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1. A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions the respiratory therapist will give the client is to breathe normally. What should the nurse teach is being measured when the client follows these directions?

• Tidal volume
• Vital capacity
• Expiratory reserve
• Inspiratory reserve

2. A spontaneous pneumothorax is suspected in a client with a history of emphysema. In addition to calling the health care provider, what action should the nurse take?

• Place the client on the unaffected side.
• Administer 60% oxygen via a Venturi mask.
• Prepare for IV administration of electrolytes.
• Give oxygen at 2L per minute via nasal cannula.

3. A client with a pulmonary embolus is intubated and placed on mechanical ventilation. What nursing action is important when suctioning the endotracheal tube?

• Apply negative pressure while inserting the suction catheter.
• Hyperoxygenate with 100% oxygen before and after suctioning.
• Suction 2 to 3 times in succession to effectively clear the airway.
• Use rapid movements of the suction catheter to loosen secretions.

4. A nurse assesses that several clients have low oxygen saturation levels. Which client would benefit the most from receiving oxygen via a nasal cannula?

• Has an upper respiratory infection
• Receives many visitors while sitting in a chair
• Has a nasogastric tube for gastric decompression
• Exhibits dry oral mucous membranes from mouth breathing

5. A chest tube is inserted into a client who was stabbed in the chest and is attached to a closed-drainage system. Which is an important nursing intervention when caring for this client?

• Observe for fluid fluctuations in the water-seal chamber.
• Obtain a prescription for morphine to minimize agitation.
• Apply a thoracic binder to prevent excessive tension on the tube.
• Clamp the tubing securely to prevent a rapid decline in pressure.

6. A client has chest tubes attached to a chest tube drainage system. What should the nurse do when caring for this client?

• Clamp the chest tubes when suctioning.
• Palpate the surrounding area for crepitus.
• Change the dressing daily using aseptic technique.
• Empty the drainage chamber at the end of the shift.

7. While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action?

• Withhold the drug until additional orders are obtained.
• Tell the client not to worry; these are expected side effects from the medicine.
• Ask the client to relax; then give instructions to breathe slowly and deeply for several minutes.
• Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

8. A nurse identifies that a client’s hemoglobin level is decreasing and is concerned about tissue hypoxia. An increase in what diagnostic test result indicates an acceleration in oxygen dissociation from hemoglobin?

• pH
• Po2
• Pco2
• HCO3

9. Which intervention should the nurse implement to help prevent atelectasis in a client with fractured ribs as a result of chest trauma?

• Apply a thoracic binder for support
• Encourage coughing and deep breathing
• Defer pain medication the first day after injury
• Position the client face-down on a soft mattress

10. A client has a bronchoscopy in the ambulatory surgery unit. What action should the nurse take to prevent laryngeal edema?

• Place ice chips in the clients mouth.
• Offer liberal amounts of fluid to the client.
• Keep the client in the semi-Fowler position.
• Tell the client to suck on medicated lozenges.

11. A client who is to be admitted for minor surgery has a chest radiograph as part of the presurgical physical. The nurse is notified that the radiograph reveals that the client has pulmonary tuberculosis. What evidence of tuberculosis is provided by the radiograph?

• Sensitized T cells
• Presence of acid-fast bacilli
• Cavities caused by caseation
• Microscopic primary infection

12. A client is diagnosed with emphysema. For what long-term problem should the nurse monitor this client?

• Localized tissue necrosis
• Carbon dioxide retention
• Increased respiratory rate
• Saturated hemoglobin molecules

13. A client with emphysema experiences a sudden episode of shortness of breath and is diagnosed with a spontaneous pneumothorax. The client asks, “How could this have happened?” What likely cause of the spontaneous pneumothorax should the nurse’s response take into consideration?

• Pleural friction rub
• Tracheoesophageal fistula
• Rupture of a subpleural bleb
• Puncture wound of the chest wall

14. A client who is taking rifampin (Rifadin) tells the nurse, “My urine looks orange.” What action should the nurse take?

• Explain this is expected.
• Check the liver enzymes.
• Strain the urine for stones.
• Ask what foods were eaten.

15. What nursing action will most help a client obtain maximum benefits after postural drainage?

• Administer prn oxygen.
• Encourage coughing deeply.
• Place the client in a sitting position.
• Encourage the client to rest for a half hour.

16. A client is admitted to the intensive care unit with acute pulmonary edema. Which rapidly acting intravenous diuretic should the nurse anticipate will be prescribed?

• Furosemide (Lasix)
• Chlorothiazide (Diuril)
• Spironolactone (Aldactone)
• AcetaZOLAMIDE (Diamox)

17. A client has a laryngectomy. The avoidance of which activity identified by the client indicates that the nurse’s teaching about activities and the stoma is understood?

• Water sports
• Strenuous exercises
• Sleeping with pillows
• High-humidity environment

18. A client is admitted with suspected atelectasis. Which clinical manifestation does the nurse expect to identify when assessing this client?

• Slow, deep respirations
• Normal oral temperature
• Dry, unproductive cough
• Diminished breath sounds

19. A nurse is caring for a variety of clients. For which client is it most essential for the nurse to implement measures to prevent pulmonary embolism?

• 59-year-old who had a knee replacement
• 60-year-old who has bacterial pneumonia
• 68-year-old who had emergency dental surgery
• 76-year-old who has a history of thrombocytopenia

20. A nurse is caring for a group of clients on a medical-surgical unit. Which client has the highest risk for developing a pulmonary embolism?

• Obese client with leg trauma
• Pregnant client with acute asthma
• Client with diabetes who has cholecystitis
• Client with pneumonia who is immunodeficient

21. How should the nurse monitor for the complication of subcutaneous emphysema after the insertion of chest tubes?

• Palpate around the tube insertion sites for crepitus.
• Auscultate the breath sounds for crackles and rhonchi.
• Observe the client for the presence of a barrel-shaped chest.
• Compare the length of inspiration with the length of expiration.

22. After a bronchoscopy because of suspected cancer of the lung, a client develops pleural effusion. What should the nurse conclude is the most likely cause of the pleural effusion?

• Excessive fluid intake
• Inadequate chest expansion
• Extension of cancerous lesions
• Irritation from the bronchoscopy

23. What must the nurse determine before discontinuing airborne precautions for a client with pulmonary tuberculosis?

• Client no longer is infected.
• Tuberculin skin test is negative.
• Sputum is free of acid-fast bacteria.
• Client’s temperature has returned to normal.

24. What is the underlying rationale why a nurse assesses a client with emphysema for clinical indicators of hypoxia?

• Pleural effusion
• Infectious obstructions
• Loss of aerating surface
• Respiratory muscle paralysis

25. A client who has acquired immunodeficiency syndrome develops bacterial pneumonia. On admission to the emergency department, the client’s Pao2 is 80 mm Hg. When the arterial blood gases are drawn again, the level is determined to be 65 mm Hg. What should the nurse do first?

• Increase the oxygen flow rate.
• Notify the health care provider.
• Decrease the tension of oxygen in the plasma.
• Have the arterial blood gases redone to verify accuracy.

26. A nurse repositions a client who is diagnosed with emphysema to facilitate breathing. Which position facilitates maximum air exchange?

• Supine
• Orthopneic
• Low-Fowler
• Semi-Fowler

27. A nurse is caring for clients whose histories include various health problems. These problems include scarlet fever, otitis media, bacterial endocarditis, rheumatic fever, and glomerulonephritis. What common factor linking these diseases should the nurse consider?

• Are self-limiting infections caused by spirilla
• Can be controlled through childhood vaccination
• Are caused by parasitic bacteria that normally live outside the body
• Result from streptococcal infections that enter via the upper respiratory tract

28. A client has a laryngectomy and radical neck dissection for cancer of the larynx. Two tubes from the area of the incision are connected to portable wound drainage systems. Inspection of the neck reveals moderate edema even though the drainage systems are functioning. For which clinical indicator should the nurse assess the client?

• Crackles
• Restlessness
• Loss of the gag reflex
• Cloudy wound drainage

29. What should the nurse include in the plan of care for a client who just had a total laryngectomy?

• Instructing the client to whisper
• Removing the outer tracheostomy tube prn
• Placing the client in the orthopneic position
• Suctioning the tracheostomy tube whenever necessary

30. A nurse is administering oxygen to a client with chest pain who is restless. What method of oxygen administration will most likely prevent a further increase in the client’s anxiety level?

• Cannula
• Catheter
• Venturi mask
• Rebreather mask

31. A client with a long history of asthma is scheduled for surgery. What information should be included in preoperative teaching?

• There is an increased risk of respiratory tract infections.
• Relaxation techniques limit the severity of asthmatic attacks.
• Coughing forcibly must be avoided because it increases the intrathoracic pressure.
• Local anesthesia is preferred because it has fewer side effects than general anesthesia.

32. When caring for an intubated client receiving mechanical ventilation, the nurse hears the high-pressure alarm. Which action is most appropriate?

• Remove secretions by suctioning.
• Lower the setting of the tidal volume.
• Check that tubing connections are secure.
• Obtain a specimen for arterial blood gases.

33. During the first 36 hours after the insertion of chest tubes, when assessing the function of a three-chamber, closed-chest drainage system, the nurse identifies that the water in the underwater seal tube is not fluctuating. What initial action should the nurse take?

• Take the client’s vital signs.
• Inform the health care provider.
• Turn the client to the unaffected side.
• Check the tube to ensure that it is not kinked.

34. The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. For which clinical indicator should the nurse assess first?

• Cyanosis
• Bradycardia
• Mental confusion
• Distended neck veins

35. After a laryngectomy a client is concerned about improving the ability to communicate. What topic should the nurse include in a teaching plan for the client?

• Sign language
• Body language
• Esophageal speech
• Computer-generated speech

36. A client is admitted for an exacerbation of emphysema. The client has a fever, chills, and difficulty breathing on exertion. What is the priority nursing action based on the clients history and present status?

• Checking for capillary refill
• Encouraging increased fluid intake
• Suctioning secretions from the airway
• Administering a high concentration of oxygen

37. A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish?

• Remove the air that is present in the intrapleural space
• Drain serosanguineous fluid from the intrapleural compartment
• Permit the development of positive pressure between the layers of the pleura
• Provide access for the instillation of medication into the pleural space

38. A client is diagnosed with a spontaneous pneumothorax. Which physiologic effect of a spontaneous pneumothorax should the nurse include in a teaching plan for the client?

• Air will move from the lung into the pleural space.
• The heart and great vessels shift toward the affected side.
• There is greater negative pressure within the chest cavity.
• Collapse of the other lung will occur if not treated immediately.

39. A nurse is caring for a client with severe dyspnea who is receiving oxygen via a Venturi mask. What should the nurse do when caring for this client?

• Assess frequently for nasal drying.
• Keep the mask tight against the face.
• Monitor oxygen saturation levels when eating.
• Set the oxygen flow at the highest setting possible.

40. A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being controlled. What should the nurse instruct the client to do?

• Perform the procedure once in the morning and once at night
• Move the trunk to an upright position and then exhale while bending over
• Inhale completely and then blow out as hard and as fast as possible through the mouthpiece
• Place the mouthpiece between the lips and in front of the teeth before starting the procedure

41. A nurse is teaching breathing exercises to a client with emphysema. What is the reason the nurse should include in the teaching as to why these exercises are necessary to promote effective use of the diaphragm?

• The residual capacity of the lungs has been increased.
• Inspiration has been markedly prolonged and difficult.
• The client has an increase in the vital capacity of the lungs.
• Abdominal breathing is an effective compensatory mechanism and is spontaneously initiated.

42. When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such a shift occurs, what potential effect is a cause for concern?

• Rupture of the pericardium
• Infection of the subpleural lining
• Decreased filling of the right heart
• Increased volume of the unaffected lung

43. In addition to treatment of the underlying cause, which medical intervention should the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)?

• Chest tube insertion
• Aggressive diuretic therapy
• Administration of beta blockers
• Positive end-expiratory pressure

44. Which nursing action is important when suctioning the secretions of a client with a tracheostomy?

• Use a new sterile catheter with each insertion.
• Initiate suction as the catheter is being withdrawn.
• Insert the catheter until the cough reflex is stimulated.
• Remove the inner cannula before inserting the suction catheter.

45. What nursing action will limit hypoxia when suctioning a client’s airway?

• Apply suction only after catheter is inserted.
• Limit suctioning with catheter to half a minute.
• Lubricate the catheter with saline before insertion.
• Use a sterile suction catheter for each suctioning episode.

46. A nurse works with a large population of immigrant clients and is concerned about the debilitating effects of influenza. Which action is the first line of defense against an emerging influenza pandemic?

• Complying with quarantine measures
• Instituting strict international travel restrictions
• Seeking aid from the international public health community
• Reporting surveillance findings to appropriate public health officials

47. A client just had a thoracentesis. For which response is it most important for the nurse to observe the client?

• Signs of infection
• Expectoration of blood
• Increased breath sounds
• Decreased respiratory rate

48. What is the priority goal for a client with asthma who is being discharged from the hospital?

• Is able to obtain pulse oximeter readings
• Demonstrates use of a metered-dose inhaler
• Knows the health care provider’s office hours
• Can identify the foods that may cause wheezing

49. A nurse is involved in an international committee to address global health problems. What suggestion is most appropri­ ate for the nurse to make to best meet the challenge associ­ated with a potential emerging influenza pandemic?

• Stockpile antibiotics.
• Establish a global surveillance plan.
• Limit vaccination programs to school-age children
• Initiate vaccination programs during the months of August and September.

50. A graduate nurse reminds a client who just had a laryngoscopy not to take anything by mouth until instructed to do so. What conclusion should be made about this intervention by the nurse preceptor who is evaluating the performance of the graduate nurse?

• Appropriate, because such clients usually experience painful swallowing for several days
• Appropriate, because early eating or drinking after such a procedure may cause aspiration
• Inappropriate, because the client is likely to be anxious and it is easier to remove the water pitcher
• Inappropriate, because the client is conscious and may be thirsty after not being allowed to drink fluids