1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?
a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.
2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?
d. Pulmonary edema
3. A female 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.
4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?
5. A male 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
6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:
a. hyperglycemia and glycosuria.
b. acute adrenocortical insufficiency.
c. GI bleeding.
d. restlessness and seizures.
7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?
a. Activity intolerance related to fatigue
b. Anxiety related to actual threat to health status
c. Risk for infection related to retained secretions
d. Impaired gas exchange related to airflow obstruction
8. 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
9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?
a. Immediately before a meal
b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized
10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?
11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:
a. helping him communicate.
b. keeping his airway patent.
c. encouraging him to perform activities of daily living.
d. preventing him from developing an infection.
12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?
a. Restricting fluid intake to 1,000 ml/day
b. Enforcing absolute bed rest
c. Teaching the client how to perform controlled coughing
d. Administering prescribed sedatives regularly and in large amounts
13. The amount of air inspired and expired with each breath is called:
a. tidal volume.
b. residual volume.
c. vital capacity.
d. dead-space volume.
14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:
15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?
a. A positive reaction indicates that the client has active tuberculosis (TB).
b. A positive reaction indicates that the client has been exposed to the disease.
c. A negative reaction always excludes the diagnosis of TB.
d. The PPD can be read within 12 hours after the injection.
16. Nurse Murphy administers albuterol (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?
a. Respiratory rate of 22 breaths/minute
b. Dilated and reactive pupils
c. Urine output of 40 ml/hour
d. Heart rate of 100 beats/minute
17. What is the normal pH range for arterial blood?
a. 7 to 7.49
b. 7.35 to 7.45
c. 7.50 to 7.60
d. 7.55 to 7.65
18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?
a. Fluid intake for the last 24 hours
b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results
19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?
a. Administer a prescribed decongestant.
b. Instruct the client to breathe into a paper bag.
c. Offer the client fluids frequently.
d. Administer prescribed supplemental oxygen.
20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?
b. Bicarbonate (HCO3–)
c. Partial pressure of arterial oxygen (PaO2)
d. Partial pressure of arterial carbon dioxide (PaCO2)
21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?
a. Endotracheal suctioning
b. Encouragement of coughing
c. Use of cooling blanket
d. Incentive spirometry
22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?
a. Measuring and documenting the drainage in the collection chamber
b. Maintaining continuous bubbling in the water-seal chamber
c. Keeping the collection chamber at chest level
d. Stripping the chest tube every hour
23. Nurse Eve 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.
24. A black male 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.
25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?
a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml
26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:
a. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.
b. vancomycin may cause irreversible neutropenia.
c. vancomycin should be administered rapidly in a large volume of fluid.
d. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.
27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history. Which condition is a predisposing factor for respiratory alkalosis?
a. Myasthenia gravis
b. Type 1 diabetes mellitus
c. Extreme anxiety
d. Narcotic overdose
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. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
a. Encouraging the client to drink three glasses of fluid daily
b. Keeping the client in semi-Fowler’s position
c. Using a high-flow Venturi mask to deliver oxygen as prescribed
d. Administering a sedative as prescribed
30. Nurse Joana 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.