Asthma and COPD NCLEX

1. An elderly client with pneumonia may appear with which of the following
symptoms first?

1. Altered mental status and dehydration

2. fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough

2. Which of the following pathophysiological mechanisms that occurs in the lung

parenchyma allows pneumonia to develop?

1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation

3. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has
a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently
had a cold. From his history, the client may have which of the following?

1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema

4. Which of the following assessment findings would help confirm a diagnosis of

asthma in a client suspected of having the disorder?

1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds

5. Which of the following types of asthma involves an acute asthma attack

brought on by an upper respiratory infection?

1. Emotional
2. Extrinsic
3. Intrinsic
4. Mediated

6. A client with acute asthma showing inspiratory and expiratory wheezes and a
decreased expiratory volume should be treated with which of the following
classes of medication right away?

1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids

7. A 19-year-old comes into the emergency department with acute asthma. His
respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory
distress. Which of the following actions should be taken first?

1. Take a full medication history

2. Give a bronchodilator by nebulizer
3. Apply a cardiac monitor to the client
4. Provide emotional support to the client.

8. A 58-year-old client with a 40-year history of smoking one to two packs of

cigarettes a day has a chronic cough producing thick sputum, peripheral edema,
and cyanotic nail beds. Based on this information, he most likely has which of the
following conditions?

1. Adult respiratory distress syndrome (ARDS)

2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

9. The term “blue bloater” refers to which of the following conditions?

1. Adult respiratory distress syndrome (ARDS)

2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

10. The term “pink puffer” refers to the client with which of the following
conditions?

1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

11. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory
muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has
no cough. He leans forward with his arms braced on his knees to support his
chest and shoulders for breathing. This client has symptoms of which of the
following respiratory disorders?

1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
12. It’s highly recommended that clients with asthma, chronic bronchitis, and
emphysema have Pneumovax and flu vaccinations for which of the following
reasons?

1. All clients are recommended to have these vaccines

2. These vaccines produce bronchodilation and improve oxygenation.
3. These vaccines help reduce the tachypnea these clients experience.
4. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Exercise has which of the following effects on clients with asthma, chronic
bronchitis, and emphysema?

1. It enhances cardiovascular fitness.

2. It improves respiratory muscle strength.
3. It reduces the number of acute attacks.
4. It worsens respiratory function and is discouraged.

14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which
of the following reasons best explains why?

1. Reducing fluid volume reduces oxygen demand.

2. Reducing fluid volume improves clients’ mobility.
3. Restricting fluid volume reduces sputum production.
4. Reducing fluid volume improves respiratory function.

15. A 69-year-old client appears thin and cachectic. He’s short of breath at rest
and his dyspnea increases with the slightest exertion. His breath sounds are
diminished even with deep inspiration. These signs and symptoms fit which of
the following conditions?

1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if

needed, or he may lose his hypoxic drive. Which of the following statements is
correct about hypoxic drive?

1. The client doesn’t notice he needs to breathe.

2. The client breathes only when his oxygen levels climb above a certain point.
3. The client breathes only when his oxygen levels dip below a certain point.
4. The client breathes only when his carbon dioxide level dips below a certain point.

17. Teaching for a client with chronic obstructive pulmonary disease (COPD)
should include which of the following topics?

1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the physician.
4. How to recognize the signs of an impending respiratory infection.

18. Which of the following respiratory disorders is most common in the first 24
to 48 hours after surgery?

1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax

19. Which of the following measures can reduce or prevent the incidence of
atelectasis in a post-operative client?

1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer

20. Emergency treatment of a client in status asthmaticus includes which of the

following medications?

1. Inhaled beta-adrenergic agents

2. Inhaled corticosteroids
3. I.V. beta-adrenergic agents
4. Oral corticosteroids

21. Which of the following treatment goals is best for the client with status
asthmaticus?

1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions

22. Dani was given dilaudid for pain. She’s sleeping and her respiratory rate is 4
breaths/minute. If action isn’t taken quickly, she might have which of the
following reactions?

1. Asthma attack
2. Respiratory arrest
3. Be pissed about receiving Narcan
4. Wake up on her own

23. Which of the following additional assessment data should immediately be

gathered to determine the status of a client with a respiratory rate of 4
breaths/minute?

1. Arterial blood gas (ABG) and breath sounds

2. Level of consciousness and a pulse oximetry value.
3. Breath sounds and reflexes
4. Pulse oximetry value and heart sounds

24. A client is in danger of respiratory arrest following the administration of a

narcotic analgesic. An arterial blood gas value is obtained. The nurse would
expect to PaCO2 to be which of the following values?

1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg

25. A client has started a new drug for hypertension. Thirty minutes after he
takes the drug, he develops chest tightness and becomes short of breath and
tachypneic. He has a decreased level of consciousness. These signs indicate which
of the following conditions?

1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis

26. Emergency treatment for a client with impending anaphylaxis secondary to

hypersensitivity to a drug should include which of the following actions first?

1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs

27. Following the initial care of a client with asthma and impending anaphylaxis
from hypersensitivity to a drug, the nurse should take which of the following
steps next?

1. Administer beta-adrenergic blockers

2. Administer bronchodilators
3. Obtain serum electrolyte levels
4. Have the client lie flat in the bed.

28. A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46
mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the
following conditions?

1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
29. A nurse plans care for a client with chronic obstructive pulmonary disease,
knowing that the client is most likely to experience what type of acid-base
imbalance?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas
results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has
determined that the client is experiencing respiratory alkalosis. Which
laboratory value would most likely be noted in this condition?

1. Sodium level of 145 mEq/L

2. Potassium level of 3.0 mEq/L
3. Magnesium level of 2.0 mg/L
4. Phosphorus level of 4.0 mg/dl

31. A nurse reviews the arterial blood gas results of a patient and notes the
following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22
mEq/L. The nurse analyzes these results as indicating:

1. Metabolic acidosis, compensated.

2. Metabolic alkalosis, uncompensated.
3. Respiratory alkalosis, compensated.
4. Respiratory acidosis, compensated.

32. A client is scheduled for blood to be drawn from the radial artery for an
ABG determination. Before the blood is drawn, an Allen’s test is performed to
determine the adequacy of the:

1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation

33. A nurse is caring for a client with a nasogastric tube that is attached to low
suction. The nurse monitors the client, knowing that the client is at risk for
which acid-base disorder?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

34. A nurse is caring for a client with an ileostomy understands that the client is
most at risk for developing which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

35. A nurse is caring for a client with diabetic ketoacidosis and documents that
the client is experiencing Kussmaul’s respirations. Based on this documentation,
which of the following did the nurse observe?

1. Respirations that are abnormally deep, regular, and increased in rate.

2. Respirations that are regular but abnormally slow.
3. Respirations that are labored and increased in depth and rate
4. Respirations that cease for several seconds.

36. A nurse understands that the excessive use of oral antacids containing
bicarbonate can result in which acid-base disturbance?

1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis

37. A nurse is caring for a client with renal failure. Blood gas results indicate a
pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L.
The nurse has determined that the client is experiencing metabolic acidosis.
Which of the following laboratory values would the nurse expect to note?

1. Sodium level of 145 mEq/L

2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL

38. A nurse is preparing to obtain an arterial blood gas specimen from a client
and plans to perform the Allen’s test on the client. Number in order of priority
the steps for performing the Allen’s test (#1 is first step).

1. Ask the client to open and close the hand repeatedly.(3)

2. Apply pressure over the ulnar and radial arteries.(2)
3. Assess the color of the extremity distal to the pressure point(5)
4. Release pressure from the ulnar artery(4)
5. Explain the procedure to the client.(1)

39. A nurse is preparing to obtain a sputum specimen from a client. Which of the
following nursing actions will facilitate obtaining the specimen?

1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.
40. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the
following signs if noted in the client should be reported immediately to the
physician?

1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm

41. A nurse is suctioning fluids from a client via a tracheostomy tube. When
suctioning, the nurse must limit the suctioning to a maximum of:

1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute

42. A nurse is suctioning fluids from a client through an endotracheal tube.

During the suctioning procedure, the nurse notes on the monitor that the heart
rate decreases. Which of the following is the most appropriate nursing
intervention?

1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxygenated the client
4. Notify the physician immediately.

43. An unconscious client is admitted to an emergency room. Arterial blood gas

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

1. Metabolic acidosis
2. Respiratory acidosis
3. Combined respiratory and metabolic acidosis
4. over compensated respiratory acidosis

44. A nurse is caring for a client hospitalized with acute exacerbation of COPD.
Which of the following would the nurse expect to note on assessment of this
client?

1. Increased oxygen saturation with exercise

2. Hypocapnia
3. A hyperinflated chest on x-ray film
4. A widened diaphragm noted on chest x-ray film
45. An oxygenated delivery system is prescribed for a client with COPD to
deliver a precise oxygen concentration. Which of the following types of oxygen
delivery systems would the nurse anticipate to be prescribed?

1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar

46. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic
airflow limitation, and the nurse instructs the client about the medication. Which
statement by the client indicates a need for further teaching?

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

2. “I will take the medication with food.”
3. “I will continue to take the medication even if I am feeling better.”
4. “Periodic blood levels will need to be obtained.”

47. A nurse is caring for a client with emphysema. The client is receiving oxygen.
The nurse assesses the oxygen flow rate to ensure that it does not exceed

1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min

48. The nurse reviews the ABG values of a client. The results indicate respiratory
acidosis. Which of the following values would indicate that this acid-base
imbalance exists?

1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3- of 20 mEq/L

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

1. Promote oxygen intake

2. Strengthen the diaphragm
3. Strengthen the intercostal muscles
4. Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm
Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values as indicating:

1. Respiratory acidosis uncompensated

2. Respiratory alkalosis uncompensated
3. Metabolic acidosis uncompensated
4. Metabolic acidosis partially compensated.

Answers and Rationale

1. Answer: 1. Altered mental status and dehydration

Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the common
symptoms of pneumonia, but elderly clients may first appear with only an altered
mental status and dehydration due to a blunted immune response.

2. Answer: 4. Inflammation

The most common feature of all types of pneumonia is an inflammatory pulmonary

response to the offending organism or agent. Atelectasis and bronchiectasis indicate a
collapse of a portion of the airway that doesn’t occur with pneumonia. An effusion is
an accumulation of excess pleural fluid in the pleural space, which may be a
secondary response to pneumonia.

3. Answer: 1. Acute asthma

Based on the client’s history and symptoms, acute asthma is the most likely diagnosis.
He’s unlikely to have bronchial pneumonia without a productive cough and fever and
he’s too young to have developed COPD or emphysema.

4. Answer: 3. Inspiratory and expiratory wheezing

Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral

cyanosis may be present in extreme cases of respiratory distress. The nurse would
expect the client to have a decreased forced expiratory volume because asthma is an
obstructive pulmonary disease. Breath sounds will be “tight” sounding or markedly
decreased; they won’t be normal.

5. Answer: 3. Intrinsic

Intrinsic asthma doesn’t have an easily identifiable allergen and can be triggered by
the common cold. Asthma caused be emotional reasons is considered to be in the
extrinsic category. Extrinsic asthma is caused by dust, molds, and pets; easily
identifiable allergens. Mediated asthma doesn’t exist.

6. Answer: 2. Bronchodilators

Bronchodilators are the first line of treatment for asthma because bronchoconstriction
is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma
and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the
inflammation but aren’t used for emergency relief.

7. Answer: 2. Give a bronchodilator by nebulizer

The client is having an acute asthma attack and needs to increase oxygen delivery to
the lung and body. Nebulized bronchodilators open airways and increase the amount
of oxygen delivered. First resolve the acute phase of the attack ad how to prevent
attacks in the future. It may not be necessary to place the client on a cardiac monitor
because he’s only 19-years-old, unless he has a past medical history of cardiac
problems.

8. Answer: 3. Chronic obstructive bronchitis

Because of his extensive smoking history and symptoms, the client most likely has
chronic obstructive bronchitis. Clients with ARDS have acute symptoms of and
typically need large amounts of oxygen. Clients with asthma and emphysema tend not
to have a chronic cough or peripheral edema.

9. Answer: 3. Chronic obstructive bronchitis

Clients with chronic obstructive bronchitis appear bloated; they have large barrel
chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis.
Clients with ARDS are acutely short of breath and frequently need intubation for
mechanical ventilation and large amounts of oxygen. Clients with asthma don’t
exhibit characteristics of chronic disease, and clients with emphysema appear pink
and cachectic (a state of ill health, malnutrition, and wasting).

10. Answer: 4. Emphysema

Because of the large amount of energy it takes to breathe, clients with emphysema are
usually cachectic. They’re pink and usually breathe through pursed lips, hence the
term “puffer”. Clients with ARDS are usually acutely short of breath. Clients with
asthma don’t have any particular characteristics, and clients with chronic obstructive
bronchitis are bloated and cyanotic in appearance.

11. Answer: 4. Emphysema

These are classic signs and symptoms of a client with emphysema. Clients with
ARDS are acutely short of breath and require emergency care; those with asthma are
also acutely short of breath during an attack and appear very frightened. Clients with
chronic obstructive bronchitis are bloated and cyanotic in appearance.

12. Answer: 4. Respiratory infections can cause severe hypoxia and possibly
death in these clients.

It’s highly recommended that clients with respiratory disorders be given vaccines to
protect against respiratory infection. Infections can cause these clients to need
intubation and mechanical ventilation, and it may be difficult to wean these clients
from the ventilator. The vaccines have no effect on bronchodilation or respiratory
care.

13. Answer: 1. It enhances cardiovascular fitness.

Exercise can improve cardiovascular fitness and help the client tolerate periods of
hypoxia better, perhaps reducing the risk of heart attack. Most exercise has little effect
on respiratory muscle strength, and these clients can’t tolerate the type of exercise
necessary to do this. Exercise won’t reduce the number of acute attacks. In some
instances, exercise may be contraindicated, and the client should check with his
physician before starting any exercise program.

14. Answer: 1. Reducing fluid volume reduces oxygen demand.

Reducing fluid volume reduces the workload of the heart, which reduces oxygen
demand and, in turn, reduces the respiratory rate. It may also reduce edema and
improve mobility a little, but exercise tolerance will still be harder to clear airways.
Reducing fluid volume won’t improve respiratory function, but may improve
oxygenation.

15. Answer: 4. Emphysema

In emphysema, the wall integrity of the individual air sacs is damaged, reducing the
surface area available for gas exchange. Very little air movement occurs in the lungs
because of bronchial collapse, as well. In ARDS, the client’s condition is more acute
and typically requires mechanical ventilation. In asthma and bronchitis, wheezing is
prevalent.

16. Answer: 3. The client breathes only when his oxygen levels dip below a
certain point.

Clients with emphysema breathe when their oxygen levels drop to a certain level; this
is known as the hypoxic drive. They don’t take a breath when their levels of carbon
dioxide are higher than normal, as do those with healthy respiratory physiology. If too
much oxygen is given, the client has little stimulus to take another breath. In the
meantime, his carbon dioxide levels continue to climb, and the client will pass out,
leading to a respiratory arrest.

17. Answer: 4. How to recognize the signs of an impending respiratory infection.

Respiratory infection in clients with a respiratory disorder can be fatal. It’s important
that the client understands how to recognize the signs and symptoms of an impending
respiratory infection. It isn’t appropriate for the wife to listen to his lung sounds,
besides, you can’t purchase stethoscopes from Wal-Mart. If the client has signs and
symptoms of an infection, he should contact his physician at once.

18. Answer: 1. Atelectasis

Atelectasis develops when there’s interference with the normal negative pressure that
promotes lung expansion. Clients in the postoperative phase often splint their
breathing because of pain and positioning, which causes hypoxia. It’s uncommon for
any of the other respiratory disorders to develop.

19. Answer: 4. Use of an incentive spirometer

Using an incentive spirometer requires the client to take deep breaths and promotes
lung expansion. Chest physiotherapy helps mobilize secretions but won’t prevent
atelectasis. Reducing oxygen requirements or placing someone on mechanical
ventilation doesn’t affect the development of atelectasis.

20. Answer: 1. Inhaled beta-adrenergic agents

Inhaled beta-adrenergic agents help promote bronchodilation, which improves

oxygenation. I.V. beta-adrenergic agents can be used but have to be monitored
because of their greater systemic effects. They’re typically used when the inhaled
beta-adrenergic agents don’t work. Corticosteroids are slow-acting, so their use won’t
reduce hypoxia in the acute phase.

21. Answer: 1. Avoiding intubation

Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen are

used to reduce bronchospasm, improve oxygenation, and avoid intubation.
Determining the trigger for the client’s attack and improving exercise tolerance are
later goals. Typically, secretions aren’t a problem in status asthmaticus.

22. Answer: 2. Respiratory arrest

Narcotics can cause respiratory arrest if given in large quantities. Its unlikely Dani
will have an asthma attack or wake up on her own. She may be pissed for a minute,
but then she’d be grateful for saving her butt.

23. Answer: 2. Level of consciousness and a pulse oximetry value.

First, the nurse should attempt to rouse the client because this should increase the
client’s respiratory rate. If available, a spot pulse oximetry check should be done and
breath sounds should be checked. The physician should be notified immediately if of
the findings. He’ll probably order ABG analysis to determine specific carbon dioxide
and oxygen levels, which will indicate the effectiveness of ventilation. Reflexes and
heart sounds will be part of the more extensive examination done after these initial
actions are completed.

24. Answer: 4. 80 mm Hg

A client about to go into respiratory arrest will have inefficient ventilation and will be
retaining carbon dioxide. The value expected would be around 80 mm Hg. All other
values are lower than expected.

25. Answer: 3. Respiratory Failure

The client was reacting to the drug with respiratory signs of impending anaphylaxis,
which could lead to eventual respiratory failure. Although the signs are also related to
an asthma attack or a pulmonary embolism, consider the new drug first. Rheumatoid
arthritis doesn’t manifest these signs.

26. Answer: 1. Administering oxygen

Giving oxygen would be the best first action in this case. Vital signs then should be
checked and the physician immediately notified. If the client doesn’t already have an
I.V. catheter, one may be inserted now if anaphylactic shock is developing. Obtaining
a CBC wouldn’t help the emergency situation.

27. Answer: 2. Administer bronchodilators

Bronchodilators would help open the client’s airway and improve his oxygenation
status. Beta-adrenergic blockers aren’t indicated in the management of asthma
because they may cause bronchospasm. Obtaining laboratory values wouldn’t be done
on an emergency basis, and having the client lie flat in bed could worsen his ability to
breathe.

28. Answer: 3. Respiratory acidosis

You all should know this. Practice some problems if you got this wrong.

29. Answer: 1. Respiratory acidosis

Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis

is most commonly caused by COPD. In end-stage disease, pathological changes lead
to airway collapse, air trapping, and disturbance of ventilation-perfusion relationships.

30. Answer: 2. Potassium level of 3.0 mEq/L

Clinical manifestations of respiratory alkalosis include headache, tachypnea,

paresthesias, tetany, vertigo, convulsions, hypokalemia, and hypocalcemia. Options 1,
3, and 4 identify normal laboratory values. Option 2 identifies the presence of
hypokalemia.

31. Answer: 3. Respiratory alkalosis, compensated.

The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite (see-saw) will

be seen between the pH and the PCO2. In this situation, the pH is at the high end of
the normal value and the PCO2 is low. In an alkalotic condition, the pH is up.
Therefore, the values identified in the question indicate a respiratory alkalosis.
Compensation occurs when the pH returns to a normal value. Because the pH is in the
normal range at the high end, compensation has occurred.

32. Answer: 2. Ulnar circulation

Before radial puncture for obtaining an ABG, you should perform an Allen’s test to
determine adequate ulnar circulation. Failure to determine the presence of adequate
collateral circulation could result in severe ischemic injury o the hand if damage to the
radial artery occurs with arterial puncture.

33. Answer: 4. Metabolic alkalosis

Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as
a result of the loss of hydrochloric acid.
34. Answer: 3. Metabolic acidosis

Intestinal secretions are high in bicarbonate and may be lost through enteric drainage
tubes or an ileostomy or with diarrhea. These conditions result in metabolic acidosis.

35. Answer: 1. Respirations that are abnormally deep, regular, and increased in
rate.

Kussmaul’s respirations are abnormally deep, regular, and increased in rate.

36. Answer: 4. Metabolic alkalosis

Increases in base components occur as a result of oral or parenteral intake of

bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral antacids
containing bicarbonate can cause metabolic alkalosis.

37. Answer: 3. Potassium level of 5.2 mEq/L

Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul’s

respirations; headache; N/V, and diarrhea; fruity-smelling breath resulting from
improper fat metabolism; CNS depression, including mental dullness, drowsiness,
stupor, and coma; twitching, and coma. Hyperkalemia will occur.

38. Answer: 5, 2, 1, 4, and then 3.

39. Answer: 2. Having the client take 3 deep breaths.

To obtain a sputum specimen, the client should rinse the mouth to prevent
contamination, breathe deeply, and then cough unto a sputum specimen container.
The client should be encouraged to cough and not spit so as to obtain sputum. Sputum
can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized
saline or water. The optimal time to obtain a specimen is on arising in the morning.

40. Answer: 4. Bronchospasm

If a biopsy was performed during a bronchoscopy, blood streaked sputum is expected

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

41. Answer: 2. 10 seconds

Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker

cells within the heart. A vasovagal response may occur causing bradycardia. The
nurse must preoxygenate the client before suctioning and limit the suctioning pass to
10 seconds.

42. Answer: 3. Stop the procedure and reoxygenated the client

During suctioning, the nurse should monitor the client closely for side effects,
including hypoxemia, cardiac irregularities such as a decrease in HR resulting from
vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side
effects develop, especially cardiac irregularities, this procedure is stopped and the
client is reoxygenated.

43. Answer: 1. Metabolic acidosis

In an acidotic condition the pH would be low, indicating the acidosis. In addition, a

low bicarbonate level along with the pH would indicate a metabolic state.

44. Answer: 3. A hyperinflated chest on x-ray film

Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on

exertion and at rest, oxygen desaturation with exercise, and the use of accessory
muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened
diaphragm is the disease is advanced.

45. Answer: 1. Venturi mask

The venture mask delivers the most accurate oxygen concentration. The Venturi mask
is the best oxygen delivery system for the client with chronic airflow limitation
because it delivers a precise oxygen concentration. The face tent, the aerosol mask,
and the tracheostomy collar are also high-flow oxygen delivery systems but most
often are used to administer high humidity.

46. Answer: 1. “I will take the medication on an empty stomach.”

Theo-Dur is a bronchodilator. The medication should be administered with food such

as milk and crackers to prevent GI irritation.

47. Answer: 2. 2 L/min

One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to 60 to

80 mm Hg. However, oxygen is used cautiously and should not exceed 2 L/min.
Because of the long-standing hypercapnia, the respiratory drive is triggered by low
oxygen levels rather than increased carbon dioxide levels, as is the case in normal
respiratory system.

48. Answer: 3. pH of 7.30

49. Answer: 4. Promote carbon dioxide elimination

Pursed lip breathing facilitates maximum expiration for clients with obstructive lung
disease. This type of breathing allows better expiration by increasing airway pressure
that keeps air passages open during exhalation.

50. Answer: 2. Respiratory alkalosis uncompensated

In respiratory alkalosis the pH will be higher than normal and the PCO2 will be low.