1.
The client is asking the nurse
a question regarding the Mantoux test for tuberculosis. The nurse should base
her response on the fact that the:
A.
area of redness is measured in 3
days and determines whether tuberculosis is present.
B.
skin test doesn't differentiate
between active and dormant tuberculosis infection.
C.
presence of a wheal at the injection
site in 2 days indicates active tuberculosis.
D.
test stimulates a reddened response
in some clients and requires a second test in 3 months.
2.
A client hospitalized with a
pneumothorax has the following arterial blood gas (ABG) analysis: pH, 7.19;
partial pressure of arterial carbon dioxide (PaCO2), 63 mm Hg; and HCO3–,
22 mEq/L. A chest tube was inserted and oxygen administered at 4 L/minute by
nasal cannula. One hour after the initiation of treatment, ABG analysis
reveals: pH, 7.28; PaCO2, 52 mm Hg; and HCO3–, 22 mEq/L. This change
in ABG analysis indicates:
A.
respiratory alkalosis.
B.
impending respiratory arrest.
C.
the need for intubation.
D.
improved respiratory status.
3.
A client is admitted to the
intensive care unit with pulmonary edema. When performing the admission
assessment, the nurse should expect:
A.
A decreased blood pressure
B.
Radiating anterior chest pain
C.
A pulse that is weak and rapid
D.
Crackles at the base of each lung
4.
A client with pneumonia is receiving
supplemental oxygen, 2 L/minute via nasal cannula. The client's history
includes chronic obstructive pulmonary disease (COPD) and coronary artery
disease. Because of these findings, the nurse closely monitors the oxygen flow
and the client's respiratory status. Which complication may arise if the client
receives a high oxygen concentration?
A.
Apnea
B.
Anginal pain
C.
Respiratory alkalosis
D.
Metabolic acidosis
5.
For a client with COPD who has
trouble raising respiratory secretions, which of the following nursing measures
would help reduce the tenacity of secretions?
A.
Ensuring that the client's diet is
low in salt.
B.
Ensuring that the client's oxygen
therapy is continuous.
C.
Helping the client maintain a high
fluid intake.
D.
Keeping the client in a semi-sitting
position as much as possible.
6.
A chronically ill, elderly female
client tells the home care nurse that the daughter with whom she lives seems
run-down and disinterested in her own health as well as the health of her
children, ages 2, 5, 7, and 12. The client tells the nurse that her daughter
coughs a good deal and does a lot of sleeping. In this situation the nurse
should pursue the daughter's condition for potential case finding because:
A.
Children younger than 12 are very
susceptible to tuberculosis
B.
Deaths from tuberculosis have been
generally on the decrease
C.
Tuberculosis has been dramatically
rising in the general population
D.
Aging clients with chronic illness
are most adversely affected by tuberculosis
7.
When turning a client following a
right pneumonectomy, the nurse should plan to place the client in either the:
A.
Right or left side-lying position
B.
High-Fowler's or supine position
C.
Supine or right side-lying position
D.
Left side-lying or low-Fowler's
position
8.
What should the nurse do first for a
client with a sucking stab wound to the chest?
A.
Draw blood for hematocrit and
hemoglobin values.
B.
Apply a dressing and tape it on
three sides.
C.
Prepare a chest-tube insertion tray.
D.
Prepare to start an I.V. line.
9.
A female client develops increased
respiratory secretions because of radiation therapy to the lung. When teaching
postural drainage, the nurse should explain that the client will know that it
is effective when she:
A.
Is free of crackles
B.
Can breathe deeply
C.
Has a productive cough
D.
Is able to expectorate saliva
10.
To determine if tissue underlying
the lower lobe of a client's right lung is filled with fluid, the nurse should
use which of the following methods of physical examination?
A.
Auscultation
B.
Inspection
C.
Palpation
D.
Percussion
11.
A client is admitted to the health
care facility with active tuberculosis. The nurse should include which
intervention in the plan of care?
A.
Putting on a mask when entering the
client's room
B.
Instructing the client to wear a
mask at all times
C.
Wearing a gown and gloves when
providing direct care
D.
Keeping the door to the client's
room open to observe the client
12.
The physician orders oxygen given in
low concentration, rather than in high concentration and continuously, for a
client with COPD to prevent:
A.
A decrease in red cell formation
B.
Rupture of emphysematous bullae
C.
Depression of the respiratory center
D.
An excessive drying of the
respiratory mucosa
13.
During assessment, the nurse
auscultates for a client's breath sounds. Auscultation produces which type of
data?
A.
Subjective
B.
Objective
C.
Secondary source
D.
Medical
14.
A client is admitted to the hospital
with a productive cough, night sweats, and a fever. Which action is most
important in the initial plan of care?
A.
Assessing the client's temperature
every 8 hours
B.
Placing the client in respiratory
isolation
C.
Monitoring the client's fluid intake
and output
D.
Wearing gloves during all client
contact
15.
A client with bacterial pneumonia is
coughing up tenacious, purulent sputum. Which of the following measures would
most likely help liquefy these viscous secretions?
A.
Performing postural drainage.
B.
Breathing humidified air.
C.
Clapping and percussing over the
affected lung.
D.
Performing coughing and
deep-breathing exercises.
16.
A few days after a colectomy, a
client suddenly develops chest pain, shortness of breath, and air hunger. The
nurse knows she must further assess the client's chest pain to determine its
origin. When determining whether the chest pain is cardiac or pleuritic in
nature, the nurse knows that pleuritic chest pain typically:
A.
is described as crushing and
substernal.
B.
worsens with deep inspiration.
C.
is relieved with nitroglycerin.
D.
is relieved when the client leans
forward.
17.
The nurse auscultates a client's
lungs and notes a fine crackling sound in the left lower lung during
respiration. If crackles and rhonchi in the left lower lung were charted on the
nurse's notes, the notation would be:
A.
A nursing diagnosis
B.
A correct nursing notation
C.
An inaccurate interpretation
D.
Correct if palpation ruled out
crepitus
18.
Following a tonic-clonic seizure, a
client has snoring respirations. The physician orders a nasopharyngeal airway
inserted to protect the client's airway. The nurse is inserting the airway
correctly when she:
A.
depresses the tongue as the airway
is inserted.
B.
lubricates the airway with petroleum
jelly.
C.
inserts the airway with the tip
upward.
D.
gently pushes the airway along the
floor of the nostril.
19.
Which statement is true about
crackles?
A.
They're grating sounds.
B.
They're high-pitched, musical
squeaks.
C.
They're low-pitched noises that
sound like snoring.
D.
They may be fine, medium, or coarse.
20.
Which of the following instructions
would the nurse give to the parents of an 8-year-old child with asthma who is
being switched from parenteral steroid therapy to a daily dose of oral
prednisone?
A.
Administer the dose before bedtime
to minimize side effects.
B.
Give the medication according to the
child's response.
C.
Have the child take the dose with
meals to prevent gastric irritation.
D.
Make sure the pill is given intact
to maintain the enteric coating.
21.
After staying several hours with her
10-year-old daughter who is admitted to the hospital with an asthmatic attack,
the mother leaves to attend to her other children. The child exhibits continued
signs and symptoms of respiratory distress. Which of the following findings
would lead the nurse to make a nursing diagnosis of Anxiety related to
respiratory distress?
A.
Complaints of an inability to get
comfortable.
B.
Frequently requests for someone to stay
in the room.
C.
Inability to remember his exact
address.
D.
Verbalization of a feeling of
tightness in his chest.
22.
A client's respiratory status
necessitates endotracheal intubation and positive pressure ventilation. The
most immediate nursing intervention for this client at this time would be to:
A.
Prepare the client for emergency
surgery
B.
Facilitate the client's verbal
communication
C.
Assess the client's response to the
equipment
D.
Maintain sterility of the
ventilation system the client is using
23.
When discussing the use of cromolyn
sodium (Intal) with the parent of a child diagnosed with asthma, the nurse
should teach the mother that the medication will be ineffective if it is
administered at which of the following?
A.
Intermittently for short-term use.
B.
During an asthmatic attack.
C.
Preparation for going to bed.
D.
Prior to riding a bicycle for a
block.
24.
The nurse is aware that a client
understands the instructions about an appropriate breathing technique for COPD
when the client:
A.
Inhales through the mouth
B.
Increases the respiratory rate
C.
Holds each breath for a second at
the end of inspiration
D.
Progressively increases the length
of the inspiratory phase
25.
A client suffers adult respiratory
distress syndrome as a consequence of shock. The client's condition deteriorates
rapidly, and endotracheal intubation and mechanical ventilation are initiated.
When the high-pressure alarm on the mechanical ventilator sounds, the nurse
starts to check for the cause. Which condition triggers the high-pressure
alarm?
A.
Kinking of the ventilator tubing
B.
A disconnected ventilator tube
C.
An endotracheal cuff leak
D.
A change in the oxygen concentration
without resetting the oxygen level alarm
26.
In the early stage of shock, the
nurse would expect the results of arterial blood gas (ABG) analysis to
indicate:
A.
Respiratory alkalosis.
B.
Respiratory acidosis.
C.
Metabolic alkalosis.
D.
Metabolic acidosis.
27.
After insertion of a chest tube for
a pneumothorax, a client becomes hypotensive with neck vein distention,
tracheal shift, absent breath sounds, and diaphoresis. The nurse suspects a
tension pneumothorax has occurred. What cause of tension pneumothorax should
the nurse check for?
A.
Infection of the lung
B.
Kinked or obstructed chest tube
C.
Excessive water in the water-seal
chamber
D.
Excessive chest tube drainage
28.
A client with a pneumothorax
receives a chest tube attached to a Pleur-evac. The nurse notices that the
fluid of the second chamber of the Pleur-evac isn't bubbling. Which nursing
assumption would be most invalid?
A.
The tubing from the client to the
chamber is blocked.
B.
There is a leak somewhere in the
tubing system.
C.
The client's affected lung has
reexpanded.
D.
The tubing needs to be cleared of
fluid.
29.
A client has a chest tube for a
pneumothorax. The nurse finds the client in respiratory difficulty with the
chest tube separated from the drainage system. The nurse should:
A.
Obtain a new sterile drainage system
B.
Clamp the drainage tubing with two
clamps
C.
Reconnect the client's tube to the
drainage system
D.
Place the client in the
high-Fowler's position immediately
30.
A client undergoes a total
laryngectomy and tracheostomy formation. On discharge, the nurse should give
which instruction to the client and family?
A.
"Clean the tracheostomy tube
with alcohol and water."
B.
"Family members should continue
to talk to the client."
C.
"Oral intake of fluids should
be limited for 1 week only."
D.
"Limit the amount of protein in
the diet."
31.
A client who suffered a
cerebrovascular accident has a nursing diagnosis of Ineffective airway
clearance. The goal of care for this client is to mobilize pulmonary
secretions. Which of the following interventions would help meet this goal?
A.
Repositioning the client every 2
hours
B.
Restricting fluids to 1,000 ml/24
hours
C.
Administering oxygen by cannula, as
ordered
D.
Keeping the head of the bed at a 30-degree
angle
32.
Immediately after a thoracentesis a
client's right lung collapses. A chest tube is inserted and attached to a
three-chamber closed drainage system. The nurse knows that the chest tube is
functioning properly when fluid:
A.
Is bubbling gently in the chest
drainage chamber
B.
Remains constant in the chest
drainage chamber
C.
Is bubbling vigorously in the
suction control chamber
D.
Rises in the tube of the water-seal
chamber on inspiration
33.
Before weaning a client from a
ventilator, which assessment parameter is most important for the nurse to
review?
A.
Fluid intake for the last 24 hours
B.
Baseline arterial blood gas (ABG)
levels
C.
Prior outcomes of weaning
D.
Electrocardiogram (ECG) results
34.
The nurse is taking a nursing
history on a preoperative client. Which of the following pieces of information
would most likely have a significant impact on the client's recovery
postoperatively? The client:
A.
Has smoked 1 pack of cigarettes a
day for 12 years.
B.
Had a cold 6 weeks ago.
C.
Drinks about two beers a week on a
regular basis.
D.
Is 10 pounds overweight.
35.
Which of the following interventions
is most helpful in determining the need for oxygen therapy in a client with
chronic obstructive pulmonary disease?
A.
Ask the client to tell the nurse
when oxygen is needed.
B.
Assess the client’s fatigue level.
C.
Use a pulse oximeter to determine
oxygen saturation.
D.
Evaluate the client’s hemoglobin
level daily.
36.
A client is brought to the emergency
department in acute respiratory distress. After endotracheal intubation and
initiation of mechanical ventilation, the client is transferred to the
intensive care unit. Before suctioning the endotracheal tube, the nurse
hyperventilates and hyperoxygenates the client. What is the rationale for these
interventions?
A.
They help prevent subcutaneous emphysema.
B.
They help prevent pneumothorax.
C.
They help prevent cardiac
arrhythmias.
D.
They help prevent pulmonary edema.
37.
A client's chest tube accidentally
disconnects from the drainage tube when she turns onto her side. Which of the
following actions should the nurse take first?
A.
Notify the physician.
B.
Clamp the chest tube.
C.
Raise the level of the drainage
system.
D.
Reconnect the tube.
38.
A nurse is caring for a client who
has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will
most likely lower the client's arterial blood oxygen saturation?
A.
Endotracheal suctioning
B.
Encouragement of coughing
C.
Use of cooling blanket
D.
Incentive spirometry
39.
Which of the following would be an
appropriate nursing diagnosis for a hospitalized client with bacterial
pneumonia and shortness of breath?
A.
Ineffective Cardiopulmonary Tissue
Perfusion related to myocardial damage.
B.
Risk for Self-Care Deficit related
to fatigue.
C.
Deficient Fluid Volume related to
nausea and vomiting.
D.
Disturbed Thought Processes related
to inadequate relief of chest pain.
40.
A client with acquired
immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which
nursing diagnosis has the highest priority for this client?
A.
Impaired gas exchange
B.
Impaired oral mucous membranes
C.
Imbalanced nutrition: Less than body
requirements
D.
Activity intolerance
41.
A client abruptly sits up in bed,
reports having difficulty breathing, and has an arterial oxygen saturation of
88%. Which mode of oxygen delivery would most likely reverse the manifestations?
A.
Simple mask
B.
Nonrebreather mask
C.
Face tent
D.
Nasal cannula
42.
The morning weight for a client
indicates that the client has gained 5 pounds in less than a week, even though
his oral intake has been modest. The client's weight gain may reflect which associated
complication of COPD?
A.
Polycythemia
B.
Cor pulmonale
C.
Left ventricular failure
D.
Compensated acidosis
43.
Parents of a child with cystic
fibrosis demonstrate knowledge of the effects of hot weather on their child
when they state that hot weather is hazardous because the child has which of
the following?
A.
Poor ability to concentrate urine.
B.
Little skin pigment to prevent
sunburn.
C.
Poorly functioning temperature
control center.
D.
Abnormally high salt loss through
perspiration.
44.
A male adolescent with cystic fibrosis
whose parents are both carriers of the disease asks the nurse, "When I
have children could they have cystic fibrosis like me?" The nurse should
base a response on the knowledge that:
A.
Men with cystic fibrosis generally
have a 50% chance of having children with the disease
B.
Only women pass this disease to
their children because it is carried on the sex chromosome
C.
This client has a greater chance of
passing the disease to his children because his parents were only carriers
D.
Men with cystic fibrosis are usually
unable to father a baby, although their sexual functioning is not affected
45.
The nurse 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
per day.
46.
The nurse recognizes that a client
with tuberculosis needs further teaching when the client states:
A.
"I'll have to take these
medications for 9 to 12 months."
B.
"It won't be necessary for the
people I work with to take medication."
C.
"I'll need to have scheduled
lab tests while I'm on the medication."
D.
"The people I have contact with
at work should be checked regularly."
47.
Following surgery, the physician
orders an incentive spirometer for a client. The nurse would know that the
client was using the spirometer correctly when observing that the client:
A.
Coughs twice before inhaling deeply
through the mouthpiece
B.
Uses the incentive spirometer for 10
consecutive breaths per hour
C.
Inhales deeply, seals the lips
around the mouthpiece, and exhales
D.
Inhales deeply through the
mouthpiece, relaxes, and then exhales
48.
The nurse notes 12 mm of induration
at the site of a Mantoux test when a client returns to the health office to
have it read. The nurse should explain to the client that this:
A.
Test result is negative, and no
follow-up is needed
B.
Test was used for screening and a
tine test will now be given
C.
Skin test is inconclusive and will
have to be repeated in 6 weeks
D.
Result indicates a need for further
tests, including a chest x-ray film examination
49.
The nurse is caring for a client
experiencing an acute asthma attack. The client stops wheezing, and breath
sounds aren't audible. The reason for this change is that:
A.
the attack is over.
B.
the airways are so swollen that no
air can get through.
C.
the swelling has decreased.
D.
crackles have replaced wheezes.
50.
The nurse is interviewing a slightly
overweight 43-year-old man with mild emphysema and borderline hypertension. He
admits to smoking one pack of cigarettes per day. When developing a teaching
plan, which of the following should receive highest priority to help decrease
respiratory complications?
A.
Weight reduction
B.
Decreasing salt intake
C.
Smoking cessation
D.
Decreasing caffeine intake
51.
Which common substances is the
client most likely to inhale to become intoxicated?
A.
Glue, cleaning solutions,
insecticides
B.
Glue, nail polish remover, aerosols
C.
Paint thinners, insecticides, spray
paint
D.
Cleaning solutions, insecticides,
spray paint
52.
When assessing the child with asthma
for allergic rhinitis, which of the following would the nurse expect to find?
A.
Nasal crease.
B.
Abdominal pain.
C.
Fever.
D.
Mouth breathing.
53.
Staff nurses learn that a patient
they have been caring for during the last few weeks has just been diagnosed
with tuberculosis. When the nurses express concern about contracting tuberculosis
themselves, the charge nurse's response should be based on which of the
following statements?
A.
Tuberculosis is easily treated with
a short course of antibiotics.
B.
The Mantoux test is used to confirm
diagnosis of tuberculosis.
C.
Tuberculosis is not highly
infectious when standard precautions are followed.
D.
Vaccination with Bacille Calmette
Guerin (BCG) will be used to immunize the nurses against infection.
54.
The client with acute bronchitis
requires careful monitoring when receiving:
A.
oxygen therapy.
B.
fluid resuscitation.
C.
humidified air.
D.
postural drainage.
55.
The nurse knows that when a client
has a tracheostomy tube with a high-volume, low- pressure cuff, it is used
primarily to prevent:
A.
Lung infection
B.
Leakage of air
C.
Mucosal necrosis
D.
Tracheal secretion
56.
Which of the following statements by
the parents of a child with asthma being taught the reasons for using a peak
expiratory flow meter indicates the need for additional teaching?
A.
"If there is no increase in
flow after he gets his bronchodilator, we should give another treatment."
B.
"Finally, we have a way to
monitor his condition and predict when he is getting worse."
C.
"This meter will help to
monitor our child's condition, so changes can be made in therapy."
D.
"The meter readings will help
us determine if he has other possible triggers besides dust and cold."
57.
A client with pulmonary tuberculosis
is being treated in the home. To help control the spread of the disease, the
client should be instructed to:
A.
Have visitors sit at least 8 feet
away
B.
Keep personal articles away from the
rest of the family
C.
Open the windows slightly to allow a
good airflow throughout the house
D.
Avoid putting used dishes in the
dishwasher with the rest of the family's dishes
58.
In addition to raising the head of
the bed of an infant who has had a surgical repair of a diaphragmatic hernia,
the nurse should place the infant in the:
A.
Contour position in an infant seat
B.
Supine position with the knees
flexed
C.
Prone position with the head to the
side
D.
Side-lying position on the operative
side
59.
The nurse is assessing the breath
sounds of a client with emphysema. The nurse understands that the client's
respiratory status is affected by what primary pathophysiologic changes?
A.
Constricted airspaces in the lungs.
B.
Destruction of alveolar walls.
C.
Elevation of the diaphragm.
D.
Increased airflow out of the lungs.
60.
In teaching a client with
tuberculosis about self-care at home, the nurse will include all of the
following measures. Which of the measures would have the highest priority?
A.
Getting adequate rest.
B.
Eating a nourishing diet.
C.
Taking medications as prescribed.
D.
Quitting smoking.
61.
Which of the following would be most
important to teach a client older than 65 years to prevent a recurrence of
bacterial pneumonia?
A.
Change current diet habits.
B.
Seek prompt antibiotic therapy for
viral infections.
C.
Receive prophylactic antibiotic
therapy.
D.
Obtain annual influenza and
pneumococcal vaccines.
62.
During the insertion of a rigid
scope for bronchoscopy, a client experiences a vasovagal response. The nurse
should expect:
A.
the client's pupils to become
dilated.
B.
the client to experience
bronchodilation.
C.
a decrease in the client's gastric
secretions.
D.
a drop in the client's heart rate.
63.
The nurse is teaching a client with
chronic bronchitis about breathing exercises. Which of the following should the
nurse include in the teaching?
A.
Make inhalation longer than
exhalation.
B.
Exhale through an open mouth.
C.
Use diaphragmatic breathing.
D.
Use chest breathing.
64.
A client is on a ventilator. One of
the nurses asks what should be done when condensation resulting from humidity
collects in the ventilator tubing. The best response to this question would be
to:
A.
"Notify the respiratory
therapist."
B.
"Empty the fluid from the
tubing."
C.
"Decrease the amount of
humidity."
D.
"Measure the fluid and record
it on the I&O."
65.
With a diagnosis of right rib
fracture and closed pneumothorax, the client should be placed in:
A.
Modified Trendelenburg's position
with the lower extremities elevated.
B.
Reverse Trendelenburg's position
with the head down.
C.
Left side-lying position with the
head elevated 15 to 30 degrees.
D.
Semi- to high-Fowler's position,
tilted toward the right side.
66.
A client appears very anxious, with
respirations that are shallow and very rapid (40 per minute). The client
complains of feeling dizzy and light-headed and of having tingling sensations
of the fingertips and around the lips. The nurse should recognize that the
client's complaints are probably related to:
A.
Eupnea
B.
Hyperventilation
C.
Kussmaul's respirations
D.
Carbon dioxide intoxication
67.
The physician orders supplemental
oxygen for a client with a respiratory problem. To provide the highest possible
oxygen concentration, the nurse expects to use which oxygen delivery device?
A.
Nasal cannula
B.
Venturi mask
C.
Partial rebreathing mask
D.
Nonrebreathing mask
68.
A client with chronic obstructive
pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The
nurse should provide which instructions?
A.
"Weigh yourself daily and
report a loss of 1 lb in 1 day."
B.
"Eat a high-sodium diet."
C.
"Weigh yourself daily and
report a gain of 2 lb in 1 day."
D.
"Maintain bedrest."
69.
A hospitalized client develops a
nosocomial upper respiratory infection. After being informed of this fact the
client asks the nurse what this means. The nurse should reply:
A.
"The infection you had prior to
hospitalization has flared up."
B.
"You acquired the infection
after being admitted to the hospital."
C.
"This is a highly contagious
infection requiring complete isolation."
D.
"As a result of medical
treatment, you have developed a secondary infection."
70.
A client with oat cell lung cancer
is scheduled for a mediastinoscopy with biopsy. The nurse should:
A.
Tell the client that chest tubes
will be present after the procedure
B.
Explain that the procedure will
visualize the lungs and the chest cavity
C.
Advise the client of the NPO status
after midnight the night before the test
D.
Inform the client that some pleural
fluid will be removed during the procedure
71.
In the evaluation of the condition
of a client with burns of the upper body, an assessment that would indicate
potential respiratory obstruction is:
A.
Deep breathing
B.
Pink-tinged, frothy sputum
C.
Hoarse quality to the voice
D.
Rapid abdominal breathing
72.
The breathing exercises that the
nurse teaches to a client with emphysema (COPD) should include:
A.
An inhalation that is longer than an
exhalation
B.
Abdominal exercises to limit the use
of accessory muscles
C.
Sit-ups to strengthen the abdominal
and intercostal muscles
D.
Diaphragmatic exercises to improve
contraction of the diaphragm
73.
During a routine physical
examination, a client's chest x-ray film reveals a lesion in the right upper
lobe. When the nurse obtains a history from the client, the information that
supports the physician's tentative diagnosis of pulmonary tuberculosis is:
A.
Frothy sputum and fever
B.
Dry cough and pulmonary congestion
C.
Night sweats and blood-tinged sputum
D.
Productive cough and engorged neck
veins
74.
A client is admitted to the
intensive care unit with a diagnosis of adult respiratory distress syndrome.
When assessing this client the nurse should expect to find:
A.
Hypertension
B.
Tenacious sputum
C.
An altered mental status
D.
A slowed rate of breathing
75.
A male client with cystic fibrosis
(CF) becomes romantically involved with a female with the same disease. He asks
the nurse about the chances of having an affected child like himself. The most
appropriate response by the nurse would be:
A.
"Use condoms for protection
from pregnancy."
B.
"Young women with cystic
fibrosis are not fertile."
C.
"All of your children would be
carriers of cystic fibrosis."
D.
"You are probably not able to
father children because of your cystic fibrosis."
76.
Which of the following assessments
would be the priority for a 2-year-old after a bronchoscopy?
A.
Cardiac rate.
B.
Respiratory quality.
C.
Sputum color.
D.
Pulse pressure changes.
77.
For the child diagnosed with an
asthmatic attack, which of the following manifestations would best
correlate with the child's arterial blood gas results, which include pH of
7.46, bicarbonate of 21, and a PCO2 of 33 mm Hg?
A.
Greatly diminished breath sounds.
B.
A tingling sensation in the
fingertips.
C.
Heart rate of 68 beats/minute.
D.
Absence of urination for several
hours.
78.
When assessing a client with pleural
effusion, the nurse should expect to find:
A.
Moist crackles at the posterior of
the lungs
B.
Deviation of the trachea toward the
involved side
C.
Reduced or absent breath sounds at
the base of the lung
D.
Increased resonance with percussion
of the involved area
79.
During the weaning of the
postoperative client from mechanical ventilation, the nurse organizes activities
to:
A.
Remain with the client to assess
responses
B.
Allow family members to participate
in the process
C.
Permit the client more extended
times alone for independence
D.
Observe monitoring devices at the
control panel of the ventilator
80.
The nurse is caring for four clients
on a step-down intensive care unit. The client at the highest risk for
developing nosocomial pneumonia is the one who:
A.
has a respiratory infection.
B.
is intubated and on a ventilator.
C.
has pleural chest tubes.
D.
is receiving feedings through a
jejunostomy tube.
81.
Theophylline ethylenediamide is
administered to a client with COPD to:
A.
Reduce bronchial secretions.
B.
Relax bronchial smooth muscle.
C.
Strengthen myocardial contractions.
D.
Decrease alveolar elasticity.
82.
A patient who has acquired immune
deficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia (PCP). The
patient asks the nurse, "How did I get this pneumonia?" The nurse's
response should be based on which of these statements about PCP?
A.
It occurs in immunosuppressed
persons from proliferation of organisms that are normally present in the body.
B.
It is transmitted from close contact
with an infected individual who has a suppressed immune system.
C.
It results from exposure to a
carrier of the organism who has not taken appropriate precautions.
D.
It is most often acquired from
unprotected sex with an infected individual.
83.
A client is chronically short of
breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen
saturation (SaO2) 96% or better. The client most likely has:
A.
poor peripheral perfusion.
B.
a possible hematologic problem.
C.
a psychosomatic disorder.
D.
left-sided heart failure.
84.
A 10-year-old with history of
bronchial asthma triggered by exposure to cold, smoke, and nuts is brought to
the hospital's emergency room by his mother. Appearing restless and anxious,
the child has a respiratory rate of 36 breaths/minute and pulse rate of 160
bpm. Which of the following findings would be of greatest concern to the
nurse?
A.
Increased respiratory effort.
B.
Moist, loose cough.
C.
Absence of wheezing.
D.
Prolonged expiratory phase.
85.
The nurse is caring for a client who
recently underwent a tracheostomy. The first priority when caring for a client
with a tracheostomy is:
A.
helping him communicate.
B.
keeping his airway patent.
C.
encouraging him to perform
activities of daily living.
D.
preventing him from developing an
infection.
86.
For a client with chronic
obstructive pulmonary disease, which nursing intervention would help maintain a
patent airway?
A.
Restricting fluid intake to 1,000 ml
per day
B.
Enforcing absolute bed rest
C.
Teaching the client how to perform
controlled coughing
D.
Administering prescribed sedatives
regularly and in large amounts
87.
The nurse is assisting with a
subclavian vein central line insertion when the client's oxygen saturation
rapidly drops. He complains of shortness of breath and becomes tachypneic. The
nurse suspects a pneumothorax has developed. Further assessment findings
supporting the presence of a pneumothorax include:
A.
diminished or absent breath sounds
on the affected side.
B.
paradoxical chest wall movement with
respirations.
C.
tracheal deviation to the unaffected
side.
D.
muffled or distant heart sounds.
88.
A positive Mantoux test indicates
that the client:
A.
is actively immune to tuberculosis.
B.
has produced an immune response.
C.
will develop full-blown
tuberculosis.
D.
has an active case of tuberculosis.
89.
A client with a pulmonary embolus is
intubated and placed on mechanical ventilation. When suctioning the
endotracheal tube, the nurse should:
A.
Apply suction while inserting the
catheter
B.
Hyperoxygenate with 100% oxygen
before and after suctioning
C.
Use short, jabbing movements of the
catheter to loosen secretions
D.
Suction two to three times in quick
succession to remove all secretions
90.
While inspecting the client's chest,
the nurse notes that the chest wall contracts on inspiration and bulges on
expiration. From this assessment, she suspects:
A.
hemothorax.
B.
flail chest.
C.
pneumothorax.
D.
tension pneumothorax.
91.
The nurse is caring for a client who
required chest tube insertion for a pneumothorax. To assess a client for
pneumothorax resolution, the nurse can anticipate that he'll require:
A.
monitoring of arterial oxygen
saturation (SaO2).
B.
arterial blood gas (ABG) studies.
C.
chest auscultation.
D.
a chest X-ray.
92.
A client who has been hospitalized
for treatment of a pneumothorax is ready for discharge. Which outcome indicates
that he has adequate respiratory function?
A.
The client exhibits orthopneic
breathing.
B.
The client breathes at a rate of 16
to 20 breaths/minute
C.
The client uses accessory muscles to
breathe.
D.
The client exhibits bilateral rales
on auscultation.
93.
A 3-year-old child with cystic
fibrosis is admitted to the hospital with bronchopneumonia. Which of the
following signs and symptoms would be most helpful in providing
supportive diagnostic data for this child's condition?
A.
Weight loss and stringy stools.
B.
Cough and fever.
C.
Constipation and vomiting.
D.
Dysuria and rash.
94.
A client has been diagnosed with
bacterial pneumonia. After 1 day of antibiotic therapy, the client's white
blood cell count is still 14,000/mm³. In response to this report, the nurse
should:
A.
Notify the physician.
B.
Increase the next dose of the
antibiotic.
C.
Initiate reverse isolation
precautions.
D.
Administer the next scheduled
antibiotic dose early.
95.
A client has hypoxemia of pulmonary
origin. What portion of arterial blood gas results is most useful in
distinguishing between acute respiratory distress syndrome and acute
respiratory failure?
A.
Partial pressure of arterial oxygen
(PaO2)
B.
Partial pressure of arterial carbon
dioxide (PaCO2)
C.
pH
D.
Bicarbonate (HCO3–)
96.
A young adult was told that he had a
significant reaction to the Mantoux test. The nurse explains that this means
he:
A.
has active tuberculosis.
B.
had active tuberculosis.
C.
has been exposed to tuberculosis.
D.
is immunocompromised.
97.
The nurse knows that a closed chest
drainage system connected to a client's pleural chest tube is functioning
properly when the fluid in the water-seal chamber of the drainage system:
A.
Contains many small air bubbles
B.
Bubbles vigorously on inspiration
C.
Rises with inspiration and falls
with expiration
D.
Remains at a consistent level during
the respiratory cycle
98.
Medical therapy for a client with a
newly positive Mantoux skin test who does not have active tuberculosis would
involve which of the following?
A.
Reevaluating the client's condition
every 6 months.
B.
Performing a repeat skin test every
6 months.
C.
Administering isoniazid for about 9
months.
D.
Administering isoniazid until the
skin test reverts to negative.
99.
A young baby has an open repair of a
fractured sternum and has a chest tube. The nurse explains to the baby's mother
that the chest tube:
A.
Will be removed once the baby is
feeding well and is afebrile
B.
Does not cause discomfort and is put
in place for emergency use
C.
Is left in to drain the air from the
chest cavity that entered during surgery
D.
Drains the extra air in the baby's
chest that accumulated following the punctured lung
100.A nurse has just finished teaching a group of new nursing
assistants about the spread of tuberculosis (TB). She knows that her teaching
has been effective when one of the assistants states:
A.
"I could get TB by coming in
contact with the client's stool."
B.
"I could get TB if I become
contaminated with the client's blood."
C.
"I could get TB if I inhale
infected droplets when the client coughs."
D.
"I could get TB if I handle the
client's urine without wearing gloves."
101.A 9-month-old, well-nourished boy who lives with his
extensive extended family tests positive for tuberculosis. Which of the
following is a risk factor for tuberculosis in this client?
A.
Male sex.
B.
The infant is in the 95th percentile
for height and weight.
C.
His mother did not receive prenatal
care until the second trimester of her pregnancy.
D.
Age.
102.Which of the following outcome criteria would be most
appropriate for the client with a nursing diagnosis of Ineffective airway
clearance?
A.
Presence of congestion on X-ray
B.
Breath sounds clear on auscultation
C.
Continued use of oxygen when
necessary
D.
Respiratory rate of 24
breaths/minute
103.Following a laryngectomy, a client, who is being discharged,
exhibits concern that the laryngectomy tube may become dislodged. The nurse
should teach the client to first:
A.
Notify the physician at once
B.
Reinsert another tube immediately
C.
Keep calm because there is no
immediate emergency
D.
Recognize that prompt closure of the
tracheal opening may occur
104.On the first day following a right pneumonectomy a male
client suddenly sits straight up in bed. His respirations are labored, and he
is making a crowing sound. His skin is pale, cool, and moist. Immediately the
nurse should:
A.
Notify the physician
B.
Auscultate the left lung
C.
Inspect the incision for bleeding
D.
Check the chest tube for patency
105.After a thoracentesis for pleural effusion a client returns
to the physician's office for a follow-up visit. The nurse would suspect a
recurrence of pleural effusion when the client says:
A.
"Lately I can only breathe well
if I sit up."
B.
"During the night I sometimes
have a fever and chills."
C.
"I get a sharp, stabbing pain
when I take a deep breath."
D.
"I'm coughing up larger amounts
of thicker mucus for the last 2 days."
106.A client has had thoracic surgery for removal of a benign
mediastinal tumor. He has a left chest tube to water seal drainage. The nurse
auscultates scattered crackles bilaterally. Which of the following
interventions would be most appropriate?
A.
Check the water-seal system.
B.
Encourage deep breathing and
ambulation as soon as the client is able.
C.
Perform suctioning once per shift
and ask the physician to order an expectorant.
D.
Reduce the frequency of pain
medication and increase the suction in the water-seal bottle.
107.A 68-year-old male client has been hospitalized repeatedly
for chronic obstructive pulmonary disease (COPD). During this latest admission,
he has refused to participate in his self-care. Every time the nurse approaches
him, the client states, "I just want to die. I'm no good to anyone
anymore." The nurse realizes that he's experiencing:
A.
self-actualization
B.
confabulation.
C.
reaction formation.
D.
grief.
108.A client is diagnosed as having pulmonary tuberculosis, and
one of the drugs the physician orders is pyrazinamide (PZA). The nurse
evaluates that the teaching concerning the drug was effective when the client
says, "I will:
A.
Drink at least 2 quarts of fluid a
day."
B.
Take the medication 2 hours after
each meal."
C.
Report any changes in vision to the
physician."
D.
Expect a discoloration of urine,
sweat, and tears."
109.The physician has ordered O2 at 3 liters/minute via nasal
cannula. O2 amounts greater than this are contraindicated in the client with
COPD because:
A.
Higher concentrations result in
severe headache.
B.
Hypercapnic drive is necessary for
breathing.
C.
Higher levels will be required later
for pO2.
D.
Hypoxic drive is needed for
breathing.
110.A client admitted to the facility for treatment for tuberculosis
receives instructions about the disease. Which statement made by the client
indicates the need for further instruction?
A.
"I'll have to take the
medication for up to a year."
B.
"This disease may come back
later if I'm under stress."
C.
"I'll stay in isolation for at
least 6 weeks."
D.
"I'll always have a positive
test for tuberculosis."
111.When teaching a client with tuberculosis about recovery
after discharge from the hospital, the nurse should reinforce that the
treatment measure with the highest priority is:
A.
Having sufficient rest
B.
Getting plenty of fresh air
C.
Changing the current life-style
D.
Consistently taking prescribed
medication
112.For a client with a sucking stab wound in the chest wall,
the nurse should first:
A.
Start administering oxygen.
B.
Cover the wound with a
petroleum-impregnated dressing.
C.
Prepare to do a tracheostomy.
D.
Prepare for endotracheal intubation.
113.The nurse is caring for a client who has a tracheostomy tube
and is undergoing mechanical ventilation. The nurse can help prevent tracheal
dilation, a complication of tracheostomy tube placement, by:
A.
suctioning the tracheostomy tube
frequently.
B.
using a cuffed tracheostomy tube.
C.
using the minimal air leak technique
with cuff pressure less than 25 cm H2O.
D.
keeping the tracheostomy tube
plugged.
114.A client with chronic obstructive lung disease tells the
nurse that he feels short of breath. The client's respiratory rate is 36
breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen
saturation is 84%. The nurse calls the assigned respiratory therapist to
administer a prescribed nebulizer treatment. The therapist says, "I have
several more percussions to do on the unit where I am now. As soon as I'm done,
I'll come assess the client." The nurse's most appropriate action is to:
A.
notify the primary physician
immediately.
B.
stay with the client until the
therapist arrives.
C.
administer the treatment by
metered-dose inhaler.
D.
give the nebulizer treatment
herself.
115.A client is admitted to the emergency department with a
suspected overdose of an unknown drug. The client's arterial blood gas values
indicate respiratory acidosis. What should the nurse do first?
A.
Prepare to assist with ventilation.
B.
Monitor the client's heart rhythm.
C.
Prepare to begin gastric lavage.
D.
Obtain urine for drug screening.
116.A client's chest X-ray reveals bilateral white-outs,
indicating adult respiratory distress syndrome (ARDS). This syndrome results
from:
A.
cardiogenic pulmonary edema.
B.
respiratory alkalosis.
C.
increased pulmonary capillary
permeability.
D.
renal failure.
117.A client hospitalized with pneumonia has thick, tenacious
secretions. To help liquefy these secretions, the nurse should:
A.
Turn the client every 2 hours.
B.
Elevate the head of the bed 30
degrees.
C.
Encourage increased fluid intake.
D.
Maintain a cool room temperature.
118.The nurse is assessing the puncture site of a client who has
received a purified protein derivative test. Which finding indicates a need for
further evaluation?
A.
15-mm induration
B.
Reddened area
C.
10-mm bruise
D.
Blister
119.Oxygen at the rate of 2 liters per minute through nasal
cannula is prescribed for a client with COPD. Which of the following statements
best describes why the oxygen therapy is maintained at a relatively low
concentration?
A.
The oxygen will be lost at the
client's nostrils if given at a higher level with a nasal cannula.
B.
The client's long history of
respiratory problems indicates that he would be unable to absorb oxygen given
at a higher rate.
C.
The cells in the alveoli are so
damaged by the client's long history of respiratory problems that increased
oxygen levels and reduced carbon dioxide levels likely will cause the cells to
burst.
D.
The client's respiratory center is
so accustomed to high carbon dioxide and low blood oxygen concentrations that
changing these concentrations with oxygen therapy may eliminate his stimulus
for breathing.
120.When caring for a client with acute respiratory failure, the
nurse should expect to focus on resolving which of the following problems?
A.
Hypotension, hyperoxemia, and
hypercapnia
B.
Hyperventilation, hypertension, and
hypocapnia
C.
Hyperoxemia, hypocapnia, and
hyperventilation
D.
Hypercapnia, hypoventilation, and
hypoxemia
121.The nurse's assignment for the day includes a 3-day
postoperative thoracotomy client with two chest tubes in place. When making the
morning assessments on this client, the nurse notes the fluid in the water-seal
chamber isn't fluctuating. Which of the following provides the most likely
explanation?
A.
The chest tubes aren't positioned
correctly.
B.
The lung has reexpanded.
C.
The water-seal chamber needs more
sterile water.
D.
The suction needs to be increased.
122.The nurse caring for a patient in pre-term labor should be
aware that the patient may exhibit which of the following side effects when
administered intravenous terbutaline sulfate (Brethine)?
A.
Uterine hypertonia
B.
Epistaxis
C.
Tachycardia
D.
Dysuria
123.A client with pneumonia develops respiratory failure and has
a partial pressure of arterial oxygen of 55 mm Hg. He's placed on mechanical
ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal
should be to reduce the FIO2 to no greater than:
A.
0.21.
B.
0.35.
C.
0.5.
D.
0.7.
124.The nurse is planning care for a patient with pneumonia. The
patient is to be suctioned PRN. Which of the following techniques, if used by
the nurse, MOST accurately describes proper suctioning?
A.
Apply suction, for no more than 20
seconds, as the catheter is inserted.
B.
Apply suction, for no more than 10
seconds, as the catheter is both inserted and withdrawn.
C.
Apply suction, for no more than 10
seconds, as the catheter is withdrawn.
D.
Apply suction each time the patient
inhales.
125.To help control pain during coughing for a client who has
had a lobectomy, the nurse should:
A.
Place the bed in slight
Trendelenburg's position and help the client turn onto her operative side to
splint the incision.
B.
Raise the bed to semi-Fowler's
position and place one hand on the client's back, on the left side, and one
hand under the incision.
C.
Keep the bed flat and tell the
client to place her hands over the incision before taking a deep breath.
D.
Raise the bed to complete Fowler's
position and help the client turn onto her operative side to splint the
incision.
For answers and rationale click the link below:
http://ilovenurselouie.blogspot.com/2014/12/disorders-of-respiratory-system_11.html
For answers and rationale click the link below:
http://ilovenurselouie.blogspot.com/2014/12/disorders-of-respiratory-system_11.html
