KABC – RESPI QUESTIONS

1. The emergency department nurse is assessing a client who has a. Continue to suction.
sustained a blunt injury to the chest wall. Which finding indicates b. Notify the health care provider immediately.
the presence of a pneumothorax in this client? c. Stop the procedure and re-oxygenate the client.
a. A low respiratory rate d. Ensure that the suction is limited to 15 seconds.
b. Diminished breath sounds
c. The presence of a barrel chest 8. The nurse is assessing the respiratory status of a client who has
d. A sucking sound at the site of injury suffered a fractured rib. The nurse should expect to note which
finding?
2. The nurse is caring for a client hospitalized with acute exacerbation a. Slow, deep respirations
of chronic obstructive pulmonary disease. Which findings would the b. Rapid, deep respirations
nurse expect to note on assessment of this client? Select all that c. Paradoxical respirations
apply. d. Pain, especially with inspiration
a. A low arterial PCo2 level
b. A hyperinflated chest noted on the chest x -ray 9. A client with a chest injury has suffered flail chest. The nurse
c. Decreased oxygen saturation with mild exercise assesses the client for which most distinctive sign of flail chest?
d. A widened diaphragm noted on the chest x-ray a. Cyanosis
e. Pulmonary function tests that demonstrate b. Hypotension
f. increased vital capacity c. Paradoxical chest movement
d. Dyspnea, especially on exhalation
3. The nurse instructs a client to use the pursed-lip method of
breathing and evaluates the teaching by asking the client about the 10. A client has been admitted with chest trauma after a motor vehicle
purpose of this type of breathing. The nurse determines that the crash and has undergone subsequent intubation. The nurse checks
client understands if the client states that the primary purpose of the client when the high-pressure alarm on the ventilator sounds,
pursed-lip breathing is to promote which outcome? and notes that the client has absence of breath sounds in the right
a. Promote oxygen intake upper lobe of the lung. The nurse immediately assesses for other
b. Strengthen the diaphragm signs of which condition?
c. Strengthen the intercostal muscles a. Right pneumothorax
d. Promote carbon dioxide elimination b. Pulmonary embolism
c. Displaced endotracheal tube
4. The nurse is preparing a list of home care instructions for a client d. Acute respiratory distress syndrome
who has been hospitalized and treated for tuberculosis. Which
instructions should the nurse include on the list? Select all that 11. The nurse is assessing a client with multiple trauma who is at risk
apply. for developing acute respiratory distress syndrome. The nurse should
a. Activities should be resumed gradually. assess for which earliest sign of acute respiratory distress syndrome?
b. Avoid contact with other individuals, except family a. Bilateral wheezing
members, for at least 6 months. b. Inspiratory crackles
c. A sputum culture is needed every 2 to 4 weeks once c. Intercostal retractions
medication therapy is initiated. d. Increased respiratory rate
d. Respiratory isolation is not necessary because family
members already have been exposed. 12. The nurse is discussing the techniques of chest physiotherapy and
e. Cover the mouth and nose when coughing or sneezing and postural drainage (respiratory treatments) to a client having
put used tissues in plastic bags. expectoration problems because of chronic thick, tena cious mucus
f. When 1 sputum culture is negative, the client is no longer production in the lower airway. The nurse explains that after the
considered infectious and usually can return to former client is positioned for postural drainage the nurse will perform
employment. which action to help loosen secretions?
a. Palpation and clubbing
5. The nurse is caring for a client after a bronchoscopy and biopsy. b. Percussion and vibration
Which finding, if noted in the client, should be reported immediately c. Hyperoxygenation and suctioning
to the health care provider? d. Administer a bronchodilator and monitor peak flow
a. Dry cough
b. Hematuria 13. The nurse has conducted discharge teaching with a client diagnosed
c. Bronchospasm with tuberculosis who has been receiving medication for 2 weeks.
d. Blood-streaked sputum The nurse determines that the client has understood the inform ation
if the client makes which statement?
6. The nurse is preparing to suction a client via a tracheostomy tube. a. “I need to continue medication therapy for 1 month.”
The nurse should plan to limit the suctioning time to a maximum of b. “I can’t shop at the mall for the next 6 months.”
which time period? c. “I can return to work if a sputum culture comes back
a. 5 seconds negative.”
b. 10 seconds d. “I should not be contagious after 2 to 3 weeks of
c. 30 seconds e. medication therapy.”
d. 60 seconds
14. The nurse is preparing to give a bed bath to an immobilized client
7. The nurse is suctioning a client via an endotracheal tube. During the with tuberculosis. The nurse should wear which items when
suctioning procedure, the nurse notes on the monitor that the heart performing this care?
rate is decreasing. Which nursing intervention is appropriate? a. Surgical mask and gloves

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 KABC – RESPI QUESTIONS

b. Particulate respirator, gown, and gloves associated with tuberculosis. The nurse informs the participants tha t
c. Particulate respirator and protective eyewear tuberculosis is considered as a diagnosis if which signs and
d. Surgical mask, gown, and protective eyewear symptoms are present? Select all that apply.
a. Dyspnea
15. A client has experienced pulmonary embolism. The nurse should b. Headache
assess for which symptom, which is most commonly reported? c. Night sweats
a. Hot, flushed feeling d. A bloody, productive cough
b. Sudden chills and fever e. A cough with the expectoration of mucoid sputum
c. Chest pain that occurs suddenly
d. Dyspnea when deep breaths are taken 23. The nurse performs an admission assessment on a client with a
diagnosis of tuberculosis. The nurse should check the results of
16. A client who is human immunodeficiency virus (HIV)–positive has had which diagnostic test that will confirm this diagnosis?
a tuberculin skin test (TST). The nurse notes a 7-mm area of a. Chest x-ray
induration at the site of the skin test and interprets the result as b. Bronchoscopy
which finding? c. Sputum culture
a. Positive d. Tuberculin skin test
b. Negative
c. Inconclusive 24. The low-pressure alarm sounds on a ventilator. The nurse assesses
d. Need for repeat testing the client and then attempts to determine the cause of the alarm. If
unsuccessful in determining the cause of the alarm, the nurse should
17. A client with acquired immunodeficiency syndrome (AIDS) has take what initial action?
histoplasmosis. The nurse should assess the client for which a. Administer oxygen
expected finding? b. Check the client’s vital signs
a. Dyspnea c. Ventilate the client manuall y
b. Headache d. Start cardiopulmonary resuscitation
c. Weight gain
d. Hypothermia 25. A client has a prescription to take guaifenesin. The nurse determines
that the client understands the proper administration of this
18. The nurse is giving discharge instructions to a client with pulmonary medication if the client states that he or she will perform which
sarcoidosis. The nurse concludes that the client understands the action?
information if the client indicates to report which early sign of a. Take an extra dose if fever develops
exacerbation? b. Take the medication with meals only
a. Fever c. Take the tablet with a full glass of water
b. Fatigue d. Decrease the amount of daily fluid intake
c. Weight loss
d. Shortness of breath 26. The nurse is preparing to administer a dose of naloxone
intravenously to a client with an opioid overdose. Which supportive
19. The nurse is taking the history of a client with occupational lung medical equipment should the nurse plan to have at the client’s
disease (silicosis). The nurse should assess whether the client wears bedside if needed?
which item during periods of exposure to silica particles? a. Nasogastric tube
a. Mask b. Paracentesis tray
b. Gown c. Resuscitation equipment
c. Gloves d. Central line insertion tray
d. Eye protection
27. The nurse teaches a client about the effects of diphenhydramine,
20. An oxygen delivery system is p rescribed for a client with chronic which has been prescribed as a cough suppressant. The nurse
obstructive pulmonary disease to deliver a precise oxygen determines that the client needs further instruction if the client
concentration. Which oxygen delivery system would the nurse makes which statement?
prepare for the client? a. “I will take the medication on an empty stomach.”
a. Face tent b. “I won’t drink alcohol while taking this medication.”
b. Venturi mask c. “I won’t do activities that require mental alertness while
c. Aerosol mask taking this medication.”
d. Tracheostomy collar d. “I will use sugarless gum, candy, or oral rinses to decrease
dryness in my mouth.”
21. The nurse is instructing a hospitalized client with a diagnosis of
emphysema about measures that will enhance the effectiveness of 28. Acromolyn sodium inhaler is prescribed for a client with allergic
breathing during dyspneic periods. Which position should the nurse asthma. The nurse provides instructions regarding the adverse
instruct the client to assume? effects of this medication and should tell the client that which
a. Sitting up in bed undesirable effect is associated with this medication?
b. Side-lying in bed a. Insomnia
c. Sitting in a recliner chair b. Constipation
d. Sitting up and leaning on an overbed table c. Hypotension
d. Bronchospasm
22. The community health nurse is conducting an educational session
with community members regarding the signs and symptoms

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 KABC – RESPI QUESTIONS

29. Terbutaline is prescribed for a client with bronch itis. The nurse c. Alternating a single puff of each, beginning with the
checks the client’s medical history for which disorder in which the beclomethasone
medication should be used with caution?
a. Osteoarthritis 37. Rifabutin is prescribed for a client with active Mycobacterium avium
b. Hypothyroidism complex (MAC) disease and tuberculosis. For which side and adverse
c. Diabetes mellitus effects of the medication should the nurse monitor? Select all that
d. Polycystic disease apply.
a. Signs of hepatitis
30. Zafirlukast is prescribed for a client with bronchial asthma. Which b. Flulike syndrome
laboratory test does the nurse expect to be prescribed before the c. Low neutrophil count
administration of this medication? d. Vitamin B6 deficiency
a. Platelet count e. Ocular pain or blurred vision
b. Neutrophil count f. Tingling and numbness of the fingers
c. Liver function tests
d. Complete blood count 38. A client has begun therapy with theophylline. The nurse should plan
to teach the client to limit the intake of which items while taking
31. A client has been taking isoniazid for 2 months. The client complains this medication?
to the nurse about numbness, paresthesias, and tingling in the a. Coffee, cola, and chocolate
extremities. The nurse interprets that the client is experiencing b. Oysters, lobster, and shrimp
which problem? c. Melons, oranges, and pineapple
a. Hypercalcemia d. Cottage cheese, cream cheese, and dairy creamers
b. Peripheral neuritis
c. Small blood vessel spasm 39. The nurse has just administered the first dose of omalizumab to a
d. Impaired peripheral circulation client. Which statement by the client would alert the nurse that the
client may be experiencing a life-threatening effect?
32. A client is to begin a 6-month course of therapy with isoniazid. The a. “I have a severe headache.”
nurse should plan to teach the client to take which action? b. “My feet are quite swollen.”
a. Use alcohol in small amounts only. c. “I am nauseated and may vomit.”
b. Report yellow eyes or skin immediately. d. “My lips and tongue are swollen.”
c. Increase intake of Swiss or aged cheeses.
d. Avoid vitamin supplements during the rapy. 40. The nurse is caring for a client with a diagnosis of influenza who first
began to experience symptoms yesterday. Antiviral the rapy is
33. A client has been started on long -term therapy with rifampin. The prescribed and the nurse provides instructions to the client about
nurse should provide which information to the client about the the therapy. Which statement by the client indicates an
medication? understanding of the instructions?
a. Should always be taken with food or antacids a. “I must take the medication exactly as prescribed.”
b. Should be double-dosed if 1 dose is forgotten b. “Once I start the medication, I will no longer be
c. Causes orange discoloration of sweat, tears, urine, and contagious.”
feces c. “I will not get any colds or infections while taking this
d. May be discontinued independently if symptoms are gone medication.”
in 3 months d. “This medication has minimal side effects and I can return
to normal activities.”
34. The nurse has given a client taking ethambutol information about
the medication. The nurse determines that the client understands
the instructions if the client states that he or she will immediately
report which finding ?
a. Impaired sense of hearing
b. Gastrointestinal side effects
c. Orange-red discoloration of body secretions
d. Difficulty in discriminating the color red from green

35. A client with tuberculosis is being started on anti -tuberculosis

therapy with isoniazid. Before giving the client the first dose, the
nurse should ensure that which baseline study has been completed?
a. Electrolyte levels
b. Coagulation times
c. Liver enzyme levels
d. Serum creatinine level

36. The nurse has a prescription to give a client salmeterol, 2 puffs, and
beclomethasone di propionate, 2 puffs, by metered-dose inhaler. The
nurse should administer the medication using which procedure?
a. Beclomethasone first and then the sal meterol
b. Salmeterol first and then the beclomethasone Alternating
a single puff of each, beginning with the salmeterol

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 KABC – RESPI QUESTIONS

1. B 8. D
This client has sustained a blunt or closed -chest injury. Basic Rib fractures result from a blunt injury or a fall. Typical
symptoms of a closed pneumothorax are shortness of breath and signs and symptoms include pain and tenderness localized at the
chest pain. A larger pneumothorax may cause tachypne a, cyanosis, fracture site that is exacerbated by inspiration and palpation,
diminished breath sounds, and subcutaneous emphysema. shallow respirations, splinting or guarding the chest protectively to
Hyperresonance also may occur on the affected side. A sucking sound minimize chest movement, and possible bruising at the fracture site.
at the site of injury would be noted with an open chest injury. Paradoxical respirations are seen with flail chest.

2. B, C 9. C
Clinical manifestations of chronic obstructive pulm onary disease Flail chest results from multiple rib fractures. This results in a
(COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at “floating” section of ribs. Because this section is unattached to the
rest, oxygen desaturation with exercise, and the use of accessory rest of the bony rib cage, this segment results in paradoxical chest
muscles of respiration. Chest x -rays reveal a hyperinflated chest and movement. This means that the force of inspiration pulls the
a flattened diaphragm if the disease is advanced. Pulmonary function fractured segment inward, while the rest of the chest expands.
tests will demonstrate decreased vital capacity. Similarly, during exhalation, the segment balloons outward while the
rest of the chest moves inward. This is a characteristic sign of flail
3. D chest.
Pursed-lip breathing facilitates maximal expiration for clients with
obstructive lung disease. This type of breathing allows better 10. A.
expiration by increasing airway pressure that keeps air passages Pneumothorax is characterized by restlessness, tachycardia,
open during exhalation. Options A, B, and C are not the purposes of dyspnea, pain with respiration, asymmetrical chest expansion, and
this type of breathing. diminished or absent breath sounds on the affected side.
Pneumothorax can cause increased airway pressure because of
4. A, C, D, E resistance to lung inflation. Acute respiratory distress syndrome and
The nurse should provide the client and family with information pulmonary embolism are not characterized by absent breath sounds.
about tuberculosis and allay concerns about the contagious aspec t An endotracheal tube that is inserted too far can cause abse nt breath
of the infection. The client needs to follow the medication regimen sounds, but the lack of breath sounds most likely would be on the
exactly as prescribed and always have a supply of the medication on left side because of the degree of curvature of the right and left
hand. Side and adverse effects of the medication and ways of mainstem bronchi.
minimizing them to ensure compliance should be explained. After 2
to 3 weeks of medication therapy, it is unlikely that the client will 11. D
infect anyone. Activities should be resumed gradually and a well - The earliest detectable sign of acute respiratory distress syndrome
balanced diet that is rich in iron, protein, and vitamin C to promote is an increased respiratory rate, which can begin from 1 to 96 hours
healing and prevent recurrence of infectio n should be consumed. after the initial insult to the body. This is followed by increasing
Respiratory isolation is not necessary because family members dyspnea, air hunger, retraction of accessory muscles, and cyanosis.
already have been exposed. Instruct the client about thorough hand Breath sounds may be clear or consist of fine inspiratory crackles or
washing, to cover the mouth and nose when coughing or sneezing, diffuse coarse crackles.
and to put used tissues into plastic bags . A sputum culture is needed
every 2 to 4 weeks once medication therapy is initiated. When the 12. B.
results of 3 sputum cultures are negative, the client is no longer Chest physiotherapy of percussion and vibration helps to loosen
considered infectious and can usually return to former employment. secretions in the smaller lower airways. Postural drainage positions
the client so that gravity can help mucus move from smaller airways
5. C to larger ones to support expectoration of the mucus. Options A, C,
If a biopsy was performed during a bronchoscopy, blood-streaked and D are not actions that will loosen secretions.
sputum is expected for several hours. Frank blood indicates
hemorrhage. A dry cough may be expected. The client should be 13. D
assessed for signs of complications, which would include cyanosis, The client is continued on medication therapy for up to 12 months,
dyspnea, stridor, bronchosp asm, hemoptysis, hypotension, depending on the situation. The client generally is considered
tachycardia, and dysrhythmias. Hematuria is unrelated to this noncontagious after 2 to 3 weeks of medication therapy. The client
procedure. is instructed to wear a mask if there will be exposure to crowds until
the medication is effective in preventing transmission. The client is
6. B allowed to return to work when the results of 3 sputum cultures are
Hypoxemia can be caused by prolonged suctioning, which stimulates negative.
the pacemaker cells in the heart. A vasovagal response may occur,
causing bradycardia. The nurse must preoxygenate the client before 14. B
suctioning and limit the suctioning pass to 10 seconds. The nurse who is in contact with a client with tuberculosis should
wear an individually fitted particulate respirator. The nurse also
7. C would wear gloves as per standard precautions. The nurse wears a
During suctioning, the nurse should monitor the client closely for gown when the possibility exists that the clothing could become
adverse effects, including hypoxemia, cardiac irregularities such as contaminated, such as when giving a bed bath.
a decrease in heart rate resulting from vagal stimulation, mucosal
trauma, hypotension, and paroxysmal coughing. If adverse effects 15. C
develop, especially cardiac irregularities, the procedure is stopped The most common initial symptom in pulmonary embolism is chest
and the client is reoxygenated. pain that is sudden in onset. The next most commonly reported
symptom is dyspnea, which is accompanied by an increased

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 KABC – RESPI QUESTIONS

respiratory rate. Other typical symptoms of pulmonary embolism 24. C

include apprehension and restlessness, tachycardia, cough, and If at any time an alarm is sounding and the nur se cannot quickly
cyanosis. ascertain the problem, the client is disconnected from the ventilator
and manual resuscitation is used to support respirations until the
16. A problem can be corrected. No reason is given to begin
The client with HIV infection is considered to have positive results cardiopulmonary resuscitation. Checking vital signs is not the initial
on tuberculin skin testing with an area of induration larger than 5 action. Although oxygen is helpful, it will not provide ventilation to
mm. The client without HIV is positive with an induration larger than the client.
10 mm. The client with HIV is immunosuppressed, making a smaller
area of induration positive for this type of client. It is possible for
the client infected with HIV to have false -negative readings because
of the immunosuppression factor. Options B, C, and D are incorrect 25. C
interpretations. Guaifenesin is an expectorant and should be taken with a full glass
of water to decrease the viscosity of secretions. Extra doses should
17. A not be taken. The client should contact the health care provider if
Histoplasmosis is an opportunistic fungal infection that can occur in the cough lasts longer than 1 week or is accompanied by fever, rash,
the client with AIDS. The infection begins as a respiratory infection sore throat, or persistent headache. Fluids are needed to decrease
and can progress to disseminated infection. Typical signs and the viscosity of secretions. The medication does not have to be taken
symptoms include fever, dyspnea, cough, and weight loss. with meals.
Enlargement of the client’s lymph nodes, liver, and spleen may occur
as well. 26. C
The nurse administering naloxone for suspected opioid overdose
should have resuscitation equipment readily available to support
18. D naloxone therapy if it is needed. Other adjuncts that may be needed
Dry cough and dyspnea are typical early manifestations of pulmonary include oxygen, a mechanical ventilator, and vasopressors.
sarcoidosis. Later manifestations include night sweats, fever, weight
loss, and skin nodules. 27. A
Diphenhydramine has several uses, including as an antihistamine,
19. A. antitussive, antidyskinetic, and sedativehypnotic. Instructions for
Silicosis results from chronic, excessive inhalation of particles of use include taking with food or milk to decrease gastrointestinal
free crystalline silica dust. The client should wear a mask to limit upset and using oral rinses, sugarless gum, or hard candy to minimize
inhalation of this substance, which can cause restrictive lung disease dry mouth. Because the medication causes drowsiness, the client
after years of exposure. Options B, C, and D are not necessary. should avoid use of alcohol or central nervous system depressants,
operating a car, or engaging in other activities requiring mental
20. B awareness during use.
The Venturi mask delivers the most accurate oxygen concentration.
It is the best oxygen delivery system for the client with chronic 28. D
airflow limitation such as chronic obstructive pulmonary disease, Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a
because it delivers a precise oxygen concentration. The face tent, mast cell stabilizer. Undesirable effects associated with inhalation
aerosol mask, and tracheostomy collar are also high-flow oxygen therapy of cromolyn sodium are bronchospasm, cough, nasal
delivery systems but most often are used to administer high congestion, throat irritation, and wheezing. Clients r eceiving this
humidity. medication orally may experience pruritus, nausea, diarrhea, and
myalgia.
21. D
Positions that will assist the client with emphysema with breathing 29. C
include sitting up and leaning on an overbed table, sitting up and Terbutaline is a bronchodilator and is contraindicated in clients with
resting the elbows on the knees, and standing and leaning against hypersensitivity to sympathomimetics. It should be used with
the wall. caution in clients with impaired cardiac function, diabetes mellitus,
hypertension, hyperthyroidism, or a history of seizures. The
22. A, C, D, E medication may increase blood glucose levels.
Tuberculosis should be considered for any clients with a persistent
cough, weight loss, anorexia, night sweats, hemoptysis, shortness of 30. C
breath, fever, or chills. The client’s previous exposure to Zafirlukast is a leukotriene receptor antagonist used in the
tuberculosis should also be assessed and correlated with the clinical prophylaxis and long-term treatment of bronchial asthma.
manifestations. Zafirlukast is used with caution in clients with impaired hepatic
function. Liver function laboratory tests should be performed to
23. C obtain a baseline, and the levels should be monitored during
Tuberculosis is definitively diagnosed through culture administration of the medication. It is not necessary to perform the
and isolation of Mycobacterium tuberculosis. A presumptive other laboratory tests before administration of the medication.
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. Test-Taking Strategy:
Focus on the subject, confirming the diagnosis of tuberculosis. 31. B
Confirmation is made by identifying the bacteria, M. tuberculosis. Isoniazid is an antitubercular medication. A common side effect of
isoniazid is peripheral neuritis, manifested by numbness, tingling,

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 KABC – RESPI QUESTIONS

and paresthesias in the extremities. T his can be minimized with numbness and tingling in the extremities are associated with the use
pyridoxine (vitamin B6) intake. Options A, C, and D are not of isoniazid.
associated with the information in the question.
38. A
32. B Theophylline is a methylxanthine bronchodilator. The nurse teaches
Isoniazid is hepatotoxic, and therefore the client is taught to report the client to limit the intake of xanthine containing foods while
signs and symptoms of hepatitis immediately, which include yellow taking this medication. These foods include coffee, cola, and
skin and sclera. For the same reason, alcohol should be avoided chocolate.
during therapy. The client should avoid intake of Swiss cheese, fish
such as tuna, and foods containing tyramine because they may cause 39. D
a reaction characterized by redness and itching of the skin, flushing, Omalizumab is an antiinflammatory used for longterm control of
sweating, tachycardia, headache, or lightheadedness. The client can asthma. Anaphylactic reactions can occur with the administration of
avoid developing peripheral neuritis by increasing the intake of omalizumab. The nurse administering the medication should monitor
pyridoxine (vitamin B6) during the course of isoniazid for adverse reactions of the medication. Swelling of the lips and
therapy. tongue are an indication of an anaphylaxis. The client statements in
options A, B, and C are not indicative of an adverse reaction.
33. C
Rifampin causes orange-red discoloration of body secretions and will 40. A
stain soft contact lenses permanently. Rifampin should be taken Antiviral medications for influenza must be taken exactly as
exactly as directed. Doses should not be doubled or skipped. The prescribed. These medications do not prevent the spread of influenza
client should not stop therapy until directed to do so by a health care and clients are usually contagious for up to 2 days after the initiation
provider. It is best to administer the medication on an empty of antiviral medications. Secondary bacterial infections may occur
stomach unless it causes gastrointestinal upset, and then it may be despite antiviral treatment. Side effects occur with these
taken with food. Antacids, if prescribed, should be taken at least 1 medications and may necessitate a change in activities, especially
hour before the medication. when driving or operating machinery if dizziness occurs.

34. D
Ethambutol causes optic neuritis , which decreases visual acuity and
the ability to discriminate between the colors red and green. This
poses a potential safety hazard when a client is driving a motor
vehicle. The client is taught to report this symptom immediately.
The client also is taught to take the medication with food if
gastrointestinal upset occurs. Impaired hearing results from
antitubercular therapy with streptomycin. Orange-red discoloration
of secretions occurs with rifampin.

35. C
Isoniazid therapy can cause an elevation of hepat ic enzyme levels
and hepatitis. Therefore, liver enzyme levels are monitored when
therapy is initiated and during the first 3 months of therapy. They
may be monitored longer in the client who is older than 50 years or
abuses alcohol. The laboratory tests i n options A, B, and D are not
necessary.

36. B
Salmeterol is an adrenergic type of bronchodilator and
beclomethasone dipropionate is a glucocorticoid. Bronchodilators
are always administered before glucocorticoids when both are to be
given on the same time schedule. This allows for widening of the air
passages by the bronchodilator, which then makes the glucocorticoid
more effective.

37. A, B, C, E
Rifabutin may be prescribed for a client with active MAC disease and
tuberculosis. It inhibits mycobacterial DNA-dependent RNA
polymerase and suppresses protein synthesis. Side and adverse
effects include rash, gastrointestinal disturbances, neutropenia (low
neutrophil count), redorange – colored body secretions, uveitis
(blurred vision and eye pain), myositis, ar thralgia, hepatitis, chest
pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and

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 KABC – RESPI QUESTIONS

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with sees many abbreviations. What does a lowercase “a” in ABG value
newly diagnose asthma. When teaching the patient about this drug, present?
the nurse should explain that it may cause: a. Acid-base balance
a. Nasal congestion b. Arterial Blood
b. Nervousness c. Arterial oxygen saturation
c. Lethargy d. Alveoli
d. Hyperkalemia
9. A male patient is admitted to the healthcare facility for treatment
2. Miriam, a college student with acute rhinitis sees the campus nurse of chronic obstructive pulmonary disease. Which nursing diagnosis
because of excessive nasal drainage. The nurse asks the patient is most important for this patient?
about the color of the drainage. In acute rhinitis, nasal drainage a. Activity intolerance related to fatigue
normally is: b. Anxiety related to actual threat to health status
a. Yellow c. Risk for infection related to retained secretions
b. Green d. Impaired gas exchange related to airflow obstruction
c. Clear
d. Gray 10. Nurse Ruth assessing a patient for tracheal displacement should
know that the trachea will deviate toward the:
3. A male adult patient hospitalized for treatment of a pulmonary a. Contralateral side in a simple pneumothorax
embolism develops respiratory alkalosis. Which clinical findings b. Affected side in a hemothorax
commonly accompany respiratory alkalosis? c. Affected side in a tension pneumothorax
a. Nausea or vomiting d. Contralateral side in hemothorax
b. Abdominal pain or diarrhea
c. Hallucinations or tinnitus 11. After undergoing a left pneumonectomy, a female patient has a chest
d. Lightheadedness or paresthesia tube in place for drainage. When caring for this patient, the nurse
must:
4. 4. Before administering ephedri ne, Nurse Tony assesses the patient’s a. Monitor fluctuations in the water -seal chamber
history. Because of ephedrine’s central nervous system (CNS) b. Clamp the chest tube once every shift
effects, it is not recommended for: c. Encourage coughing and deep breathing
a. Patients with an acute asthma attack d. Milk the chest tube every 2 hours
b. Patients with narcolepsy
c. Patients under age 6 12. When caring for a male patient who has just had a total
d. Elderly patients laryngectomy, the nurse should plan to:
a. Encourage oral feeding as soon as possible
5. A female patient suffers adult respiratory distress syndrome as a b. Develop an alternative communication method
consequence of shock. The patient’s condition deteriorates rapidly, c. Keep the tracheostomy cuff fully inflated
and endotracheal intubation and mechanical ventilation are d. Keep the patient flat in bed
initiated. When the high-pressure alarm on the mechanical
ventilator, alarm sounds, the nurse starts to check for the cause. 13. A male patient has a sucking stab wound to the chest. Which action
Which condition triggers the high -pressure alarm? should the nurse take first?
a. Kinking of the ventilator tubing
b. A disconnected ventilator tube a. Drawing blood for a hematocrit and hemoglobin level
c. An endotracheal cuff leak b. Applying a dressing over the wound and taping it on three
d. A change in the oxygen concentration without resetting sides
the oxygen level alarm c. Preparing a chest tube insertion tray
d. Preparing to start an I.V. line
6. A male adult patient on mechanical ventilation is receiving
pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which 14. For a patient with advanced chronic obstructive pulmonary disease
assessment finding indicates that the patient needs another (COPD), which nursing action best promotes adequate gas exchange?
pancuronium dose? a. Encouraging the patient to drink three glasses of fluid
a. Leg movement daily
b. Finger movement b. Keeping the patient in semi -Fowler’s position
c. Lip movement c. Using a high-flow venture mask to deliver oxygen as
d. Fighting the ventilator prescribe
d. Administering a sedative, as prescribe
7. On auscultation, which finding suggests a right pneumothorax?
a. Bilateral inspiratory and expiratory crackles 15. A male patient’s X-ray result reveals bilateral white-outs, indicating
b. Absence of breaths sound in the right thorax adult respiratory distress syndrome (ARDS). This syndrome results
c. Inspiratory wheezes in the right thorax from:
d. Bilateral pleural friction rub. a. Cardiogenic pulmonary edema
b. Respiratory alkalosis
8. Rhea, confused and short breath, is brought to the emergency c. Increased pulmonary capillary permeability
department by a family member. The medical history reveals chronic d. Renal failure
bronchitis and hypertension. To learn more about the current
respiratory problem, the doctor orders a chest x -ray and arterial 16. For a female patient with chronic obstructive pulmonary disease,
blood gas (ABG) analysis. When reviewing the ABG report, the nurses which nursing intervention would help maintain a patent airway?

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a. Restricting fluid intake to 1,000 ml per day 24. Nurse Reese is caring for a client hospitalized with acute
b. Enforcing absolute bed rest exacerbation of chronic obstructive pulmonary disease. Which of the
c. Teaching the patient how to perform controlled coughing following would the nurse expect to note on assessment of this
d. Administering prescribe sedative s regularly and in large client?
amounts a. Hypocapnia
b. A hyperinflated chest noted on the ches t x-ray
17. Nurse Lei caring for a client with a pneumothorax and who has had a c. Increased oxygen saturation with exercise
chest tube inserted notes continues gentle bubbling in the suction d. A widened diaphragm noted on the chest x -ray
control chamber. What action is appropriate?
a. Do nothing, because this is an expected fi nding 25. An oxygen delivery system is prescribed for a male client with
b. Immediately clamp the chest tube and notify the physician chronic obstructive pulmonary disease to deliver a precise oxygen
c. Check for an air leak because the bubbling should be concentration. Which of the fol lowing types of oxygen delivery
intermittent systems would the nurse anticipate to be prescribed?
d. Increase the suction pressure so that the bubbling a. Face tent
becomes vigorous b. Venturi mask
c. Aerosol mask
18. Nurse Maureen has assisted a physician with the insertion of a chest d. Tracheostomy collar
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 26. Blessy, a community health nurse is conducting an educational
this assessment, which action would be appropriate? session with community members regarding tuberculosi s. The nurse
a. Inform the physician tells the group that one of the first symptoms associated with
b. Continue to monitor the client tuberculosis is:
c. Reinforce the occlusive dressing a. Dyspnea
d. Encourage the client to deep breathe b. Chest pain
c. A bloody, productive cough
19. Nurse Reynolds caring for a client with a chest tube turns the client d. A cough with the expectoration of mucoid sputum
to the side, and the chest tube accidentally disconnects. The initial
nursing action is to: 27. A nurse performs an admission assessment on a female client with a
a. Call the physician diagnosis of tuberculosis. The nurse reviews the result of which
b. Place the tube in bottle of sterile water diagnosis test that will confirm this diagnosis?
c. Immediately replace the chest tube system a. Bronchoscopy
d. Place a sterile dressing over the disconnection site b. Sputum culture
c. Chest x-ray
20. A nurse is assisting a physician with the removal of a chest tube. The d. Tuberculin skin test
nurse should instruct the client to:
a. Exhale slowly 28. A nurse is caring for a male client with emphysema who is receiving
b. Stay very still oxygen. The nurse assesses the oxygen flow rate to ensure that it
c. Inhale and exhale quickly does not exceed:
d. Perform the Valsalva maneuver a. 1 L/min
b. 2 L/min
21. While changing the tapes on a tracheostomy tube, the male client c. 6 L/min
coughs and tube is dislodged. The initial nursing action is to: d. 10 L/min
a. Call the physician to reinsert the tube
b. Grasp the rete ntion sutures to spread the opening 29. A nurse instructs a female client to use the pursed -lip method of
c. Call the respiratory therapy department to reinsert the breathing and the client asks the nurse about the purpose of this
tracheotomy type of breathing. The nurse responds, knowing that the primary
d. Cover the tracheostomy site with a sterile dressing to purpose of pursed-lip breathing is to:
prevent infection a. Promote oxygen intake
b. Strengthen the diaphragm
22. Nurse Oliver is caring for a client immediately after removal of the c. Strengthen the intercostal muscles
endotracheal tube. The nurse reports which of the following signs d. Promote carbon dioxide elimination
immediately if experienced by the client?
a. Stridor 30. A nurse is caring for a male client with acute respira tory distress
b. Occasional pink-tinged sputum syndrome. Which of the following would the nurse expect to note in
c. A few basilar lung crackles on the right the client?
d. Respiratory rate 24 breaths/min a. Pallor
b. Low arterial PaO2
23. An emergency room nurse is assessing a male c lient who has c. Elevated arterial PaO2
sustained a blunt injury to the chest wall. Which of these signs would d. Decreased respiratory rate
indicate the presence of a pneumothorax in this client?
a. A low respiratory rate 31. A nurse is preparing to obtain a sputum specimen from a male client.
b. Diminished breath sounds Which of the following nursing actions will facilitate obtaining the
c. The presence of a barrel chest specimen?
d. A sucking sound at the site of injury a. Limiting fluid
b. Having the client take deep breaths

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 KABC – RESPI QUESTIONS

c. Asking the client to spit into the collection container 39. Which phrase is used to describe the volume of air inspired and
d. Asking the client to obtain the specimen after eating expired with a normal breath?
32. Nurse Joy is caring for a client after a bronchoscopy and biopsy. a. Total lung capacity
Which of the following signs, if noticed in the client, should be b. Forced vital capacity
reported immediately to the physician? c. Tidal volume
a. Dry cough d. Residual volume
b. Hematuria
c. Bronchospasm 40. A male client abruptly sits up in bed, reports having difficulty
d. Blood-streaked sputum breathing and has an arterial oxygen saturation of 88%. Which mode
of oxygen delivery would most likely reverse the manifestations?
33. A nurse is suctioning fluids from a male client via a tracheos tomy a. Simple mask
tube. When suctioning, the nurse must limit the suctioning time to a b. Non-rebreather mask
maximum of: c. Face tent
a. 1 minute d. Nasal cannula
b. 5 seconds
c. 10 seconds 41. A female client must take streptomycin for tuberculosis. Before
d. 30 seconds therapy begins, the nurse should instruct the client to notify the
physician if which health concern occurs?
34. A nurse is suctioning fluids from a female client through an a. Impaired color discrimination
endotracheal tube. During the suctioning procedure, the nurse notes b. Increased urinary frequency
on the monitor that the heart rate is decreasing. Which if the c. Decreased hearing acuity
following is the appropriate nursing intervention? d. Increased appetite
a. Continue to suction
b. Notify the physician immediately 42. A male client is asking the nurse a question regarding the Mantoux
c. Stop the procedure and reoxygenate the client test for tuberculosis. The nurse should base her response on the fact
d. Ensure that the suction is limited to 15 s econds that the:
a. Area of redness is measured in 3 days and determines
35. A male adult client is suspected of having a pulmonary embolus. A whether tuberculosis is present.
nurse assesses the client, knowing that which of the following is a b. Skin test doesn’t differentiate between active and
common clinical manifestation of pulmonary embolism? dormant tuberculosis infection.
a. Dyspnea c. Presence of a wheal at the injection site in 2 days
b. Bradypnea indicates active tuberculosis.
c. Bradycardia d. Test stimulates a reddened response in some clients and
d. Decreased respirations requires a second test in 3 months.

36. A slightly obese female client with a history of allergy -induced 43. A female adult client has a tracheostomy but doesn’t require
asthma, hypertension, and mitral valve prolapse is admitted to an continuous mechanical ventilation. When weaning the client from
acute care facility for elective surgery. The nurse obtains a complete the tracheostomy tube, the nurse initially should plug the opening
history and performs a thorough physical examination, pa ying in the tube for:
special attention to the cardiovascular and respiratory systems. a. 15 to 60 seconds.
When percussing the client’s chest wall, the nurse expects to elicit: b. 5 to 20 minutes.
a. Resonant sounds. c. 30 to 40 minutes.
b. Hyperresonant sounds. d. 45 to 60 minutes.
c. Dull sounds.
d. Flat sounds. 44. Nurse Oliver observes constant bubbling in the water -seal chamber
of a closed chest drainage system. What should the nurse conclude?
37. A male client who weighs 175 lb (79.4 kg) is recei ving aminophylline a. The system is functioning normally
(Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline b. The client has a pneumothorax.
level is reported as 6 mcg/ml. The nurse calls the physician who c. The system has an air leak.
instructs the nurse to change the dosage to 0.45 mg/kg/hour. The d. The chest tube is obstructed.
nurse should:
a. Question the order because it’s too low. 45. A black client with asthma seeks emergency care for acute
b. Question the order because it’s too high. respiratory distress. Because of this client’s dark skin, the nurse
c. Set the pump at 45 ml/hour. should assess for cyanosis by inspecting the:
d. Stop the infusion and have the laboratory repeat the a. Lips.
theophylline measurement. b. Mucous membranes.
38. The nurse is teaching a male client with chronic bronchitis about c. Nail beds.
breathing exercises. Which of the following should the nurse include d. Earlobes.
in the teaching?
a. Make inhalation longer than exhalation. 46. For a male client with an endotracheal (ET) tube, which nursing
b. Exhale through an open mouth. action is most essential?
c. Use diaphragmatic breathing. a. Auscultating the lungs for bilateral breath sounds
d. Use chest breathing. 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

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 KABC – RESPI QUESTIONS

d. A change in the oxygen concentration without resetting

47. The nurse assesses a male client’s respiratory status. Which the oxygen level alarm
observation indicates that the client is experiencing difficulty
breathing? 54. A female client with chronic obstructive pulmonary disease (COPD)
a. Diaphragmatic breathing takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a
b. Use of accessory muscles routine clinic visit, the client asks the nurse how the drug works.
c. Pursed-lip breathing What is the mechanism of action of anhydrous theophylline in
d. Controlled breathing treating a nonreversible obstructive airway disease such as COPD?
a. It makes the central respiratory center more sensitive to
48. A female client is undergoing a complete physical examination as a carbon dioxide and stimulates the respiratory drive.
requirement for college. When checking the client’s respiratory b. It inhibits the enzyme phosphodiesterase, decreasing
status, the nurse observes respiratory excursio n to help assess: degradation of cyclic adenosine monop hosphate, a
a. Lung vibrations. bronchodilator.
b. Vocal sounds. c. It stimulates adenosine receptors, causing
c. Breath sounds. bronchodilation.
d. Chest movements. d. It alters diaphragm movement, increasing chest expansion
and enhancing the lung’s capacity for gas exchange.
49. A male client comes to the emergency department complaining of
sudden onset of diarrhea, anorexia, malaise, cough, headache, and 55. A male client with pneumococcal pneumonia is admitted to an acute
recurrent chills. Based on the client’s histo ry and physical findings, care facility. The client in the next room is being treated for
the physician suspects legionnaires’ disease. While awaiting mycoplasmal pneumonia. Despite the different causes of the various
diagnostic test results, the client is admitted to the facility and types of pneumonia, all of them share which feature?
started on antibiotic therapy. What is the drug of choice for treating a. Inflamed lung tissue
legionnaires’ disease? b. Sudden onset
a. Erythromycin (Erythrocin) c. Responsiveness to penicillin.
b. Rifampin (Rifadin) d. Elevated white blood cell (WBC) count
c. Amantadine (Symmetrel)
d. Amphotericin B (Fungizone) 56. A client with Guillain-Barré syndrome develops respiratory acidosis
as a result of reduced alveolar ventilation. Which combination of
50. A male client with chronic obstructive pulmonary disease (COPD) is arterial blood gas (ABG) values confirms respiratory acidosis?
recovering from a myocardial infarction. Because the client is a. pH, 5.0; PaCO2 30 mm Hg
extremely weak and can’t produce an e ffective cough, the nurse b. pH, 7.40; PaCO2 35 mm Hg
should monitor closely for: c. pH, 7.35; PaCO2 40 mm Hg
a. Pleural effusion. d. pH, 7.25; PaCO2 50 mm Hg
b. Pulmonary edema.
c. Atelectasis. 57. A male client admitted to an acute care facility with pneumonia is
d. Oxygen toxicity. receiving supplemental oxygen, 2 L/minute via nasal cannula. The
client’s history includes chronic obstructive pulmonary disease
51. The nurse in charge is teaching a client with emphysema how to (COPD) and coronary artery disease. Because of these history
perform pursed-lip breathing. The client asks the nurse to explain findings, the nurse closely monitors the oxygen flow and the client’s
the purpose of this breathing technique. Which explanation should respiratory status. Which complication may aris e if the client
the nurse provide? receives a high oxygen concentration?
a. It helps prevent early airway collapse. a. Apnea
b. It increases inspiratory muscle strength. b. Anginal pain
c. It decreases use of accessory breathing muscles. c. Respiratory alkalosis
d. It prolongs the inspiratory phase of respira tion. d. Metabolic acidosis

52. After receiving an oral dose of codeine for an intractable cough, the 58. At 11 p.m., a male client is admitted to the emergency department.
male client asks the nurse, “How long will it take for this drug to He has a respiratory rate of 44 breaths/minute. He’s anxious, and
work?” How should the nurse respond? wheezes are audible. The client is immediately given oxygen by face
a. In 30 minutes mask and methylprednisolone (Depo -medrol) I.V. At 11:30 p.m., the
b. In 1 hour client’s arterial blood oxygen saturation is 86% and he’s still
c. In 2.5 hours wheezing. The nurse should plan to administer:
d. In 4 hours a. Alprazolam (Xanax).
b. Propranolol (Inderal)
53. A male client suffers adult respiratory distress syndrome as a c. Morphine.
consequence of shock. The client’s condition deteriorates rapidly, d. Albuterol (Proventil).
and endotracheal (ET) intubation and mechanical ventilation are
initiated. When the high -pressure alarm on the mechanical ventilator 59. After undergoing a thoracotomy, a male client is receiving epidural
sounds, the nurse starts to check for the cause. Which condition analgesia. Which assessment finding indicates that the client has
triggers the high-pressure alarm? developed the most serious complication of epidural analgesia?
a. Kinking of the ventilator tubing a. Heightened alertness
b. A disconnected ventilator tube b. Increased heart rate
c. An ET cuff leak c. Numbness and tingling of the extremities
d. Respiratory depression

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 KABC – RESPI QUESTIONS

60. 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.

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 KABC – RESPI QUESTIONS

1. Answer: B. Nervousness 9. Answer: D. Impaired gas exchange related to airflow obstruction

Albuterol may cause nervousness. The inhaled form of the drug may A patient airway and an adequate breathing pattern are the top
cause dryness and irritation of the nose and throat, not nasal priority for any patient, making “impaired gas exchange related to
congestion; insomnia, not lethargy; and h ypokalemia (with high airflow obstruction” the most important nursing diagnosis. The other
doses), not hyperkalemia. Other adverse effects of albuterol include options also may apply to this patient but less important.
tremor, dizziness, headache, tachycardia, palpitations,
hypertension, heartburn, nausea, vomiting and muscle cramps. 10. Answer: D. Contralateral side in hemothorax
The trachea will shift according to the pressure gradients within the
2. Answer: C. Clear thoracic cavity. In tension pneumothorax and hemothorax,
Normally, nasal drainage in acute rhinitis is clear. Yellow or green accumulation of air or fluid causes a shift away from the injured side.
drainage indicates spread of the infection to the sinuses. Gray If there is no significant air or fluid accumulation, the trachea will
drainage may indicate a secondary infection. not shift. Tracheal deviation toward the contralateral side in simple
pneumothorax is seen when the thoracic contents shift in response
3. Answer: D. Lightheadedness or paresthesia to the release of normal thoracic pressure gradients on the injured
The patient with respiratory alkalosis may complain of side.
lightheadedness or paresthesia (numbness and tingling in the arms
and legs). Nausea, vomiting, abdominal pain, and diarrhea may 11. Answer: C. Encourage coughing and deep breathing
accompany respiratory acidosis. Hallucinations and tinnitus rare are When caring for a patient who is recovering from a pneumonectomy,
associated with respiratory alkalosis or any other acid -base the nurse should encourage coughing and deep breathing to prevent
imbalance. pneumonia in the unaffected lung. Because the lung has been
removed, the water-seal chamber should display no fluctuations.
4. Answer: D. Elderly patients Reinflation is not the purpose of chest tube. Chest tube milking is
Ephedrine is not recommended for elderly patients, who are controversial and should be done only to remove blood clots that
particularly susceptible to CNS reactions (such as confusion and obstruct the flow of drainage.
anxiety) and to cardiovascular reactions (such as increased systolic
blood pressure, coldness in the extremities, and anginal pain). 12. Answer: B. Develop an alternative communication method
Ephedrine is used for its bronchodilator effects with acute and A patient with a laryngectomy cannot speak, yet still needs to
chronic asthma and occasionally for its CNS stimulant actions for communicate. Therefore, the nurse should plan to develop an
narcolepsy. It can be administered to children age 2 and older. alternative communication method. After a laryngectomy, edema
interferes with the ability to swallow and necessitates tube (enteral)
5. Answer: A. Kinking of the ventilator tubing feedings. To prevent injury to the tracheal mucosa, th e nurse should
Conditions that trigger the high -pressure alarm include kinking of deflate the tracheostomy cuff or use the minimal leak technique. To
the ventilator tubing, bronchospasm or pulmonary embolus, mucus decrease edema, the nurse should place the patient in semi -Fowler’s
plugging, water in the tube, coughing or biting on endotracheal tube, position.
and the patient’s being out of breathing rhythm with the ventilator.
A disconnected ventilator tube or an endotracheal cuff leak would 13. Answer: B. Applying a dressing over the wound and taping it on
trigger the low pressure alarm. Changing the oxygen concentration three sides
without resetting the oxygen level alarm would trigger the oxygen The nurse immediately should apply a dressing over the stab wound
alarm. and tape it on three sides to allow air to escape and to prevent
tension pneumothorax (which is more life -threatening than an open
6. Answer: D. Fighting the ventilator chest wound). Only after covering and taping the wound should the
Pancuronium, a nondepolarizing blocking agent, is used for muscle nurse draw blood for laboratory tests, assist with chest tube
relaxation and paralysis. It assists mechanical ventilation by insertion, and start an I.V. line.
promoting endotracheal intubation and paralyzing the patient so
that the mechanical ventilator can do its wor k. Fighting the 14. Answer: C. Using a high-flow venture mask to deliver oxygen as
ventilator is a sign that the patient needs another pancuronium dose. prescribed
The nurse should administer 0.01 to 0.02 mg/kg I.V. every 20 to 60 The patient with COPD retains carbon dioxide, which inhibits
minutes. Movement of the legs, or lips has no effect on the ventilator stimulation of breathing by the med ullary center in the brain. As a
and therefore is not used to determine the need for another dose. result, low oxygen levels in the blood stimulate respiration, and
7. Answer: B. Absence of breaths sound in the right thorax administering unspecified, unmonitored amounts of oxygen may
In pneumothorax, the alveoli are deflated and no air exchange occurs depress ventilation. To promote adequate gas exchange, the nurse
in the lungs. Therefore, breath sounds in the affected lung field are should use a Venturi mask to de liver a specified, controlled amount
absent. None of the other o ptions are associated with pneumothorax. of oxygen consistently and accurately. Drinking three glasses of fluid
Bilateral crackles may result from pulmonary congestion, inspiratory daily would not affect gas exchange or be sufficient to liquefy
wheezes may signal asthma, and a pleural friction rub may indicate secretions, which are common in COPD. Patients with COPD and
pleural inflammation. respiratory distress should be places in high -Fowler’s position and
should not receive sedatives or other drugs that may further depress
8. Answer: B. Arterial Blood the respiratory center.
A lowercase “a” in an ABG valu e represents arterial blood. For
instance, the abbreviation PaO2 refers to the partial pressure of 15. Answer: C. Increased pulmonary capillary permeability
oxygen in arterial blood. The pH value reflects the acid -base balance ARDS results from increased pulmonary capillary permeability, w hich
in arterial blood. Sa02 indicates arterial oxygen saturation. An leads to noncardiogenic pulmonary edema. In cardiogenic pulmonary
uppercase “A” represents alveolar conditions: for example, PA02 edema, pulmonary congestion occurs secondary to heart failure. In
indicates the partial pressure of oxygen in the alveoli. the initial stage of ARDS, respiratory alkalosis may arise secondary

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 KABC – RESPI QUESTIONS

to hyperventilation; however, it does not cause AR DS. Renal failure Hyperresonance also may occur on the affected side. A sucking sound
does not cause ARDS, either . at the site of injury would be noted with an open chest injury.

16. Answer: C. Teaching the patient how to perform controlled 24. Answer: B. A hyperinflated chest noted on the chest x -ray
coughing Clinical manifestations of chronic obstructive pulmonary disease
Controlled coughing helps maintain a patent airway by helping to (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at
mobilize and remove secretions. A moderate fluid intake (usually 2 L rest, oxygen desaturation with exercise, and the use of accessory
or more daily) and moderate activity help liquefy and mobilize muscles of respiration. Chest x -rays reveal a hyperinflated chest and
secretions. Bed rest and sedatives may limit the patient’s ability to a flattened diaphragm if the disease is advanced.
maintain a patent airway, causing a high risk for infection from
pooled secretions. 25. Answer: B. Venturi mask
The Venturi mask delivers the most accurate oxygen concentration.
17. Answer: A. Do nothing, because this is an exp ected finding It is the best oxygen delivery system for the client with chronic
Continuous gentle bubbling should be noted in the suction control airflow limitation because it delivers a precise oxygen
chamber. Option b is incorrect. Chest tubes should only be clamped concentration. The face tent, aerosol mask, and tracheostomy collar
to check for an air leak or when changing drainage devices (according are also high-flow oxygen delivery systems but most often are used
to agency policy). Option c is incorrec t. Bubbling should be to administer high humidity.
continuous and not intermittent. Option d is incorrect because
bubbling should be gentle. Increasing the suction pressure only 26. Answer: D. A cough with the expectoration of mucoid sputum
increases the rate of evaporation of water in the drainage system. One of the first pulmonary symptoms is a slight cough with the
expectoration of mucoid sputum. Options A, B, an d C are late
18. Answer: B. Continue to monitor the client symptoms and signify cavitation and extensive lung involvement.
The presence of fluctuation of the fluid level in the water seal
chamber indicates a patent drainage system. With normal breathing, 27. Answer: B. Sputum culture
the water level rises with inspiration and falls with expiration. Tuberculosis is definitively diagnosed through culture and isolation
Fluctuation stops if the tube is obstructed, if a d ependent loop of Mycobacterium tuberculosis. A presumptive diagnosis is made
exists, if the suction is not working properly, or if the lung has based on a tuberculin skin test, a sputum smear that is positive for
reexpanded. Options A, C, and D are incorrect. acid-fast bacteria, a chest x-ray, and histological evidence of
granulomatous disease on biopsy.
19. Answer: B. Place the tube in bottle of sterile water
If the chest drainage system is disconnected, the end of the tube is 28. Answer: B. 2 L/min
placed in a bottle of sterile water held below the level of the chest. Oxygen is used cautiously and should not exceed 2 L/min. Because of
The system is replaced if it breaks or cracks or if the collection the long-standing hypercapnia that occurs in emphysema, the
chamber is full. Placing a sterile dressing over the disconnection site respiratory drive is triggered by low oxygen levels rather than
will not prevent complications resulting from the d isconnection. The increased carbon dioxide levels, as is the case in a normal respiratory
physician may need to be notified, but this is not the initial action. system.

20. Answer: D. Perform the Valsalva maneuver 29. Answer: D. Promote carbon dioxide elimination
When the chest tube is removed, the client is asked to perform the Pursed-lip breathing facilitates maximal expiration for clients with
Valsalva maneuver (take a deep breath, exhale, and bear do wn). The obstructive lung disease. This type of breathing allows better
tube is quickly withdrawn, and an airtight dressing is taped in place. expiration by increasing airway pressure that keeps air passages
An alternative instruction is to ask the client to take a deep breath open during exhalation. Options A, B, and C are not the purposes of
and hold the breath while the tube is removed. Options A, B, and C this type of breathing.
are incorrect client instructions.
30. Answer: B. Low arterial PaO2
21. Answer: B. Grasp the retention sutures to spread the opening The earliest clinical sign of acute respiratory distress syndrome is an
If the tube is dislodged accidentally, the initial nursing action is to increased respiratory rate. Breathing becomes labored, and the
grasp the retention sutures and spread the opening. If agency policy client may exhibit air hunger, retractions, and cyanosis. Arterial
permits, the nurse then attempts immediately to replace t he tube. blood gas analysis reveals increasing hypoxemia, with a PaO2 lower
Covering the tracheostomy site will block the airway. Options A and than 60 mm Hg.
C will delay treatment in this emergency situation.
31. Answer: B. Having the client take deep breaths
22. Answer: A. Stridor To obtain a sputum specimen, the client should rinse the mouth to
The nurse reports stridor to the physician immediately. This is a reduce contamination, breathe deeply, and then cough into a sputum
high-pitched, coarse sound that is heard with the stethoscope over specimen container. The client should be encouraged to cough and
the trachea. Stridor indicates airway edema and places the client at not spit so as to obtain sputum. Sputum can be thinned by fluids or
risk for airway obstruction. Options B, C, and D are not signs that by a respiratory treatment such as inhalation of nebulized saline or
require immediate notification of the physician. water. The optimal time to obtain a specimen is on arising in th e
morning.
23. Answer: B. Diminished breath sounds
This client has sustained a blunt or a closed chest injury. Basic 32. Answer: C. Bronchospasm
symptoms of a closed pneumothorax are shortness of breath and If a biopsy was performed during a bronchoscopy, blood -streaked
chest pain. A larger pneumothorax may cause tachypnea, cyanosis, sputum is expected for several hours. Frank blood indicates
diminished breath sounds, and subcutaneous emphysema. hemorrhage. A dry cough may be expected. The client should be
assessed for signs of complication s, which would include cyanosis,

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 KABC – RESPI QUESTIONS

dyspnea, stridor, bronchospasm, hemoptysis, hypotension, 41. Answer: C. Decreased hearing acuity
tachycardia, and dysrhythmias. Hematuria is unrelated to this Decreased hearing acuity indicates ototoxicity, a serious adverse
procedure. effect of streptomycin therapy. The client should notify the
physician immediately if it occurs so that streptomycin can be
33. Answer: C. 10 seconds discontinued and an alternative drug can be prescribed. The other
Hypoxemia can be caused by prolonged suctioning, which stimulates options aren’t associated with streptomycin. Impaired colo r
the pacemaker cells in the heart. A vasovagal response may occur, discrimination indicates color blindness; increased urinary frequency
causing bradycardia. The nurse must preoxygenate the client before and increased appetite accompany diabetes mellitus.
suctioning and limit the suctioning pass to 10 seconds.
42. Answer: B. Skin test doesn’t differentiate between active and
34. Answer: C. Stop the procedure and reoxygenate the client dormant tuberculosis infection.
During suctioning, the nurse should monitor the client closely for The Mantoux test doesn’t differentiat e between active and dormant
side effects, including hypoxemia, cardiac irregularities such as a infections. If a positive reaction occurs, a sputum smear and culture
decrease in heart rate resulting from vagal stimulation, mucosal as well as a chest X-ray are necessary to provide more information.
trauma, hypotension, and paroxysmal coughing. If side effects Although the area of redness is measured in 3 days, a second test
develop, especially cardiac irregularities, the procedure is stopped may be needed; neither test indicates that tuberculosis is active. In
and the client is reoxygenated. the Mantoux test, an induration 5 to 9 mm in diameter indicates a
borderline reaction; a larger induration indicates a positive reaction.
35. Answer: A. Dyspnea The presence of a wheal within 2 days doesn’t indicate active
The common clinical manifestations of pulmonary embolism are tuberculosis.
tachypnea, tachycardia, dyspnea, and chest pain.
43. Answer: B. 5 to 20 minutes.
36. Answer: A. Resonant sounds. Initially, the nurse should plug the opening in the tracheostomy tube
When percussing the chest wall, the nurse expects to elicit resonant for 5 to 20 minutes, then gradually lengthen this interval according
sounds — low-pitched, hollow sounds heard over normal lung tissue. to the client’s respiratory status. A client who doesn’t require
Hyperresonant sounds indicate increased air in the lungs or pleural continuous mechanical ventilation already is breathi ng without
space; they’re louder and lower pitched than resonant s ounds. assistance, at least for short periods; therefore, plugging the
Although hyperresonant sounds occur in such disorders as opening of the tube for only 15 to 60 seconds wouldn’t be long
emphysema and pneumothorax, they may be normal in children and enough to reveal the client’s true tolerance to the procedure.
very thin adults. Dull sounds, normally heard only over the liver and Plugging the opening for more than 20 minutes would inc rease the
heart, may occur over dense lung tissue, such as from conso lidation risk of acute respiratory distress because the client requires an
or a tumor. Dull sounds are thudlike and of medium pitch. Flat adjustment period to start breathing normally.
sounds, soft and high-pitched, are heard over airless tissue and can
be replicated by percussing the thigh or a bony structure. 44. Answer: C. The system has an air leak.
Constant bubbling in the chamber indicates an air leak and requires
37. Answer: A. Question the order because it’s too low. immediate intervention. The client with a pneumothorax will have
A therapeutic theophylline level is 10 to 20 mcg/ml. The client is intermittent bubbling in the water -seal chamber. Clients without a
currently receiving 0.5 mg/kg/hour of aminophylline. Because the pneumothorax should have no evidence of bubbling in the chamber.
client’s theophylline level is sub -therapeutic, reducing the dose If the tube is obstructed, the nurse should notice that the fluid has
(which is what the physician’s order would do) would be stopped fluctu ating in the water-seal chamber.
inappropriate. Therefore, the nurse should question the order.
45. Answer: B. Mucous membranes.
38. Answer: C. Use diaphragmatic breathing. Skin color doesn’t affect the mucous membranes. The lips, nail beds,
In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic and earlobes are less reliable indicators of cyanosis because they’re
breathing helps to strengthen the diaphragm and maximizes affected by skin color.
ventilation. Exhalation should be longer than inhalation to prevent
collapse of the bronchioles. The client with chronic bronchitis should 46. Answer: A. Auscultating the l ungs for bilateral breath sounds
exhale through pursed lips to prolong exhalation, keep the For a client with an ET tube, the most important nursing action is
bronchioles from collapsing, and prevent air trapping. auscultating the lungs regularly for bilateral breath sounds to ensure
Diaphragmatic breathing — not chest breathing — increases lung proper tube placement and effective oxygen delivery. Although the
expansion. other options are appropriate for this client, they’re secondary to
ensuring adequate oxygenation.
39. Answer: C. Tidal volume
Tidal volume refers to the volume of air inspired and expired with a 47. Answer: B. Use of accessory muscles
normal breath. Total lung capacity is the maximal amount of air the The use of accessory muscles for respiration indicates the client is
lungs and respiratory passages can hold after a forced inspiration. having difficulty breathing. Diaphragmatic and pursed -lip breathing
Forced vital capacity is the vital capacity performed with a are two controlled breathing techniques that help the client
maximally forced expiration. Residual volume is the maximal amount conserve energy.
of air left in the lung after a maximal expiration.
48. Answer: D. Chest movements.
40. Answer: B. Non-rebreather mask The nurse observes respiratory excursion to help assess chest
A non-rebreather mask can deliver levels of the fraction of inspired movements. Normally, thoracic expansion is symmetrical; unequal
oxygen (FIO2) as high as 100%. Other modes — simple mask, face expansion may indicate pleural effusion, atelectasis, pulmonary
tent, and nasal cannula — deliver lower levels of FIO2. embolus, or a rib or sternum fracture. The nurse assesses vocal
sounds to evaluate air flow when checking for tactile fremitus; after

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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. The nurse assesses
breath sounds during auscultation.
49. Answer: A. Erythromycin (Erythrocin)
Erythromycin is the drug of choice for treating legionnaires’ disease.
Rifampin may be added to the regimen if erythromycin alone is
ineffective; however, it isn’t administered first. Amantadine, an
antiviral agent, and amphotericin B, an antifungal
ineffective against legionnaires’ disease, which
bacterial infection.
50. 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. An
ineffective cough doesn’t cause pleural effusion (fluid accumulation
in the pleural space). Pulmonary edema usually results from left -
sided heart failure, not an ineffective cough.
noncardiac conditions may cause pulmonary edema, an ineffective
cough isn’t one of them. Oxygen toxicity results from prolonged
administration of high oxygen concentrations, not an ineffective
cough.
51. Answer: A. It helps prevent early airway collapse.
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.)
52. Answer: A. In 30 minutes
Codeine’s onset of action is 30 minutes. Its peak concentration
occurs in about 1 hour; its half -life, in 2.5 hours; and its duration of
action is 4 to 6 hours.
53. Answer: A. Kinking of the ventilator tubing
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 the ET tube, and
the client’s being out of breathing rhythm with the ventilator. A
disconnected ventilator tube or an ET cuff leak would trigger the
low-pressure alarm. Changing the oxygen concentration without
resetting the oxygen level alarm would trigger the oxygen alarm.
54. Answer: A. It makes the central respiratory center more sensitive
to carbon dioxide and stimulates the respiratory drive.
Anhydrous theophylline and other methylxanthine agents make the
central respiratory center more sensitive to CO2 and stimulate the
respiratory drive. Inhibition of phosphodiesterase is the drug’s
mechanism of action in treating asthma and other
obstructive airway diseases — not COPD. Methylxanthine agents
inhibit rather than stimulate adenosine receptors. Although these
agents reduce diaphragmatic fatigue in clients
bronchitis or emphy sema, they don’t alter diaphragm movement to
increase chest expansion and enhance gas exchange.
55. Answer: A. Inflamed lung tissue
The common feature of all types of pneumonia is an inflammatory
pulmonary response to the offending organism or agent. Although
most types of pneumonia have a sudden onset, a few (such as
KABC – RESPI QUESTIONS
anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an
insidious onset. Antibiotic therapy is the primary treatment for most
types of pneumonia; however, the antibiotic must be specific for the
causative agent, which may not be responsive to penicillin. A few
types of pneumonia, such as viral pneumonia, aren’t treated with
antibiotics. Although pneumonia usually causes an elevated WBC
count, some types, such as mycoplasmal pneumonia, don ’t.
56. Answer: D. pH, 7.25; PaCO2 50 mm Hg
agent, are In respiratory acidosis, ABG analysis reveals an arterial pH below
is caused by 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.
57. Answer: A. Apnea
Hypoxia is the main breathing stimulus for a client with COPD.
Although many Excessive oxygen administration may lead to apnea by removing that
stimulus. Anginal pain results from a reduced myocardial oxygen
supply. A client with COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia; however, administering
oxygen at any concentration dilates blood vessels, easing anginal
pain. Respiratory alkalosis results from alveolar hyperventilation,
not excessive oxygen administration. In a client with COPD, high
oxygen concentrations decrease the ventilatory drive, leading to
respiratory acidosis, not alkalosis. High oxygen concentrations don’t
cause metabolic acidosis.
58. Answer: D. Albuterol (Proventil).
The client is hypoxemic because of bronchoconstriction as evidenced
by wheezes and a subnormal arterial oxygen saturation level. The
client’s greatest need is bronchodilation, which can be accomplished
by administering bronchodilators. Albuterol is a beta2 adrenergic
agonist, which causes dilation of the bronchioles. It’s giv en 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 client’s breathing. Propranolol is c ontraindicated in a
client who’s wheezing because it’s a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and is contraindicated
in this situation.
59. Answer: D. Respiratory depression
Respiratory depression is the most serious complic ation of epidural
analgesia. Other potential complications include hypotension,
decreased sensation and movement of the extremities, allergic
reactions, and urine retention. Typically, epidural analgesia causes
central nervous system depression (indicated by drowsiness) as well
as a decreased heart rate and blood pressure.
60. Answer: B. Being overweight.
Conditions that increase oxygen demands include obesity, smoking,
exposure to temperature extremes, and stress. A client with chronic
reversible 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
with chronic 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 doesn’t increase
oxygen demands. To help maintain adequate nutritional intake, th e
client with chronic bronchitis should eat small, frequent meals (up
to six a day).
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