1.

Dr. Jones prescribes albuterol sulfate

a. b. c. d. 7. a. b. c. d. 8.

Leg movement Finger movement Lip movement Fighting the ventilator On auscultation, which finding suggests a Bilateral inspiratory and expiratory crackles Absence of breaths sound in the right thorax Inspiratory wheezes in the right thorax Bilateral pleural friction rub. Rhea, confused and short breath, is brought

(Proventil) for a patient with newly diagnose asthma. When teaching the patient about this drug, the nurse should explain that it may cause: a. b. c. d. 2. Nasal congestion Nervousness Lethargy Hyperkalemia Miriam, a college student with acute rhinitis

right pneumothorax?

sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In a acute rhinitis, nasal drainage normally is: a. b. c. d. 3. Yellow Green Clear Gray A male adult patient hospitalized for

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 sees many abbreviations. What does a lowercase a in ABG value present? a. b. c. d. 9. Acid-base balance Arterial Blood Arterial oxygen saturation Alveoli A male patient is admitted to the health care

treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a. b. c. d. 4. Nausea or vomiting Abdominal pain or diarrhea Hallucinations or tinnitus Lightheadedness or paresthesia Before administering ephedrine, Nurse Tony

facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? a. b. c. d. 10. Activity intolerance related to fatigue Anxiety related to actual threat to health Risk for infection related to retained Impaired gas exchange related to airflow Nurse Ruth assessing a patient for

assesses the patients history. Because of ephedrines central nervous system (CNS) effects, it is not recommended for: a. b. c. d. 5. Patients with an acute asthma attack Patients with narcolepsy Patients under age 6 Elderly patients A female patient suffers adult respiratory

status secretions obstruction tracheal displacement should know that the trachea will deviate toward the: a. b. c. d. 11. Contralateral side in a simple pneumothorax Affected side in a hemothorax Affected side in a tension pneumothorax Contralateral side in hemothorax After undergoing a left pneumonectomy,

distress syndrome as a consequence of shock. The patients 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? a. b. c. d. 6. Kinking of the ventilator tubing A disconnected ventilator tube An endotracheal cuff leak A change in the oxygen concentration A male adult patient on mechanical

a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must: a. b. c. d. 12. Monitor fluctuations in the water-seal Clamp the chest tube once every shift Encourage coughing and deep breathing Milk the chest tube every 2 hours When caring for a male patient who has chamber

without resetting the oxygen level alarm 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?

just had a total laryngectomy, the nurse should

plan to: a. b. c. d. 13. first? a. b. c. d. 14. Drawing blood for a hematocrit and Applying a dressing over the wound and Preparing a chest tube insertion tray Preparing to start an I.V. line For a patient with advance chronic hemoglobin level taping it on three sides Encourage oral feeding as soon as possible Develop an alternative communication Keep the tracheostomy cuff fully inflated Keep the patient flat in bed A male patient has a sucking stab wound

c. d. 18.

Check for an air leak because the bubbling Increase the suction pressure so that the Nurse Maureen has assisted a physician

should be intermittent bubbling becomes vigorous 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? a. b. c. d. 19. Inform the physician Continue to monitor the client Reinforce the occlusive dressing Encourage the client to deep-breathe Nurse Ryan caring for a client with a chest

method

to the chest. Which action should the nurse take

tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to: a. b. c. d. 20. Call the physician Place the tube in bottle of sterile water Immediately replace the chest tube system Place a sterile dressing over the A nurse is assisting a physician with the

obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a. b. c. d. 15. Encouraging the patient to drink three Keeping the patient in semi-fowlers position Using a high-flow venture mask to deliver Administering a sedative, as prescribe A male patients X-ray result reveals glasses of fluid daily

disconnection site removal of a chest tube. The nurse should instruct the client to: a. b. c. d. 21. Exhale slowly Stay very still Inhale and exhale quickly Perform the Valsalva maneuver While changing the tapes on a

oxygen as prescribe

bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from: a. b. c. d. 16. Cardiogenic pulmonary edema Respiratory alkalosis Increased pulmonary capillary permeability Renal failure For a female patient with chronic

tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to: a. b. c. d. 22. Call the physician to reinsert the tube Grasp the retention sutures to spread the Call the respiratory therapy department to Cover the tracheostomy site with a sterile Nurse Oliver is caring for a client

obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? a. b. c. d. 17. Restricting fluid intake to 1,000 ml per day Enforcing absolute bed rest Teaching the patient how to perform Administering prescribe sedatives regularly Nurse Lei caring for a client with a

opening reinsert the tracheotomy dressing to prevent infection immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? a. b. c. d. 23. Stridor Occasional pink-tinged sputum A few basilar lung crackles on the right Respiratory rate 24 breaths/min An emergency room nurse is assessing a

controlled coughing and in large amounts pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate? a. b. Do nothing, because this is an expected Immediately clamp the chest tube and notify finding the physician

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? a. b. c. d. 24. A low respiratory rate Diminished breath sounds The presence of a barrel chest A sucking sound at the site of injury Nurse Reese is caring for a client

c. d. 29.

6 L/min 10 L/min 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: a. b. c. d. 30. Promote oxygen intake Strengthen the diaphragm Strengthen the intercostal muscles Promote carbon dioxide elimination A nurse is caring for a male client with

hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. b. ray c. d. ray 25. 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? a. b. c. d. 26. Face tent Venturi mask Aerosol mask Tracheostomy collar Blessy, a community health nurse is Increased oxygen saturation with exercise A widened diaphragm noted on the chest xHypocapnia A hyperinflated chest noted on the chest x-

acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client? a. b. c. d. Pallor Low arterial PaO2 Elevated arterial PaO2 Decreased respiratory rate nervousness. The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia. Otther adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps. 2. Answer C. Normally, nasal drainage in acute rhinitis is clear. Yellow or green drainage indicates spread of the infection to the sinuses. Gray drainage may indicate a secondary infection. 3. Answer D. The patient with respiratory alkalosis may complain of lightheadedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rare are associated with respiratory alkalosis or any other acid-base imbalance. 4. Answer D. 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 used for its bronchodilator effects with acute and chronic asthma and occasionally for its CNS

1. Answer B. Albuterol may cause

conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: a. b. c. d. 27. Dyspnea Chest pain A bloody, productive cough A cough with the expectoration of mucoid A nurse performs an admission

sputum assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis? a. b. c. d. 28. Bronchoscopy Sputum culture Chest x-ray Tuberculin skin test 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: a. b. 1 L/min 2 L/min

stimulant actions for narcolepsy. It can be administered to children age 2 and older. 5. Answer A. Conditions that trigger the high pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on endotracheal tube, and the patients being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an endotracheal cuff leak would trigger the low pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would tigger the oxygen alarm. 6. Answer D. Pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation and paralysis. It assists mechanical ventilation by promoting encdotracheal 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. 7. Answer B. In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation. 8. Answer B. 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. The pH value reflects the acid base balance in arterial blood. Sa02 indicates arterial oxygen saturation. An uppercase A represents alveolar conditions: for example, PA02 indicates the partial pressure of oxygen in the alveoli. 9. Answer D. 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. The other

options also may apply to this patient but less important. 10. Answer D. The trachea will shift according to the pressure gradients within the thoracic cavity. In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. If there is no significant air or fluid accumulation, the trachea will not shift. 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. 11. Answer C. 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. Because the lung has been removed, the water-seal chamber should display no fluctuations. Reinflation is not the purpose of chest tube. Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage. 12. Answer B. A patient with a laryngectomy cannot speak, yet still needs to communicate. Therefore, the nurse should plan to develop an alternative communication method. After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. To prevent injury to the tracheal mucosa, the nurse should deflate the tracheostomy cuff or use the minimal leak technique. To decrease edema, the nurse should place the patient in semi-fowlers position. 13. Answer B. 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). 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. 14. Answer C. 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. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowlers position and should not receive sedatives or other drugs that may further depress the respiratory center. 15. Answer C. ARDS results from increased pulmonary capillary permeability, which leads to noncardiogenic pulmonary edema. In cardiogenic pulmonary edema, pulmonary congestion occurs secondary to heart failure. In the initial stage of ARDS, respiratory alkalosis may arise secondary to hyperventilation; however, it does not cause ARDS. Renal failure does not cause ARDS, either. 16. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the patients ability to maintain a patent airway, causing a high risk for infection from pooled secretions. 17. Answer A. Continuous gentle bubbling should be noted in the suction control chamber. Option b is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option c is incorrect. Bubbling should be continuous and not intermittent. Option d is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system. 18. Answer B. 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

reexpanded. Options A, C, and D are incorrect. 19. Answer B. 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. The system is replaced if it breaks or cracks or if the collection chamber is full. Placing a sterile dressing over the disconnection site will not prevent complications resulting from the disconnection. The physician may need to be notified, but this is not the initial action. 20. Answer D. 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. Options A, B, and C are incorrect client instructions. 21. Answer B. If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures and spread the opening. If agency policy permits, the nurse then attempts immediately to replace the tube. Covering the tracheostomy site will block the airway. Options A and C will delay treatment in this emergency situation. 22. Answer A. 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. Options B, C, and D are not signs that require immediate notification of the physician. 23. Answer B. 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 sucking sound at the site of injury would be noted with an open chest injury. 24. Answer B. 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. 25. Answer B. 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. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity. 26. Answer D. One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement. 27. Answer B. Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acidfast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy. 28. Answer B. 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. 29. Answer D. 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. Options A, B, and C are not the purposes of this type of breathing. 30. Answer B. 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. 1. The nurse is caring for a male client with a

a. b. c. d. 2.

Place the end of the chest tube in a Apply an occlusive dressing and notify the Clamp the chest tube immediately. Secure the chest tube with tape. A male elderly client is admitted to an acute

container of sterile saline. physician.

care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza? a. b. c. d. 3. Septicemia Pneumonia Meningitis Pulmonary edema A female client has a tracheostomy but

doesnt require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: a. b. c. d. 4. 15 to 60 seconds. 5 to 20 minutes. 30 to 40 minutes. 45 to 60 minutes. 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? a. b. c. d. 5. Hypoxia Delirium Hyperventilation Semiconsciousness A male client with Guillain-Barr

syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? a. b. c. d. 6. pH, 5.0; PaCO2 30 mm Hg pH, 7.40; PaCO2 35 mm Hg pH, 7.35; PaCO2 40 mm Hg pH, 7.25; PaCO2 50 mm Hg 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. b. hyperglycemia and glycosuria. acute adrenocortical insufficiency.

chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?

c. d. 7.

GI bleeding. restlessness and seizures. A male client is admitted to the health care

12.

For a male client with chronic obstructive

pulmonary disease, which nursing intervention would help maintain a patent airway? a. b. c. d. 13. a. b. c. d. 14. Restricting fluid intake to 1,000 ml/day Enforcing absolute bed rest Teaching the client how to perform Administering prescribed sedatives regularly The amount of air inspired and expired tidal volume. residual volume. vital capacity. dead-space volume. A male client with pneumonia develops

facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? a. b. c. d. 8. Activity intolerance related to fatigue Anxiety related to actual threat to health Risk for infection related to retained Impaired gas exchange related to airflow A male client abruptly sits up in bed, reports

controlled coughing and in large amounts with each breath is called:

status secretions obstruction having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations? a. b. c. d. 9. Simple mask Non-rebreather mask Face tent Nasal cannula A male adult client with cystic fibrosis is

respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. Hes 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: a. b. c. d. 15. 0.21 0.35 0.5 0.7 Nurse Mickey is administering a purified

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. b. c. d. 10. Immediately before a meal At least 2 hours after a meal When bronchospasms occur When secretions have mobilized On arrival at the intensive care unit, a

protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true? a. b. c. d. 16. A positive reaction indicates that the client A positive reaction indicates that the client A negative reaction always excludes the The PPD can be read within 12 hours after Nurse Murphy administers albuterol has active tuberculosis (TB). has been exposed to the disease. diagnosis of TB. the injection. (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? a. b. c. d. Respiratory rate of 22 breaths/minute Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/minute What is the normal pH range for 7 to 7.49 7.35 to 7.45 7.50 to 7.60 7.55 to 7.65 arterial blood? a. b. c. d.

critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the clients arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? a. b. c. d. 11. Fever Tachypnea Tachycardia Hypotension 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. b. c. d. helping him communicate. keeping his airway patent. encouraging him to perform activities of preventing him from developing an infection.

31. 17.

daily living.

18.

Before weaning a male client from a

increase oxygen demands. Such conditions include: a. b. c. d. 24. drinking more than 1,500 ml of fluid daily. being overweight. eating a high-protein snack at bedtime. eating more than three large meals a day. A black male client with asthma seeks

ventilator, which assessment parameter is most important for the nurse to review? a. b. c. d. 19. Fluid intake for the last 24 hours Baseline arterial blood gas (ABG) levels Prior outcomes of weaning Electrocardiogram (ECG) results Which of the following would be most

emergency care for acute respiratory distress. Because of this clients dark skin, the nurse should assess for cyanosis by inspecting the: a. b. c. d. 25. lips. mucous membranes. nail beds. earlobes. A female client with asthma is receiving a

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. b. c. d. 20. bag. Offer the client fluids frequently. Administer prescribed supplemental A female client is receiving supplemental Administer a prescribed decongestant. Instruct the client to breathe into a paper

theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the clients serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? a. b. c. d. 26. 1 to 2 mcg/ml 2 to 5 mcg/ml 5 to 10 mcg/ml 10 to 20 mcg/ml A male client is to receive I.V. vancomycin

oxygen. oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a. b. c. d. 21. pH Bicarbonate (HCO3) Partial pressure of arterial oxygen (PaO2) Partial pressure of arterial carbon dioxide Nurse Julia is caring for a client who has a

(PaCO2) tracheostomy and temperature of 103 F (39.4 C). Which of the following interventions will most likely lower the clients arterial blood oxygen saturation? a. b. c. d. 22. Endotracheal suctioning Encouragement of coughing Use of cooling blanket Incentive spirometry For a male client who has a chest tube

(Vancocin). When preparing to administer this drug, the nurse should keep in mind that: a. b. c. d. 27. vancomycin should be infused over 60 to 90 vancomycin may cause irreversible vancomycin should be administered rapidly vancomycin should be administered over 1 Before seeing a newly assigned female minutes in a large volume of fluid. neutropenia. in a large volume of fluid. to 2 minutes as an I.V. bolus. client with respiratory alkalosis, the nurse quickly reviews the clients medical history. Which condition is a predisposing factor for respiratory alkalosis? a. b. c. d. 28. Myasthenia gravis Type 1 diabetes mellitus Extreme anxiety Narcotic overdose At 11 p.m., a male client is admitted to the

connected to a closed water-seal drainage system, the nurse should include which action in the plan of care? a. b. c. d. 23. Measuring and documenting the drainage in Maintaining continuous bubbling in the Keeping the collection chamber at chest Stripping the chest tube every hour Nurse Eve formulates a nursing diagnosis the collection chamber water-seal chamber level

emergency department. He has a respiratory rate of 44 breaths/minute. Hes 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 clients arterial blood oxygen saturation

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

is 86% and hes still wheezing. The nurse should plan to administer: a. b. c. d. 29. a. b. c. d. 30 alprazolam (Xanax). propranolol (Inderal) morphine. albuterol (Proventil). Pulmonary disease (COPD), which nursing Encouraging the client to drink three Keeping the client in semi-Fowlers position Using a high-flow Venturi mask to deliver Administering a sedative as prescribed Nurse Joana is teaching a client with

influenza. Meningitis and pulmonary edema arent associated with influenza. 3. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and then gradually lengthen this interval according to the clients respiratory status. A client who doesnt 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 wouldnt be long enough to reveal the clients true tolerance to the procedure. 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. 4. Answer A. As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and place. Hyperventilation (respiratory rate greater than that metabolically necessary for gas exchange) is marked by an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized by limited motor and verbal responses and decreased orientation. 5. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs. 6. Answer B. Administration of a corticosteroid such as prednisone suppresses the bodys natural cortisol secretion, which may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation. 7. Answer D. A patent airway and an adequate

action best promotes adequate gas exchange? glasses of fluid daily

oxygen as prescribed

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. b. c. d. It helps prevent early airway collapse. It increases inspiratory muscle strength It decreases use of accessory breathing It prolongs the inspiratory phase of

muscles. respiration.

1.

Answer A. If a chest drainage system is

disconnected, the nurse may place the end of the chest tube in a container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out not if the system is disconnected. The nurse shouldnt clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected. 2. Answer B. Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reyes syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from

breathing pattern are the top priority for any client, making impaired gas exchange related to airflow obstruction the most important nursing diagnosis. The other options also may apply to this client but are less important. 8. Answer B. 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. 9. Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to reduce the risk of vomiting and aspiration. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isnt available) are a contraindication for postural drainage, another component of chest physiotherapy. 10. Answer D. Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry values by reducing arterial blood flow. Likewise, movement of the finger to which the oximeter is applied may interfere with interpretation of SaO2. All of these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia dont affect pulse oximetry values directly. 11. Answer B. Maintaining a patent airway is the most basic and critical human need. All other interventions are important to the clients wellbeing but not as important as having sufficient oxygen to breathe. 12. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the clients ability to maintain a patent airway, causing a high risk of infection from pooled secretions. 13. Answer A. Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the lungs after maximal inspiration and expiration. Dead-space volume is the

amount of air remaining in the upper airways that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways. 14. Answer C. An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and surfactant activity. The ideal oxygen source is room air F IO 2 0.18 to 0.21. 15. Answer B. A positive reaction means the client has been exposed to TB; it isnt conclusive of the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In immunosuppressed clients, a negative reaction doesnt exclude the presence of active disease. 16. Answer A. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect. 17. Answer B. A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates alkalosis. 18. Answer B. Before weaning a client from mechanical ventilation, its most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the clients record, and the nurse can refer to them before the weaning process begins. 19. Answer B. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. All of the other options such as administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldnt raise the lowered PaCO2 level. 20. Answer C. The most significant and direct

indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the clients ventilation status, not oxygenation. 21. Answer A. Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and incentive spirometry improves oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldnt be affected. 22. Answer A. The nurse should measure and document the amount of chest tube drainage regularly to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse should not strip chest tubes because doing so may traumatize the tissue or dislodge the tube. 23. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesnt increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day). 24. Answer B. Skin color doesnt affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because theyre affected by skin color. 25. Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10 mcg/ml arent

therapeutic. 26. Answer A. To avoid a hypotensive reaction from rapid I.V. administration, the nurse should infuse vancomycin slowly, over 60 to 90 minutes, in a large volume of fluid. Although neutropenia may occur in approximately 5% to 10% of clients receiving vancomycin, this adverse effect reverses rapidly when the drug is discontinued. 27. Answer C. Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, and injury to the brains respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes mellitus may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmauls respirations) dont cause excessive CO2 loss. Myasthenia gravis and narcotic overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis. 28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The clients greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. Its given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the clients breathing. Propranolol is contraindicated in a client whos wheezing because its a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation. 29. Answer C. The client 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. Drinking

three glasses of fluid daily wouldnt affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowlers position and shouldnt receive sedatives or other drugs that may further depress the respiratory center. 30. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

action would be appropriate? a. b. c. d. 4. Inform the physician. Continue to monitor the client. Reinforce the occlusive dressing. Encourage the client to deep-breathe. The nurse caring for a male client with a

chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to: a. b. c. d. 5. Call the physician. Place the tube in a bottle of sterile water. Immediately replace the chest tube system. Place the sterile dressing over the Nurse Paul is assisting a physician with the

disconnection site. removal of a chest tube. The nurse should instruct the client to: a. b. c. d. 6. Exhale slowly. Stay very still. Inhale and exhale quickly. Perform the Valsalva maneuver. While changing the tapes on a

1.

A male client who takes theophylline for

tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to: a. b. c. d. 7. Call the physician to reinsert the tube. Grasp the retention sutures to spread the Call the respiratory therapy department to Cover the tracheostomy site with a sterile A nurse is caring for a male client

chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the clients baseline theophylline level was: a. b. c. d. 2. 10 mcg/mL 12 mcg/mL 15 mcg/mL 18mcg/mL Nurse Kim is caring for a client with a

opening. reinsert the tracheotomy. dressing to prevent infection. immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? a. b. c. d. 8. Stridor Occasional pink-tinged sputum A few basilar lung crackles on the right Respiratory rate of 24 breaths/min An emergency room nurse is assessing a

pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate? a. b. c. d. 3. Do nothing, because this is an expected Immediately clamp the chest tube and notify Check for an air leak because the bubbling Increase the suction pressure so that A nurse has assisted a physician with the finding. the physician. should be intermittent. bubbling becomes vigorous. insertion of a chest tube. The nurse monitors the adult client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which

female 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? a. b. c. d. 9. A low respiratory Diminished breathe sounds The presence of a barrel chest A sucking sound at the site of injury A nurse is caring for a male 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? a. b. ray c. d. ray 10. 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: a. b. c. d. 11. Dyspnea Chest pain A bloody, productive cough A cough with the expectoration of mucoid A nurse performs an admission Increase oxygen saturation with exercise A widened diaphragm noted on the chest xHypocapnia A hyperinflated chest noted on the chest x-

c. d. 15.

Strengthen the intercostal muscles. Promote carbon dioxide elimination. Nurse Hannah is preparing to obtain a

sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? a. b. c. d. 16. Limiting fluids Having the clients take three deep breaths Asking the client to split into the collection Asking the client to obtain the specimen A nurse is caring for a female client after a

container after eating bronchoscope and biopsy. Which of the following signs, if noted in the client, should be reported immediately to the physicians? a. b. c. d. 17. Dry cough Hematuria Bronchospasm Blood-streaked sputum A nurse is suctioning fluids from a male

sputum assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the results of which diagnostic test that will confirm this diagnosis? a. b. c. d. 12. Bronchoscopy Sputum culture Chest x-ray Tuberculin skin test The nursing instructor asks a nursing

client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of: a. b. c. d. 18. 1 minute 5 seconds 10 seconds 30 seconds A nurse is suctioning fluids from a female

student to describe the route of transmission of tuberculosis. The instructor concludes that the student understands this information if the student states that the tuberculosis is transmitted by: a. b. c. d. 13. Hand and mouth The airborne route The fecal-oral route Blood and body fluids A nurse is caring for a male client with

client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention? a. b. c. d. 19. Continue to suction. Notify the physician immediately. Stop the procedure and reoxygenate the Ensure that the suction is limited to 15 An unconscious male client is admitted to

client. seconds. an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of: a. b. c. d. Metabolic acidosis Respiratory acidosis Overcompensated respiratory acidosis Combined respiratory and metabolic

emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: a. b. c. d. 14. 1 L/min 2 L/min 6 L/min 10 L/min 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: a. b. Promote oxygen intake. Strengthen the diaphragm.

acidosis

20.

A female client is suspected of having a

assesses for other signs of: a. b. c. d. 26. Right pneumothorax Pulmonary embolism Displaced endotracheal tube Acute respiratory distress syndrome A nurse is teaching a male client with

pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? a. b. c. d. 21. Dyspnea Bradypnea Bradycardia Decreased respiratory A nurse teaches a male client about the

chronic respiratory failure how to use a metereddose inhaler correctly. The nurse instructs the client to: a. b. c. d. 27. Inhale quickly Inhale through the nose Hold the breath after inhalation Take two inhalations during one breath A nurse is assessing a female client with

use of a respiratory inhaler. Which action by the client indicates a need for further teaching? a. b. c. d. 22. Inhales the mist and quickly exhales Removes the cap and shakes the inhaler Presses the canister down with the finger as Waits 1 to 2 minutes between puffs if more A female client has just returned to a

well before use he breathes in than one puff has been prescribed nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? a. b. c. d. 23. Administering atropine intravenously Administering small doses of midazolam Encouraging additional fluids for the next 24 Ensuring the return of the gag reflex before A nurse is assessing the respiratory status

multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome? a. b. c. d. 28. Bilateral wheezing Inspiratory crackles Intercostal retractions Increased respiratory rate A nurse is taking pulmonary artery catheter

measurements of a male client with acute respiratory distress syndrome. The pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this readings is: a. b. c. d. 29. High and expected Low and unexpected Normal and expected Uncertain and unexpected A nurse is assessing a male client with

(Versed) hours offering food or fluids of a male client who has suffered a fractured rib. The nurse would expect to note which of the following? a. b. c. d. 24. Slow deep respirations Rapid deep respirations Paradoxical respirations Pain, especially with inspiration A female client with chest injury has

chronic airflow limitations and notes that the client has a barrel chest. The nurse interprets that this client has which of the following forms of chronic airflow limitations? a. b. c. d. 30. Emphysema Bronchial asthma Chronic obstructive bronchitis Bronchial asthma and bronchitis A nurse is caring for a female client

suffered flail chest. A nurse assesses the client for which most distinctive sign of flail chest? a. b. c. d. 25. Cyanosis Hypotension Paradoxical chest movement Dyspnea, especially on exhalation A male client has been admitted with chest

diagnosed with tuberculosis. Which assessment, if made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis and may indicate the development of a concurrent problem? a. b. c. d. Cough High-grade fever Chills and night sweats Anorexia and weight loss

trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately

1.

Answer A. The therapeutic range for the

not prevent complications resulting from the disconnection. The physician may need to be notified, but this is not the initial action. 5. Answer D. When the chest tube is removed,

serum theophylline level is 10 to 20 mcg/mL. If the level is below the therapeutic range, the client may experience frequent exacerbations of the disorder. Although all the options identify values within the therapeutic range, option A is the option that reflects a need for compliance with medication. 2. Answer A. Continuous gentle bubbling

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. Options A, B, and C are incorrect client instructions. 6. Answer B. If the tube is dislodged

should be noted in the suction control chamber. Option B is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option C is incorrect. Bubbling should be continuous and not intermittent. Option D is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system. 3. Answer B. The presence of fluctuation of

accidentally, the initial nursing action is to grasp the retention sutures and spread the opening. If agency policy permits, the nurse then attempts immediately to replace the tube. Covering the tracheostomy site will block the airway. Options 1 and 3 will delay treatment in this emergency situation. 7. Answer A. The nurse reports stridor to the

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 reexpanded. Options A, C, and D are incorrect. 4. Answer B. If the chest drainage system is

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. Options B, C, and D are not signs that require immediate notification of the physician. 8. Answer B. This client has sustained a blunt

disconnected, the end of the tube is placed in a bottle of sterile water held below the level of the chest. The system is replaced if it breaks or cracks or if the collection chamber is full. Placing a sterile dressing over the disconnection site will

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 sucking sound at the site of injury would be noted with an open chest injury. 9. Answer B. Clinical manifestations of chronic

14.

Answer D. 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. Options A, B, and C are not the purposes of this type of breathing. 15. Answer B. To obtain a sputum specimen,

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. 10. Answer D. One of the first pulmonary

the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning. 16. Answer C. If a biopsy was performed

symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement. 11. Answer B. Tuberculosis is definitively

diagnosed through culture and isolation of Mycobacterium tuberculosis. 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. 12. Answer B. Tuberculosis is an infectious

during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure. 17. Answer C. Hypoxemia can be caused by

disease caused by the bacillus Mycobacterium tuberculosis and is spread primarily by the airborne route. Options A, C, and D are incorrect. 13. Answer B. Oxygen is used cautiously and

should not exceed 2 L/min. Because of the longstanding 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.

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.

18.

Answer C. During suctioning, the nurse

from a blunt injury or a fall. Typical signs and symptoms include pain and tenderness localized at the fracture site and exacerbated by inspiration and palpation, shallow respirations, splinting or guarding the chest protectively to minimize chest movement, and possible bruising at the fracture site. Paradoxical respirations are seen with flail chest. 24. Answer C. Flail chest results from fracture

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. 19. Answer A. In an acidotic condition, the pH

would be low, indicating the acidosis. In addition, a low bicarbonate level along with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect. 20. Answer A. The common clinical

of two or more ribs in at least two places each. This results in a floating section of ribs. Because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical chest movement. This means that the force of inspiration pulls the fractured segment inward, while the rest of the chest expands. Similarly, during exhalation, the

manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain. 21. Answer A. The client should be instructed

segment balloons outward while the rest of the chest moves inward. This is a telltale sign of flail chest. 25. Answer A. Pneumothorax is characterized

to hold his or her breath for at least 10 to 15 seconds before exhaling the mist. Options B, C, and D are accurate instructions regarding the use of the inhaler. 22. Answer D. After bronchoscopy, the nurse

by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi.

keeps the client on NPO status until the gag reflex returns because the preoperative sedation and local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Additional fluids are unnecessary because no contrast dye is used that would need flushing from the system. Atropine and midazolam would be administered before the procedure, not after. 23. Answer D. Rib fractures are a common

injury, especially in the older client, and result

26.

Answer C. Instructions for using a

chills and sweats (which may occur at night), and a low-grade fever.

metered-dose inhaler include shaking the canister, holding it right side up, inhaling slowly and evenly through the mouth, delivering one spray per breath, and holding the breath after inhalation. 27. Answer D. The earliest detectable sign of

acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles. 28. Answer C. The normal pulmonary capillary

wedge pressure (PCWP) is 8 to 13 mm Hg, and the client is considered to have high readings if they exceed 18 to 20 mm Hg. The client with acute respiratory distress syndrome has a normal PCWP, which is an expected finding because the edema is in the interstitium of the lung and is noncardiac. 29. Answer A. The client with emphysema has

hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, referred to as barrel chest. The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion. 30. Answer B. The client with tuberculosis

usually experiences cough (productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain,