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RESPIRATORY DISORDER

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnose asthma. When teaching the
patient about this drug, the nurse should explain that it may cause:
A. Nasal congestion
B. Nervousness
C. Lethargy
D. Hyperkalemia
2. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The
nurse asks the patient about the color of the drainage. In a acute rhinitis, nasal drainage normally is:
A. Yellow
B. Green
C. Clear
D. Gray
3. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which
clinical findings commonly accompany respiratory alkalosis?
A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Lightheadedness or paresthesia
4. Before administering ephedrine, Nurse Tony assesses the patients history. Because of ephedrines central
nervous system (CNS) effects, it is not recommended for:
A. Patients with an acute asthma attack
B. Patients with narcolepsy
C. Patients under age 6
D. Elderly patients
5. A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patients
condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the
high pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which
condition triggers the high pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An endotracheal cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as
needed. Which assessment finding indicates that the patient needs another pancuronium dose?
A. Leg movement
B. Finger movement
C. Lip movement
D. Fighting the ventilator
7. On auscultation, which finding suggests a right pneumothorax?
A. Bilateral inspiratory and expiratory crackles
B. Absence of breaths sound in the right thorax
C. Inspiratory wheezes in the right thorax
D. Bilateral pleural friction rub.
8. Rhea, confused and short breath, is brought to the emergency department by a family member. The medical
history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the
doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses
sees many abbreviations. What does a lowercase a in ABG value present?
A. Acid-base balance
B. Arterial Blood

C. Arterial oxygen saturation


D. Alveoli
9. A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease.
Which nursing diagnosis is most important for this patient?
A. Activity intolerance related to fatigue
B. Anxiety related to actual threat to health status
C. Risk for infection related to retained secretions
D. Impaired gas exchange related to airflow obstruction
10. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward
the:
A. Contralateral side in a simple pneumothorax
B. Affected side in a hemothorax
C. Affected side in a tension pneumothorax
D. Contralateral side in hemothorax
11. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring
for this patient, the nurse must:
A. Monitor fluctuations in the water-seal chamber
B. Clamp the chest tube once every shift
C. Encourage coughing and deep breathing
D. Milk the chest tube every 2 hours
12. When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:
A. Encourage oral feeding as soon as possible
B. Develop an alternative communication method
C. Keep the tracheostomy cuff fully inflated
D. Keep the patient flat in bed
13. A male patient has a sucking stab wound to the chest. Which action should the nurse take first?
A. Drawing blood for a hematocrit and hemoglobin level
B. Applying a dressing over the wound and taping it on three sides
C. Preparing a chest tube insertion tray
D. Preparing to start an I.V. line
14. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best
promotes adequate gas exchange?
A. Encouraging the patient to drink three glasses of fluid daily
B. Keeping the patient in semi-fowlers position
C. Using a high-flow venture mask to deliver oxygen as prescribe
D. Administering a sedative, as prescribe
15. A male patients X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome
(ARDS). This syndrome results from:
A. Cardiogenic pulmonary edema
B. Respiratory alkalosis
C. Increased pulmonary capillary permeability
D. Renal failure
16. For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help
maintain a patent airway?
A. Restricting fluid intake to 1,000 ml per day
B. Enforcing absolute bed rest
C. Teaching the patient how to perform controlled coughing
D. Administering prescribe sedatives regularly and in large amounts
17. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues
gentle bubbling in the suction control chamber. What action is appropriate?

A. Do nothing, because this is an expected finding


B. Immediately clamp the chest tube and notify the physician
C. Check for an air leak because the bubbling should be intermittent
D. Increase the suction pressure so that the bubbling becomes vigorous
18. Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and
notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment,
which action would be appropriate?
A. Inform the physician
B. Continue to monitor the client
C. Reinforce the occlusive dressing
D. Encourage the client to deep-breathe
19. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube
accidentally disconnects. The initial nursing action is to:
A. Call the physician
B. Place the tube in bottle of sterile water
C. Immediately replace the chest tube system
D. Place a sterile dressing over the disconnection site
20. A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
A. Exhale slowly
B. Stay very still
C. Inhale and exhale quickly
D. Perform the Valsalva maneuver
21. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial
nursing action is to:
A. Call the physician to reinsert the tube
B. Grasp the retention sutures to spread the opening
C. Call the respiratory therapy department to reinsert the tracheotomy
D. Cover the tracheostomy site with a sterile dressing to prevent infection
22. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which
of the following signs immediately if experienced by the client?
A. Stridor
B. Occasional pink-tinged sputum
C. A few basilar lung crackles on the right
D. Respiratory rate 24 breaths/min
23. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall.
Which of these signs would indicate the presence of a pneumothorax in this client?
A. A low respiratory rate
B. Diminished breath sounds
C. The presence of a barrel chest
D. A sucking sound at the site of injury
24. Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary
disease. Which of the following would the nurse expect to note on assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-ray
C. Increased oxygen saturation with exercise
D. A widened diaphragm noted on the chest x-ray
25. An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to
deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse
anticipate to be prescribed?
A. Face tent
B. Venturi mask

C. Aerosol mask
D. Tracheostomy collar
26. Blessy, a community health nurse is conducting an educational session with community members regarding
tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:
A. Dyspnea
B. Chest pain
C. A bloody, productive cough
D. A cough with the expectoration of mucoid sputum
27. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse
reviews the result of which diagnosis test that will confirm this diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
28. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen
flow rate to ensure that it does not exceed:
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
29. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse
about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip
breathing is to:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination
30. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the
nurse expect to note in the client?
A. Pallor
B. Low arterial PaO2
C. Elevated arterial PaO2
D. Decreased respiratory rate
31. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions
will facilitate obtaining the specimen?
A. Limiting fluid
B. Having the client take deep breaths
C. Asking the client to spit into the collection container
D. Asking the client to obtain the specimen after eating
32. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in
the client, should be reported immediately to the physician?
A. Dry cough
B. Hermaturia
C. Bronchospasm
D. Blood-streaked sputum
33. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit
the suctioning time to a maximum of:
A. 1 minute
B. 5 seconds
C. 10 seconds
D. 30 seconds

34. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning
procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the
appropriate nursing intervention?
A. Continue to suction
B. Notify the physician immediately
C. Stop the procedure and reoxygenate the client
D. Ensure that the suction is limited to 15 seconds
35. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that
which of the following is a common clinical manifestation of pulmonary embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respirations
36. A slightly obese female client with a history of allergy-induced asthma,hypertension, and mitral valve
prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and
performs a thorough physical examination, paying special attention to the cardiovascular and respiratory
systems. When percussing the clients chest wall, the nurse expects to elicit:
A. Resonant sounds.
B. Hyperresonant sounds.
C. Dull sounds.
D. Flat sounds.
37. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50
ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to
change the dosage to 0.45 mg/kg/hour. The nurse should:
A. Question the order because its too low.
B. Question the order because its too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the theophylline measurement.
38. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following
should the nurse include in the teaching?
A. Make inhalation longer than exhalation.
B. Exhale through an open mouth.
C. Use diaphragmatic breathing.
D. Use chest breathing.
39. Which phrase is used to describe the volume of air inspired and expired with a normal breath?
A. Total lung capacity
B. Forced vital capacity
C. Tidal volume
D. Residual volume
40. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation
of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
41. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the
client to notify the physician if which health concern occurs?
A. Impaired color discrimination
B. Increased urinary frequency
C. Decreased hearing acuity
D. Increased appetite

42. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should
base her response on the fact that the:
A. Area of redness is measured in 3 days and determines whether tuberculosis is present.
B. Skin test doesnt differentiate between active and dormant tuberculosis infection.
C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
D. Test stimulates a reddened response in some clients and requires a second test in 3 months.
43. A female adult client has a tracheostomy but doesnt require continuous mechanical ventilation. When
weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
44. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What
should the nurse conclude?
A. The system is functioning normally
B. The client has a pneumothorax.
C. The system has an air leak.
D. The chest tube is obstructed.
45. A black client with asthma seeks emergency care for acute respiratory distress. Because of this clients dark
skin, the nurse should assess for cyanosis by inspecting the:
A. Lips.
B. Mucous membranes.
C. Nail beds.
D. Earlobes.
46. For a male client with an endotracheal (ET) tube, which nursing action is most essential?
A. Auscultating the lungs for bilateral breath sounds
B. Turning the client from side to side every 2 hours
C. Monitoring serial blood gas values every 4 hours
D. Providing frequent oral hygiene
47. The nurse assesses a male clients respiratory status. Which observation indicates that the client is
experiencing difficulty breathing?
A. Diaphragmatic breathing
B. Use of accessory muscles
C. Pursed-lip breathing
D. Controlled breathing
48. A female client is undergoing a complete physical examination as a requirement for college. When checking
the clients respiratory status, the nurse observes respiratory excursion to help assess:
A. Lung vibrations.
B. Vocal sounds.
C. Breath sounds.
D. Chest movements.
49. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia,
malaise, cough, headache, and recurrent chills. Based on the clients history and physical findings, the physician
suspects legionnaires disease. While awaiting diagnostic test results, the client is admitted to the facility and
started on antibiotic therapy. What is the drug of choice for treating legionnaires disease?
A. Erythromycin (Erythrocin)
B. Rifampin (Rifadin)
C. Amantadine (Symmetrel)
D. Amphotericin B (Fungizone)
50. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction.
Because the client is extremely weak and cant produce an effective cough, the nurse should monitor closely for:

A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.
51. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks
the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength.
C. It decreases use of accessory breathing muscles.
D. It prolongs the inspiratory phase of respiration.
52. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, How long will
it take for this drug to work? How should the nurse respond?
A. In 30 minutes
B. In 1 hour
C. In 2.5 hours
D. In 4 hours
53. A male client suffers adult respiratory distress syndrome as a consequence of shock. The clients condition
deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the highpressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition
triggers the high-pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An ET cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
54. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg
P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the
mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such
as COPD?
A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a
bronchodilator.
C. It stimulates adenosine receptors, causing bronchodilation.
D. It alters diaphragm movement, increasing chest expansion and enhancing the lungs capacity for gas exchange.
55. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room
is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all
of them share which feature?
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count
56. A client with Guillain-Barr syndrome develops respiratory acidosis as a result of reduced alveolar
ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
57. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute
via nasal cannula. The clients history includes chronic obstructive pulmonary disease (COPD) and coronary
artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the clients
respiratory status. Which complication may arise if the client receives a high oxygen concentration?
A. Apnea
B. Anginal pain

C. Respiratory alkalosis
D. Metabolic acidosis
58. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44
breaths/minute. Hes anxious, and wheezes are audible. The client is immediately given oxygen by face mask and
methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the clients arterial blood oxygen saturation is 86% and hes
still wheezing. The nurse should plan to administer:
A. Alprazolam (Xanax).
B. Propranolol (Inderal)
C. Morphine.
D. Albuterol (Proventil).
59. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding
indicates that the client has developed the most serious complication of epidural analgesia?
A. Heightened alertness
B. Increased heart rate
C. Numbness and tingling of the extremities
D. Respiratory depression
60. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation
and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid
conditions that increase oxygen demands. Such conditions include:
A. Drinking more than 1,500 ml of fluid daily.
B. Being overweight.
C. Eating a high-protein snack at bedtime.
D. Eating more than three large meals a day.
PART 2: ASTHMA /COPD
1. An elderly client with pneumonia may appear with which of the following symptoms first?
1. Altered mental status and dehydration
2. fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough
2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma
allows pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation
3. A 7-year-old client is brought to the E.R. Hes tachypneic and afebrile and has a respiratory rate of 36
breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which
of the following?
1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema
4. Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of
having the disorder?
1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds
5. Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory
infection?

1. Emotional
2. Extrinsic
3. Intrinsic
4. Mediated
6. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume
should be treated with which of the following classes of medication right away?
1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids
7. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44
breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be
taken first?
1. Take a full medication history
2. Give a bronchodilator by nebulizer
3. Apply a cardiac monitor to the client
4. Provide emotional support to the client.
8. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough
producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has
which of the following conditions?
1. Adult respiratory distress syndrome (ARDS)
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
9. The term blue bloater refers to which of the following conditions?
1. Adult respiratory distress syndrome (ARDS)
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
10. The term pink puffer refers to the client with which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
11. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. Hes
tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his
knees to support his chest and shoulders for breathing. This client has symptoms of which of the following
respiratory disorders?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
12. Its highly recommended that clients with asthma, chronic bronchitis, andemphysema have Pneumovax and
flu vaccinations for which of the following reasons?
1. All clients are recommended to have these vaccines
2. These vaccines produce bronchodilation and improve oxygenation.
3. These vaccines help reduce the tachypnea these clients experience.
4. Respiratory infections can cause severe hypoxia and possibly death in these clients.
13. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?
1. It enhances cardiovascular fitness.
2. It improves respiratory muscle strength.

3. It reduces the number of acute attacks.


4. It worsens respiratory function and is discouraged.
14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best
explains why?
1. Reducing fluid volume reduces oxygen demand.
2. Reducing fluid volume improves clients mobility.
3. Restricting fluid volume reduces sputum production.
4. Reducing fluid volume improves respiratory function.
15. A 69-year-old client appears thin and cachectic. Hes short of breath at rest and his dyspnea increases with
the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms
fit which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic
drive. Which of the following statements is correct about hypoxic drive?
1. The client doesnt notice he needs to breathe.
2. The client breathes only when his oxygen levels climb above a certain point.
3. The client breathes only when his oxygen levels dip below a certain point.
4. The client breathes only when his carbon dioxide level dips below a certain point.
17. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the
following topics?
1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the physician.
4. How to recognize the signs of an impending respiratory infection.
18. Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?
1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax
19. Which of the following measures can reduce or prevent the incidence of atelectasis in a post-operative client?
1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer
20. Emergency treatment of a client in status asthmaticus includes which of the following medications?
1. Inhaled beta-adrenergic agents
2. Inhaled corticosteroids
3. I.V. beta-adrenergic agents
4. Oral corticosteroids
21. Which of the following treatment goals is best for the client with status asthmaticus?
1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions
22. Dani was given dilaudid for pain. Shes sleeping and her respiratory rate is 4 breaths/minute. If action isnt
taken quickly, she might have which of the following reactions?

1. Asthma attack
2. Respiratory arrest
3. Be pissed about receiving Narcan
4. Wake up on her own
23. Which of the following additional assessment data should immediately be gathered to determine the status of
a client with a respiratory rate of 4 breaths/minute?
1. Arterial blood gas (ABG) and breath sounds
2. Level of consciousness and a pulse oximetry value.
3. Breath sounds and reflexes
4. Pulse oximetry value and heart sounds
24. A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood
gas value is obtained. The nurse would expect to PaCO2 to be which of the following values?
1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg
25. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest
tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs
indicate which of the following conditions?
1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis
26. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should
include which of the following actions first?
1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs
27. Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug,
the nurse should take which of the following steps next?
1. Administer beta-adrenergic blockers
2. Administer bronchodilators
3. Obtain serum electrolyte levels
4. Have the client lie flat in the bed.
28. A clients ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L;
SaO2 81%. This ABG result represents which of the following conditions?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
29. A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most
likely to experience what type of acid-base imbalance?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a
PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which
laboratory value would most likely be noted in this condition?

1. Sodium level of 145 mEq/L


2. Potassium level of 3.0 mEq/L
3. Magnesium level of 2.0 mg/L
4. Phosphorus level of 4.0 mg/dl
31. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg;
and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating:
1. Metabolic acidosis, compensated.
2. Metabolic alkalosis, uncompensated.
3. Respiratory alkalosis, compensated.
4. Respiratory acidosis, compensated.
32. A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before the blood
is drawn, an Allens test is performed to determine the adequacy of the:
1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation
33. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the
client, knowing that the client is at risk for which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
34. A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing
which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
35. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing
Kussmauls respirations. Based on this documentation, which of the following did the nurse observe?
1. Respirations that are abnormally deep, regular, and increased in rate.
2. Respirations that are regular but abnormally slow.
3. Respirations that are labored and increased in depth and rate
4. Respirations that cease for several seconds.
36. A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acidbase disturbance?
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis
37. A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg,
and a bicarbonate concentration of 20 mEq/L. The nurse has determined that the client is experiencing metabolic
acidosis. Which of the following laboratory values would the nurse expect to note?
1. Sodium level of 145 mEq/L
2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL
38. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allens
test on the client. Number in order of priority the steps for performing the Allens test (#1 is first step).
1. Ask the client to open and close the hand repeatedly.
2. Apply pressure over the ulnar and radial arteries.

3. Assess the color of the extremity distal to the pressure point


4. Release pressure from the ulnar artery
5. Explain the procedure to the client.
39. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will
facilitate obtaining the specimen?
1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.
40. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the
client should be reported immediately to the physician?
1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm
41. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must limit the
suctioning to a maximum of:
1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute
42. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure, the
nurse notes on the monitor that the heart rate decreases. Which of the following is the most appropriate nursing
intervention?
1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxygenated the client
4. Notify the physician immediately.
43. An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of
7.30, a low bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. An elevated potassium
level is also present. These results indicate the presence of:
1. Metabolic acidosis
2. Respiratory acidosis
3. Combined respiratory and metabolic acidosis
4. over compensated respiratory acidosis
44. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the
nurse expect to note on assessment of this client?
1. Increased oxygen saturation with exercise
2. Hypocapnia
3. A hyperinflated chest on x-ray film
4. A widened diaphragm noted on chest x-ray film
45. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen
concentration. Which of the following types of oxygen deliverysystems would the nurse anticipate to be
prescribed?
1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar
46. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and the nurse
instructs the client about the medication. Which statement by the client indicates a need for further teaching?

1. I will take the medication on an empty stomach.


2. I will take the medication with food.
3. I will continue to take the medication even if I am feeling better.
4. Periodic blood levels will need to be obtained.
47. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen
flow rate to ensure that it does not exceed
1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min
48. The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the following
values would indicate that this acid-base imbalance exists?
1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3- of 20 mEq/L
49. A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the
purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing
is:
1. Promote oxygen intake
2. Strengthen the diaphragm
3. Strengthen the intercostal muscles
4. Promote carbon dioxide elimination
50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The
nurse interprets these values as indicating:
1. Respiratory acidosis uncompensated
2. Respiratory alkalosis uncompensated
3. Metabolic acidosis uncompensated
4. Metabolic acidosis partially compensated.
PART 3: ASTHMA COPD
1. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the
medication, knowing that the primary action of this medication is to:
1. Promote expectoration
2. Suppress the cough
3. Relax smooth muscles of the bronchial airway
4. Prevent infection
2. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for
which side effect of this medication?
1. Constipation
2. Diarrhea
3. Bradycardia
4. Tachycardia
3. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for
further teaching?
1. Removes the cap and shakes the inhaler well before use.
2. Presses the canister down with finger as he breathes in.
3. Inhales the mist and quickly exhales.
4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
4. A female client is scheduled to have a chest radiograph. Which of the following questions is of most
importance to the nurse assessing this client?

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


2. Are you wearing any metal chains or jewelry?
3. Can you hold your breath easily?
4. Are you able to hold your arms above your head?
5. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the
following nursing interventions for this client?
1. Encouraging additional fluids for the next 24 hours
2. Ensuring the return of the gag reflex before offering foods or fluids
3. Administering atropine intravenously
4. Administering small doses of midazolam (Versed).
6. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:
1. Brachial and radial arteries, and then releases them and observes the circulation of the hand.
2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.
3. Radial artery and observes for color changes in the affected hand.
4. Ulnar artery and observes for color changes in the affected hand.
7. A nurse is assessing a client with chronic airflow limitation and notes that the client has a barrel chest. The
nurse interprets that this client has which of the following forms of chronic airflow limitation?
1. Chronic obstructive bronchitis
2. Emphysema
3. Bronchial asthma
4. Bronchial asthma and bronchitis
8. A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is
having the intended effect if the client experiences:
1. Decreased anxiety level
2. Increased comfort level
3. Reduction of N/V
4. Decreased frequency and intensity of cough
9. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract
infection? The client will:
1. Maintain a fluid intake of 800 ml every 24 hours.
2. Experience chills only once a day
3. Cough productively without chest discomfort.
4. Experience less nasal obstruction and discharge.
10. Which of the following individuals would the nurse consider to have the highest priority for receiving an
influenza vaccination?
1. A 60-year-old man with a hiatal hernia
2. A 36-year-old woman with 3 children
3. A 50-year-old woman caring for a spouse with cancer
4. a 60-year-old woman with osteoarthritis
11. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the
following instructions would be appropriate for the nurse to give the client?
1. Use your nasal decongestant spray regularly to help clear your nasal passages.
2. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.
3. It is important to increase your activity. A daily brisk walk will help promote drainage.
4. Keep a diary if when your symptoms occur. This can help you identify what precipitates your attacks.
12. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she develops
a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the
nurse best interpret these assessment findings?
1. It is likely that the client is developing a secondary bacterial pneumonia.
2. The assessment findings are consistent with influenza and are to be expected.

3. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions.
4. The client has not been taking her decongestants and bronchodilators as prescribed.
13. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is
200mg/5ml. How many mL should the nurse administer each dose?
1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml
14. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible
side effect of this drug?
1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness
15. A client with COPD reports steady weight loss and being too tired from just breathing to eat. Which of the
following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?
1. Altered nutrition: Less than body requirements related to fatigue.
2. Activity intolerance related to dyspnea.
3. Weight loss related to COPD.
4. Ineffective breathing pattern related to alveolar hypoventilation.
16. When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that
the client will do which of the following?
1. Develop infections easily
2. Maintain current status
3. Require less supplemental oxygen
4. Show permanent improvement.
17. Which of the following outcomes would be appropriate for a client with COPDwho has been discharged to
home? The client:
1. Promises to do pursed lip breathing at home.
2. States actions to reduce pain.
3. States that he will use oxygen via a nasal cannula at 5 L/minute.
4. Agrees to call the physician if dyspnea on exertion increases.
18. Which of the following physical assessment findings would the nurse expect to find in a client with
advanced COPD?
1. Increased anteroposterior chest diameter
2. Underdeveloped neck muscles
3. Collapsed neck veins
4. Increased chest excursions with respiration
19. Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?
1. To promote oxygen intake
2. To strengthen the diaphragm
3. To strengthen the intercostal muscles
4. To promote carbon dioxide elimination
20. Which of the following is a priority goal for the client with COPD?
1. Maintaining functional ability
2. Minimizing chest pain
3. Increasing carbon dioxide levels in the blood
4. Treating infectious agents
21. A clients arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36
mEq/L. Which of the following signs or symptoms would the nurse expect?

1. Cyanosis
2. Flushed skin
3. Irritability
4. Anxiety
22. When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:
1. While inhaling through an open mouth.
2. While exhaling through pursed lips
3. After exhaling but before inhaling.
4. While taking a deep breath and holding it.
23. The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s
would be included in the teaching plan?
1. Clubbing of nail beds
2. Hypertension
3. Peripheral edema
4. Increased appetite
24. The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary
to an upper respiratory tract infection. Which of the following findings would be expected?
1. Normal breath sounds
2. Prolonged inspiration
3. Normal chest movement
4. Coarse crackles and rhonchi
25. Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?
1. Increased PaCO2
2. Increased PaO2
3. Increased pH.
4. Increased oxygen saturation
26. Which of the following diets would be most appropriate for a client with COPD?
1. Low fat, low cholesterol
2. Bland, soft diet
3. Low-Sodium diet
4. High calorie, high-protein diet
27. The nurse is planning to teach a client with COPD how to cough effectively. Which of the following
instructions should be included?
1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.
2. Lie flat on back, splint the thorax, take two deep breaths and cough.
3. Take several rapid, shallow breaths and then cough forcefully.
4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.
28. A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that
the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles.
Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action
should the nurse take to initiate care of the client?
1. Initiate oxygen therapy and reassess the client in 10 minutes.
2. Draw blood for an ABG analysis and send the client for a chest x-ray.
3. Encourage the client to relax and breathe slowly through the mouth
4. Administer bronchodilators
29. The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe
asthma attack?
1. Decreased PaCO2, increased PaO2, and decreased pH.
2. Increased PaCO2, decreased PaO2, and decreased pH.
3. Increased PaCO2, increased PaO2, and increased pH.
4. Decreased PaCO2, decreased PaO2, and increased pH.

30. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of
steroids in clients with asthma?
1. Corticosteroids promote bronchodilation
2. Corticosteroids act as an expectorant
3. Corticosteroids have an anti-inflammatory effect
4. Corticosteroids prevent development of respiratory infections.
31. The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug.
Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.
1. The inhaler is held upright.
2. Head is tilted down while inhaling the medication
3. Client waits 5 minutes between puffs.
4. Mouth is rinsed with water following administration
5. Client lies supine for 15 minutes following administration.
32. A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4 hours. The
nurse instructs the client to report side effects. Which of the following are potential side effects of
metaproterenol?
1. Irregular heartbeat
2. Constipation
3. Pedal edema
4. Decreased heart rate.
33. A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the
nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most
appropriate?
1. This is an anticipated side-effect of your medication. It should go away in a couple of weeks.
2. You are using your inhaler too much and it has irritated your mouth.
3. You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.
4. Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.
34. Which of the following health promotion activities should the nurse include in the discharge teaching plan for
a client with asthma?
1. Incorporate physical exercise as tolerated into the treatment plan.
2. Monitor peak flow numbers after meals and at bedtime.
3. Eliminate stressors in the work and home environment
4. Use sedatives to ensure uninterrupted sleep at night.
35. The client with asthma should be taught that which of the following is one of the most common precipitating
factors of an acute asthma attack?
1. Occupational exposure to toxins
2. Viral respiratory infections
3. Exposure to cigarette smoke
4. Exercising in cold temperatures
36. A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that
she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The
physician orders ABGs, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L;
SaO2 86%. Considering these results, the first intervention is to:
1. Begin mechanical ventilation
2. Place the client on oxygen
3. Give the client sodium bicarbonate
4. Monitor for pulmonary embolism.
37. Basilar crackles are present in a clients lungs on auscultation. The nurse knows that these are discrete, non
continuous sounds that are:
1. Caused by the sudden opening of alveoli
2. Usually more prominent during expiration

3. Produced by airflow across passages narrowed by secretions


4. Found primarily in the pleura.
38. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing
action would be to:
1. Wait until the clients lab work is done.
2. Not administer oxygen unless ordered by the physician.
3. Administer oxygen at 2 L flow per minute.
4. Administer oxygen at 10 L flow per minute and check the clients nail beds.
39. Immediately following a thoracentesis, which clinical manifestations indicate that a complication has
occurred and the physician should be notified?
1. Serosanguineous drainage from the puncture site
2. Increased temperature and blood pressure
3. Increased pulse and pallor
4. Hypotension and hypothermia
40. If a client continues to hypoventilate, the nurse will continually assess for a complication of:
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
41. A client is admitted to the hospital with acute bronchitis. While taking the clients VS, the nurse notices he has
an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the
result of:
1. Respiratory acidosis
2. A build-up of carbon dioxide
3. A build-up of oxygen without adequate expelling of carbon dioxide.
4. An acute respiratory infection.
42. Auscultation of a clients lungs reveals crackles in the left posterior base. The nursing intervention is to:
1. Repeat auscultation after asking the client to deep breathe and cough.
2. Instruct the client to limit fluid intake to less than 2000 ml/day.
3. Inspect the clients ankles and sacrum for the presence of edema
4. Place the client on bedrest in a semi-Fowlers position.
43. The most reliable index to determine the respiratory status of a client is to:
1. Observe the chest rising and falling
2. Observe the skin and mucous membrane color.
3. Listen and feel the air movement.
4. Determine the presence of a femoral pulse.
44. A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in
the plan of care because of the polycythemia?
1. Fluid volume deficit related to blood loss.
2. Impaired tissue perfusion related to thrombosis
3. Activity intolerance related to dyspnea
4. Risk for infection related to suppressed immune response.
45. The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered
postoperatively for his is the:
1. Nonoperative side or back
2. Operative side or back
3. Back only
4. Back or either side.
46. Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:

1. A flushed face
2. Dyspnea and pain
3. Decreased temperature
4. Severe cough and no pain.
47. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in
completing this procedure would be to:
1. Change the tracheostomy dressing
2. Provide humidity with a trach mask
3. Apply oral or nasal suction
4. Deflate the tracheal cuff
48. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this
means. The nurse explains that the tidal volume is the amount of air:
1. Exhaled forcibly after a normal expiration
2. Exhaled after there is a normal inspiration
3. Trapped in the alveoli that cannot be exhaled
4. Forcibly inspired over and above a normal respiration.
49. An acceleration in oxygen dissociation from hemoglobin, and thus oxygendelivery to the tissues, is caused
by:
1. A decreasing oxygen pressure in the blood
2. An increasing carbon dioxide pressure in the blood
3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.
4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.
50. The best method of oxygen administration for client with COPD uses:
1. Cannula
2. Simple Face mask
3. Non rebreather mask
4. Venturi mask
PART IV
1. Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is
present?
1. Dehydration
2. Group living
3. Malnutrition
4. Severe periodontal disease
2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma
allows pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation
3. Which of the following organisms most commonly causes community-acquiredpneumonia in adults?
1. Haemiphilus influenzae
2. Klebsiella pneumoniae
3. Streptococcus pneumoniae
4. Staphylococcus aureus
4. An elderly client with pneumonia may appear with which of the following symptoms first?
1. Altered mental status and dehydration
2. Fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough
5. When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following
sounds over areas of consolidation?
1. Bronchial
2. Bronchovesicular
3. Tubular
4. Vesicular
6. A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
1. ABG analysis
2. Chest x-ray
3. Blood cultures
4. sputum culture and sensitivity

7. A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and difficulty expelling
his secretions. The nurse auscultates his lung fields and hears bronchial sounds in the left lower lobe. The nurse
determines that the client requires which of the following treatments first?
1. Antibiotics
2. Bed rest
3. Oxygen
4. Nutritional intake
8. A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will be
discharged today. Which of the following physical findings would lead the nurse to believe it is appropriate to
discharge this client?
1. Continued dyspnea
2. Fever of 102*F
3. Respiratory rate of 32 breaths/minute
4. Vesicular breath sounds in right base
9. The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and
raised about 3mm where the test was given. This PPD would be read as having which of the following results?
1. Indeterminate
2. Needs to be redone
3. Negative
4. Positive
10. A client with primary TB infection can expect to develop which of the following conditions?
1. Active TB within 2 weeks
2. Active TB within 1 month
3. A fever that requires hospitalization
4. A positive skin test
11. A client was infected with TB 10 years ago but never developed the disease. Hes now being treated
for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection?
1. Active infection
2. Primary infection
3. Superinfection
4. Tertiary infection
12. A client has active TB. Which of the following symptoms will he exhibit?
1. Chest and lower back pain
2. Chills, fever, night sweats, and hemoptysis
3. Fever of more than 104*F and nausea
4. Headache and photophobia
13. Which of the following diagnostic tests is definitive for TB?
1. Chest x-ray
2. Mantoux test
3. Sputum culture
4. Tuberculin test
14. A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is
this done?
1. To confirm the diagnosis
2. To determine if a repeat skin test is needed
3. To determine the extent of the lesions
4. To determine if this is a primary or secondary infection
15. A chest x-ray should a clients lungs to be clear. His Mantoux test is positive, with a 10mm if induration. His
previous test was negative. These test results are possible because:
1. He had TB in the past and no longer has it.
2. He was successfully treated for TB, but skin tests always stay positive.
3. Hes a seroconverter, meaning the TB has gotten to his bloodstream.
4. Hes a tuberculin converter, which means he has been infected with TB since his last skin test.
16. A client with a positive skin test for TB isnt showing signs of active disease. To help prevent the
development of active TB, the client should be treated with isoniazid, 300 mg daily, for how long?
1. 10 to 14 days
2. 2 to 4 weeks
3. 3 to 6 months
4. 9 to 12 months
17. A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician
should take which of the following actions?
1. Admit him to the hospital in respiratory isolation
2. Prescribe isoniazid and tell him to go home and rest
3. Give a tuberculin test and tell him to come back in 48 hours and have it read.
4. Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home.
18. A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would
the client show if therapy is inadequate?
1. Decreased shortness of breath
2. Improved chest x-ray
3. Nonproductive cough
4. Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
19. A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?
1. To evaluate his condition
2. To determine his compliance

3. To prevent spread of the disease


4. To determine the need for antibiotic therapy.
20. A high level of oxygen exerts which of the following effects on the lung?
1. Improves oxygen uptake
2. Increases carbon dioxide levels
3. Stabilizes carbon dioxide levels
4. Reduces amount of functional alveolar surface area
21. A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He
reports that it started suddenly. The assessment should include which of the following interventions?
1. Auscultation of breath sounds
2. Chest x-ray
3. Echocardiogram
4. Electrocardiogram (ECG)
22. A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to
the base. Which of the following conditions would best explain this?
1. Acute asthma
2. Chronic bronchitis
3. Pneumonia
4. Spontaneous pneumothorax
23. Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
1. Antibiotics
2. Bronchodilators
3. Chest tube placement
4. Hyperbaric chamber
24. Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
1. Auscultate breath sounds
2. Have the client use an incentive spirometer
3. Take a chest x-ray
4. stick a needle in the area of decreased breath sounds
25. A pulse oximetry gives what type of information about the client?
1. Amount of carbon dioxide in the blood
2. Amount of oxygen in the blood
3. Percentage of hemoglobin carrying oxygen
4. Respiratory rate
26. What effect does hemoglobin amount have on oxygenation status?
1. No effect
2. More hemoglobin reduces the clients respiratory rate
3. Low hemoglobin levels cause reduces oxygen-carrying capacity
4. Low hemoglobin levels cause increased oxygen-carrying capacity.
27. Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
1. Alveoli need oxygen to live
2. Alveoli have no effect on oxygenation
3. Collapsed alveoli increase oxygen demand
4. Gaseous exchange occurs in the alveolar membrane.
28. Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve
oxygenation in hypoxic patients by which of the following methods?
1. The mask provides 100% oxygen to the client.
2. The mask provides continuous air that the client can breathe.
3. The mask provides pressurized oxygen so the client can breathe more easily.
4. The mask provides pressurized at the end of expiration to open collapsed alveoli.
29. Which of the following best describes pleural effusion?
1. The collapse of alveoli
2. The collapse of bronchiole
3. The fluid in the alveolar space
4. The accumulation of fluid between the linings of the pleural space.
30. If a pleural effusion develops, which of the following actions best describes how the fluid can be removed
from the pleural space and proper lung status restored?
1. Inserting a chest tube
2. Performing thoracentesis
3. Performing paracentesis
4. Allowing the pleural effusion to drain by itself.
31. A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and
coughs. Which action should the nurse take?
1. Remove the airway and insert a shorter one.
2. Reposition the airway.
3. Leave the airway in place until the client gets used to it.
4. Remove the airway and attempt suctioning without it.
32. An 87-year-old client requires long term ventilator therapy. He has a tracheostomy in place and requires
frequent suctioning. Which of the following techniques is correct?
1. Using intermittent suction while advancing the catheter.
2. Using continuous suction while withdrawing the catheter.
3. Using intermittent suction while withdrawing the catheter.
4. Using continuous suction while advancing the catheter.
33. A clients ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24
mEq/L. What do these values indicate?

1. Metabolic acidosis
2. Respiratory alkalosis
3. Metabolic alkalosis
4. Respiratory acidosis
34. A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders
an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate
for this injection?
1. 5/8 to 25G to 27G needle.
2. 1 to 3 20G to 25G needle.
3. to 3/8 26 or 27G needle.
4. 1 20G needle.
35. A 76-year old client is admitted for elective knee surgery. Physical examination reveals shallow respirations
but no signs of respiratory distress. Which of the following is a normal physiologic change related to aging?
1. Increased elastic recoil of the lungs
2. Increased number of functional capillaries in the alveoli
3. Decreased residual volume
4. Decreased vital capacity.
36. A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
1. Acute pain related to lung expansion secondary to lung infection
2. Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
3. Anxiety related to dyspnea and chest pain.
4. Ineffective airway clearance related to retained secretions.
37. A community health nurse is conducting an educational session with community members regarding TB. The
nurse tells the group that one of the first symptoms associated with TB is:
1. A bloody, productive cough
2. A cough with the expectoration of mucoid sputum
3. Chest pain
4. Dyspnea
38. A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by
intravenous infusion. The nurse would determine that a therapeutic blood level exists if which of the following
were noted in the laboratory report?
1. 5 mcg/mL
2. 15 mcg/mL
3. 25 mcg/mL
4. 30 mcg/mL
39. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical
record of the client. Which of the following, if noted in the clients history, would require physician notification?
1. Heart disease
2. Allergy to penicillin
3. Hepatitis B
4. Rheumatic fever
40. A client is experiencing confusion and tremors is admitted to a nursing unit. An initial ABG report indicates
that the PaCO2 level is 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that the client is most
likely experiencing:
1. Carbon monoxide poisoning
2. Carbon dioxide narcosis
3. Respiratory alkalosis
4. Metabolic acidosis
41. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin
test. The nurse interprets the results as:
1. Positive
2. Negative
3. Inconclusive
4. The need for repeat testing.
42. A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be
consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem?
1. Nonproductive or productive cough
2. Anorexia and weight loss
3. Chills and night sweats
4. High-grade fever
43. A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse
suggests that the client increase intake of:
1. Meats and citrus fruits
2. Grains and broccoli
3. Eggs and spinach
4. Potatoes and fish
44. Which of the following would be priority assessment data to gather from a client who has been diagnosed
with pneumonia? Select all that apply.
1. Auscultation of breath sounds
2. Auscultation of bowel sounds
3. Presence of chest pain.
4. Presence of peripheral edema
5. Color of nail beds
45. A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive cough.
The nurse should include which of the following measures in the plan of care?

1. Position changes q4h


2. Nasotracheal suctioning to clear secretions
3. Frequent linen changes
4. Frequent offering of a bedpan.
46. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
1. Decreased cardiac output
2. Pleural effusion
3. Inadequate peripheral circulation
4. Decreased oxygenation of the blood.
47. Which of the following mental status changes may occur when a client withpneumonia is first experiencing
hypoxia?
1. Coma
2. Apathy
3. Irritability
4. Depression
48. A client with pneumonia has a temperature ranging between 101* and 102*F and periods of diaphoresis.
Based on this information, which of the following nursing interventions would be a priority?
1. Maintain complete bedrest
2. Administer oxygen therapy
3. Provide frequent linen changes.
4. Provide fluid intake of 3 L/day
49. Which of the following would be an appropriate expected outcome for an elderly client recovering from
bacterial pneumonia?
1. A respiratory rate of 25 to 30 breaths per minute
2. The ability to perform ADLs without dyspnea
3. A maximum loss of 5 to 10 pounds of body weight
4. Chest pain that is minimized by splinting the ribcage.
50. Which of the following symptoms is common in clients with TB?
1. Weight loss
2. Increased appetite
3. Dyspnea on exertion
4. Mental status changes
51. The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the
following laboratory techniques is most commonly used to identify tubercle bacilli in sputum?
1. Acid-fast staining
2. Sensitivity testing
3. Agglutination testing
4. Dark-field illumination
52. Which of the following antituberculous drugs can cause damage to the eighth cranial nerve?
1. Streptomycin
2. Isoniazid
3. Para-aminosalicylic acid
4. Ethambutol hydrochloride
53. The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
1. Vertigo
2. Facial paralysis
3. Impaired vision
4. Difficulty swallowing
54. Which of the following family members exposed to TB would be at highest risk for contracting the disease?
1. 45-year-old mother
2. 17-year-old daughter
3. 8-year-old son
4. 76-year-old grandmother
55. The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family
members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all
that apply.
1. I will need to dispose of my old clothing when I return home.
2. I should always cover my mouth and nose when sneezing.
3. It is important that I isolate myself from family when possible.
4. I should use paper tissues to cough in and dispose of them properly.
5. I can use regular plate and utensils whenever I eat.
56. A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the
client has:
1. Active TB
2. Had contact with Mycobacterium tuberculosis
3. Developed a resistance to tubercle bacilli
4. Developed passive immunity to TB.
57. INH treatment is associated with the development of peripheral neuropathies. Which of the following
interventions would the nurse teach the client to help prevent this complication?
1. Adhere to a low cholesterol diet
2. Supplement the diet with pyridoxine (vitamin B6)
3. Get extra rest
4. Avoid excessive sun exposure.
58. The nurse should include which of the following instructions when developing a teaching plan for clients
receiving INH and rifampin for treatment for TB?

1. Take the medication with antacids


2. Double the dosage if a drug dose is forgotten
3. Increase intake of dairy products
4. Limit alcohol intake
59. The public health nurse is providing follow-up care to a client with TB who does not regularly take his
medication. Which nursing action would be most appropriate for this client?
1. Ask the clients spouse to supervise the daily administration of the medications.
2. Visit the clinic weekly to ask him whether he is taking his medications regularly.
3. Notify the physician of the clients non-compliance and request a different prescription.
4. Remind the client that TB can be fatal if not taken properly.
60. The Causative agent of Tuberculosis is said to be:
1. Mycobacterium Tuberculosis
2. Hansens Bacilli
3. Bacillus Anthracis
4. Group A Beta Hemolytic Streptococcus
PART V RESPIRATORY MEDICATIONS
1. A Cromolyn sodium (Intal) inhaler is prescribed to a client with asthma. A nurse provides instructions
regarding the side effects of this medication. The nurse tells the client that which undesirable effect is associated
with this medication?
A. Wheezing.
B. Insomnia.
C. Hypotension.
D. Constipation.
2. A client is prescribed with Guaifenesin (Mucinex). The nurse determines that the client understands the proper
administration of this medication if the client states that he or she will:
A. Drink extra fluids while taking this medication.
B. Take the medication with meals only.
C. Take an additional dose once fever and cough persist.
D. Limit oral fluid intake.
3. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler) 2 puff by
metered dose inhaler. The nurse plans to administer by?
A. Alternating with a single puff each, starting with albuterol.
B. Alternating with a single puff each, starting with budesonide.
C. Budesonide inhaler first then the albuterol.
D. Albuterol inhaler first then the budesonide.
4. A nurse is about to administer Naloxone hydrochloride (Narcan) to a client with known opioid overdose. Which
of the following equipment should be readily available at the bedside?
A. Suction machine.
B. Resuscitative equipment.
C. Nasogastric tube.
D. Dressing tray.
5. A client is receiving theophylline intravenously. After several dosages, the client started to become restless
and complains of palpitations. The nurse determines that the client is experiencing theophylline toxicity in which
of the following?
A. Theophylline level of 10mcg/ml.
B. Theophylline level of 15mcg/ml.
C. Theophylline level of 20mcg/ml.
D. Theophylline level of 25mcg/ml.
6. A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon
reviewing the medical history of the patient, the nurse questions the prescription if which of the following is
noted?
A. History of smoking.
B. History of allergy to egg.
C. History of allergy to peanut.
D. History of a previous infection.

7. Montelukast (Singulair) is prescribed to a client with asthma. During the medication therapy, which of the
following laboratories should be monitored?
A. Complete blood count (CBC).
B. Sodium and Potassium.
C. Calcium and Platelet count.
D. ALT and AST.
8. The nurse is giving medication teachings to a client receiving theophylline. The nurse instruct the client to limit
the intake of which of the following?
A. Apple and banana.
B. Yogurt and cheese.
C. Tuna and oysters.
D. Cola and chocolate.
9. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the following statements
made by the client will need further instructions?
A. I can eat gum after I drink the medicine.
B. I can take the medicine on an empty stomach.
C. I should avoid using alcohol.
D. I will avoid driving while using this medication.
10. A pediatric client with asthma has just received Omalizumab (Xolair). The nurse determines that the client
might be suffering a life-threatening effect in which of the following?
A. Headache and dizziness.
B. Nausea and vomiting.
C. Swelling of the tongue.
D. Joint pain.
11. A client with influenza is prescribed with an antiviral drug. The nurse determines that the client indicates an
understanding of the treatment if he or she state the following?
A. I will take the medication exactly as prescribed.
B. I will not be able to infect others while I am on this treatment.
C. I will stop the medication once I feel okay.
D. I will resume my usual activities because these medications have minimal undesirable effects.
12. A client is to begin taking Rifampin (Rifadin). The nurse correctly teaches the client this medication:
A. Is to be discontinued after three months.
B. Is to be taken with food and antacids.
C. Take an additional dose once with skip dose.
D. Will cause orange discoloration of sweat, urine, and feces.
13. A nurse is caring for a client who is starting a long-term therapy of isoniazid (INH). The nurse plans to instruct
the client to which of the following?
A. To discontinue vitamin supplements such as Vit B6.
B. To report an incidence of yellowish skin.
C. To increase intake of tuna for additional nutrition.
D. To drink alcohol in moderation.
14. A client has been taking isoniazid (INH). The client went to the health care facility with complaints of
numbness and tingling sensation in the extremities. The nurse determines that the client is most likely suffering
from?
A. Impaired peripheral circulation.
B. Hypercalcemia.
C. Peripheral neuritis.
D. Guillan Barre syndrome.
15. A nurse is monitoring a client receiving an Ethambutol (Myambutol) for adverse effects. The nurse determines
that the client is experiencing a side effect of the medication, in which of the following?

A. Red-orange colored bodily secretions.


B. Damaged hearing.
C. Loss of balance.
D. Difficulty distinguishing the color red from green.
16. A client with tuberculosis is receiving Ethambutol (Myambutol). All of which are laboratories to be examined,
except?
A. Complete blood count.
B. Liver function test.
C. Triglyceride level.
D. Uric acid level.
17. A nurse is giving instructions to a client receiving Pyrazinamide. Which of the following is not true regarding
this medication?
A. Take the medication with food.
B. Photosensitivity is one of the side effects.
C. It enhances the effect of allopurinol.
D. Use with caution in patients with diabetes mellitus.
18. A client is taking streptomycin. The nurse explains the nervous system side effects of this medication. The
nurse correctly states that this medication causes damage in which cranial nerve?
A. Cranial nerve VII.
B. Cranial nerve VIII.
C. Cranial nerve IX.
D. Cranial nerve X.
19. All of which are examples of antiviral influenza medications except?
A. Ethionamide (Trecator).
B. Amantadine (Symmetrel).
C. Oseltamivir (Tamiflu).
D. Zanamivir (Relenza).
20. Rifabutin (Mycobutin) is prescribed to a client with active Mycobacterium avium complex disease and
tuberculosis. The nurse determines that the client is experiencing side effects in which of the following, except?
A. Tingling and numbness of the fingers.
B. Blurred vision.
C. Arthralgia.
D. Flu-like symptoms.