1. 1.

Question
1 point(s)
Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma.
When teaching the patient about this drug, the nurse should explain that it may cause:
o A. Nasal congestion
o B. Nervousness
o C. Lethargy
o D. Hyperkalemia
Correct
Correct Answer: B. Nervousness
Albuterol may cause nervousness. The primary adverse effects of albuterol therapy are
tremors and nervousness, mostly seen in children who are 2 to 6 years of age, though can be
seen at any age. Tremors are the result of activation of the beta-2 receptors found on the
motor nerve terminals which increases intracellular cAMP. These side effects occur in
approximately one in every five patients. Other adverse effects of albuterol include tremor,
dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and
muscle cramps.
 Option A: The inhaled form of the drug may cause dryness and irritation of
the nose and throat, not nasal congestion. Monitoring parameters for albuterol
include forced expiratory volume, peak flow, blood pressure, heart rate, central
nervous system stimulation, serum potassium, serum glucose, and asthma
symptoms.
 Option C: Other side effects include insomnia and nausea, which occur in
approximately 1 in every ten patients. Less common adverse effects may
include fever, bronchospasm, vomiting, headache, dizziness, cough, allergic
reactions, otitis media, epistaxis, increased appetite, urinary tract infections,
dry mouth, gas, hyperhidrosis, pain, dyspepsia, hyperactivity, chills,
lymphadenopathy, ocular pruritus, sweating, conjunctivitis, and dysphonia.
 Option D: Albuterol also has been shown to increase blood pressure and may
cause hypokalemia. Increased blood glucose concentrations and prolonged
QTc interval and ST-segment depression have occurred, although rarely.
2. 2. Question
1 point(s)
Miriam, a college student with acute rhinitis sees the campus nurse because of excessive
nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis,
nasal drainage normally is:
o A. Yellow
 o B. Green
o C. Clear
o D. Gray
Correct
Correct Answer: C. Clear
Normally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically reveals
swelling of the nasal mucosa and thin, clear secretions. The inferior turbinates may take on a
bluish hue, and cobblestoning of the nasal mucosa may be present. On physical examination,
clinicians may notice mouth breathing, frequent sniffling and/or throat clearing, transverse
supra-tip nasal crease, and dark circles under the eyes (allergic shiners).
 Option A: Yellow drainage indicates spread of the infection to the sinuses.
Yellow mucus is a sign that whatever virus or infection the client has is taking
hold. The body is fighting back. The yellow color comes from the cells —
white blood cells, for example — rushing to kill the offending germs. Once
the cells have done their work, they’re discarded in the drainage and tinge it a
yellowish-brown.
 Option B: Green drainage may also indicate infection. If the immune system
kicks into high gear to fight infection, the drainage may turn green and
become especially thick. The color comes from dead white blood cells and
other waste products. Some sinus infections may be viral, not bacterial.
 Option D: Gray drainage may indicate a secondary infection. This could be a
fungal sinus infection. These are different from viral or bacterial infections
because the fungi feeds on the nasal tissue—and reproduces. Fungal sinus
infections may occur due to a previous nasal injury or long-term nasal
inflammation, as well as a weakened immune system. Growths called “fungus
balls” develop in the cheek sinus as clumps of fungal spores. The fungus balls
must be removed by surgery.
3. 3. Question
1 point(s)
A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory
alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
o A. Nausea or vomiting
o B. Abdominal pain or diarrhea
o C. Hallucinations or tinnitus
o D. Lightheadedness or paresthesia
Correct
Correct Answer: D. Lightheadedness or paresthesia
The patient with respiratory alkalosis may complain of lightheadedness or paresthesia
(numbness and tingling in the arms and legs). The exact history and physical exam findings
are highly variable as there are many pathologies that induce the pH disturbance. These may
include acute onset dyspnea, fever, chills, peripheral edema, orthopnea, weakness, confusion,
light-headedness, dizziness, anxiety, chest pain, wheezing, hemoptysis, trauma, history of
central line catheter, recent surgery, history of thromboembolic disease, history of asthma,
history of COPD, acute focal neurological signs, numbness, paresthesia, abdominal pain,
nausea, vomiting, tinnitus, or weight loss.
 Option A: Nausea, vomiting, abdominal pain, and diarrhea may accompany
respiratory acidosis. Following a performance predominantly relying on
anaerobic glycolysis, systemic acidosis may cause vomiting as a physiological
response to drain H + and thereby allow the stomach to add bicarbonate to the
body
 Option B: Hyperchloremic acidosis is caused by the loss of too much sodium
bicarbonate from the body, which can happen with severe diarrhea. In
pathologies with profuse watery diarrhea, bicarbonate within the intestines is
lost through the stool due to increased motility of the gut. This leads to further
secretion of bicarbonate from the pancreas and intestinal mucosa, leading to
net acidification of the blood from bicarbonate loss.
 Option C: Hallucinations and tinnitus are associated with respiratory alkalosis
or any other acid-base imbalance. Respiratory alkalosis in itself is not life-
threatening; however, the underlying etiology may be. Always look for and
treat the source of the illness. Interventions to reduce pH directly are typically
not necessary as there is no mortality benefit to this therapy.
4. 4. Question
1 point(s)
Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of
ephedrine’s central nervous system (CNS) effects, it is not recommended for:
o A. Patients with an acute asthma attack.
o B. Patients with narcolepsy.
o C. Patients under age
o D. Elderly patients.
Correct
Correct Answer: D. Elderly patients
Ephedrine is not recommended for elderly patients, who are particularly susceptible to CNS
reactions (such as confusion and anxiety) and to cardiovascular reactions (such as increased
systolic blood pressure, coldness in the extremities, and anginal pain). Ephedrine is also
arrhythmogenic, and caution should be used during administration to patients who are
predisposed to arrhythmias or taking other arrhythmogenic medications, particularly digitalis.
  Option A: Ephedrine is used for its bronchodilator effects with acute and
chronic asthma. Oral formulations of ephedrine have been used historically to
treat asthma via pulmonary vasoconstriction and reduction in airway edema
along with beta-induced bronchodilation, but it is rarely used for this purpose
in modern medicine due to unwanted cardiac effects and availability of more
selective beta-agonists such as albuterol.
 Option B: Ephedrine is used occasionally for its CNS stimulant actions for
narcolepsy. Ephedrine acts as both a direct and indirect sympathomimetic. It
binds directly to both alpha and beta receptors; however, its primary mode of
action is achieved indirectly, by inhibiting neuronal norepinephrine reuptake
and by displacing more norepinephrine from storage vesicles. This action
allows norepinephrine to be present in the synapse longer to bind postsynaptic
alpha and beta receptors.
 Option C: It can be administered to children age 2 and older. The FDA has
not formally established safety and effectiveness in pediatric populations.
Additionally, ephedrine is distributed by the manufacturer in 50mg/mL vials
and requires dilution before intravenous use.
5. 5. Question
1 point(s)
A female patient suffers acute respiratory distress syndrome as a consequence of shock. The
patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical
ventilation are initiated. When the high-pressure alarm on the mechanical ventilator, alarm
sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure
alarm?
o A. Kinking of the ventilator tubing.
o B. A disconnected ventilator tube.
o C. An endotracheal cuff leak.
o D. A change in the oxygen concentration without resetting the oxygen level
alarm.
Correct
Correct Answer: A. Kinking of the ventilator tubing.
Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing,
bronchospasm or pulmonary embolism, mucus plugging, water in the tube, coughing or
biting on endotracheal tube, and the patient’s being out of breathing rhythm with the
ventilator. If an alarm occurs, the caregiver should always evaluate the patient before
checking the ventilator.
 Option B: A disconnected ventilator tube would trigger the low-pressure
alarm. If the pressure inside the breathing circuit drops below the Low Airway
 Pressure Alarm limit set on the ventilator, an audible and/or visual alarm
activates.
 Option C: Some causes for low-pressure alarms are: the patient becomes
disconnected from the ventilator circuit; inadequate inflation of the
tracheostomy tube cuff; poorly fitting noninvasive masks or nasal
pillows/prongs; loose circuit and tubing connections; or the patient demands
higher levels of air than the ventilator is putting out.
 Option D: Changing the oxygen concentration without resetting the oxygen
level alarm would trigger the oxygen alarm. Oxygen concentration is the
amount of oxygen delivered to the patient. When the patient is not receiving
added oxygen, the oxygen level will be the same as room air (21%).
6. 6. Question
1 point(s)
A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon),
0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another
pancuronium dose?
1. Leg movement
o A. Leg movement
o B. Finger movement
o C. Lip movement
o D. Fighting the ventilator
Correct
Correct Answer: D. Fighting the ventilator
Pancuronium, a non-depolarizing blocking agent, is used for muscle relaxation and paralysis.
It assists mechanical ventilation by promoting endotracheal intubation and paralyzing the
patient so that the mechanical ventilator can do its work. Fighting the ventilator is a sign that
the patient needs another pancuronium dose. The nurse should administer 0.01 to 0.02 mg/kg
I.V. every 20 to 60 minutes. Movement of the legs, or lips has no effect on the ventilator and
therefore is not used to determine the need for another dose.
 Option A: Leg movement is not used as an indication for another dose.
Pancuronium bromide is a long-acting, bis-quaternary aminosteroid, non-
depolarizing, neuromuscular blocking drug (NMBD), which was first
synthesized in 1964 and found to possess fewer adverse effects with regards to
hemodynamic stability and histamine release as compared to the prototypical
NMBD, d-tubocurarine.
 Option B: Finger movement does not determine if the client needs another
dose. Pancuronium administration is by intravenous bolus. A continuous IV
infusion may be a consideration in the management of critically ill patients.
  Option C: Lip movement does not indicate that the patient needs another
dose. The typical intubating dose is 0.1 mg/kg with a 3 to 5-minute onset to
maximal muscle relaxation. The 95% effective dose is 0.07 mg/kg. There is a
60- to the 90-minute duration of action (return to 25% of control twitches)
with a typical intubating dose. Maintenance of neuromuscular blockade is
possible with a dose of 0.02 mg/kg, titrated to the level of blockade.
7. 7. Question
1 point(s)
On auscultation, which finding suggests a right pneumothorax?
o A. Bilateral inspiratory and expiratory crackles.
o B. Absence of breaths sound in the right thorax.
o C. Inspiratory wheezes in the right thorax.
o D. Bilateral pleural friction rub.
Correct
Correct Answer: B. Absence of breaths sound in the right thorax
In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore,
breath sounds in the affected lung field are absent. A pneumothorax is defined as a collection
of air outside the lung but within the pleural cavity. It occurs when air accumulates between
the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on
the lung and make it collapse. The degree of collapse determines the clinical presentation of
pneumothorax. None of the other options are associated with pneumothorax.
 Option A: Bilateral crackles may result from pulmonary congestion.
Pneumonia is an infection in the lungs. It may be in one or both lungs. The
infection causes air sacs in the lungs to become pus-filled and inflamed. This
causes a cough, difficulty breathing, and crackles. Pneumonia may be mild or
life-threatening.
 Option C: Inspiratory wheezes may signal asthma. Asthma is a heterogeneous
syndrome characterized by variable, reversible airway obstruction and
abnormally increased responsiveness (hyperreactivity) of the airways to
various stimuli. The syndrome is characterized by wheezing, chest tightness,
dyspnea, and/or cough, and results from widespread contraction of
tracheobronchial smooth muscle (bronchoconstriction), hypersecretion of
mucus, and mucosal edema, all of which narrow the caliber of the airways.
 Option D: A pleural friction rub may indicate pleural inflammation.
Auscultation of a pleural friction rub can occur when the normally smooth
surfaces of the visceral and parietal pleura become roughened by
inflammation. A pleural friction rub is an adventitious breath sound heard on
auscultation of the lung. The pleural rub sound results from the movement of
inflamed and roughened pleural surfaces against one another during
 movement of the chest wall. This sound is non-musical, and described as
“grating,” “creaky,” or “the sound made by walking on fresh snow.”
8. 8. Question
1 point(s)
Rhea, confused and short breath, is brought to the emergency department by a family
member. The medical history reveals chronic bronchitis and hypertension. To learn more
about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas
(ABG) analysis. When reviewing the ABG report, the nurses see many abbreviations. What
does a lowercase “a” in ABG value present?
o A. Acid-base balance
o B. Arterial Blood
o C. Arterial oxygen saturation
o D. Alveoli
Incorrect
Correct Answer: B. Arterial Blood
A lowercase “a” in an ABG value represents arterial blood. For instance, the abbreviation
PaO2 refers to the partial pressure of oxygen in arterial blood. Arterial blood gas analysis can
be used to assess gas exchange and acid base status as well as to provide immediate
information about electrolytes.
 Option A: The pH value reflects the acid-base balance in arterial blood. pH is
a logarithmic scale of the concentration of hydrogen ions in a solution. It is
inversely proportional to the concentration of hydrogen ions. When a solution
becomes more acidic the concentration of hydrogen ions increases and the pH
falls.
 Option C: Sa02 indicates arterial oxygen saturation. Oxygen saturation
(SaO2) is a measurement of the percentage of how much hemoglobin is
saturated with oxygen. Oxygen is transported in the blood in two ways:
oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin
(SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved
in plasma.
 Option D: An uppercase “A” represents alveolar conditions: for example,
PA02 indicates the partial pressure of oxygen in the alveoli. Partial pressure of
oxygen (PaO2). This measures the pressure of oxygen dissolved in the blood
and how well oxygen is able to move from the airspace of the lungs into the
blood.
9. 9. Question
1 point(s)
A male patient is admitted to the healthcare facility for treatment of chronic obstructive
pulmonary disease. Which nursing diagnosis is most important for this patient?
o A. Activity intolerance related to fatigue.
o B. Anxiety related to actual threat to health status.
o C. Risk for infection related to retained secretions.
o D. Impaired gas exchange related to airflow obstruction.
Correct
Correct Answer: D. Impaired gas exchange related to airflow obstruction.
A patient airway and an adequate breathing pattern are the top priority for any patient,
making “impaired gas exchange related to airflow obstruction” the most important nursing
diagnosis. Monitor O2 saturation and titrate oxygen to maintain Sp02 between 88% to 92%.
Pulse oximetry reading of 87% below may indicate the need for oxygen administration while
a pulse oximetry reading of 92% or higher may require oxygen titration. The other options
also may apply to this patient but less important.
 Option A: Patients with COPD experience progressive activity and exercise
intolerance. Evaluation of the patient’s activity tolerance and limitations helps
create strategies to promote independent ADLs. Assess the patient’s
respiratory response to activity which includes monitoring of respiratory rate
and depth, oxygen saturation, and use of accessory muscles for respiration.
 Option B: Ineffective Coping may be related to decreased socialization,
depression, anxiety, and inability to work. Provide instructions for self-
management of COPD. Assessment of the patient’s knowledge and including
family members about the therapeutic regimen increases adherence to
treatment regimen.
 Option C: Respiratory infections that are minor in nature may be threatening
to people with COPD. Bronchopulmonary infections must be controlled or
prevented to diminish inflammatory edema. Review the importance of
breathing exercises, effective cough, frequent position changes, and adequate
fluid intake.
10. 10. Question
1 point(s)
Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will
deviate toward the:
o A. Contralateral side in a simple pneumothorax.
o B. Affected side in a hemothorax.
o C. Affected side in a tension pneumothorax.
o D. Contralateral side in hemothorax.
Incorrect
Correct Answer: D. Contralateral side in hemothorax.
The trachea will shift according to the pressure gradients within the thoracic cavity. If there is
no significant air or fluid accumulation, the trachea will not shift. The pressure gradient
inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is
negative when compared to atmospheric pressure. When the chest wall expands outwards, the
lung also expands outwards due to surface tension between parietal and visceral pleura.
 Option A: Tracheal deviation toward the contralateral side in simple
pneumothorax is seen when the thoracic contents shift in response to the
release of normal thoracic pressure gradients on the injured side. When there is
communication between the alveoli and the pleural space, air fills this space
changing the gradient, lung collapse unit equilibrium is achieved, or the
rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this
vital capacity, and oxygen partial pressure decreases.
 Option B: In hemothorax, accumulation of air or fluid causes a shift away
from the injured side. Traumatic pneumothorax can result from blunt or
penetrating trauma, these often create a one-way valve in the pleural space
(letting the airflow in but not to flow out) and hence hemodynamic
compromise.
 Option C: A tension pneumothorax can cause severe hypotension (obstructive
shock) and even death. An increase in central venous pressure can result in
distended neck veins, hypotension. Patients may have tachypnea, dyspnea,
tachycardia, and hypoxia.
11. 11. Question
1 point(s)
After undergoing a left pneumonectomy, a female patient has a chest tube in place for
drainage. When caring for this patient, the nurse must:
o A. Monitor fluctuations in the water-seal chamber.
o B. Clamp the chest tube once every shift.
o C. Encourage coughing and deep breathing.
o D. Milk the chest tube every 2 hours.
Incorrect
Correct Answer: C. Encourage coughing and deep breathing
When caring for a patient who is recovering from a pneumonectomy, the nurse should
encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. Assist
the patient with splinting painful areas when coughing, deep breathing. Supporting chest and
abdominal muscles makes coughing more effective and less traumatic.
  Option A: Because the lung has been removed, the water-seal chamber should
display no fluctuations. Bubbling during expiration reflects venting of
pneumothorax (desired action). Bubbling usually decreases as the lung
expands or may occur only during expiration or coughing as the pleural space
diminishes. The absence of bubbling may indicate complete lung re-expansion
(normal) or represent complications such as an obstruction in the tube.
 Option B: Reinflation is not the purpose of a chest tube. Know the location of
air leak (patient- or system-centered) by clamping thoracic catheter just distal
to exit from the chest. If bubbling stops when the catheter is clamped at the
insertion site, leak is patient-centered (at the insertion site or within the
patient).
 Option D: Chest tube milking is controversial and should be done only to
remove blood clots that obstruct the flow of drainage. Although routine
stripping is not recommended, it may be necessary occasionally to maintain
drainage in the presence of fresh bleeding, large blood clots, or purulent
exudate (empyema).
12. 12. Question
1 point(s)
When caring for a male patient who has just had a total laryngectomy, the nurse should plan
to:
o A. Encourage oral feeding as soon as possible.
o B. Develop an alternative communication method.
o C. Keep the tracheostomy cuff fully inflated.
o D. Keep the patient flat in bed.
Correct
Correct Answer: B. Develop an alternative communication method.
A patient with a laryngectomy cannot speak, yet still needs to communicate. Therefore, the
nurse should plan to develop an alternative communication method. Assess the effectiveness
of nonverbal communication methods. The client may use hand signals, facial expressions,
and changes in body posture to communicate with others. However, others may have
difficulty in interpreting these nonverbal techniques. Each new method needs to be assessed
for effectiveness and altered as necessary.
 Option A: After a laryngectomy, edema interferes with the ability to swallow
and necessitates tube (enteral) feedings. Typically most patients wait a
minimum of 7 days following total laryngectomy before oral feeding is
started. 84% of 141 American surgeons reported that they waited until after
the seventh postoperative day in a questionnaire survey by Boyce and Meyers
in 1989. However, periods of up to three weeks were reported. The choice
 often depends on the surgeon’s experience and preference and on the patient’s
comorbidities and tumor characteristics.
 Option C: To prevent injury to the tracheal mucosa, the nurse should deflate
the tracheostomy cuff or use the minimal leak technique. Cuff should be
deflated if the patient uses a speaking valve. Cuff should be inflated just
enough to allow minimal air leak.
 Option D: To decrease edema, the nurse should place the patient in semi-
Fowler’s position. Early complications after total laryngectomy include
bleeding, postoperative edema, and airway compromise. These, especially in
the immediate postoperative, should be carefully monitored. Administration of
corticosteroids is recommended to minimize postoperative edema and airway
compromise.
13. 13. Question
1 point(s)
A male patient has a sucking stab wound to the chest. Which action should the nurse
take first?
o A. Drawing blood for a hematocrit and hemoglobin level.
o B. Applying a dressing over the wound and taping it on three sides.
o C. Preparing a chest tube insertion tray.
o D. Preparing to start an I.V. line.
Correct
Correct Answer: B. Applying a dressing over the wound and taping it on three sides.
The nurse immediately should apply a dressing over the stab wound and tape it on three sides
to allow air to escape and to prevent tension pneumothorax (which is more life-threatening
than an open chest wound). The nurse may use a first aid device called a chest seal or
improvise with the packaging sterile dressings coming in. Peel open the packaging and tape
the entire plastic portion over the wound.Only after covering and taping the wound should the
nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.
 Option A: Initial assessment to determine whether the patient is stable or
unstable dictates further evaluation. If the patient is hemodynamically unstable
and in acute respiratory failure, bedside ultrasound should be performed to
confirm the diagnosis if it is available for immediate use. When a patient is
hemodynamically stable, radiographic evaluation is recommended. The initial
assessment is with a chest radiograph (CXR) to confirm the diagnosis.
 Option C: Chest tubes are usually managed by experienced nurses,
respiratory therapists, surgeons, and ICU physicians. In 90% of the cases, a
chest tube is sufficient; however, there are certain cases where surgical
interventions are required, and that can either be video-assisted thoracoscopic
surgery (VATS) or thoracotomy.
  Option D: Tension and traumatic pneumothoraces are usually managed in the
emergency department or the intensive care unit. Management strategies
depend on the hemodynamic stability of the patient. In any patient presenting
with chest trauma, airway, breathing, and circulation should be assessed.
14. 14. Question
1 point(s)
For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing
action best promotes adequate gas exchange?
o A. Encouraging the patient to drink three glasses of fluid daily.
o B. Keeping the patient in semi-Fowler's position.
o C. Using a high-flow venturi mask to deliver oxygen as prescribed.
o D. Administering a sedative, as prescribed.
Correct
Correct Answer: C. Using a high-flow venturi mask to deliver oxygen as prescribe
The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the
medullary center in the brain. As a result, low oxygen levels in the blood stimulate
respiration, and administering unspecified, unmonitored amounts of oxygen may depress
ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to
deliver a specified, controlled amount of oxygen consistently and accurately.
 Option A: Drinking three glasses of fluid daily would not affect gas exchange
or be sufficient to liquefy secretions, which are common in COPD. Increase
fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or
tepid liquids. Recommend the intake of fluids between, instead of during,
meals. Hydration helps decrease the viscosity of secretions, facilitating
expectoration.
 Option B: Patients with COPD and respiratory distress should be placed in
high-Fowler’s position. Elevation of the head of the bed facilitates respiratory
function by use of gravity; however, the patient in severe distress will seek the
position that most eases breathing. Supporting arms and legs with table,
pillows, and so on helps reduce muscle fatigue and can aid chest expansion.
 Option D: They should not receive sedatives or other drugs that may further
depress the respiratory center. Assess the patient’s respiratory response to
activity which includes monitoring of respiratory rate and depth, oxygen
saturation, and use of accessory muscles for respiration. Patients with COPD
can experience hypoxia during increased activity and may need oxygenation to
avoid hypoxemia which puts them at risk for exacerbations of the condition.
15. 15. Question
1 point(s)
A male patient’s X-ray result reveals bilateral white-outs, indicating acute respiratory distress
syndrome (ARDS). This syndrome results from:
o A. Cardiogenic pulmonary edema
o B. Respiratory alkalosis
o C. Increased pulmonary capillary permeability
o D. Renal failure
Correct
Correct Answer: C. Increased pulmonary capillary permeability
ARDS results from increased pulmonary capillary permeability, which leads to
noncardiogenic pulmonary edema. ARDS is defined as an acute disorder that starts within 7
days of the inciting event and is characterized by bilateral lung infiltrates and severe
progressive hypoxemia in the absence of any evidence of cardiogenic pulmonary edema.
ARDS is defined by the patient’s oxygen in arterial blood (PaO2) to the fraction of the
oxygen in the inspired air (FiO2). These patients have a PaO2/FiO2 ratio of less than 300.
 Option A: In cardiogenic pulmonary edema, pulmonary congestion occurs
secondary to heart failure. The pulmonary epithelial and endothelial cellular
damage is characterized by inflammation, apoptosis, necrosis, and increased
alveolar-capillary permeability, which leads to the development of alveolar
edema and proteinosis. Alveolar edema, in turn, reduces gas exchange, leading
to hypoxemia.
 Option B: In the initial stage of ARDS, respiratory alkalosis may arise
secondary to hyperventilation; however, it does not cause ARDS. Segments of
the lung may be more severely affected, resulting in decreased regional lung
compliance, which classically involves the bases more than the apices. This
intrapulmonary differential in pathology results in a variant response to
oxygenation strategies.
 Option D: Renal failure does not cause ARDS, either. ARDS has many risk
factors. Besides pulmonary infection or aspiration, extra-pulmonary sources
include sepsis, trauma, massive transfusion, drowning, drug overdose, fat
embolism, inhalation of toxic fumes, and pancreatitis. These extra-thoracic
illnesses and/or injuries trigger an inflammatory cascade culminating in
pulmonary injury.
16. 16. Question
1 point(s)
For a female patient with chronic obstructive pulmonary disease, which nursing intervention
would help maintain a patent airway?
o A. Restricting fluid intake to 1,000 ml per day.
o B. Enforcing absolute bed rest.
 o C. Teaching the patient how to perform controlled coughing.
o D. Administering prescribed sedatives regularly and in large amounts.
Correct
Correct Answer: C. Teaching the patient how to perform controlled coughing.
Controlled coughing helps maintain a patent airway by helping to mobilize and remove
secretions. Cough can be persistent but ineffective, especially if the patient is elderly, acutely
ill, or debilitated. Coughing is most effective in an upright or in a head-down position after
chest percussion.
 Option A: A moderate fluid intake (usually 2 L or more daily) and moderate
activity help liquefy and mobilize secretions. Hydration helps decrease the
viscosity of secretions, facilitating expectoration. Using warm liquids may
decrease bronchospasm. Fluids during meals can increase gastric distension
and pressure on the diaphragm.
 Option B: Bed rest may limit the patient’s ability to maintain a patent airway,
causing a high risk for infection from pooled secretions. Assist the patient to
turn every 2 hours. If ambulatory, allow the patient to ambulate as tolerated.
Movement aids in mobilizing secretions to facilitate clearing of airways.
 Option D: Administer bronchodilators if prescribed. More aggressive
measures to maintain airway patency. Suction secretions as needed. Suctioning
clear secretions that obstruct the airway, therefore, improves oxygenation.
17. 17. Question
1 point(s)
Nurse Lei, caring for a client with a pneumothorax and who has had a chest tube inserted,
continues gentle bubbling in the suction control chamber. What action is appropriate?
o A. Do nothing, because this is an expected finding.
o B. Immediately clamp the chest tube and notify the physician.
o C. Check for an air leak because the bubbling should be intermittent.
o D. Increase the suction pressure so that the bubbling becomes vigorous.
Correct
Correct Answer: A. Do nothing, because this is an expected finding.
Continuous gentle bubbling should be noted in the suction control chamber. Bubbling during
expiration reflects venting of pneumothorax (desired action). Bubbling usually decreases as
the lung expands or may occur only during expiration or coughing as the pleural space
diminishes.
 Option B: Chest tubes should only be clamped to check for an air leak or
when changing drainage devices (according to agency policy). Clamp tubing
in stepwise fashion downward toward the drainage unit if air leak continues.
 Isolates location of a system-centered air leak.Note: Information indicates that
clamping for a suspected leak may be the only time that the chest tube should
be clamped.
 Option C: Bubbling should be continuous and not intermittent. Seal drainage
tubing connection sites securely with lengthwise tape or bands according to
established policy.Prevents and corrects air leaks at connector sites.
 Option D: Bubbling should be gentle. Increasing the suction pressure only
increases the rate of evaporation of water in the drainage system. Position
drainage system tubing for an optimal function like shorten tubing or coil extra
tubing on the bed, making sure tubing is not kinked or hanging below the
entrance to the drainage container. Drain accumulated fluid as necessary.
18. 18. Question
1 point(s)
Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors
the client and notes fluctuation of the fluid level in the water seal chamber after the tube is
inserted. Based on this assessment, which action would be appropriate?
o A. Inform the physician.
o B. Continue to monitor the client.
o C. Reinforce the occlusive dressing.
o D. Encourage the client to deep breathe.
Correct
Correct Answer: B. Continue to monitor the client.
The presence of fluctuation of the fluid level in the water seal chamber indicates a patent
drainage system. With normal breathing, the water level rises with inspiration and falls with
expiration. Fluctuation stops if the tube is obstructed, if a dependent loop exists, if the suction
is not working properly, or if the lung has re-expanded.
 Option A: Monitor water-seal chamber “tidaling.” Note whether the change is
transient or permanent. The water-seal chamber serves as an intrapleural
manometer (gauges intrapleural pressure); therefore, fluctuation (tidaling)
reflects pressure differences between inspiration and expiration.
 Option C: If the catheter is dislodged from the chest, cover insertion site
immediately with petrolatum dressing and apply firm pressure. Notify the
physician at once. Pneumothorax may recur, requiring prompt intervention to
prevent fatal pulmonary and circulatory impairment.
 Option D: Assist the patient with splinting painful areas when coughing, deep
breathing. Supporting chest and abdominal muscles makes coughing more
effective and less traumatic.
19. 19. Question
1 point(s)
Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest
tube accidentally disconnects. The initial nursing action is to:
o A. Call the physician.
o B. Place the tube in a bottle of sterile water.
o C. Immediately replace the chest tube system.
o D. Place a sterile dressing over the disconnection site.
Incorrect
Correct Answer: B. Place the tube in a bottle of sterile water.
If the chest drainage system is disconnected, the end of the tube is placed in a bottle of sterile
water held below the level of the chest. Anchor thoracic catheter to the chest wall and provide
an extra length of tubing before turning or moving the patient. Prevents thoracic catheter
dislodgement or tubing disconnection and reduces pain and discomfort associated with
pulling or jarring of tubing.
 Option A: The physician may need to be notified, but this is not the initial
action. Observe for signs of respiratory distress. If possible, reconnect thoracic
catheter to tubing or suction, using clean technique.
 Option C: The system is replaced if it breaks or cracks or if the collection
chamber is full. Pneumothorax may recur, requiring prompt intervention to
prevent fatal pulmonary and circulatory impairment.
 Option D: Placing a sterile dressing over the disconnection site will not
prevent complications resulting from the disconnection. If the catheter is
dislodged from the chest, cover the insertion site immediately with petrolatum
dressing and apply firm pressure. Notify the physician at once.
20. 20. Question
1 point(s)
A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct
the client to:
o A. Exhale slowly
o B. Stay very still
o C. Inhale and exhale quickly
o D. Perform the Valsalva maneuver
Incorrect
Correct Answer: D. Perform the Valsalva maneuver.
When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a
deep breath, exhale, and bear down). The tube is quickly withdrawn, and an airtight dressing
is taped in place. An alternative instruction is to ask the client to take a deep breath and hold
the breath while the tube is removed.
 Option A: The removal of the chest tube is usually performed quickly and
without sedation. The doctor will give specific instructions on how to breathe
when the tube is removed. In most cases, the chest tube will be removed as the
client is holding his breath. This ensures extra air doesn’t get into the lungs.
 Option B: Digital drainage systems have the advantage of accurately
measuring the presence of air leak and thereby eradicating interobserver
variability. These devices are gaining increasing popularity and are the subject
of ongoing research on tube thoracostomy management. Additionally, they
may play a useful role in younger pediatric patients who are unable to perform
forceful expiratory maneuvers or cough on demand; however, this possibility
has not yet been well studied.
 Option C: No air leak should be present—that is, no bubbling should be seen
in the air-leak chamber during forced expiratory maneuvers (eg, Valsalva
maneuver) or cough. The swing in the fluid level in the tube in the underwater
seal bottle should be minimal, relating to the normal negative pressures in the
chest during the phases of respiration.
21. 21. Question
1 point(s)
While changing the tapes on a tracheostomy tube, the male client coughs and the tube is
dislodged. The initial nursing action is to:
o A. Call the physician to reinsert the tube.
o B. Grasp the retention sutures to spread the opening.
o C. Call the respiratory therapy department to reinsert the tracheotomy.
o D. Cover the tracheostomy site with a sterile dressing to prevent infection.
Correct
Correct Answer: B. Grasp the retention sutures to spread the opening.
If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures
and spread the opening. The stay suture (if present) or tracheal dilator may be used to help
keep the stoma open if necessary. If agency policy permits, the nurse then attempts
immediately to replace the tube. Options A and C will delay treatment in this emergency
situation.
 Option A: When a tube is dislodged, a nurse is generally the first responder.
At the first sign of a possible dislodged tube, another caregiver should send
another individual to urgently summon a physician.
  Option C: If the tracheostomy is new, only a physician should reinsert the
tube, and a nurse or respiratory therapist should never attempt to reposition the
tube. This is because it takes time for the tract to form, and repositioning
before the tract has formed can lead to complications as severe as those caused
by the failure to act.
 Option D: Covering the tracheostomy site will block the airway. A dislodged
tube also calls for immediate attempts at manual ventilation, and suction with
a solution of sodium chloride. This will rule out a mucus plug. Once this is
done, to prevent brain damage the nurse should immediately deflate the
tracheostomy cuff and take out the tracheostomy tube.
22. 22. Question
1 point(s)
Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The
nurse reports which of the following signs immediately if experienced by the client?
o A. Stridor
o B. Occasional pink-tinged sputum
o C. A few basilar lung crackles on the right
o D. Respiratory rate 24 breaths/min
Correct
Correct Answer: A. Stridor
The nurse reports stridor to the physician immediately. This is a high-pitched, coarse sound
that is heard with the stethoscope over the trachea. Stridor indicates airway edema and places
the client at risk for airway obstruction. Post-extubation stridor is uncommon and seen only
in less than 10% of unselected critically ill patients and correlates with increased rates of
reintubation, prolonged duration of mechanical ventilation, and longer length of ICU stay.
Options B, C, and D are not signs that require immediate notification of the physician.
 Option B: A pink-tinged sputum is normal after removal of the endotracheal
tube. Ensure adequate secretion management, encourage coughing and deep
breathing, maintain airway hydration, and patent central airway. The
immediate post-extubation phase should be managed as carefully as the
ventilated phase because the first 24 hours post-extubation are difficult and
tenuous.
 Option C: After the removal of the ETT, suction the oral cavity and ask the
patient to take a deep breath and cough out all secretions. Frequent airway
suction should be considered to prevent re-intubation. There may be a few
crackles upon auscultation.
 Option D: 24 breaths/min is a normal respiratory rate. The patient should be
placed on supplemental oxygen afterward. Ensure adequate oxygenation;
consider nasal cannula, oxygen mask, full face mask, venturi mask as
 appropriate to ensure good O2 supply. In recent times, high flow oxygen
systems have gained popularity in selected patients with hypoxemic
respiratory failure and studies have shown to reduce the re-intubation rate.
23. 23. Question
1 point(s)
An emergency room nurse is assessing a male client who has sustained a blunt injury to the
chest wall. Which of these signs would indicate the presence of a pneumothorax in this
client?
o A. A low respiratory rate.
o B. Diminished breath sounds.
o C. The presence of a barrel chest.
o D. A sucking sound at the site of injury.
Correct
Correct Answer: B. Diminished breath sounds.
This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed
pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause
tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema.
Hyperresonance also may occur on the affected side. A pneumothorax is defined as a
collection of air outside the lung but within the pleural cavity. It occurs when air accumulates
between the parietal and visceral pleura inside the chest. The air accumulation can apply
pressure on the lung and make it collapse.
 Option A: An increase in central venous pressure can result in distended neck
veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and
hypoxia. Clinical presentation of a pneumothorax can range anywhere from
asymptomatic to chest pain and shortness of breath.
 Option C: Barrel chest could also be present which consists in increased
anterior-posterior diameter of the chest wall and is a normal finding in
children, but it is suggestive of hyperinflation with chronic obstructive
pulmonary disease (COPD) in adults.
 Option D: A sucking sound at the site of injury would be noted with an open
chest injury. Open “sucking” chest wounds are treated initially with a three-
sided occlusive dressing. Further treatment may require tube thoracostomy
and/or chest wall defect repair.
24. 24. Question
1 point(s)
Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive
pulmonary disease. Which of the following would the nurse expect to note on assessment of
this client?
 o A. Hypocapnia
o B. A hyperinflated chest noted on the chest x-ray.
o C. Increased oxygen saturation with exercise.
o D. A widened diaphragm noted on the chest x-ray.
Correct
Correct Answer: B. A hyperinflated chest noted on the chest x-ray.
Clinical manifestations of chronic obstructive pulmonary disease (COPD) include
hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise,
and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and
a flattened diaphragm if the disease is advanced. Hyperinflation of the lungs is often seen on
imaging studies and occurs due to air trapping from airway collapse during exhalation.
 Option A: The inability to fully exhale also causes elevations in carbon
dioxide (CO2) levels. As the disease progresses, impairment of gas exchange
is often seen. The reduction in ventilation or increase in physiologic dead
space leads to CO2 retention. Patients may have acute respiratory failure and
physical findings of hypoxemia and hypercapnia.
 Option C: Acute exacerbations of COPD are common and usually occur due
to a trigger (e.g., bacterial or viral pneumonia, environmental irritants). There
is an increase in inflammation and air trapping often requiring corticosteroid
and bronchodilator treatment. Acute exacerbations of COPD usually present
with increased dyspnea, productive cough, and wheezing.
 Option D: Radiographic imaging includes a chest x-ray and computed
tomography (CT). Chest x-rays may show hyperinflation, flattening of the
diaphragm, and increased anterior-posterior diameter. In cases of chronic
bronchitis, bronchial wall thickening may be present.
25. 25. Question
1 point(s)
An oxygen delivery system is prescribed for a male client with chronic obstructive
pulmonary disease to deliver a precise oxygen concentration. Which of the following types of
oxygen delivery systems would the nurse anticipate to be prescribed?
o A. Face tent
o B. Venturi mask
o C. Aerosol mask
o D. Tracheostomy collar
Correct
Correct Answer: B. Venturi mask
The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen
delivery system for the client with chronic airflow limitation because it delivers a precise
oxygen concentration. An air-entrainment (also known as venturi) mask can provide a pre-set
oxygen to the patient using jet mixing. As the percent of inspired oxygen increases using such
a mask, the air to oxygen ratio decreases, causing the maximum concentration of oxygen
provided by an air-entrainment mask to be around 40%. The face tent, aerosol mask, and
tracheostomy collar are also high-flow oxygen delivery systems but most often are used to
administer high humidity.
 Option A: Face tents are used to provide a controlled concentration of oxygen
and increase moisture for patients who have facial burn or a broken nose, or
who are claustrophobic. The mask covers the nose and mouth and does not
create a seal around the nose. It can provide 28% to 100% O2 Flow meter
should be set to deliver O2 at a minimum of 15 L/min. It is difficult to achieve
high levels of oxygenation with this mask.
 Option C: A mask used for the therapeutic administration of a nebulized
solution, humidity, or high airflow with oxygen enrichment. It has a large-bore
inlet and an exhalation port. When the required concentration needs to change
during oxygen therapy, the adult aerosol mask, with the choice of 6 venturis or
a multi venturi mask kit will offer the choice to suit the individual patient’s
requirements. The aerosol mask can be used with a nebuliser or 22mm
corrugated tubing for combined oxygen therapy and humidification.
 Option D: One is to use a tracheostomy collar, which is placed over a
breathing tube in a tracheotomy incision in the throat, and through which
humidified oxygen is given. The other is to reduce the pressure support
supplied via the ventilator. A study found tracheostomy collars significantly
outperformed pressure support in helping patients breathe on their own again.
26. 26. Question
1 point(s)
Blessy, a community health nurse is conducting an educational session with community
members regarding tuberculosis. The nurse tells the group that one of the first symptoms
associated with tuberculosis is:
o A. Dyspnea
o B. Chest pain
o C. A bloody, productive cough.
o D. A cough with the expectoration of mucoid sputum.
Correct
Correct Answer: D. A cough with the expectoration of mucoid sputum
One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid
sputum. A chronic cough, hemoptysis, weight loss, low-grade fever, and night sweats are
some of the most common physical findings in pulmonary tuberculosis. Other options are late
symptoms and signify cavitation and extensive lung involvement.
 Option A: Secondary tuberculosis differs in clinical presentation from the
primary progressive disease. In secondary disease, the tissue reaction and
hypersensitivity is more severe, and patients usually form cavities in the upper
portion of the lungs
 Option B: Pulmonary or systemic dissemination of the tubercles may be seen
in active disease, and this may manifest as miliary tuberculosis characterized
by millet-shaped lesions on chest x-ray. Disseminated tuberculosis may also
be seen in the spine, the central nervous system, or the bowel.
 Option C: As the bacterium begins multiplying in the body and destroying
tissue, it causes symptoms such as a bad, persistent cough, fatigue/loss of
energy, weight loss, loss of appetite, chills, fever, drenching night sweats,
chest pain, and coughing up or spitting up bright red blood, a symptom that
occurs when the blood vessels inside the lungs become eroded and begin to
bleed.
27. 27. Question
1 point(s)
A nurse performs an admission assessment on a female client with a diagnosis of
tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this
diagnosis?
o A. Bronchoscopy
o B. Sputum culture
o C. Chest x-ray
o D. Tuberculin skin test
Correct
Correct Answer: B. Sputum culture
Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium
tuberculosis. Mycobacterial culture is the gold standard for diagnosis. Mycobacterial culture
should be performed on both the solid and liquid medium. Liquid media culture can detect
very low bacterial load and is considered a gold standard. Culture essential for drug
susceptibility testing. A presumptive diagnosis is made based on a tuberculin skin test, a
sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of
granulomatous disease on biopsy. Active tuberculosis is diagnosed by isolating
Mycobacterium tuberculosis complex bacilli from bodily secretions.
 Option A: If all measures fail to obtain a sputum sample, a fiberoptic
bronchoscopy with bronchoalveolar lavage can be performed with or without a
transbronchial biopsy. Bronchoscopy can also be performed in high clinical
 suspicion with negative sputum studies and to rule out an alternative
diagnosis.
 Option C: Primary tuberculosis often causes middle and lower lung field
opacities associated with mediastinal adenopathy. Whereas secondary
tuberculosis commonly involves upper lobes, causing opacities, cavities, or
fibrotic scar tissue.
 Option D: The Mantoux test is a two-part test consisting of an intradermal
injection of .1ml purified protein derivative and observing for induration 48-
72 hours. The patient’s risk of exposure is taken into consideration when
interpreting the result. Patients are then classified into three groups based on
the size of the induration and the risk of exposure.
28. 28. Question
1 point(s)
A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse
assesses the oxygen flow rate to ensure that it does not exceed:
o A. 1 L/min
o B. 2 L/min
o C. 6 L/min
o D. 10 L/min
Incorrect
Correct Answer: B. 2 L/min
Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing
hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen
levels rather than increased carbon dioxide levels, as is the case in a normal respiratory
system. Supplemental oxygen can successfully reach the alveoli in these lungs, which
prevents this vasoconstriction and thereby increases perfusion and improves gas exchange,
thus resulting in improvement of hypoxemia.
 Option A: Routine supplemental oxygen does not improve the quality of life
or clinical outcomes in stable patients. Continuous long-term, i.e., longer than
15 hours of supplemental oxygen is recommended in patients with COPD with
PaO2 less than 55 mmHg (or oxygen saturation less than 88%) or PaO2 less
than 59 mm Hg in case of cor pulmonale.
 Option C: Oxygen therapy has shown to increase the survival of these
patients with severe resting hypoxemia. For those who desaturate with
exercise, intermittent oxygen will help. The goal is to maintain oxygen
saturation greater than 90%.
 Option D: Excessive correction of hypoxia in a patient with longstanding
COPD can sometimes lead to hypercapnia. This is due to the loss of
 compensatory vasoconstriction with an ineffective gas exchange as there is a
loss of hypoxic drive for ventilation. Also, increased oxyhemoglobin decreases
the uptake of carbon dioxide due to the Haldane effect.
29. 29. Question
1 point(s)
A nurse instructs a female client to use the pursed-lip method of breathing and the client asks
the nurse about the purpose of this type of breathing. The nurse responds, knowing that the
primary purpose of pursed-lip breathing is to:
o A. Promote oxygen intake.
o B. Strengthen the diaphragm.
o C. Strengthen the intercostal muscles.
o D. Promote carbon dioxide elimination.
Correct
Correct Answer: D. Promote carbon dioxide elimination.
Pursed-lip breathing facilitates maximal 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. Pursed-lip breathing is a technique that allows people to
control their oxygenation and ventilation. The technique requires a person to inspire through
the nose and exhale through the mouth at a slow controlled flow.
 Option A: Deep breathing prevents air from getting trapped in the lungs,
which can cause the client to feel short of breath. As a result, he can breathe in
more fresh air. It’s best to do this exercise with other daily breathing exercises
that can be performed for 10 minutes at a time, 3 to 4 times per day.
 Option B: Diaphragmatic breathing, or “belly breathing,” engages the
diaphragm, which is supposed to do most of the heavy lifting when it comes to
breathing. This technique is particularly helpful in people with COPD, as the
diaphragm isn’t as effective in these individuals and could be strengthened.
The technique best used when feeling rested.
 Option C: Breathing exercises which slowly fill the lungs with air to expand
the chest and work the intercostal muscles. To do this exercise, it is typically
recommended to sit or stand with the back straight, then take a full breath
from the bottom of the lungs. It can help to think of breathing from the
diaphragm, by slowly expanding the abdominal muscles while inhaling, then
pushing air from the lungs using these same muscles.
30. 30. Question
1 point(s)
A nurse is caring for a male client with acute respiratory distress syndrome. Which of the
following would the nurse expect to note in the client?
 o A. Pallor
o B. Low arterial PaO2
o C. Elevated arterial PaO2
o D. Decreased respiratory rate
Correct
Correct Answer: B. Low arterial PaO2
The earliest clinical sign of acute respiratory distress syndrome is an increased respiratory
rate. Breathing becomes labored, and the client may exhibit air hunger, retractions, and
cyanosis. Arterial blood gas analysis reveals increasing hypoxemia, with a PaO2 lower than
60 mm Hg. Despite 100% oxygen, patients have low oxygen saturation.
 Option A: Systemic signs may also be evident depending on the severity of
illness, such as central or peripheral cyanosis resulting from hypoxemia,
tachycardia, and altered mental status. Chest auscultation usually reveals rales,
especially bibasilar, but are often auscultated throughout the chest.
 Option C: ARDS is defined by the patient’s oxygen in arterial blood (PaO2)
to the fraction of the oxygen in the inspired air (FiO2). These patients have a
PaO2/FiO2 ratio of less than 300. When interviewing patients that are able to
communicate, they often start to complain of mild dyspnea initially, but within
12 to 24 hours, the respiratory distress escalates, becoming severe and
requiring mechanical ventilation to prevent hypoxia.
 Option D: The syndrome is characterized by the development of dyspnea and
hypoxemia, which progressively worsens within hours to days, frequently
requiring mechanical ventilation and intensive care unit-level care. The
physical examination will include findings associated with the respiratory
system, such as tachypnea and increased effort to breathe.
31. 31. Question
1 point(s)
A nurse is preparing to obtain a sputum specimen from a male client. Which of the following
nursing actions will facilitate obtaining the specimen?
o A. Limiting fluid.
o B. Having the client take deep breaths.
o C. Asking the client to spit into the collection container.
o D. Asking the client to obtain the specimen after eating.
Correct
Correct Answer: B. Having the client take deep breaths.
To obtain a sputum specimen, the client should rinse the mouth to reduce contamination,
breathe deeply, and then cough into a sputum specimen container. To cough deeply from the
lungs, the client might need to take three deep breaths before he coughs forcefully.
 Option A: Sputum can be thinned by fluids or by a respiratory treatment such
as inhalation of nebulized saline or water. Drinking plenty of fluids can help
loosen the secretions and make it easier to cough up sputum. The doctor may
ask the client to rinse out his mouth with clear water to help get rid of any
other bacteria and extra saliva.
 Option C: The client should be encouraged to cough and not spit so as to
obtain sputum. To be sure the test is accurate, the client must cough up sputum
from deep inside the lungs. Sputum from the lungs is usually thick and sticky.
Saliva comes from your mouth and is watery and thin. Do not collect saliva.
 Option D: The optimal time to obtain a specimen is on rising in the morning.
As soon as the client wakes up in the morning (before he eats or drinks
anything), he should brush his teeth and rinse his mouth with water. Do not
use mouthwash.
32. 32. Question
1 point(s)
Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following
signs, if noticed in the client, should be reported immediately to the physician?
o A. Dry cough
o B. Hematuria
o C. Bronchospasm
o D. Blood-streaked sputum
Correct
Correct Answer: C. Bronchospasm
If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for
several hours. The client should be assessed for signs of complications, which would include
cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and
dysrhythmias. Cardiac arrhythmias may also occur especially in patients with pre-existing
cardiac disease.
 Option A: A dry cough may be expected. In 1% to 3% of patients,
pneumothorax may occur after transbronchial biopsies. Small pneumothoraces
may be managed conservatively, while symptomatic and large pneumothorax
will require chest tube insertion and hospitalization.
 Option B: Hematuria is unrelated to this procedure. A tension pneumothorax
results in hemodynamic instability and should be recognized even without
 imaging studies. Appropriate life-saving measures such as chest tube insertion
should be undertaken immediately.
 Option D: Frank blood indicates hemorrhage. In most cases, bleeding is
usually self-limited. The pulmonologists should carefully ascertain for
hemostasis, and in the event of severe bleeding prompt management should be
immediately instituted.
33. 33. Question
1 point(s)
A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the
nurse must limit the suctioning time to a maximum of:
o A. 1 minute
o B. 5 seconds
o C. 10 seconds
o D. 30 seconds
Incorrect
Correct Answer: C. 10 seconds
Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells in
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. It is of
particular importance for patients with mechanical ventilators, endotracheal tube (ET)
intubations, tracheostomies, or other airway adjuncts. Clearance of airway secretions is a
normal process and is critical to the prevention of respiratory infections, atelectasis, and
preservation of airway patency.
 Option A: Preoxygenation with 100% oxygen should be initiated prior to
suctioning. This is in preparation for the hypoxia that is precipitated by
suctioning, both from mechanical interruption and cessation of oxygen flow
briefly. Suctioning can stimulate the vagus nerve, predisposing the patient to
bradycardia and hypoxia.
 Option B: The catheter should be introduced to the desired depth, and then
suctioning should be started. Brief, 10-second suction duration is usually
recommended to avoid mucosal damage and prolonged hypoxia. Hypoxia can
be profound from occlusion, interruption of oxygen supply, and prolonged
suctioning.
 Option D: The adequacy of suctioning can be assessed by the clearance of
secretions, improved breath sounds, improved air entry, good pulse oximetry
readings, and improvement in respiratory distress in a patient. Complications
from airway
34. 34. Question
1 point(s)
A nurse is suctioning fluids from a female client through an endotracheal tube. During the
suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which
if the following is the appropriate nursing intervention?
o A. Continue to suction.
o B. Notify the physician immediately.
o C. Stop the procedure and reoxygenate the client.
o D. Ensure that the suction is limited to 15 seconds.
Correct
Correct Answer: C. Stop the procedure and reoxygenate the client.
During suctioning, the nurse should monitor the client closely for side effects, including
hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal
stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side effects develop,
especially cardiac irregularities, the procedure is stopped and the client is reoxygenated.
 Option A: Suction gently and intermittently, use proper catheter size and
technique. Clears airway and pool of secretions without injury to the trachea,
prolonged suctioning causes vagal stimulation and bradycardia and high
pressure may damage the mucosa of the trachea.
 Option B: Monitor arterial blood gasses and oxygen saturation. Pulse
oximetry is a useful tool to detect early changes in oxygen saturation. Oxygen
saturation should be kept at 90% or greater. Increasing PaCo2 and decreasing
PaO2 are signs of hypoxemia and respiratory acidosis.
 Option D: Brief, 10-second suction duration is usually recommended to avoid
mucosal damage and prolonged hypoxia. Hypoxia can be profound from
occlusion, interruption of oxygen supply, and prolonged suctioning.
35. 35. Question
1 point(s)
A male adult client is suspected of having a pulmonary embolism. A nurse assesses the client,
knowing that which of the following is a common clinical manifestation of pulmonary
embolism?
o A. Dyspnea
o B. Bradypnea
o C. Bradycardia
o D. Decreased respirations
Correct
Correct Answer: A. Dyspnea
The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia,
dyspnea, and chest pain. PE leads to impaired gas exchange due to obstruction of the
pulmonary vascular bed leading to a mismatch in the ventilation to perfusion ratio because
alveolar ventilation remains the same, but pulmonary capillary blood flow decreases,
effectively leading to dead space ventilation and hypoxemia.
 Option B: The most common symptoms of PE include the following:
dyspnea, pleuritic chest pain, cough, hemoptysis, presyncope, or syncope.
Dyspnea may be acute and severe in central PE, whereas it is often mild and
transient in small peripheral PE.
 Option C: If a patient with PE who has tachycardia on presentation develops
sudden bradycardia or develops a new broad complex tachycardia (with right
bundle branch block), providers should look for signs of right ventricular
strain and possible impending shock.
 Option D: On examination, patients with PE might have tachypnea and
tachycardia, which are common but nonspecific findings. Other examination
findings include calf swelling, tenderness, erythema, palpable cords, pedal
edema, rales, decreased breath sounds, signs of pulmonary hypertension such
as elevated neck veins, loud P2 component of second heart sound, a right-
sided gallop, and a right ventricular parasternal lift might be present on
examination.
36. 36. Question
1 point(s)
A slightly obese female client with a history of allergy-induced asthma, hypertension, and
mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse
obtains a complete history and performs a thorough physical examination, paying special
attention to the cardiovascular and respiratory systems. When percussing the client’s chest
wall, the nurse expects to elicit:
o A. Resonant sounds.
o B. Hyperresonant sounds.
o C. Dull sounds.
o D. Flat sounds.
Correct
Correct Answer: A. Resonant sounds.
When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched,
hollow sounds heard over normal lung tissue. Percussion over normal, healthy lung tissue
should produce a resonant note. With the patient in an upright seated position, with the
scapula protracted; percuss on the posterior chest wall; either side of the midclavicular line in
the interspaces at 5cm intervals.
  Option B: Hyperresonant sounds indicate increased air in the lungs or pleural
space; they’re louder and lower pitched than resonant sounds. Although
hyperresonant sounds occur in such disorders as emphysema and
pneumothorax, they may be normal in children and very thin adults.
 Option C: Dull sounds, normally heard only over the liver and heart, may
occur over dense lung tissue, such as from consolidation or a tumor. Dull
sounds are thudlike and of medium pitch. Dull percussive sounds are
indicative of abnormal lung density. Likely indicating: atelectasis, tumour,
pleural effusion, lobar pneumonia
 Option D: Flat sounds, soft and high-pitched, are heard over airless tissue and
can be replicated by percussing the thigh or a bony structure. Percussion
produces sounds on a spectrum from flat to dull depending on the density of
the underlying tissue.
37. 37. Question
1 point(s)
A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (400
mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls
the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse
should:
o A. Question the order because it’s too low.
o B. Question the order because it’s too high.
o C. Set the pump at 45 ml/hour.
o D. Stop the infusion and have the laboratory repeat the theophylline
measurement.
Incorrect
Correct Answer: A. Question the order because it’s too low.
A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5
mg/kg/hour of aminophylline. Because the client’s theophylline level is sub-therapeutic,
reducing the dose (which is what the physician’s order would do) would be inappropriate.
Therefore, the nurse should question the order.
 Option B: Intravenous administration of aminophylline occurs via two
methods. A loading dose is given to achieve a serum concentration of 10
mcg/ml. Once the serum concentration has reached 10 to 15 mcg/ml, the
maintenance constant infusion follows. The dosage given depends on the
clearance of theophylline and whether the person has taken theophylline in the
last 24 hours. These dosages vary by age, body weight, and the health status of
the patient.
 Option C: The loading dose is 5.7 mg/kg based on the ideal body weight for
all age groups. Loading doses should be administered over 30 minutes at a rate
 not to exceed 21 mg/hr and should be calculated using ideal body weight. This
dose is for patients who have not taken aminophylline in the past 24 hours.
The loading dose calculation must use the formula given below for patients
who have taken aminophylline in the last 24 hours.
 Option D: Patients taking aminophylline require monitoring for CNS effects,
respiratory rate, arterial blood gasses, and serum theophylline concentrations.
Clinicians must measure serum concentrations before initiating a loading dose
in a person who has taken theophylline in the last 24 hours. A repeat serum
concentration is necessary before starting the maintenance dose, as well.
38. 38. Question
1 point(s)
The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which
of the following should the nurse include in the teaching?
o A. Make inhalation longer than exhalation.
o B. Exhale through an open mouth.
o C. Use diaphragmatic breathing.
o D. Use chest breathing.
Correct
Correct Answer: C. Use diaphragmatic breathing.
In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to
strengthen the diaphragm and maximizes ventilation. When the client has COPD, air often
becomes trapped in the lungs, pushing down on the diaphragm. The neck and chest muscles
must then assume an increased share of the work of breathing. This can leave the diaphragm
weakened and flattened, causing it to work less efficiently.
 Option A: Exhalation should be longer than inhalation to prevent collapse of
the bronchioles. Never allow a patient to force expiration. expiration should be
relaxed or lightly controlled. forced expiration only increases turbulence in the
airways leading to bronchospasm and increased airway restriction.
 Option B: The client with chronic bronchitis should exhale through pursed
lips to prolong exhalation, keep the bronchioles from collapsing, and prevent
air trapping. The client should tighten his stomach muscles, letting them fall
inward as he exhales through pursed lips. The hand on his upper chest must
remain as still as possible.
 Option D: Diaphragmatic breathing — not chest breathing — increases lung
expansion. Controlled breathing techniques, which emphasize diaphragmatic
breathing are designed to improve the efficiency of ventilation, decrease the
work of breathing, increase the excursion of the diaphragm, and improve gas
exchange and oxygenation.
 39. 39. Question
1 point(s)
Which phrase is used to describe the volume of air inspired and expired with a normal
breath?
o A. Total lung capacity
o B. Forced vital capacity
o C. Tidal volume
o D. Residual volume
Correct
Correct Answer: C. Tidal volume
Tidal volume refers to the volume of air inspired and expired with a normal breath. Tidal
volume is the amount of air that moves in or out of the lungs with each respiratory cycle. It
measures around 500 mL in an average healthy adult male and approximately 400 mL in a
healthy female. It is a vital clinical parameter that allows for proper ventilation to take place.
 Option A: Total lung capacity is the maximal amount of air the lungs and
respiratory passages can hold after a forced inspiration. Among healthy adults,
the average lung capacity is about 6 liters. Age, gender, body composition, and
ethnicity are factors affecting the different ranges of lung capacity among
individuals. TLC rapid increases from birth to adolescence and plateaus at
around 25 years old.
 Option B: Forced vital capacity is the vital capacity performed with a
maximally forced expiration. Vital capacity may be measured as inspiratory
vital capacity (IVC), slow vital capacity (SVC), or forced vital capacity
(FVC). The FVC is similar to VC, but it is measured as the patient exhales
with maximum speed and effort.
 Option D: Residual volume is the maximal amount of air left in the lung after
a maximal expiration. In other words, it is the volume of air that cannot be
expelled, thus causing the alveoli to remain open at all times. The residual
volume remains unchanged regardless of the lung volume at which expiration
was started.
40. 40. Question
1 point(s)
A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial
oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the
manifestations?
o A. Simple mask
o B. Non-rebreather mask
 o C. Face tent
o D. Nasal cannula
Correct
Correct Answer: B. Non-rebreather mask
A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as
100%. Other modes — simple mask, face tent, and nasal cannula — deliver lower levels of
FIO2. Non-rebreathing masks have a bag attached to the mask known as a reservoir bag,
which inhalation draws from to fill the mask through a one-way valve and features ports at
each side for exhalation, resulting in an ability to provide the patient with 100% oxygen at a
higher LPM flow rate.
 Option A: Face masks can be generally divided into simple facemasks, air-
entrainment masks, and non-rebreathers. A simple facemask is a mask with no
bag attached, which delivers oxygen at 5 to 8 LPM. A disadvantage of this and
other full face masks is the inability of the patient to eat, drink, or easily
communicate while using such a device.
 Option C: Face tents are used to provide a controlled concentration of oxygen
and increase moisture for patients who have facial burn or a broken nose, or
who are claustrophobic. The mask covers the nose and mouth and does not
create a seal around the nose. It can provide 28% to 100% O2 Flow meter
should be set to deliver O2 at a minimum of 15 L/min. It is difficult to achieve
high levels of oxygenation with this mask.
 Option D: Nasal cannula is a thin tube, often affixed behind the ears and used
to deliver oxygen directly to the nostrils from a source connected with tubing.
This is the most common method of delivery for home use and provides flow
rates of 2 to 6 liters per minute (LPM) comfortably, allowing the delivery of
oxygen while maintaining the patient’s ability to utilize his or her mouth to
talk, eat, etc.
41. 41. Question
1 point(s)
A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse
should instruct the client to notify the physician if a health concern occurs?
o A. Impaired color discrimination
o B. Increased urinary frequency
o C. Decreased hearing acuity
o D. Increased appetite
Correct
Correct Answer: C. Decreased hearing acuity
Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin
therapy. The client should notify the physician immediately if it occurs so that streptomycin
can be discontinued and an alternative drug can be prescribed. Ototoxicity and vestibular
impairment are often thought to be the hallmark of streptomycin toxicity. In extreme cases,
deafness may occur due to ototoxicity, thus caution must be exercised when combining
streptomycin with other potentially ototoxic drugs. The other options aren’t associated with
streptomycin.
 Option A: Impaired color discrimination indicates color blindness. There are
also reports of neuromuscular blockade with streptomycin use in association
with installation into body cavities, use during anesthesia involving the use of
neuromuscular blocking agents, and overdose in children. Neurotoxic effects
can lead to optic nerve dysfunction, peripheral neuritis, and encephalopathy.
 Option B: Increased urinary frequency accompanies diabetes mellitus.
Monitoring for streptomycin toxicity is especially important in the young and
patients with renal impairment, as streptomycin occurs via glomerular
filtration. Renal impairment can lead to a prolonged half-life of 50 to 100
hours.
 Option D: Increased appetite is not associated with streptomycin. Monitoring
is based on the limited therapeutic index of aminoglycosides and known
toxicities, particularly nephrotoxicity and ototoxicity. In general, clinicians
should avoid concomitant use of additional medications with possible ototoxic
or nephrotoxic effects.
42. 42. Question
1 point(s)
A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The
nurse should base her response on the fact that the:
o A. Area of redness is measured in 3 days and determines whether tuberculosis
is present.
o B. Skin test doesn’t differentiate between active and dormant
tuberculosis infection.
o C. Presence of a wheal at the injection site in 2 days indicates active
tuberculosis.
o D. Test stimulates a reddened response in some clients and requires a second
test in 3 months.
Correct
Correct Answer: B. Skin test doesn’t differentiate between active and dormant
tuberculosis infection.
The Mantoux test doesn’t differentiate between active and dormant infections. If a positive
reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide
more information. According to CDC, this test is performed using the ‘Mantoux technique,’
which is injecting 0.1 mL of a solution containing 5 units of tuberculin purified protein
derivative into the inner surface of the forearm through the intradermal route. It should be
administered two or more than 2 inches from the elbow, wrist, or any other injection site.
 Option A: Although the area of redness is measured in 3 days, a second test
may be needed; neither test indicates that tuberculosis is active. It is a time-
sensitive test. Tests that are read late are not accurate as they tend to under-
estimate the size of the skin reaction. Therefore, the reliability of the test is
compromised, and the results are doubtful. To avoid this, repeat testing is
recommended if the reaction is not read on time.
 Option C: The presence of a wheal within 2 days doesn’t indicate active
tuberculosis. Type IV hypersensitivity reaction (delayed-type) to the injected
tuberculin PPD antigen is seen and measured. The reaction starts at 5 to 6
hours, with a peak effect at 48 to 72 hours, after which it begins to subside.
Therefore, the right time to read the test is after 48 to 72 hours of intradermal
test placement.
 Option D: In the Mantoux test, an induration 5 to 9 mm in diameter indicates
a borderline reaction; a larger induration indicates a positive reaction.
Induration is the palpable, raised swelling, which is measured transversely by
inspection and palpation.
43. 43. Question
1 point(s)
A female adult client has a tracheostomy but doesn’t require continuous mechanical
ventilation. When weaning the client from the tracheostomy tube, the nurse initially should
plug the opening in the tube for:
o A. 15 to 60 seconds.
o B. 5 to 20 minutes.
o C. 30 to 40 minutes.
o D. 45 to 60 minutes.
Correct
Correct Answer: B. B. 5 to 20 minutes.
Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then
gradually lengthen this interval according to the client’s respiratory status. Tracheal plugging
is ordered by the doctor to help the client wean off an artificial airway. Plugging covers the
opening of the trach tube in the throat, and allowing her to breathe through her nose mouth.
Plugging will also help make the sound of her voice stronger.
 Option A: A client who doesn’t require continuous mechanical ventilation
already is breathing without assistance, at least for short periods; therefore,
 plugging the opening of the tube for only 15 to 60 seconds wouldn’t be long
enough to reveal the client’s true tolerance to the procedure.
 Option C: Plugging the opening for more than 20 minutes would increase the
risk of acute respiratory distress because the client requires an adjustment
period to start breathing normally. Weaning from a tracheostomy tube by
either decannulation cap or speaking valve increases the workload of
breathing.
 Option D: During the weaning process, one of the benefits that can be
achieved for the patient is the ability to vocalize for short periods of time.
Adjuncts that allow patients to vocalize increase the workload of breathing
and therefore should only be considered for use in patients in whom it has
been agreed within the multidisciplinary team to commence weaning from the
tracheostomy tube.
44. 44. Question
1 point(s)
Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage
system. What should the nurse conclude?
o A. The system is functioning normally.
o B. The client has a pneumothorax.
o C. The system has an air leak.
o D. The chest tube is obstructed.
Correct
Correct Answer: C. The system has an air leak.
Constant bubbling in the chamber indicates an air leak and requires immediate intervention.
With suction applied, this indicates a persistent air leak that may be from a large
pneumothorax at the chest insertion site (patient-centered) or chest drainage unit (system-
centered).
 Option A: Clients without a pneumothorax should have no evidence of
bubbling in the chamber. Absence of bubbling may indicate complete lung re-
expansion (normal) or represent complications such as obstruction in the tube.
 Option B: The client with a pneumothorax will have intermittent bubbling in
the water-seal chamber. Bubbling during expiration reflects venting of
pneumothorax (desired action). Bubbling usually decreases as the lung
expands or may occur only during expiration or coughing as the pleural space
diminishes.
 Option D: If the tube is obstructed, the nurse should notice that the fluid has
stopped fluctuating in the water-seal chamber. Monitor water-seal chamber
“tidaling.” Note whether the change is transient or permanent. Tidaling of 2–6
 cm during inspiration is normal and may increase briefly during coughing
episodes. Continuation of excessive tidal fluctuations may indicate the
existence of airway obstruction or the presence of a large pneumothorax.
45. 45. Question
1 point(s)
A black client with asthma seeks emergency care for acute respiratory distress. Because of
this client’s dark skin, the nurse should assess for cyanosis by inspecting the:
o A. Lips
o B. Mucous membranes
o C. Nail beds
o D. Earlobes
Incorrect
Correct Answer: B. Mucous membranes
Skin color doesn’t affect the mucous membranes. When the oxygen level has dropped only a
small amount, cyanosis may be hard to detect. In dark-skinned people, cyanosis may be
easier to see in the mucous membranes (lips, gums, around the eyes) and nails. The lips, nail
beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin
color.
 Option A: Red blood cells provide oxygen to body tissues. Most of the time,
nearly all red blood cells in the arteries carry a full supply of oxygen. These
blood cells are bright red and the skin is pinkish or red. Blood that has lost its
oxygen is dark bluish-red. People whose blood is low in oxygen tend to have a
bluish color to their skin. This condition is called cyanosis.
 Option C: But in dark-skinned patients, cyanosis may present as gray or
whitish (not bluish) skin around the mouth, and the conjunctivae may appear
gray or bluish. When assessing a patient’s skin, use natural light or a halogen
lamp rather than fluorescent light, which may alter the skin’s true color and
give the illusion of a bluish tint.
 Option D: Skin color is particularly important in detecting cyanosis and
staging pressure ulcers. Cyanosis occurs when a person has 5 g/dL of
unoxygenated hemoglobin in the arterial blood. Central cyanosis (cyanosis of
the lips, mucous membranes, and tongue) occurs when arterial oxygen
saturation falls below 85% in patients with normal hemoglobin levels.
46. 46. Question
1 point(s)
For a male client with an endotracheal (ET) tube, which nursing action is most essential?
o A. Auscultating the lungs for bilateral breath sounds.
 o B. Turning the client from side to side every 2 hours.
o C. Monitoring serial blood gas values every 4 hours.
o D. Providing frequent oral hygiene.
Correct
Correct Answer: A. Auscultating the lungs for bilateral breath sounds.
For a client with an ET tube, the most important nursing action is auscultating the lungs
regularly for bilateral breath sounds to ensure proper tube placement and effective oxygen
delivery. Adventitious breath sounds such as wheezes and crackles are an indication of
respiratory difficulties. Quick assessment allows for early detection of deterioration or
improvement. Although the other options are appropriate for this client, they’re secondary to
ensuring adequate oxygenation.
 Option B: Turn the client every 2 hours. Turning mobilizes secretions and
helps prevent ventilator-associated pneumonia. Auscultate the lungs for the
presence of normal or adventitious breath sounds.
 Option C: Assess arterial blood gases (ABGs). Signs of respiratory
compromise including decreasing Pao2 and increasing Paco2. Monitor oxygen
saturation prior to and after suctioning using pulse oximetry. This assessment
provides an evaluation of the effectiveness of therapy.
 Option D: Brush teeth two to three times per day with a soft toothbrush.
Chlorhexidine-based rinses may also be incorporated into oral care protocols.
Oral care reduces colonization of the oropharynx with respiratory pathogens
that can be aspirated into the lungs.
47. 47. Question
1 point(s)
The nurse assesses a male client’s respiratory status. Which observation indicates that the
client is experiencing difficulty breathing?
o A. Diaphragmatic breathing
o B. Use of accessory muscles
o C. Pursed-lip breathing
o D. Controlled breathing
Correct
Correct Answer: B. Use of accessory muscles
The use of accessory muscles for respiration indicates the client is having difficulty
breathing. Accessory muscles of respiration are muscles other than the diaphragm and
intercostal muscles that may be used for labored breathing. The sternocleidomastoid, spinal,
and neck muscles may be used as accessory muscles of respiration; their use is a sign of an
abnormal or labored breathing pattern. Diaphragmatic and pursed-lip breathing are two
controlled breathing techniques that help the client conserve energy.
 Option A: Diaphragmatic breathing is a type of breathing exercise that helps
strengthen the diaphragm, an important muscle that helps breathe as it
represents 80% of breathing. This breathing exercise is also sometimes
called( belly breathing or abdominal breathing).
 Option C: Pursed lip breathing is a technique that helps people living with
asthma or COPD when they experience shortness of breath. Pursed lip
breathing helps control shortness of breath, and provides a quick and easy way
to slow the pace of breathing, making each breath more effective.
 Option D: Controlled breathing’ (sometimes called ‘pursed lips breathing’)
will help the client to get as much air as possible into the lungs. This may help
to ease shortness of breath. It is one way to slow down breathing and to make
each breath as effective as possible.
48. 48. Question
1 point(s)
A female client is undergoing a complete physical examination as a requirement for college.
When checking the client’s respiratory status, the nurse observes respiratory excursion to help
assess:
o A. Lung vibrations
o B. Vocal sounds
o C. Breath sounds
o D. Chest movements.
Correct
Correct Answer: D. Chest movements
The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic
expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis,
pulmonary embolism, or a rib or sternum fracture. During the inspection, the examiner should
pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal breathing,
coastal markings, and use of accessory breathing muscles. The use of accessory breathing
muscles (i.e., scalenes, sternocleidomastoid muscle, intercostal muscles) could point to
excessive breathing effort caused by pathologies.
 Option A: After asking the client to say “99,” the nurse palpates the vibrations
transmitted from the bronchopulmonary system along the solid surfaces of the
chest wall to the nurse’s palms. An increase in the tactile fremitus points
towards an increased intraparenchymal density and a decreased fremitus hints
towards a pleural process that separates the pleura from the parenchyma
(pleural effusion, pneumothorax).
  Option B: The nurse assesses vocal sounds to evaluate air flow when
checking for tactile fremitus. Palpation should focus on detecting
abnormalities like masses or bony crepitus. Of note, the fremitus can also be
auscultated and can be referred to as vocal fremitus.
 Option C: The nurse assesses breath sounds during auscultation. The
movement of air generates normal breath sounds through the large and small
airways. Normal breath sounds have a frequency of approximately 100 Hz.
The absence of breath sounds should prompt the health care provider to
consider shallow breath, abnormal anatomy, or pathologic entities such as
airway obstruction, bulla, hyperinflation, pneumothorax, pleural effusion or
thickening, and obesity.
49. 49. Question
1 point(s)
A male client comes to the emergency department complaining of sudden onset of diarrhea,
anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and
physical findings, the physician suspects Legionnaires’ disease. While awaiting diagnostic
test results, the client is admitted to the facility and started on antibiotic therapy. What is the
drug of choice for treating Legionnaires’ disease?
o A. erythromycin (Erythrocin)
o B. rifampin (Rifadin)
o C. amantadine (Symmetrel)
o D. amphotericin B (Fungizone)
Correct
Correct Answer: A. Erythromycin (Erythrocin)
Erythromycin is the drug of choice for treating Legionnaires’ disease. Erythromycin has
traditionally; it has been used for various respiratory infections (i.e., community-acquired
pneumonia, Legionnaires disease), prophylaxis of neonatal conjunctivitis, and chlamydia.
Erythromycin is a bacteriostatic antibiotic, which means it prevents the further growth of
bacteria rather than directly destroying it. This action occurs by inhibiting protein synthesis.
 Option B: Rifampin may be added to the regimen if erythromycin alone is
ineffective; however, it isn’t administered first. Clinically, rifampin is
recommended for infections where the disease-causing organisms are
identified, their drug susceptibility determined, and it is used in combination
with other antimicrobial agents to prevent the drug resistance.
 Option C: Amantadine, an antiviral agent, is ineffective against Legionnaires’
disease, which is caused by bacterial infection. Amantadine is now used
mostly for Parkinson disease. Clinical trials have shown that amantadine
decreases symptoms of bradykinesia, rigidity, and tremor. Amantadine is an
antiviral agent with mild antiparkinsonian activity. Amantadine was used in
 the early 2000s for Influenza A treatment. A 2006 meta-analysis showed that
the drug decreased influenza symptoms by one day and decreased the severity
of fever and other symptoms.
 Option D: Amphotericin B, an antifungal agent, is ineffective against
Legionnaires disease because it is caused by bacteria. Amphotericin B
deoxycholate belongs to the polyene class of antifungals. It is also known by
the name conventional amphotericin B and has been in use for the treatment of
invasive fungal infections for more than 50 years. It was first isolated as a
natural product of a soil actinomycete.
50. 50. Question
1 point(s)
A male client with chronic obstructive pulmonary disease (COPD) is recovering from a
myocardial infarction. Because the client is extremely weak and can’t produce an effective
cough, the nurse should monitor closely for:
o A. Pleural effusion
o B. Pulmonary edema
o C. Atelectasis
o D. Oxygen toxicity
Correct
Correct Answer: C. Atelectasis
In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes
mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis.
Adults with COPD have extensive collateral ventilation secondary to airway destruction and
thus are less likely to develop resorption atelectasis in the presence of an obstructing lesion
(i.e., intrathoracic tumor). The use of high inspiratory oxygen concentration (high FiO2)
during induction and maintenance of general anesthesia also contributes to atelectasis via
absorption atelectasis.
 Option A: An ineffective cough doesn’t cause pleural effusion (fluid
accumulation in the pleural space). Common causes of transudates include
conditions that alter the hydrostatic or oncotic pressures in the pleural space
like congestive left heart failure, nephrotic syndrome, liver cirrhosis,
hypoalbuminemia leading to malnutrition and the initiation of peritoneal
dialysis.
 Option B: Pulmonary edema usually results from left-sided heart failure, not
an ineffective cough. Although many noncardiac conditions may cause
pulmonary edema, an ineffective cough isn’t one of them. Noncardiogenic
pulmonary edema is caused by lung injury with a resultant increase in
pulmonary vascular permeability leading to the movement of fluid, rich in
proteins, to the alveolar and interstitial compartments.
 Option D: Oxygen toxicity results from prolonged administration of high
oxygen concentrations, not an ineffective cough. Extended exposure to above-
normal oxygen partial pressures, or shorter exposures to very high partial
pressures, can cause oxidative damage to cell membranes leading to the
collapse of the alveoli in the lungs. Pulmonary effects can present as early as
within 24 hours of breathing pure oxygen.