1. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?
a. Limiting fluid
b. Having the client take deep breaths
c. Asking the client to spit into the collection container
d. Asking the client to obtain the specimen after eating
2. 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?
a. Dry cough
d. Blood-streaked sputum
3. 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:
a. 1 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds
4. 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?
a. Continue to suction
b. Notify the physician immediately
c. Stop the procedure and reoxygenate the client
d. Ensure that the suction is limited to 15 seconds
5. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?
d. Decreased respirations
6. 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:
a. Resonant sounds.
b. Hyperresonant sounds.
c. Dull sounds.
d. Flat sounds.
7. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (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:
a. Question the order because it’s too low.
b. Question the order because it’s too high.
c. Set the pump at 45 ml/hour.
d. Stop the infusion and have the laboratory repeat the theophylline measurement.
8. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?
a. Make inhalation longer than exhalation.
b. Exhale through an open mouth.
c. Use diaphragmatic breathing.
d. Use chest breathing.
9. Which phrase is used to describe the volume of air inspired and expired with a normal breath?
a. Total lung capacity
b. Forced vital capacity
c. Tidal volume
d. Residual volume
10. 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?
a. Simple mask
b. Non-rebreather mask
c. Face tent
d. Nasal cannula
11. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?
a. Impaired color discrimination
b. Increased urinary frequency
c. Decreased hearing acuity
d. Increased appetite
12. 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:
a. Area of redness is measured in 3 days and determines whether tuberculosis is present.
b. Skin test doesn’t differentiate between active and dormant tuberculosis infection.
c. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
d. Test stimulates a reddened response in some clients and requires a second test in 3 months.
13. 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:
a. 15 to 60 seconds.
b. 5 to 20 minutes.
c. 30 to 40 minutes.
d. 45 to 60 minutes.
14. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?
a. The system is functioning normally
b. The client has a pneumothorax.
c. The system has an air leak.
d. The chest tube is obstructed.
15. 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:
b. Mucous membranes.
c. Nail beds.
16. For a male client with an endotracheal (ET) tube, which nursing action is most essential?
a. Auscultating the lungs for bilateral breath sounds
b. Turning the client from side to side every 2 hours
c. Monitoring serial blood gas values every 4 hours
d. Providing frequent oral hygiene
17. The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty breathing?
a. Diaphragmatic breathing
b. Use of accessory muscles
c. Pursed-lip breathing
d. Controlled breathing
18. 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:
a. Lung vibrations.
b. Vocal sounds.
c. Breath sounds.
d. Chest movements.
19. 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?
a. Erythromycin (Erythrocin)
b. Rifampin (Rifadin)
c. Amantadine (Symmetrel)
d. Amphotericin B (Fungizone)
20. 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:
a. Pleural effusion.
b. Pulmonary edema.
d. Oxygen toxicity.
21. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?
a. It helps prevent early airway collapse.
b. It increases inspiratory muscle strength.
c. It decreases use of accessory breathing muscles.
d. It prolongs the inspiratory phase of respiration.
22. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond?
a. In 30 minutes
b. In 1 hour
c. In 2.5 hours
d. In 4 hours
23. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?
a. Kinking of the ventilator tubing
b. A disconnected ventilator tube
c. An ET cuff leak
d. A change in the oxygen concentration without resetting the oxygen level alarm
24. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD?
a. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
b. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator.
c. It stimulates adenosine receptors, causing bronchodilation.
d. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.
25. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?
a. Inflamed lung tissue
b. Sudden onset
c. Responsiveness to penicillin.
d. Elevated white blood cell (WBC) count
26. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
a. pH, 5.0; PaCO2 30 mm Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg
27. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?
b. Anginal pain
c. Respiratory alkalosis
d. Metabolic acidosis
28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:
a. Alprazolam (Xanax).
b. Propranolol (Inderal)
d. Albuterol (Proventil).
29. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?
a. Heightened alertness
b. Increased heart rate
c. Numbness and tingling of the extremities
d. Respiratory depression
30. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:
a. Drinking more than 1,500 ml of fluid daily.
b. Being overweight.
c. Eating a high-protein snack at bedtime.
d. Eating more than three large meals a day.