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 COPD who 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 client’s 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 ABG’s, 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 client’s 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 client’s 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 client’s 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 client’s 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 client’s 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 client’s 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

oxygen delivery 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

Answers and Rationale

1. Answer: 3. Relax smooth muscles of the bronchial airway

Aminophylline is a bronchodilator that directly relaxes the smooth muscles of

the bronchial airway.

2. Answer: 4. Tachycardia

Side effects that can occur from a beta 2 agonist include tremors, nausea,
nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of
the mouth or throat.

3. Answer: 3. Inhales the mist and quickly exhales.

The client should be instructed to hold his or her breath at least 10 to 15

seconds before exhaling the mist.

4. Answer: 1. “Is there any possibility that you could be pregnant?”

The most important item to ask about is the client’s pregnancy status because
pregnant women should not be exposed to radiation. Clients are also asked to
remove any chains or metal objects that could interfere with obtaining an
adequate film. A chest radiograph most often is done at full inspiration, which
gives optimal lung expansion. If a lateral view of the chest is ordered, the client
is asked to raise the arms above the head. Most films are done in posterior-
anterior view.

5. Answer: 2. Ensuring the return of the gag reflex before offering foods
or fluids

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

6. Answer: 2. Radial and ulnar arteries, releases one, evaluates the

color of the hand, and repeats the process with the other artery.

Before drawing an ABG, the nurse assesses the collateral circulation to the hand
with Allen’s test. This involves compressing the radial and ulnar arteries and
asking the client to close and open the fist. This should cause the hand to
become pale. The nurse then releases pressure on one artery and observes
whether circulation is restored quickly. The nurse repeats the process, releasing
the other artery. The blood sample may be taken safely if collateral circulation
is adequate.

7. Answer: 2. Emphysema

The client with emphysema has hyperinflation of the alveoli and flattening of
the diaphragm. These lead to increased anteroposterior diameter, which is
referred to as “barrel chest.” The client also has dyspnea with
prolonged expiration and has hyperresonant lungs to percussion.

8. Answer: 4. Decreased frequency and intensity of cough

Benzonatate is a locally acting antitussive the effectiveness of which is

measured by the degree to which it decreases the intensity and frequency of
cough without eliminating the cough reflex.

9. Answer: 4. Experience less nasal obstruction and discharge.

A client recovering from an URI should report decreasing or no nasal discharge

and obstruction. Daily fluid intake should be increased to more than 1 L every
24 hours to liquefy secretions. The temperature should be below 100*F
(37.8*C) with no chills or diaphoresis. A productive cough with
chest pain indicated pulmonary infection, not an URI.

10. Answer: 3. A 50-year-old woman caring for a spouse with cancer

Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza
to prevent transmission to those who have a decreased capacity to deal with
the disease. The wife who is caring for a husband with cancer has the highest
priority of the clients described.

11. Answer: 4. “Keep a diary if when your symptoms occur. This can
help you identify what precipitates your attacks.”

It is important for clients with allergic rhinitis to determine the precipitating

factors so that they can be avoided. Keeping a diary can help identify these
triggers. Nasal decongestant sprays should not be used regularly because they
can cause a rebound effect. Antibiotics are not appropriate. Increasing activity
will not control the client’s symptoms; in fact, walking outdoors may increase
them if the client is allergic to pollen.

12. Answer: 1. It is likely that the client is developing a secondary

bacterial pneumonia.

Pneumonia is the most common complication of influenza, especially in the

elderly. The development of a purulent cough and crackles may be indicative of
a bacterial infection are not consistent with a diagnosis of influenza. These
findings are not indicative of dehydration. Decongestants and bronchodilators
are not typically prescribed for the flu.

13. Answer: 2. 7.5 ml

14. Answer: 4. Restlessness

Side effects of pseudoephedrine are experienced primarily in the cardiovascular
system and through sympathetic effects on the CNS. The most common CNS
effects include restlessness, dizziness, tension, anxiety, insomnia, and
weakness. Common cardiovascular side effects include tachycardia,
hypertension, palpitations, and arrhythmias. Constipation and diplopia are not
side effects of pseudoephedrine. Tachycardia, not bradycardia, is a side effect of
pseudoephedrine.

15. Answer: 1. Altered nutrition: Less than body requirements related

to fatigue.

The client’s problem is altered nutrition—specifically, less than required. The

cause, as stated by the client, is the fatigue associated with the disease
process. Activity intolerance is a likely diagnosis but is not related to the client’s
nutritional problems. Weight loss is not a nursing diagnosis. Ineffective
breathing pattern may be a problem, but this diagnosis does not specifically
address the problem of weight loss described by the client.

16. Answer: 1. Develop infections easily

A client with COPD is at high risk for development of respiratory infections.

COPD is a slowly progressive; therefore, maintaining current status and
establishing a goal that the client will require less supplemental oxygen are
unrealistic expectations. Treatment may slow progression of the disease, but
permanent improvement is highly unlikely.

17. Answer: 4. Agrees to call the physician if dyspnea on exertion

increases.

Increasing dyspnea on exertion indicates that the client may be experiencing

complications of COPD, and therefore the physician should be notified.
Extracting promises from clients is not an outcome criterion. Pain is not a
common symptom of COPD. Clients with COPD use low-flow oxygen
supplementation (1 to 2 L/minute) to avoid suppressing the respiratory drive,
which, for these clients, is stimulated by hypoxia.

18. Answer: 1. Increased anteroposterior chest diameter

Increased anteroposterior chest diameter is characteristic of advanced COPD.

Air is trapped in the overextended alveoli, and the ribs are fixed in an
inspiratory position. The result is the typical barrel-chested appearance. Overly
developed, not underdeveloped, neck muscles are associated with COPD
because of their increased use in the work of breathing. Distended, not
collapsed, neck veins are associated with COPD as a symptom of the heart
failure that the client may experience secondary to the increased workload on
the heart to pump into pulmonary vasculature. Diminished, not increased, chest
excursion is associated with COPD.

19. Answer: 4. To promote carbon dioxide elimination

Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and
helping the client relax, pursed-lip breathing helps the client learn to control the
rate and depth of respiration. Pursed-lip breathing does not promote the intake
of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

20. Answer: 1. Maintaining functional ability

A priority goal for the client with COPD is to manage the s/s of the disease
process so as to maintain the client’s functional ability. Chest pain is not a
typical sign of COPD. The carbon dioxide concentration in the blood is increased
to an abnormal level in clients with COPD; it would not be a goal to increase the
level further. Preventing infection would be a goal of care for the client with
COPD.

21. Answer: 2. Flushed skin

The high PaCO2 level causes flushing due to vasodilation. The client also
becomes drowsy and lethargic because carbon dioxide has a depressant effect
on the CNS. Cyanosis is a late sign of hypoxia. Irritability and anxiety are not
common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.

22. Answer: 2. While exhaling through pursed lips

Exhaling requires less energy than inhaling. Therefore, lifting while exhaling
saves energy and reduced perceived dyspnea. Pursing the lips
prolongs exhalation and provides the client with more control over breathing.
Lifting after exhalation but before inhaling is similar to lifting with the breath
held. This should not be recommended because it is similar to the Valsalva
maneuver, which can stimulate cardiac dysrhythmias.

23. Answer: 3. Peripheral edema

Right-sided heart failure is a complication of COPD that occurs because of

pulmonary hypertension. Signs and symptoms of right-sided heart
failure include peripheral edema, jugular venous distention, hepatomegaly, and
weight gain due to increased fluid volume. Clubbing of nail beds is associated
with conditions of chronic hypoxia. Hypertension is associated with left-
sided heart failure. Clients with heart failure have decreased appetites.

24. Answer: 4. Coarse crackles and rhonchi

Exacerbations of COPD are frequently caused by respiratory infections. Coarse

crackles and rhonchi would be auscultated as air moves through airways
obstructed with secretions. In COPD, breath sounds are diminished because of
an enlarged anteroposterior diameter of the chest. Expiration, not inspiration,
becomes prolonged. Chest movement is decreased as lungs become
overdistended.

25. Answer: 1. Increased PaCO2

As COPD progresses, the client typically develops increased PaCO2 levels and
decreased PaO2 levels. This results in decreased pH and decreased oxygen
saturation. These changes are the result of air trapping and hypoventilation.

26. Answer: 4. High-calorie, high-protein diet

The client should eat high-calorie, high-protein meals to maintain nutritional

status and prevent weight loss that results from the increased work of
breathing. The client should be encouraged to eat small, frequent meals. A low-
fat, low-cholesterol diet is indicated for clients with coronary artery disease. The
client with COPD does not necessarily need to follow a sodium-restricted diet,
unless otherwise medically indicated.

27. Answer: 1. Take a deep abdominal breath, bend forward, and cough
3 to 4 times on exhalation.

The goal of effective coughing is to conserve energy, facilitate removal of

secretions, and minimize airway collapse. The client should assume a sitting
position with feet on the floor if possible. The client should bend forward slightly
and, using pursed-lip breathing, exhale. After resuming an upright position, the
client should use abdominal breathing to slowly and deeply inhale. After
repeating this process 3 or 4 times, the client should take a deep abdominal
breath, bend forward and cough 3 or 4 times upon exhalation (“huff” cough).
Lying flat does not enhance lung expansion; sitting upright promotes full
expansion of the thorax. Shallow breathing does not facilitate removal of
secretions, and forceful coughing promotes collapse of airways. A side-lying
position does not allow for adequate chest expansion to promote deep
breathing.

28. Answer: 4. Administer bronchodilators

In an acute asthma attack, diminished or absent breath sounds can be an

ominous sign of indicating lack of air movement in the lungs and impending
respiratory failure. The client requires immediate intervention with inhaled
bronchodilators, intravenous corticosteroids, and possibly intravenous
theophylline. Administering oxygen and reassessing the client 10 minutes later
would delay needed medical intervention, as would drawing an ABG and
obtaining a chest x-ray. It would be futile to encourage the client to relax and
breathe slowly without providing necessary pharmacologic intervention.

29. Answer: 2. Increased PaCO2, decreased PaO2, and decreased pH.

As the severe asthma attack worsens, the client becomes fatigued and
alveolar hypotension develops. This leads to carbon dioxide retention and
hypoxemia. The client develops respiratory acidosis. Therefore, the PaCO2 level
increase, the PaO2 level decreases, and the pH decreases, indicating acidosis.

30. Answer: 3. Corticosteroids have an anti-inflammatory effect

Corticosteroids have an anti-inflammatory effect and act to decrease edema in

the bronchial airways and decrease mucus secretion. Corticosteroids do not
have a bronchodilator effect, act as expectorants, or prevent respiratory
infections.

31. Answer: 1 and 4.

32. Answer: 1. Irregular heartbeat

Irregular heart rates should be reported promptly to the care provider.

Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain
because of its adrenergic effect on the beta-adrenergic receptors in the heart. It
is not recommended for use in clients with known cardiac disorders.
Metaproterenol does not cause constipation, petal edema, or bradycardia.

33. Answer: 3. “You have developed a fungal infection from your

medication. It will need to be treated with an antibiotic.”
Use of oral inhalant corticosteroids, such as flunisolide, can lead to the
development of oral thrush, a fungal infection. Once developed, thrush must be
treated by antibiotic therapy; it will not resolve on its own. Fungal infections can
develop even without overuse of the Corticosteroid inhaler. Although good oral
hygiene can help prevent the development of a fungal infection, it cannot be
used alone to treat the problem.

34. Answer: 1. Incorporate physical exercise as tolerated into the

treatment plan.

Physical exercise is beneficial and should be incorporated as tolerated into the

client’s schedule. Peak flow numbers should be monitored daily, usually in the
morning (before taking medication). Peak flow does not need to be monitored
after each meal. Stressors in the client’s life should be modified but cannot be
totally eliminated. Although adequate sleep is important, it is not recommended
that sedatives be routinely taken to induce sleep.

35. Answer: 2. Viral respiratory infections

The most common precipitator of asthma attacks is viral respiratory infection.

Clients with asthma should avoid people who have the flu or a cold and should
get yearly flu vaccinations. Environmental exposure to toxins or heavy
particulate matter can trigger asthma attacks; however, far fewer asthmatics
are exposed to such toxins than are exposed to viruses. Cigarette smoke can
also trigger asthma attacks, but to a lesser extent than viral respiratory
infections. Some asthmatic attacks are triggered by exercising in cold weather.

36. Answer: 2. Place the client on oxygen

The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are
involved. The client should immediately be placed on oxygen via mask so that
the SaO2 is brought up to 95%. Encourage slow, regular breathing to decrease
the amount of CO2 she is losing. This client may have pulmonary embolism, so
she should be monitored for this condition (4), but it is not the first
intervention. Sodiumbicarbonate (3) would be given to reverse acidosis;
mechanical ventilation (1) may be ordered for acute respiratory acidosis.

37. Answer: 1. Caused by the sudden opening of alveoli

Basilar crackles are usually heard during inspiration and are caused by sudden
opening of the alveoli.

38. Answer: 3. Administer oxygen at 2 L flow per minute.

Administer oxygen at 2 L/minute and no more, for if the client if emphysemic

and receives too high a level of oxygen, he will develop CO2 narcosis and
the respiratory system will cease to function.

39. Answer: 3. Increased pulse and pallor

Increased pulse and pallor are symptoms associated with shock. A compromised
venous return may occur if there is a mediastinal shift as a result of excessive
fluid removal. Usually, no more than 1 L of fluid is removed at one time to
prevent this from occurring.

40. Answer: 1. Respiratory acidosis

Respiratory acidosis represents an increase in the acid component, carbon

dioxide, and an increase in the hydrogen ion concentration (decreased pH) of
the arterial blood.

41. Answer: 2. A build-up of carbon dioxide

The arrhythmias are caused by a build-up of carbon dioxide and not enough
oxygen so that the heart is in a constant state of hypoxia.
42. Answer: 1. Repeat auscultation after asking the client to deep
breathe and cough.

Although crackles often indicate fluid in the alveoli, they may also be related to
hypoventilation and will clear after a deep breath or a cough. It is, therefore,
premature to impose fluid (2) or activity (4) restrictions (which Margaret would
totally do if Dani weren’t there to smack her). Inspection for edema (3) would
be appropriate after re-auscultation.

43. Answer: 3. Listen and feel the air movement.

To check for breathing, the nurse places her ear and cheek next to the client’s
mouth and nose to listen and feel for air movement. The chest rising and falling
(1) is not conclusive of a patent airway. Observing skin color (2) is not an
accurate assessment of respiratory status, nor is checking the femoral pulse.

44. Answer: 2. Impaired tissue perfusion related to thrombosis

Chronic hypoxia associated with COPD may stimulate excessive RBC production
(polycythemia). This results in increased blood viscosity and the risk of
thrombosis. The other nursing diagnoses are not applicable in this situation.

45. Answer: 2. Operative side or back

Positioning the client on the operative side facilitates the accumulation of

serosanguineous fluid. The fluid forms a solid mass, which prevents the
remaining lung from being drawn into the space.

46. Answer: 2. Dyspnea and pain

Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation.

Clients become short of breath, have a high temperature, and usually
experience severe pain but do not have a severe cough (4). The shortness of
breath is a result of decreased oxygen-carbon dioxide exchange at the alveolar
level.

47. Answer: 3. Apply oral or nasal suction

Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction
to the airway to prevent secretions from falling into the lung. Dressing change
(1) and humidity (2) do not relate to suctioning.

48. Answer: 2. Exhaled after there is a normal inspiration

Tidal volume (TV) is defined as the amount of air exhaled after a normal
inspiration.

49. Answer: 3. A decreasing oxygen pressure and/or an increasing

carbon dioxide pressure in the blood.

The lower the PO2 and the higher the PCO2, the more rapidly oxygen
dissociated from the oxyhemoglobin molecule.

50. Answer: 4. Venturi mask

Venturi delivers controlled oxygen.