain.
and the physician should be notified? 190.
a. Serosanguineous drainage from the puncture site 191. A fifty-year-old client has a tracheostomy and requires
b. Increased temperature and blood pressure tracheal suctioning. The first intervention in completing
c. Increased pulse and pallor this procedure would be to:
d. Hypotension and hypothermia a. Change the tracheostomy dressing
176. b. Provide humidity with a trach mask
177. If a client continues to hypoventilate, the nurse will c. Apply oral or nasal suction
continually assess for a complication of: d. Deflate the tracheal cuff
a. Respiratory acidosis 192.
b. Respiratory alkalosis 193. A client states that the physician said the tidal volume is
c. Metabolic acidosis slightly diminished and asks the nurse what this means.
 The nurse explains that the tidal volume is the amount of d. Nutritional intake
air: 208.
a. Exhaled forcibly after a normal expiration 209. A client has been treated with antibiotic therapy for right
b. Exhaled after there is a normal inspiration lower-lobe pneumonia for 10 days and will be discharged
c. Trapped in the alveoli that cannot be exhaled today. Which of the following physical findings would lead
d. Forcibly inspired over and above a normal the nurse to believe it is appropriate to discharge this
respiration. client?
194. a. Continued dyspnea
195. An acceleration in oxygen dissociation from hemoglobin, b. Fever of 102*F
and thus oxygen delivery to the tissues, is caused by: c. Respiratory rate of 32 breaths/minute
a. A decreasing oxygen pressure in the blood d. Vesicular breath sounds in right base
b. An increasing carbon dioxide pressure in the 210.
blood 211. The right forearm of a client who had a purified protein
c. A decreasing oxygen pressure and/or an derivative (PPD) test for tuberculosis is reddened and
increasing carbon dioxide pressure in the blood. raised about 3mm where the test was given. This PPD
d. An increasing oxygen pressure and/or a would be read as having which of the following results?
decreasing carbon dioxide pressure in the blood. a. Indeterminate
196. b. Needs to be redone
197. Clients with chronic illnesses are more likely to get c. Negative
pneumonia when which of the following situations is d. Positive
present? 212.
a. Dehydration 213. A client with primary TB infection can expect to develop
b. Group living which of the following conditions?
c. Malnutrition a. Active TB within 2 weeks
d. Severe periodontal disease b. Active TB within 1 month
198. c. A fever that requires hospitalization
199. Which of the following pathophysiological mechanisms d. A positive skin test
that occurs in the lung parenchyma allows pneumonia to 214.
develop? 215. A client was infected with TB 10 years ago but never
a. Atelectasis developed the disease. He’s now being treated for cancer.
b. Bronchiectasis The client begins to develop signs of TB. This is known as
c. Effusion which of the following types of infection?
d. Inflammation a. Active infection
200. b. Primary infection
201. Which of the following organisms most commonly causes c. Superinfection
community-acquired pneumonia in adults? d. Tertiary infection
a. Haemiphilus influenza 216.
b. Klebsiella pneumonia 217. A client has active TB. Which of the following symptoms
c. Steptococcus pneumonia will he exhibit?
d. Staphylococcus aureus a. Chest and lower back pain
202. b. Chills, fever, night sweats, and hemoptysis
203. When auscultating the chest of a client with pneumonia, c. Fever of more than 104*F and nausea
the nurse would expect to hear which of the following d. Headache and photophobia
sounds over areas of consolidation? 218.
a. Bronchial 219. Which of the following diagnostic tests is definitive for TB?
b. Bronchovestibular a. Chest x-ray
c. Tubular b. Mantoux test
d. Vesicular c. Sputum culture
204. d. Tuberculin test
205. A diagnosis of pneumonia is typically achieved by which of 220.
the following diagnostic tests? 221. A client with a positive Mantoux test result will be sent for
a. ABG analysis a chest x-ray. For which of the following reasons is this
b. Chest x-ray done?
c. Blood cultures a. To confirm the diagnosis
d. sputum culture and sensitivity b. To determine if a repeat skin test is needed
206. c. To determine the extent of the lesions
207. A client with pneumonia develops dyspnea with a d. To determine if this is a primary or secondary
respiratory rate of 32 breaths/minute and difficulty infection
expelling his secretions. The nurse auscultates his lung 222.
fields and hears bronchial sounds in the left lower lobe. 223. A chest x-ray should a client’s lungs to be clear. His
The nurse determines that the client requires which of the Mantoux test is positive, with a 10mm if induration. His
following treatments first? previous test was negative. These test results are possible
a. Antibiotics because:
b. Bed rest a. He had TB in the past and no longer has it.
c. Oxygen
 b. He was successfully treated for TB, but skin tests c. Pneumonia
always stay positive. d. Spontaneous pneumothorax
c. He’s a “seroconverter”, meaning the TB has 238.
gotten to his bloodstream. 239. Which of the following treatments would the nurse expect
d. He’s a “tuberculin converter,” which means he for a client with a spontaneous pneumothorax?
has been infected with TB since his last skin test. a. Antibiotics
224. b. Bronchodilators
225. A client with a positive skin test for TB isn’t showing signs c. Chest tube placement
of active disease. To help prevent the development of d. Hyperbaric chamber
active TB, the client should be treated with isonaizid, 240.
300mg daily, for how long? 241. Which of the following methods is the best way to confirm
a. 10 to 14 days the diagnosis of a pneumothorax?
b. 2 to 4 weeks a. Auscultate breath sounds
c. 3 to 6 months b. Have the client use an incentive spirometer
d. 9 to 12 months c. Take a chest x-ray
226. d. stick a needle in the area of decreased breath
227. A client with a productive cough, chills, and night sweats is sounds
suspected of having active TB. The physician should take 242.
which of the following actions? 243. A pulse oximetry gives what type of information about the
a. Admit him to the hospital in respiratory isolation client?
b. Prescribe isoniazid and tell him to go home and a. Amount of carbon dioxide in the blood
rest b. Amount of oxygen in the blood
c. Give a tuberculin test and tell him to come back c. Percentage of hemoglobin carrying oxygen
in 48 hours and have it read. d. Respiratory rate
d. Give a prescription for isoniazid, 300mg daily for 244.
2 weeks, and send him home. 245. What effect does hemoglobin amount have on oxygenation
228. status?
229. A client is diagnosed with active TB and started on triple a. No effect
antibiotic therapy. What signs and symptoms would the b. More hemoglobin reduces the client’s respiratory
client show if therapy is inadequate? rate
a. Decreased shortness of breath c. Low hemoglobin levels cause reduces oxygen-
b. Improved chest x-ray carrying capacity
c. Nonproductive cough d. Low hemoglobin levels cause increased oxygen-
d. Positive acid-fast bacilli in a sputum sample after carrying capacity.
2 months of treatment. 246.
230. 247. Which of the following statements best explains how
231. A client diagnosed with active TB would be hospitalized opening up collapsed alveoli improves oxygenation?
primarily for which of the following reasons? a. Alveoli need oxygen to live
a. To evaluate his condition b. Alveoli have no effect on oxygenation
b. To determine his compliance c. Collapsed alveoli increase oxygen demand
c. To prevent spread of the disease d. Gaseous exchange occurs in the alveolar
d. To determine the need for antibiotic therapy. membrane.
232. 248.
233. A high level of oxygen exerts which of the following effects 249. Continuous positive airway pressure (CPAP) can be
on the lung? provided through an oxygen mask to improve oxygenation
a. Improves oxygen uptake in hypoxic patients by which of the following methods?
b. Increases carbon dioxide levels a. The mask provides 100% oxygen to the client.
c. Stabilizes carbon dioxide levels b. The mask provides continuous air that the client
d. Reduces amount of functional alveolar surface can breathe.
area c. The mask provides pressurized oxygen so the
234. client can breathe more easily.
235. A 24-year-old client comes into the clinic complaining of d. The mask provides pressurized at the end of
right-sided chest pain and shortness of breath. He reports expiration to open collapsed alveoli.
that it started suddenly. The assessment should include 250.
which of the following interventions? 251. Which of the following best describes pleural effusion?
a. Auscultation of breath sounds a. The collapse of alveoli
b. Chest x-ray b. The collapse of bronchiole
c. Echocardiogram c. The fluid in the alveolar space
d. Electrocardiogram (ECG) d. The accumulation of fluid between the linings of
236. the pleural space.
237. A client with shortness of breath has decreased to absent 252.
breath sounds on the right side, from the apex to the base. 253. If a pleural effusion develops, which of the following
Which of the following conditions would best explain this? actions best describes how the fluid can be removed from
a. Acute asthma the pleural space and proper lung status restored?
b. Chronic bronchitis a. Inserting a chest tube
 b. Performing thoracentesis 267. A community health nurse is conducting an educational
c. Performing paracentesis session with community members regarding TB. The nurse
d. Allowing the pleural effusion to drain by itself. tells the group that one of the first symptoms associated
254. with TB is:
255. A comatose client needs a nasopharyngeal airway for a. A bloody, productive cough
suctioning. After the airway is inserted, he gags and b. A cough with the expectoration of mucoid
coughs. Which action should the nurse take? sputum
a. Remove the airway and insert a shorter one. c. Chest pain
b. Reposition the airway. d. Dyspnea
c. Leave the airway in place until the client gets 268.
used to it. 269. A nurse evaluates the blood theophylline level of a client
d. Remove the airway and attempt suctioning receiving aminophylline (theophylline) by intravenous
without it. infusion. The nurse would determine that a therapeutic
256. blood level exists if which of the following were noted in
257. An 87-year-old client requires long term ventilator therapy. the laboratory report?
He has a tracheostomy in place and requires frequent a. 5 mcg/mL
suctioning. Which of the following techniques is correct? b. 15 mcg/mL
a. Using intermittent suction while advancing the c. 25 mcg/mL
catheter. d. 30 mcg/mL
b. Using continuous suction while withdrawing the 270.
catheter. 271. Isoniazid (INH) and rifampin (Rifadin) have been prescribed
c. Using intermittent suction while withdrawing the for a client with TB. A nurse reviews the medical record of
catheter. the client. Which of the following, if noted in the client’s
d. Using continuous suction while advancing the history, would require physician notification?
catheter. a. Heart disease
258. b. Allergy to penicillin
259. A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 c. Hepatitis B
mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What d. Rheumatic fever
do these values indicate? 272.
a. Metabolic acidosis 273. A client is experiencing confusion and tremors is admitted
b. Respiratory alkalosis to a nursing unit. An initial ABG report indicates that the
c. Metabolic alkalosis PaCO2 level is 72 mm Hg, whereas the PaO2 level is 64 mm
d. Respiratory acidosis Hg. A nurse interprets that the client is most likely
260. experiencing:
261. A police officer brings in a homeless client to the ER. A a. Carbon monoxide poisoning
chest x-ray suggests he has TB. The physician orders an b. Carbon dioxide narcosis
intradermal injection of 5 tuberculin units/0.1 ml of c. Respiratory alkalosis
tuberculin purified derivative. Which needle is appropriate d. Metabolic acidosis
for this injection? 274.
a. 5/8” to ½” 25G to 27G needle. 275. A client who is HIV+ has had a PPD skin test. The nurse
b. 1” to 3” 20G to 25G needle. notes a 7-mm area of induration at the site of the skin test.
c. ½” to 3/8” 26 or 27G needle. The nurse interprets the results as:
d. 1” 20G needle. a. Positive
262. b. Negative
263. A 76-year old client is admitted for elective knee surgery. c. Inconclusive
Physical examination reveals shallow respirations but no d. The need for repeat testing.
signs of respiratory distress. Which of the following is a 276.
normal physiologic change related to aging? 277. A nurse is caring for a client diagnosed with TB. Which
a. Increased elastic recoil of the lungs assessment, if made by the nurse, would not be consistent
b. Increased number of functional capillaries in the with the usual clinical presentation of TB and may indicate
alveoli the development of a concurrent problem?
c. Decreased residual volume a. Nonproductive or productive cough
d. Decreased vital capacity. b. Anorexia and weight loss
264. c. Chills and night sweats
265. A 79-year-old client is admitted with pneumonia. Which d. High-grade fever
nursing diagnosis should take priority? 278. A nurse is teaching a client with TB about dietary elements
a. Acute pain related to lung expansion secondary that should be increased in the diet. The nurse suggests
to lung infection that the client increase intake of:
b. Risk for imbalanced fluid volume related to a. Meats and citrus fruits
increased insensible fluid losses secondary to b. Grains and broccoli
fever. c. Eggs and spinach
c. Anxiety related to dyspnea and chest pain. d. Potatoes and fish
d. Ineffective airway clearance related to retained 279.
secretions.
266.
280. Which of the following would be priority assessment data c. Agglunitnation testing
to gather from a client who has been diagnosed with d. Dark-field illumination
pneumonia? Select all that apply. 295.
a. Auscultation of breath sounds 296. Which of the following antituberculus drugs can cause
b. Auscultation of bowel sounds damage to the eighth cranial nerve?
c. Presence of chest pain. a. Streptomycin
d. Presence of peripheral edema b. Isoniazid
e. Color of nail beds c. Para-aminosalicylic acid
281. d. Ethambutol hydrochloride
282. A client with pneumonia has a temperature of 102.6*F 297.
(39.2*C), is diaphoretic, and has a productive cough. The 298. The client experiencing eighth cranial nerve damage will
nurse should include which of the following measures in most likely report which of the following symptoms?
the plan of care? a. Vertigo
a. Position changes q4h b. Facial paralysis
b. Nasotracheal suctioning to clear secretions c. Impaired vision
c. Frequent linen changes d. Difficulty swallowing
d. Frequent offering of a bedpan. 299.
283. 300. Which of the following family members exposed to TB
284. The cyanosis that accompanies bacterial pneumonia is would be at highest risk for contracting the disease?
primarily caused by which of the following? a. 45-year-old mother
a. Decreased cardiac output b. 17-year-old daughter
b. Pleural effusion c. 8-year-old son
c. Inadequate peripheral circulation d. 76-year-old grandmother
d. Decreased oxygenation of the blood. 301.
285. 302. The nurse is teaching a client who has been diagnosed with
286. Which of the following mental status changes may occur TB how to avoid spreading the disease to family members.
when a client with pneumonia is first experiencing Which statement(s) by the client indicate(s) that he has
hypoxia? understood the nurses instructions? Select all that apply.
a. Coma a. “I will need to dispose of my old clothing when I
b. Apathy return home.”
c. Irritability b. “I should always cover my mouth and nose when
d. Depression sneezing.”
287. c. “It is important that I isolate myself from family
288. A client with pneumonia has a temperature ranging when possible.”
between 101* and 102*F and periods of diaphoresis. d. “I should use paper tissues to cough in and
Based on this information, which of the following nursing dispose of them properly.”
interventions would be a priority? e. “I can use regular plate and utensils whenever I
a. Maintain complete bedrest eat.”
b. Administer oxygen therapy 303.
c. Provide frequent linen changes. 304. A client has a positive reaction to the PPD test. The nurse
d. Provide fluid intake of 3 L/day correctly interprets this reaction to mean that the client
289. has:
290. Which of the following would be an appropriate expected a. Active TB
outcome for an elderly client recovering from bacterial b. Had contact with Mycobacterium tuberculosis
pneumonia? c. Developed a resistance to tubercle bacilli
a. A respiratory rate of 25 to 30 breaths per minute d. Developed passive immunity to TB.
b. The ability to perform ADL’s without dyspnea 305.
c. A maximum loss of 5 to 10 pounds of body 306. INH treatment is associated with the development of
weight peripheral neuropathies. Which of the following
d. Chest pain that is minimized by splinting the interventions would the nurse teach the client to help
ribcage. prevent this complication?
291. a. Adhere to a low cholesterol diet
292. Which of the following symptoms is common in clients b. Supplement the diet with pyridoxine (vitamin B6)
with TB? c. Get extra rest
a. Weight loss d. Avoid excessive sun exposure.
b. Increased appetite 307.
c. Dyspnea on exertion 308. The nurse should include which of the following
d. Mental status changes instructions when developing a teaching plan for clients
293. receiving INH and rifampicin for treatment for TB?
294. The nurse obtains a sputum specimen from a client with a. Take the medication with antacids
suspected TB for laboratory study. Which of the following b. Double the dosage if a drug dose is forgotten
laboratory techniques is most commonly used to identify c. Increase intake of dairy products
tubercle bacilli in sputum? d. Limit alcohol intake
a. Acid-fast staining 309.
b. Sensitivity testing
310. The public health nurse is providing follow-up care to a 321.
client with TB who does not regularly take his medication. 322. A nurse has just administered a purified protein derivative
Which nursing action would be most appropriate for this (PPD) skin test to a client who is at low risk for developing
client? tuberculosis. The nurse determines that the test is positive
a. Ask the client’s spouse to supervise the daily if which of the following occurs?
administration of the medications. a. an induration of 15 mm
b. Visit the clinic weekly to ask him whether he is b. the presence of a wheal
taking his medications regularly. c. a large area of erythema
c. Notify the physician of the client’s non- d. client complains of constant itching
compliance and request a different prescription. 323.
d. Remind the client that TB can be fatal if not 324. A client who has fallen from a ladder and fractured three
taken properly. ribs has arterial blood gas (ABG) results of pH 7.38, PCO2
311. 38 mmHg, PO2 86 mmHg, and HCO3 23 mEq/L. The nurse
312. The nurse is caring for a client admitted to the hospital interprets that the client's ABGs indicate which of the
with the diagnosis of active tuberculosis. The nurse following?
determines that the diagnosis was confirmed by a: a. normal results
a. tine test b. metabolic acidosis
b. chest x-ray c. metabolic alkalosis
c. mantoux test d. respiratory acidosis
d. sputum culture 325.
313. 326. A client at risk for respiratory failure is receiving oxygen via
314. A client was admitted to the hospital 24 hours ago after nasal cannula at 6 L per minute. Arterial blood gas (ABG)
sustaining blunt chest trauma. The nurse monitors for results indicate: pH 7.29, PCO2 49 mmHg, PO2 58 mmHg,
which earliest clinical manifestation of acute respiratory HCO3 18 mEq/L. The nurse anticipates that the physician
distress syndrome (ARDS)? will order which of the following for respiratory support?
a. cyanosis and pallor a. intubation and mechanical ventilation
b. diffuse crackles and rhonchi on chest b. adding a partial rebreather mask to the current
auscultation order
c. increase respiratory rate from 18 to 30 breaths c. keeping the oxygen at 6 L per minute via nasal
per minute cannula
d. haziness or "white-out appearance of lungs on d. lowering the oxygen to 4 L per minute via nasal
chest radiograph cannula
315. 327.
316. A nurse is performing a respiratory assessment on a client 328. The nurse assists the physician with the removal of a chest
being treated for an asthma attack. The nurse determines tube. During removal of the chest tube, the nurse instructs
that the client's respiratory status is worsening if which of the client to perform which of the following?
the following occurs? a. breathe in deeply
a. loud wheezing b. breathe normally
b. wheezing on expiration c. breathe out forcefully
c. noticeably diminished breath sounds d. exhale and bear down
d. wheezing during inspiration and expiration 329.
317. 330. The nurse assesses the water seal chamber of a closed
318. A home care nurse assesses a client with chronic chest drainage system and notes fluctuations in the
obstructive pulmonary disease (COPD) who is complaining chamber. The nurse determines that this finding indicates
of increased dypsnea. The client is on home oxygen via a that:
concentrator at 2L per minute, and the client's respiratory a. the tubing is kinked
rate is 22 breaths per minute. The appropriate nursing b. an air leak is present
action is to: c. the lung has expanded
a. determine the need to increase the oxygen d. the system is functioning as expected
b. reassure the client that there is no need to worry 331.
c. conduct further assessment of the client's 332. The nurse evaluates a client following treatment for carbon
respiratory status monoxide poisoning. The nurse would document that the
d. call emergency services to take the client to the treatment was effective if which of the following were
emergency department present?
319. a. client is sleeping soundly
320. A nurse is admitting a client suspected of having b. client is awake and talking
tuberculosis (TB) to the hospital. The nurse understands c. heart monitor shows sinus tachycardia
that the most accurate method of confirming the diagnosis d. carboxyhemoglobin levels are less than 5%
is: 333.
a. a chest radiograph positive for lung lesions 334. The nurse is determining the need for suctioning in a client
b. a positive purified protein derivative test (PPD) with an endotracheal (ET) tube attached to a mechanical
c. a sputum culture positive for myconbacterium ventilator. Which observation by the nurse indicates this
tuberculosis need?
d. obtaining data about the client's long history of a. clear breath sounds
hemoptysis b. visible mucus bubbling in the ET tube
 c. apical pulse rate of 72 beats per minute a. the client had a glass of orange juice an hour ago
d. low peak inspiratory pressure on the ventilator b. the client has yellowish sputum
c. the client complains of thirst and dryness of
335. A client is intubated and receiving mechanical ventilation. mouth
The physician has added 7 cm of positive and expiratory d. the client says, he had removed his dentures
pressure (PEEP) to the ventilator settings of the client. The 343.
nurse assesses for which of the following expected but 178. The client had undergone decortication of the right lung.
adverse effects of PEEP? The nurse needs to intervene when the unlicensednursing
a. decreased peak pressure on the ventilator assistant does which of the following?
b. increased temperature from 98F to 100F rectally a. instructs the client to lie on the operated side
c. decreased heart rate from 78 to 63 beats per b. instructs the client to lie on the unoperated side
minute c. keeps the client on supine with head of the bed
d. systolic blood pressure decrease from 122 to 98 elevated
mm Hg d. ensures that chest tube with water-seal drainage
336. functions properly
337. The nurse is assessing the respiratory status of the client
following thoracentesis. The nurse would become most 179. Which of the following findings should concern the nurse
concerned with which of the following assessment that the oxygen saturation monitor is not working?
findings? a. there is no sensor light on the probe
a. equal bilateral chest expansion b. oxygen saturation (Sa O2) is 92%
b. respiratory rate of 22 breaths per minute c. pulse rate= 58/min; Sa is 97%
c. diminished breath sounds on affected side d. mucous membrane in the mouth appears pinkish
d. few scattered wheezes, unchanged from baseline 344.
338. 180. The client had left chest injury. The nurse can feel air going
173. The nurse is preparing to administer a Mantoux skin test to in and out of injured site during breathing. Which ofthe
a client. The nurse determines that which area is most following should the nurse do initially?
appropriate for injection of the medication? a. apply petrolatum jelly dressing at the site
a. dorsal aspect of the upper arm near a mole b. turn the client to right side
b. inner aspect of the forearm that is close to a c. give oxygen therapy at 2 L/min
burn scar d. transport the client to the nearest medical
c. inner aspect of the forearm that is not heavily facility
pigmented 345.
d. dorsal aspect of the upper arm that has a small 181. The client had undergone thoracentesis. Which of the
amount of hair following is a correct action by the LVN (LicensedVocational
339. Nurse) immediately after the procedure?
174. A 14-year old male is to be admitted to the unit due to high a. she turns the client towards the affected side
fever related to influenza. With whom among the following b. she turns the client towards the unaffected side
clients should he be placed together in the room? c. she places the client in a supine position
a. the 12-year old male client who had undergone d. she places the client in semi-fowler's position
appendectomy 346.
b. the 12-year old female client with flu 182. The client is diagnosed to have
c. the 12-year old boy with flu advanced chronic obstructive pulmonary
d. the 12-year old boy with leukemia disease (COPD). Which of the following nursing action
340. would best promote adequate gas exchange?
175. Why is influenza vaccine given to adults annually? a. administering sedative as prescribed
a. immunity last only for a year b. placing the client in upright position
b. some organisms are resistant to the vaccine c. using high-flow venturi mask to deliver oxygen
c. this is the routine procedure d. encourage client to drink 6 glasses of fluid daily
d. adults have low resistance to flu virus
341. 183. A 48-year old man with tuberculosis is taking INH with
176. Which of the following nursing interventions should be pyridoxine (Vit. B6). The client asks why it is necessary for
implemented for a client with influenza? him to take pyridoxine. Which of the following is the most
a. instructing family members not to visit the client appropriate response by the nurse?
until the fever declines a. it increases INH absorption
b. instructing family members or visitors to b. it prevents INH-associated neuritis
wear surgical mask before entering the client's c. it decreases toxicity of INH
room d. it increases the effectiveness of INH
c. instructing family members that there are no 347.
special precautions needed when caring for the 184. The child with croup is in a mist tent. Which of the following toys
client will be appropriate for the child?
d. instructing family members to wear gown and a. stuffed toys
gloves before entering the client's room b. drawing book
c. plastic ball
342.
d. coloring book
177. Which of the following should concern the nurse most, 348.
when caring for a client who will undergo bronchoscopy?
185. The client had been subjected to thoracentesis without written c. call another nurse to be with the client while the nurse
consent. What offense are the health care providers liable for? calls for the physician
a. Assault d. turn off the alarm
b. Battery 357.
c. Manslaughter 194. Which of the following community-acquired pneumonias
d. invasion of privacy demonstrates the highest occurrence during summer and fall?
349. a. pneumococcal pneumonia
186. The client with acute asthmatic attack is receiving Theophylline b. legionaire's pneumonia
(Aminophylline) drip. Which of the following nursing actions c. viral pneumonia
should be included in the nursing care plan of the client? d. mycoplasma pneumonia
a. note for decreased urine output 358.
b. observe for elevated temperature 195. A client is admitted to an acute care facility with a tentative
c. be alert for decreased BP diagnosis of PCP (pneumocystis cariniipneumonia). She had lost 25
d. monitor for decreased pulse rate lbs. over the past 2 months and complains of anorexia. At this
350. point, the highest priority goal is that the patient will
187. Which of the following is the best position for a client who had a. increase nutrient intake
undergone lobectomy? b. have no further weight loss
a. side-lying position c. be free from infection
b. supine position d. maintain cardiopulmonary functioning
c. sitting upright, leaning forward position 359.
d. semi-fowler's position 196. A patient underwent a pneumonectomy and developed tension
351. pneumothorax. Which of the following is an early indication of
188. Which of the following findings should be reported to the tension pneumothorax?
physician? a. frothy, blood-tinged sputum
a. vesicular breath sounds at the peripheral areas of the b. trachea shifts toward unaffected side of the chest
lungs c. development of subcutaneous emphysema
b. bronchovesicular breath sounds heard over the d. open, sucking chest wound
mainstem bronchi
c. bronchial breath sounds heard over the trachea 197. The nurse is caring for a client on mechanical ventilator. The low-
d. adventitious breath sounds heard all over the lungs pressure alarm of the ventilator turns on. The most important
352. nursing action is:
189. The client with chronic obstructive pulmonary disease (COPD) is a. prepare to suction the client
receiving Aminophylline. Which of the following manifestations b. check air leak from endotracheal tube
indicate that the client is experiencing an adverse effect of the c. check if the tube is kinked
drug? d. turn off the alarm
a. elevated temperature 360.
b. bradycardia 198. Which of the following assessment findings in a client with a
c. restlessness closed chest tube drainage should concern the nurse most?
d. tachycardia a. continuous, vigorous bubbling in the suction control
353. chamber
190. The client has closed chest drainage. Which of the following b. continuous, gentle bubbling in the suction control
observations need prompt reporting to the physician? chamber
a. the water in the water-seal drainage is constantly c. continuous fluctuations of fluid along the tube in the
bubbling water-seal chamber
b. there is continuous bubbling in the suction control d. absence of bubbling in the water-seal chamber
chamber
c. fluctuation of fluids is noted in the water seal chamber
if suction is not applied 199. A 4-year old female client is brought to the emergency room after
d. the suction control chamber is filled with 20 cm of waking up with bark-like cough and stridor. On arrival to the ER,
sterile NSS she has respiratory distress and is afebrile. The diagnosis is croup.
354. What instruction should you give the parents?
191. The client is diagnosed to have COPD (Chronic Obstructive a. perform percussion and postural drainage before
Pulmonary Disease). Which of the followingsigns and putting the child to bed and before meals
symptoms needs priority intervention by the nurse? b. run a cool mist vaporizer in patient's room during the
a. temperature of 37.5 C day
b. tachycardia c. encourage the child to do coughing and deep breathing
c. cough exercises
d. 91% oxygen saturation d. bring the child to the bathroom and have the tap run
355. with warm water during acute episodes of cough
192. A client who had vehicular accident was admitted to the 361.
emergency department. His trachea is deviated to the left. What 200. Which of the following teachings should be given to the mother
does the nurse anticipate to be done to the client? when her child is in a mist tent for liquefication of secretions?
a. the client will have endotracheal intubation a. give the child a stuff toy inside the mist tent
b. the client will have emergency tracheotomy b. avoid nylon blanket inside the mist tent
c. the client will have oxygen by mask c. advise mother to let the child stay in the mist tent
d. the client will have thoracentesis d. give the child coloring book inside the mist tent
356.
193. High pressure alarm still alarms after suctioning the client. What
should the nurse do next?
a. disconnect the client from mechanical ventilation and
do manual resuscitation
b. call the respiratory therapist