NURSING DEPARTMENT

INSTRUCTOR: KERWIN RICO L. REYES

NCM 112 (CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS,
INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC)

Oxygenation
PRELIM EXAMINATION
GENERAL INSTRUCTIONS:
Shade your answers on the answer sheet.
Use Black/Blue-inked colored pen.
Write in BOLD LETTERS your last name first followed by your given name in the space provided.
Strictly no erasures, alterations and superimpositions.
Writing on the questionnaire is allowed.
Answer sheets should be clean, tidy, and wrinkled-free as much as possible.
Read and comprehend each test questions.
If you are caught cheating, the proctor will confiscate your paper and disciplinary action will take place.

INSTRUCTIONS: Select the best answer.

1. The nurse is evaluating how well a client with chronic obstructive pulmonary disease (COPD) understands
the discharge teaching. Which statements made by the client indicate an understanding of the pursed-lip
breathing technique? (select all that apply)
A. “I exhale for 2 seconds through pursed lips.”
B. “I exhale for 4 seconds through pursed lips.”
C. “I inhale for 4 seconds through my nose, keeping my mouth closed.”
D. “I inhale for 2 seconds through my nose, keeping my mouth closed.”

2. Which teaching instructions should the nurse provide to a client with advanced chronic obstructive
pulmonary disease (COPD)? (select all that apply)
A. Follow a low calorie diet
B. Obtain a pneumococcal vaccine
C. Report increase sputum
D. Take iron to improve anemia

3. The nurse teaches safety precautions of home oxygen use to a client with emphysema being discharged
with nasal cannula and portable oxygen tank. Which client statement indicates the need for further
teaching? (select all that apply)
A. “I can apply Vaseline to my nose when my nostrils feel dry from the oxygen.”
B. “I can cook on my gas stove as long as I have a fire extinguisher in the kitchen.”
C. “I can increase the liter flow from 2-6 liters a minute whenever I feel short of breath.”
D. “I should not polish my nails when using my oxygen.”

4. The nurse develops a care plan for a critical ill client with acute respiratory distress syndrome (ARDS) who is
on a mechanical ventilator. What is the priority nursing diagnosis (ND)?
A. Imbalanced nutrition
B. Impaired gas exchange
C. Impaired tissue integrity
D. Risk for infection

5. In the intensive care unit, a client is on mechanical ventilation (MV) after having undergone a fresh
tracheostomy with retention sutures placed yesterday. The nurse hears the MV alarm sound and enters the
room. The client is coughing, respirations are 40/min, heart rate is 132/min, and the pulse oximeter is 80%.
The nurse also sees the tracheostomy tube lying on the client’s chest. What is the nurse’s immediate action?
A. Apply a rebreathing mask with high concentration oxygen at 12 L/min
B. Attempt to reinsert tube with the obturator in place
C. Insert a sterile catheter into the stoma and suction the airway
D. Pull the retention sutures apart to lift the trachea and hold the stoma open
6. An elderly client with pneumonia has a temperature of 102.2 F (39 C), blood pressure 98/66 mmHg, pulse
115/min, and respirations 30/min. Assessment reveals crackles in the right lower lobe, dusky nail beds, and
dry mucous membranes. Arrange the nursing actions chronologically to prioritize care. All options must be
used.
1. Oxygen per nasal cannula at 4L/min
2. Normal saline (NS) solution at 125 mL/hr
3. Blood cultures x 2 for temperature >102 F (38.9 C)
4. Levofloxacin 750 mg intravenous (IV) every 24 hours
5. Teaching incentive spirometer use
A. 12345
B. 54321
C. 32145
D. 12354

7. A client with type 2 diabetes, coronary artery disease and peripheral arterial disease developed hospital-
acquired pneumonia (HAP) and has been receiving intravenous (IV) antibiotics for 4 days. Which
parameter monitored by the nurse best indicates the effectiveness of treatment?
A. Color of the sputum
B. Lung sounds
C. Saturation level
D. White blood cell count (WBC)

8. A client is brought to the emergency department following a motor vehicle collision. The client’s admission
vital signs are blood pressure 70/50 mmHg, pulse 123/min, and respirations 8/min, and respirations 8/min. The
nurse anticipates the results of which diagnostic test to best evaluate the client’s oxygenation and
ventilation status?
A. Arterial blood gases
B. Chest x-ray
C. Hematocrit and hemoglobin levels
D. Serum level

9. An elderly is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Pulse oximetry is
84% on room air. The client is restlessness, has expiratory wheezing and a productive cough, and is using his
accessory muscles to breathe. Which prescription should the nurse question?
A. Albuterol 2.5 mg by nebulizer
B. Intravenous (IV) methylprednisolone 125 mg now and every 6 hours
C. IV morphine 2 mg now and may repeat every 2 hours
D. Oxygen t 2 L/min by nasal cannula

10. A client is transferred from the post-anesthesia recovery unit to the surgical unit following an open
cholecystectomy. Which interventions are most important for the nurse to perform to prevent pneumonia?
(select all that apply))
A. Administer morphine if the pain is >8on a 10-dryee pain
B. Ambulate within 8 hours after surgery, if possible
C. Have client cough with splinting every hour
D. Have client deep breath and use the incentive spirometer every hour and use the incentive spirometer
every hour

11. An elderly client is brought to the emergency department with lethargy, chills, and sharp chest pain with
deep breathing. Pulse oximeter shows 93% on room air and respirations are 24/min. what is the nurse’s initial
action?
A. Administer intravenous (IV) morphine
B. Auscultate the client’s lung sounds
C. Initiate an IV infusion of normal saline
D. Initiate nasal oxygen at 3 L/min
12. The nurse is assisting a client with a diagnosis of asthma in use of a peak flow meter. Place the steps for
measuring peak expiratory flow using a peak flow meter in the correct order. All options must be used.
1. Slide the indicator on the numbered scale on the flow meter to 0 or lowest number and instruct
the client to stand or sit as upright as possible
2. Instruct the client to breathe in deeply, place the mouthpiece in the mouth, and close the lips
tightly around it to form a seal
3. Instruct the client to exhale as quickly and forcibly as possible are note the reading on the
numbered scale
4. Repeat the procedure 2 more times with a 5-10 second rest period between exhalation
5. Record the highest reading achieved (personal best)
A. 12345
B. 54321
C. 23451
D. 34512

13. The nurse provides discharge instructions to a 67-year-old client with chronic bronchitis who was hospitalized
for community-acquired pneumonia. Which instructions should be included in the discharge teaching
plan? (select all that apply)
A. “Avoid the use of over-the-counter cough suppressant medicine.”
B. “Oral antibiotics are not needed at home as you had intravenous (IV) therapy in the hospital.”
C. “Pneumonia vaccination is not needed as you now have lifelong immunity.”
D. “Use the incentive spirometer at home.”

14. A Client with coarse crackles at the base of both lungs suddenly becomes agitated, anxious, cyanotic, and
dyspneic. Which of the following positions is appropriate?
A. High-Fowler’s
B. Left-Sims
C. Modified Trendelenburg
D. Supine

15. A client is experiencing an asthma attack. The nurse assesses extreme anxiety, dyspnea, nonproductive
cough, inspiratory and expiratory wheezing, and expiratory wheezing, and diminished breath sounds.
Respirations are 36/min, pulse is 122/min, and pulse oximeter shows 87% on room air. Which is the priority
nursing diagnosis (ND) for this client?
A. Anxiety related to hypoxia and fear of suffocation
B. Impaired gas exchange related to alveolar hypoventilation
C. Ineffective airway clearance related to abnormal viscosity of mucus
D. Ineffective breathing pattern related to decreased lung expansion

16. The nurse develops the care plan for a client diagnosed with pneumonia and identifies ineffective airway
clearance as the primary nursing diagnosis. Based on this nursing diagnosis, which outcomes are most
appropriate for the nurse to include in the client’s plan of care? (select all that apply)
A. Able to cough up secretions after respiratory treatments and deep breaths
B. Ambulates 40 ft (12.2 m) without reporting shortness of breath
C. Heart rate maintained at 60-80 beats/min
D. Clear breath sounds auscultated bilaterally

17. The nurse reviews and reinforces an asthma action plan with a client who has moderate persistent asthma.
Which statement by the client indicates an understanding of how to follow a plan appropriately when peak
expiratory flow (PEF) readings are in the green, yellow or red zones?
A. “If I am in the green zone (PEF 80%-100% of personal best) but am coughing, wheezing, and having
more trouble breathing, I will not make any changes in my medications.”
B. “If I am in the yellow zone (50-80%) and I return to the green zone after taking my rescue medication, I
will not make any changes in my daily medications.”
C. “If I am in the yellow zone (50-80%), I will take my rescue medication every 4 hours for 1-2 days and call
my health care provider (HCP) for follow up care.”
D. “If I remain in the red zone, my lips are blue and my PEF is still <50% of my personal best reading after
taking my rescue medication, I will wait 15 minutes before calling an ambulance.”
18. A client with community-acquired pneumonia is receiving 0.9% normal saline (NS) at 50 mL/hr. Pulse
oximetry shows 95% on nasal O2 at 3 L/min. the nurse identifies a nursing diagnosis of ineffective airway
clearance. Which prescription would the nurse expect to best facilitate secretion removal?
A. Incentive spirometer every 2 hours
B. Increase 0.9% NS to 125 mL/hr
C. Increase nasal oxygen to 4 L/min
D. Place the client in semi-Fowler’s position

19. The nurse admits a client to the medical unit. Based on the admission data, which priority nursing diagnosis
does the nurse identify? Check on the exhibit above for additional information.
A. Activity intolerance
B. Impaired gas exchange
C. In effective airway clearance
D. Ineffective breathing pattern

20. A nurse is reviewing the laboratory results of a client admitted for asthma exacerbation. Elevation of which
of these cells indicates that the client’s asthma may have been triggered by an allergic response?
A. Eosinophils
B. Lymphocytes
C. Neutrophils
D. Reticulocytes

21. The nurse conducts a program about strategies to prevent community-acquired pneumonia (CAP) at a
center for senior citizens, which statement made by a participant indicates the need for further instruction?
A. “I got flu vaccine and it can help prevent pneumonia.”
B. “I got the one-time pneumonia shot, so I won’t need it again.”
C. “I stopped smoking a year ago, so that should help me a lot.”
D. “I try to avoid going to the mall during the winter months.”

22. A 64-year-old hospitalized client with chronic obstructive pulmonary disease (COPD) exacerbation has
increased lethargy and confusion. The client’s pulse oximetry is 88% on 2 liters of oxygen. Arterial blood gas
(ABG) analysis shows a pH of 7.25, PO2 of 60 mmHg, and PCO2 of 80 mmHg. Which of the following should
the nurse implement first?
A. Administer PRN nebulizer treatment
B. Administer scheduled dose of IV methylprednisolone
C. Increase client’s oxygen to 4 liters
D. Place client on the bi-level positive airway pressure (BIPAP) machine

23. A nurse in the pulmonology clinic cares for a college who was recently diagnosed with moderate persistent
asthma. Which common asthma trigger does the nurse teach this client to avoid?
A. Aspirin and nonsteroidal medications
B. Latex products
C. Penicillin group antibiotics
D. Strenuous physical activity

24. A client with left lobar pneumonia is transferred to the intensive care unit due to increasing respiratory
distress. While providing care for the client, the nurse notes a significant drop in saturation when the client is
placed in which position?
A. High-Fowler’s
B. Left side
C. Right side
D. Semi-Fowler’s
25. The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD). The nurse
anticipates which laboratory results for this client?
A. Anemia
B. Neutropenia
C. Polycythemia
D. Thrombocytopenia

26. A client is admitted with a pulmonary embolus. The nurse assesses restlessness, one-word dyspnea and
shortness of breath with activity, tachycardia, pleuritic chest pain, and severe anxiety. Arterial blood gases
indicate respiratory alkalosis and hypoxemia. When initiating the care, the nurse should choose which
nursing diagnosis as the highest priority?
A. Activity intolerance related to imbalance between oxygen supply and demand
B. Acute pain related to inspiration and inflammation of pleura
C. Anxiety related to fear of the unknown, chest pain and dyspnea
D. Impaired gas exchange related to ventilation-perfusion imbalance

27. A client with pneumonia is transferred from the medical unit to the intensive care unit due to sepsis and
worsening respiratory failure. Based on the nurse’s progress note, which assessment data are most important
for the nurse to report the health care provider (HCP)? Check for additional information above.
A. Cough with mucus production
B. Refractory hypoxemia
C. Scattered rhonchi and crackles
D. Temperature 101 F (38.3 C)

28. The nurse is providing discharge instructions on the use of prescribed short-acting beta agonist (SABA) and
inhaled corticosteroid (ICS) metered-dose inhalers (MDI’s) to a client with newly diagnosed asthma. Which
instructions should the nurse include? (select all that apply)
A. “Omit the beclomethasone if the albuterol is effective.”
B. “Rinse your mouth well after using the beclomethasone inhaler and do not swallow the water,”
C. “Take the albuterol inhaler apart and wash it after every use.”
D. “Use the albuterol inhaler first if needed, then the beclomethasone inhaler.”

29. An 84-year-old client with oxygen dependent chronic obstructive pulmonary disease (COPD) is admitted
with an exacerbation. Over the past several months, the client has become increasingly frail and is “tired of
being in the hospital and being poked and prodded.” Which of the following topics would be most
important for the nurse to discuss with this client’s health care team?
A. Need for discharge to a skilled nursing facility
B. Need for nutritional consult with instruction on a high calorie diet
C. Need for physical therapy prescription to promote activity
D. Option of hospice care

30. An elderly with sepsis has a blood pressure 96/46 mmHg, pulse 100/min, and respirations 28/min. Pulse
oximetry (SpO2) shows 95% on nasal oxygen at 3 L/min. The client remains hypotensive after 2 fluid
challenges with normal saline. Two hours later the SpO2 is 86%. What is the nurse’s first action?
A. Increase oxygen flow rate
B. Notify the health care provider (HCP) of the drop in saturation
C. Reposition the pulse oximeter sensor
D. Request arterial blood gases to confirm the SpO2
31. The nurse in the outpatient procedure unit is caring for a client immediately post bronchoscopy. Which
assessment data indicate that the nurse needs to contact the health care provider immediately?
A. Absence of gag reflex
B. Bright red blood tinged sputum
C. Headache
D. Respirations 10/min and saturation of 92%

32. A client is admitted with an exacerbation of asthma following a respiratory viral illness. Which clinical
manifestations characteristics of a severe asthma attack does the nurse expect to assess? (select all that
apply)
A. Accessory muscle use
B. Chest tightness
C. Prolonged inspiration phase
D. Tachypnea

33. A client with Alzheimer disease is found slumped over the lunch tray on the bedside table, coughing
violently with emesis visible in the back of the throat. The client has a pulse of 135/min, respirations 32/min,
and oxygen saturation 84%. Place the nurse’s actions while awaiting the arrival of the rapid response team
in priority order. All options must be used.
1. Place client in high Fowler’s position
2. Perform oropharyngeal suctioning
3. Administer 100% oxygen by nonrebreather mask
4. Assess lung sounds
5. Notify the primary health care provider (HCP)
A. 13452
B. 41235
C. 12345
D. 23451

34. An unresponsive client is brought to the emergency department following a fraternity party. Friends report
that the client drank beer, may have taken some kind of pills, and then passed out. Blood pressure is 90/62
mmHg., pulse 64/min, and respirations are 8/min. Which priority action is expected to be taken following the
initial assessment?
A. Administer intravenous (IV) flumazenil
B. Administer IV naloxone
C. Administer ringer’s lactate at 125 mL/hr
D. Draws blood for toxicology and blood alcohol content (BAC) test

35. The nurse is giving report at the end of shift to the incoming nurse at 1900. A client was admitted with
pneumonia that morning. Which information is most important for the nurse to communicate about the
client during the change of shift report (hand-off)?
A. Chest x-ray showed left lobe infiltrate and while blood cell count of 14,000/mm3
B. Client’s spouse was rude to the nurse earlier
C. Current respirations are 24/min; pulse oximetry is 93% on 2 L/min
D. Intravenous (IV) line has been infusing without complications

36. A client got sick shortly after a snowstorm knocked out electrical power to the house 3 days ago. The client
has been weak and tired and unable to leave the house or go to work. The client reports a continual dull
headache, nausea, dizziness, and shortness of breath. Which question would be most helpful for the nurse
to ask while completing the history?
A. “Did you get influenza (flu) vaccine this year?”
B. “Have you ever experienced seasonal affective disorder in the winter?”
C. “How have you heated your house and stayed warm since the power went out?”
D. “What do you do for a living?”
37. The nurse is caring for a client with a chest tube to evacuate a hemo-pneumothorax after a motor vehicle
accident. The drainage has been consistently 25-50 mL/hr for the majority of the shift. However, over the
past 2 hours there has been no drainage. Which actions should the nurse take? (select all that apply)
A. Auscultate breath sounds
B. Increase amount of suction
C. Instruct client to cough and deep breath
D. Milk the chest tube

38. The charge nurse evaluates the care provided by a new registered nurse (RN) for a client receiving
mechanical ventilation (MV). Which action by the new RN indicates the need for further education?
A. Administer morphine to relieve anxiety and restlessness
B. Applies suction when inserting the catheter into the airway
C. Increases the oxygen concentration on the MV before suctioning
D. Suctions when MV high pressure alarm continues to sound and rhonchi are present

39. A home health nurse is caring for a client with progressive chronic obstructive pulmonary disease (COPD).
The client complains that food does not taste right and that this bloating, exhaustion, and shortness of
breath after meals make them not worth the effort. The client’s wife says that he has lost 10 lb (4.3 kg) in the
past 3 months and asks what will help him eat better. Which statements made by the nurse can help
improve the client’s nutritional status? (select all that apply)
A. “Have him brush his teeth and rinse his mouth before eating.”
B. “Have him drink fluids at the end of a meal, not with it.”
C. “Have him exercise by walking for 10 minutes before each meal.”
D. “Increase his intake of vegetables high in vitamin C such as broccoli and red cabbage.”

40. The charge nurse of the emergency department (ED) is mentoring a new registered nurse (RN). They are
caring for a client who has a chest tube connected to wall suction for pneumothorax. The client is being
transferred from the ED to the telemetry unit. Which action by the new RN would cause the charge nurse to
intervene?
A. Clamping the chest tube at the insertion site during the transfer
B. Disconnecting the suction tubing from the wall suction unit
C. Hanging the chest tube collection unit to the underside of the stretcher
D. Taping connections between the chest tube and suction tubing

41. The nurse is assisting the health care provider (HCP) with a client’s chest tube removal. Just as the HCP
prepares to pull the chest tube, what instructions should the nurse give the client?
A. “Breath as you normally would.”
B. “Inhale and exhale slowly.”
C. “Take a breath in, hold it and bear down.”
D. “Take rapid shallow breaths, similar to panting.”

42. The home care nurse is making an initial visit to a client just discharged after admission for severe
exacerbation of chronic obstructive pulmonary disease (COPD). The nurse observes wall to wall stacks of
old newspapers and magazines in every room, with pathways that just allow passage from one room to
another. What is the priority nursing action?
A. Call the mobile community mental health crisis unit
B. Contact a service to remove the newspapers and magazines
C. Reconcile the client’s discharge medications
D. Teach the safe use of oxygen

43. An elderly client with emphysema comes for a routine follow up visit. When performing the initial
assessment, what manifestations and/or information does the nurse assess as most characteristics of
emphysema? (select all that apply)
A. Barrel chest
B. Bilateral coarse crackles
C. Decreased activity tolerance
D. Diminished breath sounds
44. An elderly client with oxygen dependent chronic obstructive pulmonary disease (COPD) is admitted for
pneumonia. The client is “do not resuscitate” (DNR), and the nurse is concerned that the client will soon
developed respiratory failure as breathing is becoming shallow and the client is looking exhausted. Which is
the most appropriate intervention to include in the plan of care?
A. Administer morphine to decrease air hunger
B. Call the health care provider (HCP) for possible intubation
C. Promote relaxation through music and distraction
D. Titrate oxygen to maintain an oxygen saturation ≥93%

45. A client with obesity is diagnosed with pulmonary embolism (PE). Which assessment data would the nurse
expect to find? (select all that apply)
A. Bradycardia
B. Chest pain
C. Tachypnea
D. Tracheal deviation

46. A nurse on the medical surgical unit has just received report. Which client should be seen first?
A. Client 1-day post femoral-popliteal bypass grafting who has an intravenous (IV) antibiotic due now
B. Client diagnosed with deep venous thrombosis (DVT) yesterday who reports some chest discomfort and
cough
C. Client with hypertension and blood pressure of 180/92 mmHg who reports a headache
D. Client on fall precautions who just called the nurses’ station for assistance in using the bathroom
immediately

47. The home health nurses visit a 72-year-old client with pneumonia who was discharged from the hospital 3
days ago. The client has less of a productive cough at night but now reports sharp chest pain with
inspiration. Which finding is most important for the nurse to report to the health care provider?
A. Bronchial breath sounds
B. Increased tactile fremitus
C. Low pitched wheezing (rhonchi)
D. Pleural friction rub

48. When an unlicensed assistive personnel (UAP) assists a client with a chest tube back to bed from the
bedside commode, the plastic chest drainage unit accidentally falls over and cracks. The UAP immediately
reports this incident to the nurse. What is the nurse’s immediate action?
A. Clamp the tube to the client’s chest until a new chest drainage unit is setup
B. Notify the health care provider (HCP)
C. Place the distal end of the chest tube into a bottle of sterile saline
D. Position the client on the left side

49. The office nurse instructs a client newly diagnosed with asthma about the use of the peak flow meter to
evaluate airflow. Which statement made by the client indicates an understanding of the nurse’s teaching?
A. “I will exhale as quickly and forcibly as possible through the mouth piece of the device to obtain a peak
flow reading.”
B. “I will move the indicator to the desired reading on the numbered scale before using the device.”
C. “I will record my personal best reading, which is the average of 3 consecutive peak flow readings.”
D. “I will remember to use the device after taking my fluticasone metered dose inhaler (MDI).”

50. The registered nurse (RN) is caring for an elderly client with chronic obstructive pulmonary disease (COPD)
whose pulse oximeter shows 91% on room air. After physical therapy, the client reports feeling “short of
breath and exhausted” to the student nurse and says he just wants to sleep. To provide comfort, the student
nurse initiates the prn nasal oxygen to maintain a saturation ≥92%, as prescribed. When the RN conducts
end of shift rounds 3 hours later, the client is still sleeping soundly and the pulse oximeter shows 91%. Which
nursing action is most appropriate at this time?
A. Check a full set of vital signs
B. Continue to monitor
C. Increase the oxygen flow by 1 L/min
D. Remove the nasal oxygen and measure saturation
51. An elderly client with a history of stable chronic obstructive pulmonary disease (COPD), alcohol abuse, and
cirrhosis has a serum theophylline level of 25.8 mcg/mL. Which clinical manifestation associated with
theophylline toxicity should worry the nurse most?
A. Alteration in color vision
B. Gum (gingival) hypertrophy
C. Hyperthermia
D. Seizure activity

52. The nurse is caring for a client who was in a motor vehicle collision. The client had a chest tube inserted to
evacuate a pneumothorax caused by fractured ribs. In which chamber should the nurse observe the air
leak? Check on the picture above for additional information.
A. Chamber A
B. Chamber B
C. Chamber C
D. Chamber D

53. The day nurse gets the following hand off report from the night nurse. The nurse should assess which client
first?
A. Client with cellulitis, medicated with hydromorphone intravenous (IV) 1 hour ago, reports pain of 6 on a
scale of 0-10
B. Client with chronic kidney disease (CKD) with hemoglobin 8 g/dL and hematocrit 24.4%, is short of
breath with activity
C. Client with heart failure and bilateral pleural effusion with serum sodium (Na) of 133 mEq/L, is schedule
for a thoracentesis this morning
D. Client with pneumonia and reactive airway disease, developed increased shortness of breath and high
pitched wheezing 10 minutes ago

54. An experienced licensed practical nurse (LPN) is assisted to care for a client who was admitted to the
medical unit last evening with a diagnosis of moderate asthma and an upper respiratory infection. Which of
the following nursing tasks are appropriate for the registered nurse (RN) to delegate to the LPN? (select all
that apply)
A. Administer albuterol metered inhaler (MDI) medication
B. Auscultating lung sounds to determine the client’s response to MDI medication
C. Checking oxygen saturation with the pulse oximeter
D. Measuring morning peak expiratory flow (PEF) with the client’s peak flow meter

55. A nurse on a medical surgical unit receives a report on multiple clients. Based on this report, which client
should the nurse assess first?
A. A client who underwent a colon resection 3 hours ago and is bleeding
B. A client who was rescued from a burning building and shows evidence of some inhalation
C. A client with gastroenteritis who is throwing up large amounts of vomit
D. A client with peritonitis who has pain level of “8” on a scale from 1-10
56. The nurse provides to a community group about lung cancer prevention, health promotion, and smoke
cessation. Which statement made by a member of the group indicates the need for further instruction?
A. “Even though I am getting nicotine in my patches, I am not being exposed to all of the other toxic stuff
in cigarettes.”
B. “I can’t get lung cancer because I don’t smoke.”
C. “My husband needs to take smoking cessation classes.”
D. “We installed a radon detector in our home.”

57. A client is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD) and
pneumonia. Pulse oximetry is 92% with 3 L/min oxygen. The nurse assesses medium inspiratory crackles and
low pitched expiratory wheezing on auscultation, ineffective cough productive of small amounts of thick
yellow mucus, and shortness of breath. Which interventions would be most appropriate to include in the
plan of care for this client? (select all that apply)
A. Administer an intravenous corticosteroid drug
B. Administer an inhaled anticholinergic drug
C. Encourage 2-3 L/day oral fluids
D. Increase oxygen to 5 L/min

58. A client was admitted with intravenous morphine 2 mg 2 hours ago to relieve moderate abdominal pain
after appendectomy. The client becomes lethargic but arouses easily to verbal and tactile stimuli, and is
oriented to time, place, and person. The pulse oximeter reading has dropped from 99% to 89% on room air.
Which oxygen delivery device is the most appropriate for the nurse to apply?

A.

B.

C.

D.

59. The nurse is caring for a client with asthma exacerbation. Blood pressure is 146/6 mmHg, pulse is 110/min,
and respirations are 32/min. The respiratory therapist administers nebulized albuterol as prescribed. One
hour after the treatment, the nurse assesses which finding that indicates the drug is producing the
therapeutic effect?
A. Constricted pupils
B. Heart rate of 120/min
C. Respirations of 24/min
D. Tremor
60. A student nurse initiates oxygen with nonrebreather mask for a client with acute respiratory distress. While
assessing the client, the RN notices the reservoir bag is fully deflating on inspiration. What immediate action
does the RN take to correct the problem?
A. Elevates the head of the bed
B. Increase the oxygen flow
C. Opens both flutter valves (ports) on the mask
D. Tightens the face mask straps

61. The nurse is providing care for a client with cancer of the left lung who will undergo video assisted thoracic
surgery in the morning. After eating dinner, the client is nervous, jumpy, and short of breath. Pulse is 120/min,
respirations are 30/min and shallow, and expiratory wheezing is auscultated in the upper and lower lung
posteriorly. Which of the following is the priority nursing action?
A. Administer prescribed intravenous morphine 2 mg to relieve anxiety
B. Page respiratory therapist to administer inhaled bronchodilator nebulizer treatment
C. Place head of the bed in Fowler’s or high Fowler’s position
D. Stay with client and encourage client to discuss feelings about the surgery

62. The nurse prepares the client for discharge from the outpatient procedure unit after an endoscopic
bronchoscopy with bronchoalveolar lavage and lung biopsy. Which discharge/teaching instructions should
the nurse provide? (select all that apply)
A. “Do not smoke cigarettes for at least 24 hours.”
B. “Eat a soft diet for 24-48 hours.”
C. “Gargle with salt water to relieve hoarseness or sore throat.”
D. “You could cough up frank bloody sputum for about 24-48 hours.”

63. A client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia. The client is
restlessness. The nurse identifies a diagnosis of impaired gas exchange. Which intervention s most effective
in promoting adequate gas exchange?
A. Administer morphine
B. Administer oxygen using Venturi mask
C. Maintain normal saline infusion at prescribed rate of 125 mL/hr
D. Position head of bed in semi-Fowler’s position

64. The nurse performs the admission history for a 70-year-old client with newly diagnosed chronic obstructive
pulmonary disease (COPD). Which statements made by the client does the nurse recognize as the most
significant contributing factors to development of COPD? (select all that apply)
A. “I have been drinking alcohol almost daily since age 20.”
B. “I have been smoked about a pack of cigarettes a day since I was 16 years old but quit last year.”
C. “I know I eat too much fast food.”
D. “I was a car mechanic for about 40 years and had my own garage.”

65. The client has a chest tube for a pneumothorax. While repositioning the client for an x-ray, the technician
steps on the tubing and accidentally pulls the chest tube out. The client’s oxygen saturation drops and the
pulse is 132/min; the nurse hears air leaking from the insertion site. What is the nurse’s immediate action?
A. Apply an occlusive sterile dressing secured on 3 sides
B. Apply an occlusive sterile dressing secured on 4 slides
C. Assess lung sounds
D. Notify the health care provider HCP)

66. A client has chronic obstructive pulmonary disease (COPD) exacerbation. The pulse oximeters show a
saturation of 86% on room air. The nurse assesses diminished lung sounds and low pitched wheezing
posteriorly, shallow respirations, respiratory rate of 32/min, and use of accessory muscles. What is the most
appropriate oxygen delivery device for this client?
A. Nasal cannula
B. Non-rebreathering mask
C. Oxymizer
D. Venturi mask
67. The nurse cares for a client who returns from the operating room after tracheostomy tube placement
procedure. Which of the following is the nurse’s priority when caring for a client with a new tracheostomy?
A. Changing the inner cannula within the first 8 hours to help prevent mucus plugs
B. Checking the tightness of ties and adjusting if necessary, allowing 1 finger to fit under these ties
C. Deflating and re-inflating the cuff every 4 hours to prevent mucosal tissue damage
D. Performing frequent mouth care every 2 hours to help prevent infection

68. The nurse in the postanesthesia care unit (PACU) is caring for an unresponsive client who just came from the
operating room following surgery under general anesthetic for colorectal cancer. The nurse chooses what
as the highest priority nursing diagnosis (ND)?
A. Acute pain
B. Impaired physical mobility
C. Ineffective airway clearance
D. Risk for fluid volume deficit

69. The nurse assesses these symptoms in a client with bacterial pneumonia; chills, elevated temperature,
tachypnea, productive cough of yellow sputum, shortness of breath, and fatigue. Based on the assessment
data, what is the most appropriate nursing diagnosis (ND) for this client?
A. Impaired gas exchange
B. Impaired spontaneous ventilation
C. Ineffective breathing pattern
D. Risk for infection

70. The nurse is caring for a client who has been receiving mechanical ventilation (MV) for 4 days. During
multidisciplinary morning rounds, the health care provider questions the development of a ventilator
associated pneumonia (VAP). Which of the following manifestations does the nurse assess as the best
indicator of VAP?
A. Blood tinged sputum
B. Positive blood cultures
C. Positive, purulent sputum culture
D. Rhonchi and crackles

71. An 86-year-old client with diabetes and gastroparesis has had repeated hospitalizations for aspiration
pneumonia following a stroke and is now hospitalized with altered level of consciousness. Which nursing
action is most appropriate to decrease the client’s risk for developing aspiration pneumonia?
A. Assessing client’s breath sounds every 2 hours
B. Placing client in the side lying position in bed
C. Titrating client’s oxygen to maintain saturation ≥93%
D. Turning and repositioning the client every 2 hours

72. The public health nurse provides care for a client on a directly observed therapy (DOT) program to
tuberculosis. Which option best describes the care the nurse provides on this program?
A. Follow the client until 3 sputum cultures are normal
B. Gives the client bus tokens or cab fare voucher to attend schedule clinic visits
C. Provides and watches the client swallow every prescribed medication
D. Screens all of the client’s contacts

73. Which client in the emergency department should the nurse see first?
A. 2-year-old with fever and sore throat who is restless and drooling
B. 7-year-old with appendicitis who has right lower quadrant pain and vomiting
C. 9-year-old with immune thrombocytopenia who has generalized petechiae
D. 17-year-old with cystic fibrosis who is coughing up thick blood tinged sputum

74. Which client is at greatest risk for pulmonary embolism?

A. A client 6 hours postoperative cesarean section
B. A client in atrial fibrillation
C. A client with a subdural hematoma
D. A client with pneumonia
75. The nurse assesses a client with a history of cystic fibrosis who is admitted due to a pulmonary exacerbation.
Which assessment finding requires immediate action by the nurse?
A. Decrease in SpO2 from baseline 92% to 88% on room air
B. Expectorating blood tinged sputum
C. Loss appetite and recent 5 lbs. weight loss
D. No bowel movement for 2 days and right lower quadrant discomfort

76. An obese 85-year-old client, who is an avid gardener and eats only home grown fruits, legumes, and
vegetables, is admitted to the hospital with pneumonia after having an upper respiratory tract infection for
a week. Which factor puts the client at greatest risk for developing pneumonia?
A. Advanced age
B. Environmental exposure
C. Nutritional deficit
D. Obesity

77. The nurse receives a report on 4 clients. Which client should the nurse assess first?
A. A 29-year-old heroin user admitted for arm cellulitis 24 hours ago has abdominal cramps and is restless
B. A 34-year-old admitted with femur fracture 24 hours ago is confused and has SpO 2 of 91%
C. A 65-year-old admitted with serum sodium of 125 mEq/L 8 hours ago is confused
D. A 78-year-old admitted for urinary tract infection 6 hours ago is disoriented to time and place

78. The nurse is planning care for a client being admitted with newly diagnosed quadriplegia(tetraplegia).
Which intervention will the nurse prioritize?
A. Assess vital capacity and tidal volume once per shift and PRN
B. Perform passive range of motion exercise on affected joints every 4 hours
C. Provide time during each shift for the client to express feelings
D. Turn the client every 2 hours throughout the day and night

79. The nurse receives change of shift report on 4 clients Which client should the nurse assess first?
A. 6-month-old with respiratory syncytial virus and pulse oximetry of 90%
B. 1-year-old with otitis media and a temperature of 102.5 F (39.2 C rectally
C. 2-year-old with suspected epiglottitis
D. 3-year-old who has a barking-type cough

80. The nurse is caring for a client on a mechanical ventilator. The setting on the ventilator have just been
changed and the standing prescription is to draw arterial blood gas 30 minutes after a ventilator change. In
anticipation of this blood draw, what intervention should the nurse implement?
A. Avoid suctioning the client
B. Pre-oxygenate the client
C. Raise the head of the bed
D. Reduce the amount of sedation medication

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