RESPIRATORY QUIZ

1. The nurse is caring for a male client with a chest tube. If the chest drainage
system is accidentally disconnected, what should the nurse plan to do?

a. Place the end of the chest tube in a container of sterile saline.

b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.

2. A male elderly client is admitted to an acute care facility with influenza. The
nurse monitors the client closely for complications. What is the most common
complication of influenza?

a. Septicemia
b. Pneumonia
c. Meningitis
d. Pulmonary edema

3. A female client has a tracheostomy but doesn't require continuous mechanical

ventilation. When weaning the client from the tracheostomy tube, the nurse
initially should plug the opening in the tube for:

a. 15 to 60 seconds.
b. 5 to 20 minutes.
c. 30 to 40 minutes.
d. 45 to 60 minutes.

4. Gina, a home health nurse is visiting a home care client with advanced lung
cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a
respiratory rate of 10 breaths/minute. These signs are associated with which
condition?

a. Hypoxia
b. Delirium
c. Hyperventilation
d. Semiconsciousness
5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a
result of reduced alveolar ventilation. Which combination of arterial blood gas
(ABG) values confirms respiratory acidosis?

a. pH, 5.0; PaCO2 30 mm Hg

b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone

(Deltasone) to control inflammation. During client teaching, the nurse stresses the
importance of taking prednisone exactly as prescribed and cautions against
discontinuing the drug abruptly. A client who discontinues prednisone abruptly may
experience:

a. hyperglycemia and glycosuria.

b. acute adrenocortical insufficiency.
c. GI bleeding.
d. restlessness and seizures.

7. A male client is admitted to the health care facility for treatment of chronic
obstructive pulmonary disease. Which nursing diagnosis is most important for this
client?

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

8. 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
9. A male adult client with cystic fibrosis is admitted to an acute care facility with
an acute respiratory infection. Prescribed respiratory treatment includes chest
physiotherapy. When should the nurse perform this procedure?

a. Immediately before a meal

b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized

10. On arrival at the intensive care unit, a critically ill female client suffers
respiratory arrest and is placed on mechanical ventilation. The physician orders
pulse oximetry to monitor the client's arterial oxygen saturation (SaO2)
noninvasively. Which vital sign abnormality may alter pulse oximetry values?

a. Fever
b. Tachypnea
c. Tachycardia
d. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy.
The first priority when caring for a client with a tracheostomy is:

a. helping him communicate.

b. keeping his airway patent.
c. encouraging him to perform activities of daily living.
d. preventing him from developing an infection.

12. For a male client with chronic obstructive pulmonary disease, which nursing
intervention would help maintain a patent airway?

a. Restricting fluid intake to 1,000 ml/day

b. Enforcing absolute bed rest
c. Teaching the client how to perform controlled coughing
d. Administering prescribed sedatives regularly and in large amounts

13. The amount of air inspired and expired with each breath is called:

a. tidal volume.
b. residual volume.
c. vital capacity.
d. dead-space volume.

14. A male client with pneumonia develops respiratory failure and has a partial
pressure of arterial oxygen of 55 mm Hg. He's placed on mechanical ventilation
with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to
reduce the FIO2 to no greater than:

a. 0.21
b. 0.35
c. 0.5
d. 0.7

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a

homeless client. Which of the following statements concerning PPD testing is true?

a. A positive reaction indicates that the client has active tuberculosis (TB).
b. A positive reaction indicates that the client has been exposed to the disease.
c. A negative reaction always excludes the diagnosis of TB.
d. The PPD can be read within 12 hours after the injection.

16. Before weaning a male client from a ventilator, which assessment parameter is
most important for the nurse to review?

a. Fluid intake for the last 24 hours

b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results

17. Which of the following would be most appropriate for a male client with an
arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24
mEq/L, and PaO2 94 mm Hg?

a. Administer a prescribed decongestant.

b. Instruct the client to breathe into a paper bag.
c. Offer the client fluids frequently.
d. Administer prescribed supplemental oxygen.
18. A female client is receiving supplemental oxygen. When determining the
effectiveness of oxygen therapy, which arterial blood gas value is most important?

a. pH
b. Bicarbonate (HCO3-)
c. Partial pressure of arterial oxygen (PaO2)
d. Partial pressure of arterial carbon dioxide (PaCO2)

19. Nurse Julia is caring for a client who has a tracheostomy and temperature of
103° F (39.4° C). Which of the following interventions will most likely lower the
client's arterial blood oxygen saturation?

a. Endotracheal suctioning
b. Encouragement of coughing
c. Use of cooling blanket
d. Incentive spirometry

20. For a male client who has a chest tube connected to a closed water-seal
drainage system, the nurse should include which action in the plan of care?

a. Measuring and documenting the drainage in the collection chamber

b. Maintaining continuous bubbling in the water-seal chamber
c. Keeping the collection chamber at chest level
d. Stripping the chest tube every hour

21. Nurse Eve 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.

22. A black male client with asthma seeks emergency care for acute respiratory
distress. Because of this client's dark skin, the nurse should assess for cyanosis by
inspecting the:
a. lips.
b. mucous membranes.
c. nail beds.
d. earlobes.

23. A female client with asthma is receiving a theophylline preparation to promote

bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the
client's serum theophylline level closely. The nurse knows that the therapeutic
theophylline concentration falls within which range?

a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml

24. A male client is to receive I.V. vancomycin (Vancocin). When preparing to

administer this drug, the nurse should keep in mind that:

a. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

b. vancomycin may cause irreversible neutropenia.
c. vancomycin should be administered rapidly in a large volume of fluid.
d. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.
25. Before seeing a newly assigned female client with respiratory alkalosis, the
nurse quickly reviews the client's medical history. Which condition is a predisposing
factor for respiratory alkalosis?

a. Myasthenia gravis
b. Type 1 diabetes mellitus
c. Extreme anxiety
d. Narcotic overdose

26. At 11 p.m., a male client is admitted to the emergency department. He has a

respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The
client is immediately given oxygen by face mask and methylprednisolone (Depo-
medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86% and
he's still wheezing. The nurse should plan to administer:

a. alprazolam (Xanax).
b. propranolol (Inderal)
c. morphine.
d. albuterol (Proventil).

27. Pulmonary disease (COPD), which nursing action best promotes adequate gas
exchange?

a. Encouraging the client to drink three glasses of fluid daily

b. Keeping the client in semi-Fowler's position
c. Using a high-flow Venturi mask to deliver oxygen as prescribed
d. Administering a sedative as prescribed

28. Nurse Joana 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.

29. A male client who takes theophylline for chronic obstructive pulmonary disease
is seen in the urgent care center for respiratory distress. Once the client is
stabilized, the nurse begins discharge teaching. The nurse would be especially
vigilant to include information about complying with medication therapy if the
client's baseline theophylline level was:

a. 10 mcg/mL
b. 12 mcg/mL
c. 15 mcg/mL
d. 18mcg/mL

30. Nurse Kim is caring for a client with a pneumothorax and who has had a chest
tube inserted notes continuous gentle bubbling in the suction control chamber.
What action is appropriate?

a. Do nothing, because this is an expected finding.

b. Immediately clamp the chest tube and notify the physician.
c. Check for an air leak because the bubbling should be intermittent.
d. Increase the suction pressure so that bubbling becomes vigorous.
31. A nurse has assisted a physician with the insertion of a chest tube. The nurse
monitors the adult 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.

32. The nurse caring for a male client with a chest tube turns the client to the
side, and the chest tube accidentally disconnects. The initial nursing action is to:

a. Call the physician.

b. Place the tube in a bottle of sterile water.
c. Immediately replace the chest tube system.
d. Place the sterile dressing over the disconnection site.

33. Nurse Paul 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.

34. While changing the tapes on a tracheostomy tube, the male client coughs and
the tube is dislodged. The initial nursing action is to:

a. Call the physician to reinsert the tube.

b. Grasp the retention sutures to spread the opening.
c. Call the respiratory therapy department to reinsert the tracheotomy.
d. Cover the tracheostomy site with a sterile dressing to prevent infection.

35. A nurse is caring for a male client immediately after removal of the
endotracheal tube. The nurse reports which of the following signs immediately if
experienced by the client?
a. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate of 24 breaths/min

36. An emergency room nurse is assessing a female client who has sustained a blunt
injury to the chest wall. Which of these signs would indicate the presence of a
pneumothorax in this client?

a. A low respiratory
b. Diminished breathe sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury

37. A nurse is caring for a male client hospitalized with acute exacerbation of
chronic obstructive pulmonary disease. Which of the following would the nurse
expect to note on assessment of this client?

a. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
c. Increase oxygen saturation with exercise
d. A widened diaphragm noted on the chest x-ray

38. 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

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

of tuberculosis. The nurse reviews the results of which diagnostic test that will
confirm this diagnosis?

a. Bronchoscopy
b. Sputum culture
c. Chest x-ray
d. Tuberculin skin test

40. The nursing instructor asks a nursing student to describe the route of
transmission of tuberculosis. The instructor concludes that the student
understands this information if the student states that the tuberculosis is
transmitted by:

a. Hand and mouth

b. The airborne route
c. The fecal-oral route
d. Blood and body fluids

41. 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

42. A nurse instructs a female client to use the pursed-lip method of breathing and
the client asks the nurse about the purpose of this type of breathing. The nurse
responds, knowing that the primary purpose of pursed-lip breathing is to:

a. Promote oxygen intake.

b. Strengthen the diaphragm.
c. Strengthen the intercostal muscles.
d. Promote carbon dioxide elimination.

43. Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of
the following nursing actions will facilitate obtaining the specimen?

a. Limiting fluids
b. Having the clients take three deep breaths
c. Asking the client to split into the collection container
d. Asking the client to obtain the specimen after eating
44. A nurse is caring for a female client after a bronchoscope and biopsy. Which of
the following signs, if noted in the client, should be reported immediately to the
physicians?

a. Dry cough
b. Hematuria
c. Bronchospasm
d. Blood-streaked sputum

45. 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

46. A nurse is suctioning fluids from a female client through an endotracheal tube.
During the suctioning procedure, the nurse notes on the monitor that the heart
rate is decreasing. Which of the following is the appropriate nursing
intervention?

a. Continue to suction.
b. Notify the physician immediately.
c. Stop the procedure and reoxygenate the client.
d. Ensure that the suction is limited to 15 seconds.

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

gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon
dioxide level, a normal oxygen level, and an elevated potassium level. These results
indicate the presence of:

a. Metabolic acidosis
b. Respiratory acidosis
c. Overcompensated respiratory acidosis
d. Combined respiratory and metabolic acidosis
48. A female client is suspected of having a pulmonary embolus. A nurse assesses
the client, knowing that which of the following is a common clinical manifestation of
pulmonary embolism?

a. Dyspnea
b. Bradypnea
c. Bradycardia
d. Decreased respiratory

49. A nurse teaches a male client about the use of a respiratory inhaler. Which
action by the client indicates a need for further teaching?

a. Inhales the mist and quickly exhales

b. Removes the cap and shakes the inhaler well before use
c. Presses the canister down with the finger as he breathes in
d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

50. A female client has just returned to a nursing unit following bronchoscopy. A
nurse would implement which of the following nursing interventions for this client?

a. Administering atropine intravenously

b. Administering small doses of midazolam (Versed)
c. Encouraging additional fluids for the next 24 hours
d. Ensuring the return of the gag reflex before offering food or fluids

51. A nurse is assessing the respiratory status of a male client who has suffered a
fractured rib. The nurse would expect to note which of the following?

a. Slow deep respirations

b. Rapid deep respirations
c. Paradoxical respirations
d. Pain, especially with inspiration

52. A female client with chest injury has suffered flail chest. A nurse assesses the
client for which most distinctive sign of flail chest?

a. Cyanosis
b. Hypotension
c. Paradoxical chest movement
d. Dyspnea, especially on exhalation

53. A male client has been admitted with chest trauma after a motor vehicle
accident and has undergone subsequent intubation. A nurse checks the client when
the high-pressure alarm on the ventilator sounds, and notes that the client has
absence of breathe sounds in right upper lobe of the lung. The nurse immediately
assesses for other signs of:

a. Right pneumothorax
b. Pulmonary embolism
c. Displaced endotracheal tube
d. Acute respiratory distress syndrome

54. A nurse is teaching a male client with chronic respiratory failure how to use a
metered-dose inhaler correctly. The nurse instructs the client to:

a. Inhale quickly
b. Inhale through the nose
c. Hold the breath after inhalation
d. Take two inhalations during one breath

55. A nurse is assessing a female client with multiple trauma who is at risk for
developing acute respiratory distress syndrome. The nurse assesses for which
earliest sign of acute respiratory distress syndrome?

a. Bilateral wheezing
b. Inspiratory crackles
c. Intercostal retractions
d. Increased respiratory rate

56. A nurse is taking pulmonary artery catheter measurements of a male client

with acute respiratory distress syndrome. The pulmonary capillary wedge pressure
reading is 12mm Hg. The nurse interprets that this readings is:

a. High and expected

b. Low and unexpected
c. Normal and expected
d. Uncertain and unexpected
57. A nurse is assessing a male client with chronic airflow limitations and notes
that the client has a "barrel chest." The nurse interprets that this client has which
of the following forms of chronic airflow limitations?

a. Emphysema
b. Bronchial asthma
c. Chronic obstructive bronchitis
d. Bronchial asthma and bronchitis

58. A nurse is caring for a female client diagnosed with tuberculosis. Which
assessment, if made by the nurse, is inconsistent with the usual clinical
presentation of tuberculosis and may indicate the development of a concurrent
problem?

a. Cough
b. High-grade fever
c. Chills and night sweats
d. Anorexia and weight loss

59. A slightly obese female client with a history of allergy-induced asthma,

hypertension, and mitral valve prolapse is admitted to an acute care facility for
elective surgery. The nurse obtains a complete history and performs a thorough
physical examination, paying special attention to the cardiovascular and respiratory
systems. When percussing the client's chest wall, the nurse expects to elicit:

a. Resonant sounds.
b. Hyperresonant sounds.
c. Dull sounds.
d. Flat sounds.

60. 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.
61. 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

62. The nurse assesses a male client's respiratory status. Which observation
indicates that the client is experiencing difficulty breathing?

a. Diaphragmatic breathing
b. Use of accessory muscles
c. Pursed-lip breathing
d. Controlled breathing

63. A female client is undergoing a complete physical examination as a requirement

for college. When checking the client's respiratory status, the nurse observes
respiratory excursion to help assess:

a. Lung vibrations.
b. Vocal sounds.
c. Breath sounds.
d. Chest movements.

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

a. Pleural effusion.
b. Pulmonary edema.
c. Atelectasis.
d. Oxygen toxicity

65. 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

66. A male client admitted to an acute care facility with pneumonia is receiving
supplemental oxygen, 2 L/minute via nasal cannula. The client's history includes
chronic obstructive pulmonary disease (COPD) and coronary artery disease.
Because of these history findings, the nurse closely monitors the oxygen flow and
the client's respiratory status. Which complication may arise if the client receives
a high oxygen concentration?

a. Apnea
b. Anginal pain
c. Respiratory alkalosis
d. Metabolic acidosis

67. 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
www.rn101.net

RESPIRATORY QUIZ

1. Answer A. If a chest drainage system is disconnected, the nurse may place the
end of the chest tube in a container of sterile saline or water to prevent air from
entering the chest tube, thereby preventing negative respiratory pressure. The
nurse should apply an occlusive dressing if the chest tube is pulled out — not if the
system is disconnected. The nurse shouldn't clamp the chest tube because
clamping increases the risk of tension pneumothorax. The nurse should tape the
chest tube securely to prevent it from being disconnected, rather than taping it
after it has been disconnected.

2. Answer B. Pneumonia is the most common complication of influenza. It may be

either primary influenza viral pneumonia or pneumonia secondary to a bacterial
infection. Other complications of influenza include myositis, exacerbation of
chronic obstructive pulmonary disease, and Reye's syndrome. Myocarditis,
pericarditis, transverse myelitis, and encephalitis are rare complications of
influenza. Although septicemia may arise when any infection becomes
overwhelming, it rarely results from influenza. Meningitis and pulmonary edema
aren't associated with influenza.

3. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube
for 5 to 20 minutes, and then gradually lengthen this interval according to the
client's respiratory status. A client who doesn't 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 wouldn't be
long enough to reveal the client's 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

4. Answer A. As the respiratory center in the brain becomes depressed, hypoxia

occurs, producing wheezing, bradycardia, and a decreased respiratory rate.
Delirium is a state of mental confusion characterized by disorientation to time and
place. Hyperventilation (respiratory rate greater than that metabolically necessary
for gas exchange) is marked by an increased respiratory rate or tidal volume, or
both. Semiconsciousness is a state of impaired consciousness characterized by
limited motor and verbal responses and decreased orientation.

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5. 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.

6. Answer B. Administration of a corticosteroid such as prednisone suppresses the

body's natural cortisol secretion, which may take weeks or months to normalize
after drug discontinuation. Abruptly discontinuing such therapy may cause the
serum cortisol level to drop low enough to trigger acute adrenocortical
insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures
are common adverse effects of corticosteroid therapy, not its sudden cessation

7. Answer D. A patent airway and an adequate breathing pattern are the top
priority for any client, making impaired gas exchange related to airflow obstruction
the most important nursing diagnosis. The other options also may apply to this
client but are less important.

8. 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.

9. Answer B. The nurse should perform chest physiotherapy at least 2 hours after
a meal to reduce the risk of vomiting and aspiration. Performing it immediately
before a meal may tire the client and impair the ability to eat. Percussion and
vibration, components of chest physiotherapy, may worsen bronchospasms;
therefore, the procedure is contraindicated in clients with bronchospasms.
Secretions that have mobilized (especially when suction equipment isn't available)
are a contraindication for postural drainage, another component of chest
physiotherapy.

10. Answer D. Hypotension, hypothermia, and vasoconstriction may alter pulse

oximetry values by reducing arterial blood flow. Likewise, movement of the finger
to which the oximeter is applied may interfere with interpretation of SaO2. All of
these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and
tachycardia don't affect pulse oximetry values directly.

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11. Answer B. Maintaining a patent airway is the most basic and critical human need.
All other interventions are important to the client's well-being but not as
important as having sufficient oxygen to breathe.

12. 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 client's ability to maintain a patent airway, causing a high risk of
infection from pooled secretions.

13. Answer A. Tidal volume is the amount of air inspired and expired with each
breath. Residual volume is the amount of air remaining in the lungs after forcibly
exhaling. Vital capacity is the maximum amount of air that can be moved out of the
lungs after maximal inspiration and expiration. Dead-space volume is the amount of
air remaining in the upper airways that never reaches the alveoli. In pathologic
conditions, dead space may also exist in the lower airways.

14. Answer C. An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic
and can lead to decreased gas diffusion and surfactant activity. The ideal oxygen
source is room air F IO 2 0.18 to 0.21.

15. Answer B. A positive reaction means the client has been exposed to TB; it isn't
conclusive of the presence of active disease. A positive reaction consists of
palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after
the injection. In clients with positive reactions, further studies are usually done to
rule out active disease. In immunosuppressed clients, a negative reaction doesn't
exclude the presence of active disease.

16. Answer B. Before weaning a client from mechanical ventilation, it's most
important to have baseline ABG levels. During the weaning process, ABG levels will
be checked to assess how the client is tolerating the procedure. Other assessment
parameters are less critical. Measuring fluid volume intake and output is always
important when a client is being mechanically ventilated. Prior attempts at weaning
and ECG results are documented on the client's record, and the nurse can refer to
them before the weaning process begins.

17. Answer B. The ABG results reveal respiratory alkalosis. The best intervention
to raise the PaCO2 level would be to have the client breathe into a paper bag. All
of the other options — such as administering a decongestant, offering fluids

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frequently, and administering supplemental oxygen — wouldn't raise the lowered

PaCO2 level.

18. Answer C. The most significant and direct indicator of the effectiveness of
oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust
the type of oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow
rate, and oxygen percentage. The other options reflect the client's ventilation
status, not oxygenation.

19. Answer A. Endotracheal suctioning removes secretions as well as gases from

the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and
incentive spirometry improves oxygenation and should raise or maintain oxygen
saturation. Because of superficial vasoconstriction, using a cooling blanket can
lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

20. Answer A. The nurse should measure and document the amount of chest tube
drainage regularly to detect abnormal drainage patterns, such as may occur with a
hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the
water-seal chamber indicates a leak in the closed chest drainage system, which
must be corrected. The nurse should keep the collection chamber below chest level
to allow fluids to drain into it. The nurse should not strip chest tubes because
doing so may traumatize the tissue or dislodge the tube.

21. 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 doesn't increase oxygen demands. To help
maintain adequate nutritional intake, the client with chronic bronchitis should eat
small, frequent meals (up to six a day).

22. Answer B. Skin color doesn't affect the mucous membranes. The lips, nail beds,
and earlobes are less reliable indicators of cyanosis because they're affected by
skin color.

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23. Answer D. The therapeutic serum theophylline concentration ranges from 10 to

20 mcg/ml. Values below 10 mcg/ml aren't therapeutic.

24. Answer A. To avoid a hypotensive reaction from rapid I.V. administration, the
nurse should infuse vancomycin slowly, over 60 to 90 minutes, in a large volume of
fluid. Although neutropenia may occur in approximately 5% to 10% of clients
receiving vancomycin, this adverse effect reverses rapidly when the drug is
discontinued

25. Answer C. Extreme anxiety may lead to respiratory alkalosis by causing

hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other
conditions that may set the stage for respiratory alkalosis include fever, heart
failure, and injury to the brain's respiratory center, overventilation with a
mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1
diabetes mellitus may lead to diabetic ketoacidosis; the deep, rapid respirations
occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss.
Myasthenia gravis and narcotic overdose suppress the respiratory drive, causing
CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

26. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced

by wheezes and a subnormal arterial oxygen saturation level. The client's greatest
need is bronchodilation, which can be accomplished by administering
bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of
the bronchioles. It's 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
client's breathing. Propranolol is contraindicated in a client who's wheezing
because it's a beta2 adrenergic antagonist. Morphine is a respiratory center
depressant and is contraindicated in this situation.

27. Answer C. The client 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
wouldn't affect gas exchange or be sufficient to liquefy secretions, which are
common in COPD. Clients with COPD and respiratory distress should be placed in

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high Fowler's position and shouldn't receive sedatives or other drugs that may
further depress the respiratory center.

28. 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.)

29. Answer A. The therapeutic range for the serum theophylline level is 10 to 20
mcg/mL. If the level is below the therapeutic range, the client may experience
frequent exacerbations of the disorder. Although all the options identify values
within the therapeutic range, option A is the option that reflects a need for
compliance with medication.

30. 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.

31. 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.

32. 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.

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33. 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.

34. 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 1 and 3 will delay treatment in this emergency
situation.

35. 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.

36. 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.

37. 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.

38. 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.

39. 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 acid-fast bacteria, a chest
x-ray, and histological evidence of granulomatous disease on biopsy.

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40. Answer B. Tuberculosis is an infectious disease caused by the bacillus

Mycobacterium tuberculosis and is spread primarily by the airborne route. Options
A, C, and D are incorrect.

41. 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.

42. 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.

43. 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.

44. Answer C. If a biopsy was performed during a bronchoscopy, blood-streaked

sputum is expected for several hours. Frank blood indicates hemorrhage. A dry
cough may be expected. The client should be assessed for signs of complications,
which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis,
hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this
procedure.

45. 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.

46. 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.

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47. Answer A. In an acidotic condition, the pH would be low, indicating the acidosis.
In addition, a low bicarbonate level along with the low pH would indicate a
metabolic state. Therefore, options B, C, and D are incorrect.

48. Answer A. The common clinical manifestations of pulmonary embolism are

tachypnea, tachycardia, dyspnea, and chest pain.

49. Answer A. The client should be instructed to hold his or her breath for at least
10 to 15 seconds before exhaling the mist. Options B, C, and D are accurate
instructions regarding the use of the inhaler.

50. Answer D. After bronchoscopy, the nurse keeps the client on NPO status until
the gag reflex returns because the preoperative sedation and local anesthesia
impair swallowing and the protective laryngeal reflexes for a number of hours.
Additional fluids are unnecessary because no contrast dye is used that would need
flushing from the system. Atropine and midazolam would be administered before
the procedure, not after.

51. Answer D. Rib fractures are a common injury, especially in the older client, and
result from a blunt injury or a fall. Typical signs and symptoms include pain and
tenderness localized at the fracture site and exacerbated by inspiration and
palpation, shallow respirations, splinting or guarding the chest protectively to
minimize chest movement, and possible bruising at the fracture site. Paradoxical
respirations are seen with flail chest.

52. Answer C. Flail chest results from fracture of two or more ribs in at least two
places each. This results in a "floating" section of ribs. Because this section is
unattached to the rest of the bony rib cage, this segment results in paradoxical
chest movement. This means that the force of inspiration pulls the fractured
segment inward, while the rest of the chest expands. Similarly, during exhalation,
the segment balloons outward while the rest of the chest moves inward. This is a
telltale sign of flail chest.

53. Answer A. Pneumothorax is characterized by restlessness, tachycardia,

dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or
absent breath sounds on the affected side. Pneumothorax can cause increased
airway pressure because of resistance to lung inflation. Acute respiratory distress
syndrome and pulmonary embolism are not characterized by absent breath sounds.
An endotracheal tube that is inserted too far can cause absent breath sounds, but

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the lack of breath sounds most likely would be on the left side because of the
degree of curvature of the right and left main stem bronchi.

54. Answer C. Instructions for using a metered-dose inhaler include shaking the
canister, holding it right side up, inhaling slowly and evenly through the mouth,
delivering one spray per breath, and holding the breath after inhalation.

55. Answer D. The earliest detectable sign of acute respiratory distress syndrome
is an increased respiratory rate, which can begin from 1 to 96 hours after the
initial insult to the body. This is followed by increasing dyspnea, air hunger,
retraction of accessory muscles, and cyanosis. Breath sounds may be clear or
consist of fine inspiratory crackles or diffuse coarse crackles.

56. Answer C. The normal pulmonary capillary wedge pressure (PCWP) is 8 to 13 mm

Hg, and the client is considered to have high readings if they exceed 18 to 20 mm
Hg. The client with acute respiratory distress syndrome has a normal PCWP, which
is an expected finding because the edema is in the interstitium of the lung and is
noncardiac.

57. Answer A. The client with emphysema has hyperinflation of the alveoli and
flattening of the diaphragm. These lead to increased anteroposterior diameter,
referred to as "barrel chest." The client also has dyspnea with prolonged
expiration and has hyperresonant lungs to percussion.

58. Answer B. The client with tuberculosis usually experiences cough (productive or
nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest
discomfort or pain, chills and sweats (which may occur at night), and a low-grade
fever.

59. 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; they're 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.

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60. 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.

61. 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, they're secondary to ensuring adequate oxygenation.

62. 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.

63. 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 nurse's palms. The nurse assesses breath sounds during
auscultation.

64. 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 doesn't 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 isn't one of
them. Oxygen toxicity results from prolonged administration of high oxygen
concentrations, not an ineffective cough.

65. 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

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for the causative agent, which may not be responsive to penicillin. A few types of
pneumonia, such as viral pneumonia, aren't treated with antibiotics. Although
pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal
pneumonia, don't.

66. 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 don't cause metabolic acidosis.

67. 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.

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