1. Dr. Jones prescribes albuterol sulfate a.

Leg movement
(Proventil) for a patient with newly diagnose b. Finger movement
asthma. When teaching the patient about this c. Lip movement
drug, the nurse should explain that it may cause: d. Fighting the ventilator
a. Nasal congestion 7. On auscultation, which finding suggests a
b. Nervousness right pneumothorax?
c. Lethargy a. Bilateral inspiratory and expiratory crackles
d. Hyperkalemia b. Absence of breaths sound in the right thorax
2. Miriam, a college student with acute rhinitis c. Inspiratory wheezes in the right thorax
sees the campus nurse because of excessive d. Bilateral pleural friction rub.
nasal drainage. The nurse asks the patient 8. Rhea, confused and short breath, is brought
about the color of the drainage. In a acute to the emergency department by a family
rhinitis, nasal drainage normally is: member. The medical history reveals chronic
a. Yellow bronchitis and hypertension. To learn more
b. Green about the current respiratory problem, the doctor
c. Clear orders a chest x-ray and arterial blood gas
d. Gray (ABG) analysis. When reviewing the ABG report,
3. A male adult patient hospitalized for the nurses sees many abbreviations. What does
treatment of a pulmonary embolism develops a lowercase “a” in ABG value present?
respiratory alkalosis. Which clinical findings a. Acid-base balance
commonly accompany respiratory alkalosis? b. Arterial Blood
a. Nausea or vomiting c. Arterial oxygen saturation
b. Abdominal pain or diarrhea d. Alveoli
c. Hallucinations or tinnitus 9. A male patient is admitted to the health care
d. Lightheadedness or paresthesia facility for treatment of chronic obstructive
4. Before administering ephedrine, Nurse Tony pulmonary disease. Which nursing diagnosis is
assesses the patient’s history. Because of most important for this patient?
ephedrine’s central nervous system (CNS) a. Activity intolerance related to fatigue
effects, it is not recommended for: b. Anxiety related to actual threat to health
a. Patients with an acute asthma attack status
b. Patients with narcolepsy c. Risk for infection related to retained
c. Patients under age 6 secretions
d. Elderly patients d. Impaired gas exchange related to airflow
5. A female patient suffers adult respiratory obstruction
distress syndrome as a consequence of shock. 10. Nurse Ruth assessing a patient for
The patient’s condition deteriorates rapidly, and tracheal displacement should know that the
endotracheal intubation and mechanical trachea will deviate toward the:
ventilation are initiated. When the high pressure a. Contralateral side in a simple pneumothorax
alarm on the mechanical ventilator, alarm b. Affected side in a hemothorax
sounds, the nurse starts to check for the cause. c. Affected side in a tension pneumothorax
Which condition triggers the high pressure d. Contralateral side in hemothorax
alarm? 11. After undergoing a left pneumonectomy,
a. Kinking of the ventilator tubing a female patient has a chest tube in place for
b. A disconnected ventilator tube drainage. When caring for this patient, the nurse
c. An endotracheal cuff leak must:
d. A change in the oxygen concentration a. Monitor fluctuations in the water-seal
without resetting the oxygen level alarm chamber
6. A male adult patient on mechanical b. Clamp the chest tube once every shift
ventilation is receiving pancuronium bromide c. Encourage coughing and deep breathing
(Pavulon), 0.01 mg/kg I.V. as needed. Which d. Milk the chest tube every 2 hours
assessment finding indicates that the patient 12. When caring for a male patient who has
needs another pancuronium dose? just had a total laryngectomy, the nurse should
plan to: c. Check for an air leak because the bubbling
a. Encourage oral feeding as soon as possible should be intermittent
b. Develop an alternative communication d. Increase the suction pressure so that the
method bubbling becomes vigorous
c. Keep the tracheostomy cuff fully inflated 18. Nurse Maureen has assisted a physician
d. Keep the patient flat in bed with the insertion of a chest tube. The nurse
13. A male patient has a sucking stab wound monitors the client and notes fluctuation of the
to the chest. Which action should the nurse take fluid level in the water seal chamber after the
first? tube is inserted. Based on this assessment,
a. Drawing blood for a hematocrit and which action would be appropriate?
hemoglobin level a. Inform the physician
b. Applying a dressing over the wound and b. Continue to monitor the client
taping it on three sides c. Reinforce the occlusive dressing
c. Preparing a chest tube insertion tray d. Encourage the client to deep-breathe
d. Preparing to start an I.V. line 19. Nurse Ryan caring for a client with a chest
14. For a patient with advance chronic tube turns the client to the side, and the chest
obstructive pulmonary disease (COPD), which tube accidentally disconnects. The initial nursing
nursing action best promotes adequate gas action is to:
exchange? a. Call the physician
a. Encouraging the patient to drink three b. Place the tube in bottle of sterile water
glasses of fluid daily c. Immediately replace the chest tube system
b. Keeping the patient in semi-fowler’s position d. Place a sterile dressing over the
c. Using a high-flow venture mask to deliver disconnection site
oxygen as prescribe 20. A nurse is assisting a physician with the
d. Administering a sedative, as prescribe removal of a chest tube. The nurse should
15. A male patient’s X-ray result reveals instruct the client to:
bilateral white-outs, indicating adult respiratory a. Exhale slowly
distress syndrome (ARDS). This syndrome b. Stay very still
results from: c. Inhale and exhale quickly
a. Cardiogenic pulmonary edema d. Perform the Valsalva maneuver
b. Respiratory alkalosis 21. While changing the tapes on a
c. Increased pulmonary capillary permeability tracheostomy tube, the male client coughs and
d. Renal failure tube is dislodged. The initial nursing action is to:
16. For a female patient with chronic a. Call the physician to reinsert the tube
obstructive pulmonary disease, which nursing b. Grasp the retention sutures to spread the
intervention would help maintain a patent opening
airway? c. Call the respiratory therapy department to
a. Restricting fluid intake to 1,000 ml per day reinsert the tracheotomy
b. Enforcing absolute bed rest d. Cover the tracheostomy site with a sterile
c. Teaching the patient how to perform dressing to prevent infection
controlled coughing 22. Nurse Oliver is caring for a client
d. Administering prescribe sedatives regularly immediately after removal of the endotracheal
and in large amounts tube. The nurse reports which of the following
17. Nurse Lei caring for a client with a signs immediately if experienced by the client?
pneumothorax and who has had a chest tube a. Stridor
inserted notes continues gentle bubbling in the b. Occasional pink-tinged sputum
suction control chamber. What action is c. A few basilar lung crackles on the right
appropriate? d. Respiratory rate 24 breaths/min
a. Do nothing, because this is an expected 23. An emergency room nurse is assessing a
finding male client who has sustained a blunt injury to
b. Immediately clamp the chest tube and notify the chest wall. Which of these signs would
the physician indicate the presence of a pneumothorax in this
client? c. 6 L/min
a. A low respiratory rate d. 10 L/min
b. Diminished breath sounds 29. A nurse instructs a female client to use the
c. The presence of a barrel chest pursed-lip method of breathing and the client
d. A sucking sound at the site of injury asks the nurse about the purpose of this type of
24. Nurse Reese is caring for a client breathing. The nurse responds, knowing that the
hospitalized with acute exacerbation of chronic primary purpose of pursed-lip breathing is to:
obstructive pulmonary disease. Which of the a. Promote oxygen intake
following would the nurse expect to note on b. Strengthen the diaphragm
assessment of this client? c. Strengthen the intercostal muscles
a. Hypocapnia d. Promote carbon dioxide elimination
b. A hyperinflated chest noted on the chest x- 30. A nurse is caring for a male client with
ray acute respiratory distress syndrome. Which of
c. Increased oxygen saturation with exercise the following would the nurse expect to note in
d. A widened diaphragm noted on the chest x- the client?
ray a. Pallor
25. An oxygen delivery system is prescribed b. Low arterial PaO2
for a male client with chronic obstructive c. Elevated arterial PaO2
pulmonary disease to deliver a precise oxygen d. Decreased respiratory rate
concentration. Which of the following types of 1. Answer B. Albuterol may cause
oxygen delivery systems would the nurse nervousness. The inhaled form of the drug
anticipate to be prescribed? may cause dryness and irritation of the nose
a. Face tent and throat, not nasal congestion; insomnia,
b. Venturi mask not lethargy; and hypokalemia (with high
c. Aerosol mask doses), not hyperkalemia. Otther adverse
d. Tracheostomy collar effects of albuterol include tremor, dizziness,
26. Blessy, a community health nurse is headache, tachycardia, palpitations,
conducting an educational session with hypertension, heartburn, nausea, vomiting
community members regarding tuberculosis. and muscle cramps.
The nurse tells the group that one of the first 2. Answer C. Normally, nasal drainage in acute
symptoms associated with tuberculosis is: rhinitis is clear. Yellow or green drainage
a. Dyspnea indicates spread of the infection to the
b. Chest pain sinuses. Gray drainage may indicate a
c. A bloody, productive cough secondary infection.
d. A cough with the expectoration of mucoid 3. Answer D. The patient with respiratory
sputum alkalosis may complain of lightheadedness
27. A nurse performs an admission or paresthesia (numbness and tingling in the
assessment on a female client with a diagnosis arms and legs). Nausea, vomiting, abdominal
of tuberculosis. The nurse reviews the result of pain, and diarrhea may accompany
which diagnosis test that will confirm this respiratory acidosis. Hallucinations and
diagnosis? tinnitus rare are associated with respiratory
a. Bronchoscopy alkalosis or any other acid-base imbalance.
b. Sputum culture 4. Answer D. Ephedrine is not recommended
c. Chest x-ray for elderly patients, who are particularly
d. Tuberculin skin test susceptible to CNS reactions (such as
28. A nurse is caring for a male client with confusion and anxiety) and to cardiovascular
emphysema who is receiving oxygen. The nurse reactions (such as increased systolic blood
assesses the oxygen flow rate to ensure that it pressure, coldness in the extremities, and
does not exceed: anginal pain). Ephedrine is used for its
a. 1 L/min bronchodilator effects with acute and chronic
b. 2 L/min asthma and occasionally for its CNS
 stimulant actions for narcolepsy. It can be
administered to children age 2 and older.
5. Answer A. Conditions that trigger the high
pressure alarm include kinking of the
ventilator tubing, bronchospasm or
pulmonary embolus, mucus plugging, water
in the tube, coughing or biting on
endotracheal tube, and the patient’s being
out of breathing rhythm with the ventilator. A
disconnected ventilator tube or an
endotracheal cuff leak would trigger the low
pressure alarm. Changing the oxygen
concentration without resetting the oxygen
level alarm would tigger the oxygen alarm.
6. Answer D. Pancuronium, a nondepolarizing
blocking agent, is used for muscle relaxation
and paralysis. It assists mechanical
ventilation by promoting encdotracheal
intubation and paralyzing the patient so that
the mechanical ventilator can do its work.
Fighting the ventilator is a sign that the
patient needs another pancuronium dose.
The nurse should administer 0.01 to 0.02
mg/kg I.V. every 20 to 60 minutes.
Movement of the legs, or lips has no effect
on the ventilator and therefore is not used to
determine the need for another dose.
7. Answer B. In pneumothorax, the alveoli are
deflated and no air exchange occurs in the
lungs. Therefore, breath sounds in the
affected lung field are absent. None of the
other options are associated with
pneumothorax. Bilateral crackles may result
from pulmonary congestion, inspiratory
wheezes may signal asthma, and a pleural
friction rub may indicate pleural inflammation.
8. Answer B. A lowercase “a” in an ABG value
represents arterial blood. For instance, the
abbreviation PaO2 refers to the partial
pressure of oxygen in arterial blood. The pH
value reflects the acid base balance in
arterial blood. Sa02 indicates arterial oxygen
saturation. An uppercase “A” represents
alveolar conditions: for example, PA02
indicates the partial pressure of oxygen in
the alveoli.
9. Answer D. A patient airway and an adequate
breathing pattern are the top priority for any
patient, making “impaired gas exchange
related to airflow obstruction” the most
important nursing diagnosis. The other
options also may apply to this patient but
less important.
10. Answer D. The trachea will shift according to
the pressure gradients within the thoracic
cavity. In tension pneumothorax and
hemothorax, accumulation of air or fluid
causes a shift away from the injured side. If
there is no significant air or fluid
accumulation, the trachea will not shift.
Tracheal deviation toward the contralateral
side in simple pneumothorax is seen when
the thoracic contents shift in response to the
release of normal thoracic pressure gradients
on the injured side.
11. Answer C. When caring for a patient who is
recovering from a pneumonectomy, the
nurse should encourage coughing and deep
breathing to prevent pneumonia in the
unaffected lung. Because the lung has been
removed, the water-seal chamber should
display no fluctuations. Reinflation is not the
purpose of chest tube. Chest tube milking is
controversial and should be done only to
remove blood clots that obstruct the flow of
drainage.
12. Answer B. A patient with a laryngectomy
cannot speak, yet still needs to
communicate. Therefore, the nurse should
plan to develop an alternative communication
method. After a laryngectomy, edema
interferes with the ability to swallow and
necessitates tube (enteral) feedings. To
prevent injury to the tracheal mucosa, the
nurse should deflate the tracheostomy cuff or
use the minimal leak technique. To decrease
edema, the nurse should place the patient in
semi-fowler’s position.
13. Answer B. The nurse immediately should
apply a dressing over the stab wound and
tape it on three sides to allow air to escape
and to prevent tension pneumothorax (which
is more life-threatening than an open chest
wound). Only after covering and taping the
wound should the nurse draw blood for
laboratory tests, assist with chest tube
insertion, and start an I.V. line.
14. Answer C. The patient with COPD retains
carbon dioxide, which inhibits stimulation of
breathing by the medullary center in the
brain. As a result, low oxygen levels in the
blood stimulate respiration, and
administering unspecified, unmonitored
 amounts of oxygen may depress ventilation.
To promote adequate gas exchange, the
nurse should use a Venturi mask to deliver a
specified, controlled amount of oxygen
consistently and accurately. Drinking three
glasses of fluid daily would not affect gas
exchange or be sufficient to liquefy
secretions, which are common in COPD.
Patients with COPD and respiratory distress
should be places in high-Fowler’s position
and should not receive sedatives or other
drugs that may further depress the
respiratory center.
15. Answer C. ARDS results from increased
pulmonary capillary permeability, which leads
to noncardiogenic pulmonary edema. In
cardiogenic pulmonary edema, pulmonary
congestion occurs secondary to heart failure.
In the initial stage of ARDS, respiratory
alkalosis may arise secondary to
hyperventilation; however, it does not cause
ARDS. Renal failure does not cause ARDS,
either.
16. Answer C. Controlled coughing helps
maintain a patent airway by helping to
mobilize and remove secretions. A moderate
fluid intake (usually 2 L or more daily) and
moderate activity help liquefy and mobilize
secretions. Bed rest and sedatives may limit
the patient’s ability to maintain a patent
airway, causing a high risk for infection from
pooled secretions.
17. Answer A. Continuous gentle bubbling
should be noted in the suction control
chamber. Option b is incorrect. Chest tubes
should only be clamped to check for an air
leak or when changing drainage devices
(according to agency policy). Option c is
incorrect. Bubbling should be continuous and
not intermittent. Option d is incorrect
because bubbling should be gentle.
Increasing the suction pressure only
increases the rate of evaporation of water in
the drainage system.
18. Answer B. The presence of fluctuation of the
fluid level in the water seal chamber
indicates a patent drainage system. With
normal breathing, the water level rises with
inspiration and falls with expiration.
Fluctuation stops if the tube is obstructed, if a
dependent loop exists, if the suction is not
working properly, or if the lung has
reexpanded. Options A, C, and D are
incorrect.
19. Answer B. If the chest drainage system is
disconnected, the end of the tube is placed in
a bottle of sterile water held below the level
of the chest. The system is replaced if it
breaks or cracks or if the collection chamber
is full. Placing a sterile dressing over the
disconnection site will not prevent
complications resulting from the
disconnection. The physician may need to be
notified, but this is not the initial action.
20. Answer D. When the chest tube is removed,
the client is asked to perform the Valsalva
maneuver (take a deep breath, exhale, and
bear down). The tube is quickly withdrawn,
and an airtight dressing is taped in place. An
alternative instruction is to ask the client to
take a deep breath and hold the breath while
the tube is removed. Options A, B, and C are
incorrect client instructions.
21. Answer B. If the tube is dislodged
accidentally, the initial nursing action is to
grasp the retention sutures and spread the
opening. If agency policy permits, the nurse
then attempts immediately to replace the
tube. Covering the tracheostomy site will
block the airway. Options A and C will delay
treatment in this emergency situation.
22. Answer A. The nurse reports stridor to the
physician immediately. This is a high-pitched,
coarse sound that is heard with the
stethoscope over the trachea. Stridor
indicates airway edema and places the client
at risk for airway obstruction. Options B, C,
and D are not signs that require immediate
notification of the physician.
23. Answer B. This client has sustained a blunt
or a closed chest injury. Basic symptoms of a
closed pneumothorax are shortness of
breath and chest pain. A larger
pneumothorax may cause tachypnea,
cyanosis, diminished breath sounds, and
subcutaneous emphysema. Hyperresonance
also may occur on the affected side. A
sucking sound at the site of injury would be
noted with an open chest injury.
24. Answer B. Clinical manifestations of chronic
obstructive pulmonary disease (COPD)
include hypoxemia, hypercapnia, dyspnea on
exertion and at rest, oxygen desaturation
with exercise, and the use of accessory
 muscles of respiration. Chest x-rays reveal a a. Place the end of the chest tube in a
hyperinflated chest and a flattened container of sterile saline.
diaphragm if the disease is advanced. b. Apply an occlusive dressing and notify the
25. Answer B. The Venturi mask delivers the physician.
most accurate oxygen concentration. It is the c. Clamp the chest tube immediately.
best oxygen delivery system for the client d. Secure the chest tube with tape.
with chronic airflow limitation because it 2. A male elderly client is admitted to an acute
delivers a precise oxygen concentration. The care facility with influenza. The nurse monitors
face tent, aerosol mask, and tracheostomy the client closely for complications. What is the
collar are also high-flow oxygen delivery most common complication of influenza?
systems but most often are used to a. Septicemia
administer high humidity. b. Pneumonia
26. Answer D. One of the first pulmonary c. Meningitis
symptoms is a slight cough with the d. Pulmonary edema
expectoration of mucoid sputum. Options A, 3. A female client has a tracheostomy but
B, and C are late symptoms and signify doesn’t require continuous mechanical
cavitation and extensive lung involvement. ventilation. When weaning the client from the
27. Answer B. Tuberculosis is definitively tracheostomy tube, the nurse initially should
diagnosed through culture and isolation of plug the opening in the tube for:
Mycobacterium tuberculosis. A presumptive a. 15 to 60 seconds.
diagnosis is made based on a tuberculin skin b. 5 to 20 minutes.
test, a sputum smear that is positive for acid- c. 30 to 40 minutes.
fast bacteria, a chest x-ray, and histological d. 45 to 60 minutes.
evidence of granulomatous disease on 4. Gina, a home health nurse is visiting a
biopsy. home care client with advanced lung cancer.
28. Answer B. Oxygen is used cautiously and Upon assessing the client, the nurse discovers
should not exceed 2 L/min. Because of the wheezing, bradycardia, and a respiratory rate of
long-standing hypercapnia that occurs in 10 breaths/minute. These signs are associated
emphysema, the respiratory drive is triggered with which condition?
by low oxygen levels rather than increased a. Hypoxia
carbon dioxide levels, as is the case in a b. Delirium
normal respiratory system. c. Hyperventilation
29. Answer D. Pursed-lip breathing facilitates d. Semiconsciousness
maximal expiration for clients with obstructive 5. A male client with Guillain-Barré
lung disease. This type of breathing allows syndrome develops respiratory acidosis as a
better expiration by increasing airway result of reduced alveolar ventilation. Which
pressure that keeps air passages open combination of arterial blood gas (ABG) values
during exhalation. Options A, B, and C are confirms respiratory acidosis?
not the purposes of this type of breathing. a. pH, 5.0; PaCO2 30 mm Hg
30. Answer B. The earliest clinical sign of acute b. pH, 7.40; PaCO2 35 mm Hg
respiratory distress syndrome is an c. pH, 7.35; PaCO2 40 mm Hg
increased respiratory rate. Breathing d. pH, 7.25; PaCO2 50 mm Hg
becomes labored, and the client may exhibit 6. A female client with interstitial lung disease
air hunger, retractions, and cyanosis. Arterial is prescribed prednisone (Deltasone) to control
blood gas analysis reveals increasing inflammation. During client teaching, the nurse
hypoxemia, with a PaO2 lower than 60 mm stresses the importance of taking prednisone
Hg. exactly as prescribed and cautions against
discontinuing the drug abruptly. A client who
1. The nurse is caring for a male client with a discontinues prednisone abruptly may
chest tube. If the chest drainage system is experience:
accidentally disconnected, what should the a. hyperglycemia and glycosuria.
nurse plan to do? b. acute adrenocortical insufficiency.
c. GI bleeding. 12. For a male client with chronic obstructive
d. restlessness and seizures. pulmonary disease, which nursing intervention
7. A male client is admitted to the health care would help maintain a patent airway?
facility for treatment of chronic obstructive a. Restricting fluid intake to 1,000 ml/day
pulmonary disease. Which nursing diagnosis is b. Enforcing absolute bed rest
most important for this client? c. Teaching the client how to perform
a. Activity intolerance related to fatigue controlled coughing
b. Anxiety related to actual threat to health d. Administering prescribed sedatives regularly
status and in large amounts
c. Risk for infection related to retained 13. The amount of air inspired and expired
secretions with each breath is called:
d. Impaired gas exchange related to airflow a. tidal volume.
obstruction b. residual volume.
8. A male client abruptly sits up in bed, reports c. vital capacity.
having difficulty breathing and has an arterial d. dead-space volume.
oxygen saturation of 88%. Which mode of 14. A male client with pneumonia develops
oxygen delivery would most likely reverse the respiratory failure and has a partial pressure of
manifestations? arterial oxygen of 55 mm Hg. He’s placed on
a. Simple mask mechanical ventilation with a fraction of inspired
b. Non-rebreather mask oxygen (FIO2) of 0.9. The nursing goal should
c. Face tent be to reduce the FIO2 to no greater than:
d. Nasal cannula a. 0.21
9. A male adult client with cystic fibrosis is b. 0.35
admitted to an acute care facility with an acute c. 0.5
respiratory infection. Prescribed respiratory d. 0.7
treatment includes chest physiotherapy. When 15. Nurse Mickey is administering a purified
should the nurse perform this procedure? protein derivative (PPD) test to a homeless
a. Immediately before a meal client. Which of the following statements
b. At least 2 hours after a meal concerning PPD testing is true?
c. When bronchospasms occur a. A positive reaction indicates that the client
d. When secretions have mobilized has active tuberculosis (TB).
10. On arrival at the intensive care unit, a b. A positive reaction indicates that the client
critically ill female client suffers respiratory arrest has been exposed to the disease.
and is placed on mechanical ventilation. The c. A negative reaction always excludes the
physician orders pulse oximetry to monitor the diagnosis of TB.
client’s arterial oxygen saturation (SaO2) d. The PPD can be read within 12 hours after
noninvasively. Which vital sign abnormality may the injection.
alter pulse oximetry values? 16. Nurse Murphy administers albuterol
a. Fever (Proventil), as prescribed, to a client with
b. Tachypnea emphysema. Which finding indicates that the
c. Tachycardia drug is producing a therapeutic effect?
d. Hypotension a. Respiratory rate of 22 breaths/minute
11. The nurse is caring for a male client who b. Dilated and reactive pupils
recently underwent a tracheostomy. The first c. Urine output of 40 ml/hour
priority when caring for a client with a d. Heart rate of 100 beats/minute
tracheostomy is: 31. 17. What is the normal pH range for
a. helping him communicate. arterial blood?
b. keeping his airway patent. a. 7 to 7.49
c. encouraging him to perform activities of b. 7.35 to 7.45
daily living. c. 7.50 to 7.60
d. preventing him from developing an infection. d. 7.55 to 7.65
18. Before weaning a male client from a increase oxygen demands. Such conditions
ventilator, which assessment parameter is most include:
important for the nurse to review? a. drinking more than 1,500 ml of fluid daily.
a. Fluid intake for the last 24 hours b. being overweight.
b. Baseline arterial blood gas (ABG) levels c. eating a high-protein snack at bedtime.
c. Prior outcomes of weaning d. eating more than three large meals a day.
d. Electrocardiogram (ECG) results 24. A black male client with asthma seeks
19. Which of the following would be most emergency care for acute respiratory distress.
appropriate for a male client with an arterial Because of this client’s dark skin, the nurse
blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, should assess for cyanosis by inspecting the:
O2 saturation 96%, HCO3 24 mEq/L, and PaO2 a. lips.
94 mm Hg? b. mucous membranes.
a. Administer a prescribed decongestant. c. nail beds.
b. Instruct the client to breathe into a paper d. earlobes.
bag. 25. A female client with asthma is receiving a
c. Offer the client fluids frequently. theophylline preparation to promote
d. Administer prescribed supplemental bronchodilation. Because of the risk of drug
oxygen. toxicity, the nurse must monitor the client’s
20. A female client is receiving supplemental serum theophylline level closely. The nurse
oxygen. When determining the effectiveness of knows that the therapeutic theophylline
oxygen therapy, which arterial blood gas value is concentration falls within which range?
most important? a. 1 to 2 mcg/ml
a. pH b. 2 to 5 mcg/ml
b. Bicarbonate (HCO3–) c. 5 to 10 mcg/ml
c. Partial pressure of arterial oxygen (PaO2) d. 10 to 20 mcg/ml
d. Partial pressure of arterial carbon dioxide 26. A male client is to receive I.V. vancomycin
(PaCO2) (Vancocin). When preparing to administer this
21. Nurse Julia is caring for a client who has a drug, the nurse should keep in mind that:
tracheostomy and temperature of 103° F (39.4° a. vancomycin should be infused over 60 to 90
C). Which of the following interventions will most minutes in a large volume of fluid.
likely lower the client’s arterial blood oxygen b. vancomycin may cause irreversible
saturation? neutropenia.
a. Endotracheal suctioning c. vancomycin should be administered rapidly
b. Encouragement of coughing in a large volume of fluid.
c. Use of cooling blanket d. vancomycin should be administered over 1
d. Incentive spirometry to 2 minutes as an I.V. bolus.
22. For a male client who has a chest tube 27. Before seeing a newly assigned female
connected to a closed water-seal drainage client with respiratory alkalosis, the nurse quickly
system, the nurse should include which action in reviews the client’s medical history. Which
the plan of care? condition is a predisposing factor for respiratory
a. Measuring and documenting the drainage in alkalosis?
the collection chamber a. Myasthenia gravis
b. Maintaining continuous bubbling in the b. Type 1 diabetes mellitus
water-seal chamber c. Extreme anxiety
c. Keeping the collection chamber at chest d. Narcotic overdose
level 28. At 11 p.m., a male client is admitted to the
d. Stripping the chest tube every hour emergency department. He has a respiratory
23. Nurse Eve formulates a nursing diagnosis rate of 44 breaths/minute. He’s anxious, and
of Activity intolerance related to inadequate wheezes are audible. The client is immediately
oxygenation and dyspnea for a client with given oxygen by face mask and
chronic bronchitis. To minimize this problem, the methylprednisolone (Depo-medrol) I.V. At 11:30
nurse instructs the client to avoid conditions that 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).
29. 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
30 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.
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.
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.
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 A. In a client with emphysema,
albuterol is used as a bronchodilator. A
respiratory rate of 22 breaths/minute indicates
that the drug has achieved its therapeutic effect
because fewer respirations are required to
achieve oxygenation. Albuterol has no effect on
pupil reaction or urine output. It may cause a
change in the heart rate, but this is an adverse,
not therapeutic, effect.
17. Answer B. A pH less than 7.35 is
indicative of acidosis; a pH above 7.45 indicates
alkalosis.
18. 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.
19. 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 frequently, and
administering supplemental oxygen — wouldn’t
raise the lowered PaCO2 level.
20. 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.
21. 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.
22. 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.
23. 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).
24. 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.
25. Answer D. The therapeutic serum
theophylline concentration ranges from 10 to 20
mcg/ml. Values below 10 mcg/ml aren’t
therapeutic.
26. 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.
27. 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.
28. 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.
29. 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 action would be appropriate?
exchange or be sufficient to liquefy secretions, a. Inform the physician.
which are common in COPD. Clients with COPD b. Continue to monitor the client.
and respiratory distress should be placed in high c. Reinforce the occlusive dressing.
Fowler’s position and shouldn’t receive d. Encourage the client to deep-breathe.
sedatives or other drugs that may further 4. The nurse caring for a male client with a
depress the respiratory center. chest tube turns the client to the side, and the
30. Answer A. Pursed-lip breathing helps chest tube accidentally disconnects. The initial
prevent early airway collapse. Learning this nursing action is to:
technique helps the client control respiration a. Call the physician.
during periods of excitement, anxiety, exercise, b. Place the tube in a bottle of sterile water.
and respiratory distress. To increase inspiratory c. Immediately replace the chest tube system.
muscle strength and endurance, the client may d. Place the sterile dressing over the
need to learn inspiratory resistive breathing. To disconnection site.
decrease accessory muscle use and thus 5. Nurse Paul is assisting a physician with the
reduce the work of breathing, the client may removal of a chest tube. The nurse should
need to learn diaphragmatic (abdominal) instruct the client to:
breathing. In pursed-lip breathing, the client a. Exhale slowly.
mimics a normal inspiratory-expiratory (I:E) ratio b. Stay very still.
of 1:2. (A client with emphysema may have an c. Inhale and exhale quickly.
I:E ratio as high as 1:4.) d. Perform the Valsalva maneuver.
6. While changing the tapes on a
tracheostomy tube, the male client coughs and
1. A male client who takes theophylline for
the tube is dislodged. The initial nursing action is
chronic obstructive pulmonary disease is seen in
to:
the urgent care center for respiratory distress.
a. Call the physician to reinsert the tube.
Once the client is stabilized, the nurse begins
b. Grasp the retention sutures to spread the
discharge teaching. The nurse would be
opening.
especially vigilant to include information about
c. Call the respiratory therapy department to
complying with medication therapy if the client’s
reinsert the tracheotomy.
baseline theophylline level was:
d. Cover the tracheostomy site with a sterile
a. 10 mcg/mL
dressing to prevent infection.
b. 12 mcg/mL
7. A nurse is caring for a male client
c. 15 mcg/mL
immediately after removal of the endotracheal
d. 18mcg/mL
tube. The nurse reports which of the following
2. Nurse Kim is caring for a client with a
signs immediately if experienced by the client?
pneumothorax and who has had a chest tube
a. Stridor
inserted notes continuous gentle bubbling in the
b. Occasional pink-tinged sputum
suction control chamber. What action is
c. A few basilar lung crackles on the right
appropriate?
d. Respiratory rate of 24 breaths/min
a. Do nothing, because this is an expected
8. An emergency room nurse is assessing a
finding.
female client who has sustained a blunt injury to
b. Immediately clamp the chest tube and notify
the chest wall. Which of these signs would
the physician.
indicate the presence of a pneumothorax in this
c. Check for an air leak because the bubbling
client?
should be intermittent.
a. A low respiratory
d. Increase the suction pressure so that
b. Diminished breathe sounds
bubbling becomes vigorous.
c. The presence of a barrel chest
3. A nurse has assisted a physician with the
d. A sucking sound at the site of injury
insertion of a chest tube. The nurse monitors the
9. A nurse is caring for a male client
adult client and notes fluctuation of the fluid level
hospitalized with acute exacerbation of chronic
in the water seal chamber after the tube is
obstructive pulmonary disease. Which of the
inserted. Based on this assessment, which
following would the nurse expect to note on c. Strengthen the intercostal muscles.
assessment of this client? d. Promote carbon dioxide elimination.
a. Hypocapnia 15. Nurse Hannah is preparing to obtain a
b. A hyperinflated chest noted on the chest x- sputum specimen from a client. Which of the
ray following nursing actions will facilitate obtaining
c. Increase oxygen saturation with exercise the specimen?
d. A widened diaphragm noted on the chest x- a. Limiting fluids
ray b. Having the clients take three deep breaths
10. A community health nurse is conducting an c. Asking the client to split into the collection
educational session with community members container
regarding tuberculosis. The nurse tells the group d. Asking the client to obtain the specimen
that one of the first symptoms associated with after eating
tuberculosis is: 16. A nurse is caring for a female client after a
a. Dyspnea bronchoscope and biopsy. Which of the
b. Chest pain following signs, if noted in the client, should be
c. A bloody, productive cough reported immediately to the physicians?
d. A cough with the expectoration of mucoid a. Dry cough
sputum b. Hematuria
11. A nurse performs an admission c. Bronchospasm
assessment on a female client with a diagnosis d. Blood-streaked sputum
of tuberculosis. The nurse reviews the results of 17. A nurse is suctioning fluids from a male
which diagnostic test that will confirm this client via a tracheostomy tube. When suctioning,
diagnosis? the nurse must limit the suctioning time to a
a. Bronchoscopy maximum of:
b. Sputum culture a. 1 minute
c. Chest x-ray b. 5 seconds
d. Tuberculin skin test c. 10 seconds
12. The nursing instructor asks a nursing d. 30 seconds
student to describe the route of transmission of 18. A nurse is suctioning fluids from a female
tuberculosis. The instructor concludes that the client through an endotracheal tube. During the
student understands this information if the suctioning procedure, the nurse notes on the
student states that the tuberculosis is monitor that the heart rate is decreasing. Which
transmitted by: of the following is the appropriate nursing
a. Hand and mouth intervention?
b. The airborne route a. Continue to suction.
c. The fecal-oral route b. Notify the physician immediately.
d. Blood and body fluids c. Stop the procedure and reoxygenate the
13. A nurse is caring for a male client with client.
emphysema who is receiving oxygen. The nurse d. Ensure that the suction is limited to 15
assesses the oxygen flow rate to ensure that it seconds.
does not exceed: 19. An unconscious male client is admitted to
a. 1 L/min an emergency room. Arterial blood gas
b. 2 L/min measurements reveal a pH of 7.30, a low
c. 6 L/min bicarbonate level, a normal carbon dioxide level,
d. 10 L/min a normal oxygen level, and an elevated
14. A nurse instructs a female client to use the potassium level. These results indicate the
pursed-lip method of breathing and the client presence of:
asks the nurse about the purpose of this type of a. Metabolic acidosis
breathing. The nurse responds, knowing that the b. Respiratory acidosis
primary purpose of pursed-lip breathing is to: c. Overcompensated respiratory acidosis
a. Promote oxygen intake. d. Combined respiratory and metabolic
b. Strengthen the diaphragm. acidosis
20. A female client is suspected of having a assesses for other signs of:
pulmonary embolus. A nurse assesses the a. Right pneumothorax
client, knowing that which of the following is a b. Pulmonary embolism
common clinical manifestation of pulmonary c. Displaced endotracheal tube
embolism? d. Acute respiratory distress syndrome
a. Dyspnea 26. A nurse is teaching a male client with
b. Bradypnea chronic respiratory failure how to use a metered-
c. Bradycardia dose inhaler correctly. The nurse instructs the
d. Decreased respiratory client to:
21. A nurse teaches a male client about the a. Inhale quickly
use of a respiratory inhaler. Which action by the b. Inhale through the nose
client indicates a need for further teaching? c. Hold the breath after inhalation
a. Inhales the mist and quickly exhales d. Take two inhalations during one breath
b. Removes the cap and shakes the inhaler 27. A nurse is assessing a female client with
well before use multiple trauma who is at risk for developing
c. Presses the canister down with the finger as acute respiratory distress syndrome. The nurse
he breathes in assesses for which earliest sign of acute
d. Waits 1 to 2 minutes between puffs if more respiratory distress syndrome?
than one puff has been prescribed a. Bilateral wheezing
22. A female client has just returned to a b. Inspiratory crackles
nursing unit following bronchoscopy. A nurse c. Intercostal retractions
would implement which of the following nursing d. Increased respiratory rate
interventions for this client? 28. A nurse is taking pulmonary artery catheter
a. Administering atropine intravenously measurements of a male client with acute
b. Administering small doses of midazolam respiratory distress syndrome. The pulmonary
(Versed) capillary wedge pressure reading is 12mm Hg.
c. Encouraging additional fluids for the next 24 The nurse interprets that this readings is:
hours a. High and expected
d. Ensuring the return of the gag reflex before b. Low and unexpected
offering food or fluids c. Normal and expected
23. A nurse is assessing the respiratory status d. Uncertain and unexpected
of a male client who has suffered a fractured rib. 29. A nurse is assessing a male client with
The nurse would expect to note which of the chronic airflow limitations and notes that the
following? client has a “barrel chest.” The nurse interprets
a. Slow deep respirations that this client has which of the following forms
b. Rapid deep respirations of chronic airflow limitations?
c. Paradoxical respirations a. Emphysema
d. Pain, especially with inspiration b. Bronchial asthma
24. A female client with chest injury has c. Chronic obstructive bronchitis
suffered flail chest. A nurse assesses the client d. Bronchial asthma and bronchitis
for which most distinctive sign of flail chest? 30. A nurse is caring for a female client
a. Cyanosis diagnosed with tuberculosis. Which assessment,
b. Hypotension if made by the nurse, is inconsistent with the
c. Paradoxical chest movement usual clinical presentation of tuberculosis and
d. Dyspnea, especially on exhalation may indicate the development of a concurrent
25. A male client has been admitted with chest problem?
trauma after a motor vehicle accident and has a. Cough
undergone subsequent intubation. A nurse b. High-grade fever
checks the client when the high-pressure alarm c. Chills and night sweats
on the ventilator sounds, and notes that the d. Anorexia and weight loss
client has absence of breathe sounds in right
upper lobe of the lung. The nurse immediately
1. Answer A. The therapeutic range for the not prevent complications resulting from the

serum theophylline level is 10 to 20 mcg/mL. If disconnection. The physician may need to be

the level is below the therapeutic range, the notified, but this is not the initial action.

client may experience frequent exacerbations of 5. Answer D. When the chest tube is removed,

the disorder. Although all the options identify the client is asked to perform the Valsalva

values within the therapeutic range, option A is maneuver (take a deep breath, exhale, and bear

the option that reflects a need for compliance down). The tube is quickly withdrawn, and an

with medication. airtight dressing is taped in place. An alternative

2. Answer A. Continuous gentle bubbling instruction is to ask the client to take a deep

should be noted in the suction control chamber. breath and hold the breath while the tube is

Option B is incorrect. Chest tubes should only removed. Options A, B, and C are incorrect

be clamped to check for an air leak or when client instructions.

changing drainage devices (according to agency 6. Answer B. If the tube is dislodged

policy). Option C is incorrect. Bubbling should be accidentally, the initial nursing action is to grasp

continuous and not intermittent. Option D is the retention sutures and spread the opening. If

incorrect because bubbling should be gentle. agency policy permits, the nurse then attempts

Increasing the suction pressure only increases immediately to replace the tube. Covering the

the rate of evaporation of water in the drainage tracheostomy site will block the airway. Options

system. 1 and 3 will delay treatment in this emergency

3. Answer B. The presence of fluctuation of situation.

the fluid level in the water seal chamber 7. Answer A. The nurse reports stridor to the

indicates a patent drainage system. With normal physician immediately. This is a high-pitched,

breathing, the water level rises with inspiration coarse sound that is heard with the stethoscope

and falls with expiration. Fluctuation stops if the over the trachea. Stridor indicates airway edema

tube is obstructed, if a dependent loop exists, if and places the client at risk for airway

the suction is not working properly, or if the lung obstruction. Options B, C, and D are not signs

has reexpanded. Options A, C, and D are that require immediate notification of the

incorrect. physician.

4. Answer B. If the chest drainage system is 8. Answer B. This client has sustained a blunt

disconnected, the end of the tube is placed in a or a closed chest injury. Basic symptoms of a

bottle of sterile water held below the level of the closed pneumothorax are shortness of breath

chest. The system is replaced if it breaks or and chest pain. A larger pneumothorax may

cracks or if the collection chamber is full. Placing cause tachypnea, cyanosis, diminished breath

a sterile dressing over the disconnection site will sounds, and subcutaneous emphysema.
Hyperresonance also may occur on the affected 14. Answer D. Pursed-lip breathing facilitates

side. A sucking sound at the site of injury would maximal expiration for clients with obstructive

be noted with an open chest injury. lung disease. This type of breathing allows

9. Answer B. Clinical manifestations of chronic better expiration by increasing airway pressure

obstructive pulmonary disease (COPD) include that keeps air passages open during exhalation.

hypoxemia, hypercapnia, dyspnea on exertion Options A, B, and C are not the purposes of this

and at rest, oxygen desaturation with exercise, type of breathing.

and the use of accessory muscles of respiration. 15. Answer B. To obtain a sputum specimen,

Chest x-rays reveal a hyperinflated chest and a the client should rinse the mouth to reduce

flattened diaphragm if the disease is advanced. contamination, breathe deeply, and then cough

10. Answer D. One of the first pulmonary into a sputum specimen container. The client

symptoms is a slight cough with the should be encouraged to cough and not spit so

expectoration of mucoid sputum. Options A, B, as to obtain sputum. Sputum can be thinned by

and C are late symptoms and signify cavitation fluids or by a respiratory treatment such as

and extensive lung involvement. inhalation of nebulized saline or water. The

11. Answer B. Tuberculosis is definitively optimal time to obtain a specimen is on arising in

diagnosed through culture and isolation of the morning.

Mycobacterium tuberculosis. A presumptive 16. Answer C. If a biopsy was performed

diagnosis is made based on a tuberculin skin during a bronchoscopy, blood-streaked sputum

test, a sputum smear that is positive for acid-fast is expected for several hours. Frank blood

bacteria, a chest x-ray, and histological evidence indicates hemorrhage. A dry cough may be

of granulomatous disease on biopsy. expected. The client should be assessed for

12. Answer B. Tuberculosis is an infectious signs of complications, which would include

disease caused by the bacillus Mycobacterium cyanosis, dyspnea, stridor, bronchospasm,

tuberculosis and is spread primarily by the hemoptysis, hypotension, tachycardia, and

airborne route. Options A, C, and D are dysrhythmias. Hematuria is unrelated to this

incorrect. procedure.

13. Answer B. Oxygen is used cautiously and 17. Answer C. Hypoxemia can be caused by

should not exceed 2 L/min. Because of the long- prolonged suctioning, which stimulates the

standing hypercapnia that occurs in pacemaker cells in the heart. A vasovagal

emphysema, the respiratory drive is triggered by response may occur, causing bradycardia. The

low oxygen levels rather than increased carbon nurse must preoxygenate the client before

dioxide levels, as is the case in a normal suctioning and limit the suctioning pass to 10

respiratory system. seconds.

18. Answer C. During suctioning, the nurse from a blunt injury or a fall. Typical signs and

should monitor the client closely for side effects, symptoms include pain and tenderness localized

including hypoxemia, cardiac irregularities such at the fracture site and exacerbated by

as a decrease in heart rate resulting from vagal inspiration and palpation, shallow respirations,

stimulation, mucosal trauma, hypotension, and splinting or guarding the chest protectively to

paroxysmal coughing. If side effects develop, minimize chest movement, and possible bruising

especially cardiac irregularities, the procedure is at the fracture site. Paradoxical respirations are

stopped and the client is reoxygenated. seen with flail chest.

19. Answer A. In an acidotic condition, the pH 24. Answer C. Flail chest results from fracture

would be low, indicating the acidosis. In addition, of two or more ribs in at least two places each.

a low bicarbonate level along with the low pH This results in a “floating” section of ribs.

would indicate a metabolic state. Therefore, Because this section is unattached to the rest of

options B, C, and D are incorrect. the bony rib cage, this segment results in

20. Answer A. The common clinical paradoxical chest movement. This means that

manifestations of pulmonary embolism are the force of inspiration pulls the fractured

tachypnea, tachycardia, dyspnea, and chest segment inward, while the rest of the chest

pain. expands. Similarly, during exhalation, the

21. Answer A. The client should be instructed segment balloons outward while the rest of the

to hold his or her breath for at least 10 to 15 chest moves inward. This is a telltale sign of flail

seconds before exhaling the mist. Options B, C, chest.

and D are accurate instructions regarding the 25. Answer A. Pneumothorax is characterized

use of the inhaler. by restlessness, tachycardia, dyspnea, pain with

22. Answer D. After bronchoscopy, the nurse respiration, asymmetrical chest expansion, and

keeps the client on NPO status until the gag diminished or absent breath sounds on the

reflex returns because the preoperative sedation affected side. Pneumothorax can cause

and local anesthesia impair swallowing and the increased airway pressure because of

protective laryngeal reflexes for a number of resistance to lung inflation. Acute respiratory

hours. Additional fluids are unnecessary distress syndrome and pulmonary embolism are

because no contrast dye is used that would not characterized by absent breath sounds. An

need flushing from the system. Atropine and endotracheal tube that is inserted too far can

midazolam would be administered before the cause absent breath sounds, but the lack of

procedure, not after. breath sounds most likely would be on the left

23. Answer D. Rib fractures are a common side because of the degree of curvature of the

injury, especially in the older client, and result right and left main stem bronchi.
26. Answer C. Instructions for using a chills and sweats (which may occur at night),

metered-dose inhaler include shaking the and a low-grade fever.

canister, holding it right side up, inhaling slowly

and evenly through the mouth, delivering one

spray per breath, and holding the breath after

inhalation.

27. 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.

28. 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.

29. 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.

30. Answer B. The client with tuberculosis

usually experiences cough (productive or

nonproductive), fatigue, anorexia, weight loss,

dyspnea, hemoptysis, chest discomfort or pain,