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1. Dr.

Jones prescribes albuterol sulfate (Proventil) reactions (such as increased systolic blood pressure,
for a patient with newly diagnosed asthma. coldness in the extremities, and anginal pain).
When teaching the patient about this drug, the Ephedrine is used for its bronchodilator effects with
nurse should explain that it may cause: acute and chronic asthma and occasionally for its
a. Nasal congestion CNS stimulant actions for narcolepsy. It can be
b. Nervousness administered to children age 2 and older.
c. Lethargy
5. A female patient suffers adult respiratory distress
d. Hyperkalemia
syndrome as a consequence of shock.
Albuterol may cause nervousness. The inhaled form
The patients condition deteriorates rapidly, and
of the drug may cause dryness and irritation of the
endotracheal intubation and mechanical ventilation
nose and throat, not nasal congestion; insomnia, not
are initiated. When the high-pressure alarm on the
lethargy; and hypokalemia (with high doses), not
mechanical ventilator, alarm sounds, the nurse starts
hyperkalemia. Otther adverse effects of albuterol
to check for the cause. Which condition triggers the
include tremor, dizziness, headache, tachycardia,
high-pressure alarm?
palpitations, hypertension, heartburn, nausea,
vomiting and muscle cramps. a. Kinking of the ventilator tubing
b. A disconnected ventilator tube
2. Miriam, a college student with acute rhinitis sees
c. An endotracheal cuff leak
the campus nurse because of excessive nasal
d. A change in the oxygen concentration
drainage. The nurse asks the patient about the
without resetting the oxygen level alarm
color of the drainage. In acute rhinitis, nasal
drainage normally is: Conditions that trigger the high-pressure alarm
a. Yellow include kinking of the ventilator tubing,
b. Green bronchospasm or pulmonary embolus, mucus
c. Clear plugging, water in the tube, coughing or biting on
d. Gray endotracheal tube, and the patients being out of
breathing rhythm with the ventilator. A
Normally, nasal drainage in acute rhinitis is clear.
disconnected ventilator tube or an endotracheal cuff
Yellow or green drainage indicates spread of the
leak would trigger the low-pressure alarm. Changing
infection to the sinuses. Gray drainage may indicate
the oxygen concentration without resetting the
a secondary infection.
oxygen level alarm would trigger the oxygen alarm.
3. A male adult patient hospitalized for treatment
6. A male adult patient on mechanical ventilation is
of a pulmonary embolism develops respiratory
receiving pancuronium bromide (Pavulon), 0.01
alkalosis. Which clinical findings commonly
mg/kg I.V. as needed. Which assessment finding
accompany respiratory alkalosis?
indicates that the patient needs another
a. Nausea or vomiting
pancuronium dose?
b. Abdominal pain or diarrhea
c. Hallucinations or tinnitus a. Leg movement
d. Lightheadedness or paresthesia b. Finger movement
c. Lip movement
The patient with respiratory alkalosis may complain
d. Fighting the ventilator
of lightheadedness or paresthesia (numbness and
tingling in the arms and legs). Nausea, vomiting, Pancuronium, a nondepolarizing blocking agent, is
abdominal pain, and diarrhea may accompany used for muscle relaxation and paralysis. It assists
respiratory acidosis. Hallucinations and tinnitus rare mechanical ventilation by promoting encdotracheal
are associated with respiratory alkalosis or any other intubation and paralyzing the patient so that the
acid-base imbalance. mechanical ventilator can do its work. Fighting the
ventilator is a sign that the patient needs another
4. Before administering ephedrine, Nurse Tony
pancuronium dose. The nurse should administer 0.01
assesses the patients history. Because of
to 0.02 mg/kg I.V. every 20 to 60 minutes. Movement
ephedrines central nervous system (CNS) effects, it
of the legs, or lips has no effect on the ventilator and
is not recommended for:
therefore is not used to determine the need for
a. Patients with an acute asthma attack another dose.
b. Patients with narcolepsy
7. On auscultation, which finding suggests a right
c. Patients under age 6
pneumothorax?
d. Elderly patients
a. Bilateral inspiratory and expiratory crackles
Ephedrine is not recommended for elderly patients,
b. Absence of breaths sound in the right thorax
who are particularly susceptible to CNS reactions
c. Inspiratory wheezes in the right thorax
(such as confusion and anxiety) and to cardiovascular
d. Bilateral pleural friction rub The trachea will shift according to the pressure
gradients within the thoracic cavity. In tension
In pneumothorax, the alveoli are deflated and no air
pneumothorax and hemothorax, accumulation of air
exchange occurs in the lungs. Therefore, breath
or fluid causes a shift away from the injured side. If
sounds in the affected lung field are absent. None of
there is no significant air or fluid accumulation, the
the other options are associated with
trachea will not shift. Tracheal deviation toward the
pneumothorax. Bilateral crackles may result from
contralateral side in simple pneumothorax is seen
pulmonary congestion, inspiratory wheezes may
when the thoracic contents shift in response to the
signal asthma, and a pleural friction rub may indicate
release of normal thoracic pressure gradients on the
pleural inflammation.
injured side.
8. Rhea, confused and short breath, is brought to the
11. After undergoing a left pneumonectomy, a
emergency department by a family member. The
female patient has a chest tube in place for drainage.
medical history reveals chronic bronchitis and
When caring for this patient, the nurse must:
hypertension. To learn more about the current
respiratory problem, the doctor orders a chest x-ray a. Monitor fluctuations in the water-seal
and arterial blood gas (ABG) analysis. When chamber
reviewing the ABG report, the nurses sees many b. Clamp the chest tube once every shift
abbreviations. What does a lowercase a in ABG c. Encourage coughing and deep breathing
value present? d. Milk the chest tube every 2 hours

a. Acid-base balance When caring for a patient who is recovering from a


b. Arterial Blood pneumonectomy, the nurse should encourage
c. Arterial oxygen saturation coughing and deep breathing to prevent pneumonia
d. Alveoli in the unaffected lung. Because the lung has been
removed, the water-seal chamber should display no
A lowercase a in an ABG value represents arterial
fluctuations. Reinflation is not the purpose of chest
blood. For instance, the abbreviation PaO2 refers to
tube. Chest tube milking is controversial and should
the partial pressure of oxygen in arterial blood. The
be done only to remove blood clots that obstruct the
pH value reflects the acid-base balance in arterial
flow of drainage.
blood. Sa02 indicates arterial oxygen saturation. An
uppercase A represents alveolar conditions: for 12. When caring for a male patient who has just had
example, PA02 indicates the partial pressure of a total laryngectomy, the nurse should plan to:
oxygen in the alveoli.
a. Encourage oral feeding as soon as possible
9. A male patient is admitted to the health care b. Develop an alternative communication
facility for treatment of chronic obstructive method
pulmonary disease. Which nursing diagnosis is most c. Keep the tracheostomy cuff fully inflated
important for this patient? d. Keep the patient flat in bed

a. Activity intolerance related to fatigue A patient with a laryngectomy cannot speak, yet still
b. Anxiety related to actual threat to health needs to communicate. Therefore, the nurse should
status plan to develop an alternative communication
c. Risk for infection related to retained method. After a laryngectomy, edema interferes
secretions with the ability to swallow and necessitates tube
d. Impaired gas exchange related to airflow (enteral) feedings. To prevent injury to the tracheal
obstruction mucosa, the nurse should deflate the tracheostomy
cuff or use the minimal leak technique. To decrease
A patient airway and an adequate breathing pattern
edema, the nurse should place the patient in semi-
are the top priority for any patient, making impaired
Fowlers position.
gas exchange related to airflow obstruction the
most important nursing diagnosis. The other options 13. A male patient has a sucking stab wound to the
also may apply to this patient but less important. chest. Which action should the nurse take first?

10. Nurse Ruth assessing a patient for tracheal a. Drawing blood for a hematocrit and
displacement should know that the trachea will hemoglobin level
deviate toward the: b. Applying a dressing over the wound and
taping it on three sides
a. Contralateral side in a simple pneumothorax
c. Preparing a chest tube insertion tray
b. Affected side in a hemothorax
d. Preparing to start an I.V. line
c. Affected side in a tension pneumothorax
d. Contralateral side in hemothorax The nurse immediately should apply a dressing over
the stab wound and tape it on three sides to allow air
to escape and to prevent tension pneumothorax Controlled coughing helps maintain a patent airway
(which is more life-threatening than an open chest by helping to mobilize and remove secretions. A
wound). Only after covering and taping the wound moderate fluid intake (usually 2 L or more daily) and
should the nurse draw blood for laboratory tests, moderate activity help liquefy and mobilize
assist with chest tube insertion, and start an I.V. line. secretions. Bed rest and sedatives may limit the
patients ability to maintain a patent airway, causing
14. For a patient with advance chronic obstructive
a high risk for infection from pooled secretions.
pulmonary disease (COPD), which nursing action
best promotes adequate gas exchange? 17. Nurse Lei caring for a client with a pneumothorax
and who has had a chest tube inserted notes
a. Encouraging the patient to drink three
continues gentle bubbling in the suction control
glasses of fluid daily
chamber. What action is appropriate?
b. Keeping the patient in semi-fowlers position
c. Using a high-flow venturi mask to deliver a. Do nothing, because this is an expected
oxygen as prescribe finding
d. Administering a sedative, as prescribe b. Immediately clamp the chest tube and notify
the physician
The patient with COPD retains carbon dioxide, which
c. Check for an air leak because the bubbling
inhibits stimulation of breathing by the medullary
should be intermittent
center in the brain. As a result, low oxygen levels in
d. Increase the suction pressure so that the
the blood stimulate respiration, and administering
bubbling becomes vigorous
unspecified, unmonitored amounts of oxygen may
depress ventilation. To promote adequate gas Continuous gentle bubbling should be noted in the
exchange, the nurse should use a Venturi mask to suction control chamber. Option b is incorrect. Chest
deliver a specified, controlled amount of oxygen tubes should only be clamped to check for an air leak
consistently and accurately. Drinking three glasses of or when changing drainage devices (according to
fluid daily would not affect gas exchange or be agency policy). Option c is incorrect. Bubbling should
sufficient to liquefy secretions, which are common in be continuous and not intermittent. Option d is
COPD. Patients with COPD and respiratory distress incorrect because bubbling should be gentle.
should be places in high-Fowlers position and should Increasing the suction pressure only increases the
not receive sedatives or other drugs that may further rate of evaporation of water in the drainage system.
depress the respiratory center.
18. Nurse Maureen has assisted a physician with the
15. A male patients X-ray result reveals bilateral insertion of a chest tube. The nurse monitors the
white-outs, indicating adult respiratory distress client and notes fluctuation of the fluid level in the
syndrome (ARDS). This syndrome results from: water seal chamber after the tube is inserted. Based
on this assessment, which action would be
a. Cardiogenic pulmonary edema
appropriate?
b. Respiratory alkalosis
c. Increased pulmonary capillary permeability a. Inform the physician
d. Renal failure b. Continue to monitor the client
c. Reinforce the occlusive dressing
ARDS results from increased pulmonary capillary
d. Encourage the client to deep-breathe
permeability, which leads to noncardiogenic
pulmonary edema. In cardiogenic pulmonary edema, The presence of fluctuation of the fluid level in the
pulmonary congestion occurs secondary to heart water seal chamber indicates a patent drainage
failure. In the initial stage of ARDS, respiratory system. With normal breathing, the water level rises
alkalosis may arise secondary to hyperventilation; with inspiration and falls with expiration. Fluctuation
however, it does not cause ARDS. Renal failure does stops if the tube is obstructed, if a dependent loop
not cause ARDS, either. exists, if the suction is not working properly, or if the
lung has reexpanded. Options A, C, and D are
16. For a female patient with chronic obstructive
incorrect.
pulmonary disease, which nursing intervention
would help maintain a patent airway? 19. Nurse Reynolds caring for a client with a chest
tube turns the client to the side, and the chest tube
a. Restricting fluid intake to 1,000 ml per day
accidentally disconnects. The initial nursing action is
b. Enforcing absolute bed rest
to:
c. Teaching the patient how to perform
controlled coughing a. Call the physician
d. Administering prescribe sedatives regularly b. Place the tube in bottle of sterile water
and in large amounts c. Immediately replace the chest tube system
d. Place a sterile dressing over the
disconnection site
If the chest drainage system is disconnected, the end not signs that require immediate notification of the
of the tube is placed in a bottle of sterile water held physician.
below the level of the chest. The system is replaced
23. An emergency room nurse is assessing a male
if it breaks or cracks or if the collection chamber is
client who has sustained a blunt injury to the chest
full. Placing a sterile dressing over the disconnection
wall. Which of these signs would indicate the
site will not prevent complications resulting from the
presence of a pneumothorax in this client?
disconnection. The physician may need to be
notified, but this is not the initial action. a. A low respiratory rate
b. Diminished breath sounds
20. A nurse is assisting a physician with the removal
c. The presence of a barrel chest
of a chest tube. The nurse should instruct the client
d. A sucking sound at the site of injury
to:
This client has sustained a blunt or a closed chest
a. Exhale slowly
injury. Basic symptoms of a closed pneumothorax
b. Stay very still
are shortness of breath and chest pain. A larger
c. Inhale and exhale quickly
pneumothorax may cause tachypnea, cyanosis,
d. Perform the Valsalva maneuver
diminished breath sounds, and subcutaneous
When the chest tube is removed, the client is asked emphysema. Hyperresonance also may occur on the
to perform the Valsalva maneuver (take a deep affected side. A sucking sound at the site of injury
breath, exhale, and bear down). The tube is quickly would be noted with an open chest injury.
withdrawn, and an airtight dressing is taped in place.
24. Nurse Reese is caring for a client hospitalized
An alternative instruction is to ask the client to take
with acute exacerbation of chronic obstructive
a deep breath and hold the breath while the tube is
pulmonary disease. Which of the following would the
removed. Options A, B, and C are incorrect client
nurse expect to note on assessment of this client?
instructions.
a. Hypocapnia
21. While changing the tapes on a tracheostomy
b. A hyperinflated chest noted on the chest x-
tube, the male client coughs and tube is dislodged.
ray
The initial nursing action is to:
c. Increased oxygen saturation with exercise
a. Call the physician to reinsert the tube d. A widened diaphragm noted on the chest x-
b. Grasp the retention sutures to spread the ray
opening
Clinical manifestations of chronic obstructive
c. Call the respiratory therapy department to
pulmonary disease (COPD) include hypoxemia,
reinsert the tracheotomy
hypercapnia, dyspnea on exertion and at rest,
d. Cover the tracheostomy site with a sterile
oxygen desaturation with exercise, and the use of
dressing to prevent infection
accessory muscles of respiration. Chest x-rays reveal
If the tube is dislodged accidentally, the initial a hyperinflated chest and a flattened diaphragm if
nursing action is to grasp the retention sutures and the disease is advanced.
spread the opening. If agency policy permits, the
25. An oxygen delivery system is prescribed for a
nurse then attempts immediately to replace the
male client with chronic obstructive pulmonary
tube. Covering the tracheostomy site will block the
disease to deliver a precise oxygen concentration.
airway. Options A and C will delay treatment in this
Which of the following types of oxygen delivery
emergency situation.
systems would the nurse anticipate to be
22. Nurse Oliver is caring for a client immediately prescribed?
after removal of the endotracheal tube. The nurse
a. Face tent
reports which of the following signs immediately if
b. Venturi mask
experienced by the client?
c. Aerosol mask
a. Stridor d. Tracheostomy collar
b. Occasional pink-tinged sputum
The Venturi mask delivers the most accurate oxygen
c. A few basilar lung crackles on the right
concentration. It is the best oxygen delivery system
d. Respiratory rate 24 breaths/min
for the client with chronic airflow limitation because
The nurse reports stridor to the physician it delivers a precise oxygen concentration. The face
immediately. This is a high-pitched, coarse sound tent, aerosol mask, and tracheostomy collar are also
that is heard with the stethoscope over the trachea. high-flow oxygen delivery systems but most often
Stridor indicates airway edema and places the client are used to administer high humidity.
at risk for airway obstruction. Options B, C, and D are
26. Blessy, a community health nurse is conducting
an educational session with community members
regarding tuberculosis. The nurse tells the group that exhalation. Options A, B, and C are not the purposes
one of the first symptoms associated with of this type of breathing.
tuberculosis is:
30. A nurse is caring for a male client with acute
a. Dyspnea respiratory distress syndrome. Which of the
b. Chest pain following would the nurse expect to note in the
c. A bloody, productive cough client?
d. A cough with the expectoration of mucoid
a. Pallor
sputum
b. Low arterial PaO2
One of the first pulmonary symptoms is a slight c. Elevated arterial PaO2
cough with the expectoration of mucoid sputum. d. Decreased respiratory rate
Options A, B, and C are late symptoms and signify
The earliest clinical sign of acute respiratory distress
cavitation and extensive lung involvement.
syndrome is an increased respiratory rate. Breathing
27. A nurse performs an admission assessment on a becomes labored, and the client may exhibit air
female client with a diagnosis of tuberculosis. The hunger, retractions, and cyanosis. Arterial blood gas
nurse reviews the result of which diagnosis test that analysis reveals increasing hypoxemia, with a PaO2
will confirm this diagnosis? lower than 60 mm Hg.

a. Bronchoscopy 31. A nurse is preparing to obtain a sputum specimen


b. Sputum culture from a male client. Which of the following nursing
c. Chest x-ray actions will facilitate obtaining the specimen?
d. Tuberculin skin test
a. Limiting fluid
Tuberculosis is definitively diagnosed through b. Having the client take deep breaths
culture and isolation of Mycobacterium tuberculosis. c. Asking the client to spit into the collection
A presumptive diagnosis is made based on a container
tuberculin skin test, a sputum smear that is positive d. Asking the client to obtain the specimen
for acid-fast bacteria, a chest x-ray, and histological after eating
evidence of granulomatous disease on biopsy.
To obtain a sputum specimen, the client should rinse
28. A nurse is caring for a male client with the mouth to reduce contamination, breathe deeply,
emphysema who is receiving oxygen. The nurse and then cough into a sputum specimen container.
assesses the oxygen flow rate to ensure that it does The client should be encouraged to cough and not
not exceed: spit so as to obtain sputum. Sputum can be thinned
by fluids or by a respiratory treatment such as
a. 1 L/min
inhalation of nebulized saline or water. The optimal
b. 2 L/min
time to obtain a specimen is on arising in the
c. 6 L/min
morning.
d. 10 L/min
32. Nurse Joy is caring for a client after a
Oxygen is used cautiously and should not exceed 2
bronchoscopy and biopsy. Which of the following
L/min. Because of the long-standing hypercapnia
signs, if noticed in the client, should be reported
that occurs in emphysema, the respiratory drive is
immediately to the physician?
triggered by low oxygen levels rather than increased
carbon dioxide levels, as is the case in a normal a. Dry cough
respiratory system. b. Hermaturia
c. Bronchospasm
29. A nurse instructs a female client to use the
d. Blood-streaked sputum
pursed-lip method of breathing and the client asks
the nurse about the purpose of this type of If a biopsy was performed during a bronchoscopy,
breathing. The nurse responds, knowing that the blood-streaked sputum is expected for several hours.
primary purpose of pursed-lip breathing is to: Frank blood indicates hemorrhage. A dry cough may
be expected. The client should be assessed for signs
a. Promote oxygen intake
of complications, which would include cyanosis,
b. Strengthen the diaphragm
dyspnea, stridor, bronchospasm, hemoptysis,
c. Strengthen the intercostal muscles
hypotension, tachycardia, and dysrhythmias.
d. Promote carbon dioxide elimination
Hematuria is unrelated to this procedure.
Pursed-lip breathing facilitates maximal expiration
33. A nurse is suctioning fluids from a male client via
for clients with obstructive lung disease. This type of
a tracheostomy tube. When suctioning, the nurse
breathing allows better expiration by increasing
must limit the suctioning time to a maximum of:
airway pressure that keeps air passages open during
a. 1 minute heard over normal lung tissue. Hyperresonant
b. 5 seconds sounds indicate increased air in the lungs or pleural
c. 10 seconds space; theyre louder and lower pitched than
d. 30 seconds resonant sounds. Although hyperresonant sounds
occur in such disorders as emphysema and
Hypoxemia can be caused by prolonged suctioning,
pneumothorax, they may be normal in children and
which stimulates the pacemaker cells in the heart. A
very thin adults. Dull sounds, normally heard only
vasovagal response may occur, causing bradycardia.
over the liver and heart, may occur over dense lung
The nurse must preoxygenate the client before
tissue, such as from consolidation or a tumor. Dull
suctioning and limit the suctioning pass to 10
sounds are thudlike and of medium pitch. Flat
seconds.
sounds, soft and high-pitched, are heard over airless
34. A nurse is suctioning fluids from a female client tissue and can be replicated by percussing the thigh
through an endotracheal tube. During the suctioning or a bony structure.
procedure, the nurse notes on the monitor that the
37. A male client who weighs 175 lb (79.4 kg) is
heart rate is decreasing. Which if the following is the
receiving aminophylline (Aminophyllin) (400 mg in
appropriate nursing intervention?
500 ml) at 50 ml/hour. The theophylline level is
a. Continue to suction reported as 6 mcg/ml. The nurse calls the physician
b. Notify the physician immediately who instructs the nurse to change the dosage to 0.45
c. Stop the procedure and reoxygenate the mg/kg/hour. The nurse should:
client
a. Question the order because its too low
d. Ensure that the suction is limited to 15
b. Question the order because its too high
seconds
c. Set the pump at 45 ml/hour
During suctioning, the nurse should monitor the d. Stop the infusion and have the laboratory
client closely for side effects, including hypoxemia, repeat the theophylline measurement
cardiac irregularities such as a decrease in heart rate
A therapeutic theophylline level is 10 to 20 mcg/ml.
resulting from vagal stimulation, mucosal trauma,
The client is currently receiving 0.5 mg/kg/hour of
hypotension, and paroxysmal coughing. If side
aminophylline. Because the clients theophylline
effects develop, especially cardiac irregularities, the
level is sub-therapeutic, reducing the dose (which is
procedure is stopped and the client is reoxygenated.
what the physicians order would do) would be
35. A male adult client is suspected of having a inappropriate. Therefore, the nurse should question
pulmonary embolus. A nurse assesses the client, the order.
knowing that which of the following is a common
38. The nurse is teaching a male client with chronic
clinical manifestation of pulmonary embolism?
bronchitis about breathing exercises. Which of the
a. Dyspnea following should the nurse include in the teaching?
b. Bradypnea
a. Make inhalation longer than exhalation
c. Bradycardia
b. Exhale through an open mouth
d. Decreased respirations
c. Use diaphragmatic breathing
The common clinical manifestations of pulmonary d. Use chest breathing
embolism are tachypnea, tachycardia, dyspnea, and
In chronic bronchitis the diaphragm is flat and weak.
chest pain.
Diaphragmatic breathing helps to strengthen the
36. A slightly obese female client with a history of diaphragm and maximizes ventilation. Exhalation
allergy-induced asthma, hypertension, and mitral should be longer than inhalation to prevent collapse
valve prolapse is admitted to an acute care facility for of the bronchioles. The client with chronic bronchitis
elective surgery. The nurse obtains a complete should exhale through pursed lips to prolong
history and performs a thorough physical exhalation, keep the bronchioles from collapsing,
examination, paying special attention to the and prevent air trapping. Diaphragmatic breathing
cardiovascular and respiratory systems. When not chest breathing increases lung expansion.
percussing the clients chest wall, the nurse expects
39. Which phrase is used to describe the volume of
to elicit:
air inspired and expired with a normal breath?
a. Resonant sounds
a. Total lung capacity
b. Hyperresonant sounds
b. Forced vital capacity
c. Dull sounds
c. Tidal volume
d. Flat sounds
d. Residual volume
When percussing the chest wall, the nurse expects to
elicit resonant sounds low-pitched, hollow sounds
Tidal volume refers to the volume of air inspired and a second test may be needed; neither test indicates
expired with a normal breath. Total lung capacity is that tuberculosis is active. In the Mantoux test, an
the maximal amount of air the lungs and respiratory induration 5 to 9 mm in diameter indicates a
passages can hold after a forced inspiration. Forced borderline reaction; a larger induration indicates a
vital capacity is the vital capacity performed with a positive reaction. The presence of a wheal within 2
maximally forced expiration. Residual volume is the days doesnt indicate active tuberculosis.
maximal amount of air left in the lung after a
43. A female adult client has a tracheostomy but
maximal expiration.
doesnt require continuous mechanical ventilation.
40. A male client abruptly sits up in bed, reports When weaning the client from the tracheostomy
having difficulty breathing and has an arterial oxygen tube, the nurse initially should plug the opening in
saturation of 88%. Which mode of oxygen delivery the tube for:
would most likely reverse the manifestations?
a. 15 to 60 seconds
a. Simple mask b. 5 to 20 minutes
b. Non-rebreather mask c. 30 to 40 minutes
c. Face tent d. 45 to 60 minutes
d. Nasal cannula
Initially, the nurse should plug the opening in the
A non-rebreather mask can deliver levels of the tracheostomy tube for 5 to 20 minutes, then
fraction of inspired oxygen (FIO2) as high as 100%. gradually lengthen this interval according to the
Other modes simple mask, face tent, and nasal clients respiratory status. A client who doesnt
cannula deliver lower levels of FIO2. require continuous mechanical ventilation already is
breathing without assistance, at least for short
41. A female client must take streptomycin for
periods; therefore, plugging the opening of the tube
tuberculosis. Before therapy begins, the nurse
for only 15 to 60 seconds wouldnt be long enough
should instruct the client to notify the physician if
to reveal the clients true tolerance to the procedure.
which health concern occurs?
Plugging the opening for more than 20 minutes
a. Impaired color discrimination would increase the risk of acute respiratory distress
b. Increased urinary frequency because the client requires an adjustment period to
c. Decreased hearing acuity start breathing normally.
d. Increased appetite
44. Nurse Oliver observes constant bubbling in the
Decreased hearing acuity indicates ototoxicity, a water-seal chamber of a closed chest drainage
serious adverse effect of streptomycin therapy. The system. What should the nurse conclude?
client should notify the physician immediately if it
a. The system is functioning normally
occurs so that streptomycin can be discontinued and
b. The client has a pneumothorax
an alternative drug can be prescribed. The other
c. The system has an air leak
options arent associated with streptomycin.
d. The chest tube is obstructed
Impaired color discrimination indicates color
blindness; increased urinary frequency and Constant bubbling in the chamber indicates an air
increased appetite accompany diabetes mellitus. leak and requires immediate intervention. The client
with a pneumothorax will have intermittent bubbling
42. A male client is asking the nurse a question
in the water-seal chamber. Clients without a
regarding the Mantoux test for tuberculosis. The
pneumothorax should have no evidence of bubbling
nurse should base her response on the fact that the:
in the chamber. If the tube is obstructed, the nurse
a. Area of redness is measured in 3 days and should notice that the fluid has stopped fluctuating
determines whether tuberculosis is present. in the water-seal chamber.
b. Skin test doesnt differentiate between
45. A black client with asthma seeks emergency care
active and dormant tuberculosis infection.
for acute respiratory distress. Because of this clients
c. Presence of a wheal at the injection site in 2
dark skin, the nurse should assess for cyanosis by
days indicates active tuberculosis.
inspecting the:
d. Test stimulates a reddened response in
some clients and requires a second test in 3 a. Lips
months. b. Mucous membranes
c. Nail beds
The Mantoux test doesnt differentiate between
d. Earlobes
active and dormant infections. If a positive reaction
occurs, a sputum smear and culture as well as a chest Skin color doesnt affect the mucous membranes.
X-ray are necessary to provide more information. The lips, nail beds, and earlobes are less reliable
Although the area of redness is measured in 3 days,
indicators of cyanosis because theyre affected by physical findings, the physician suspects
skin color. legionnaires disease. While awaiting diagnostic test
results, the client is admitted to the facility and
46. For a male client with an endotracheal (ET) tube,
started on antibiotic therapy. What is the drug of
which nursing action is most essential?
choice for treating legionnaires disease?
a. Auscultating the lungs for bilateral breath
a. Erythromycin (Erythrocin)
sounds
b. Rifampin (Rifadin)
b. Turning the client from side to side every 2
c. Amantadine (Symmetrel)
hours
d. Amphotericin B (Fungizone)
c. Monitoring serial blood gas values every 4
hours Erythromycin is the drug of choice for treating
d. Providing frequent oral hygiene legionnaires disease. Rifampin may be added to the
regimen if erythromycin alone is ineffective;
For a client with an ET tube, the most important
however, it isnt administered first. Amantadine, an
nursing action is auscultating the lungs regularly for
antiviral agent, and amphotericin B, an antifungal
bilateral breath sounds to ensure proper tube
agent, are ineffective against legionnaires disease,
placement and effective oxygen delivery. Although
which is caused by bacterial infection.
the other options are appropriate for this client,
theyre secondary to ensuring adequate 50. A male client with chronic obstructive pulmonary
oxygenation. disease (COPD) is recovering from a myocardial
infarction. Because the client is extremely weak and
47. The nurse assesses a male clients respiratory
cant produce an effective cough, the nurse should
status. Which observation indicates that the client is
monitor closely for:
experiencing difficulty breathing?
a. Pleural effusion
a. Diaphragmatic breathing
b. Pulmonary edema
b. Use of accessory muscles
c. Atelectasis
c. Pursed-lip breathing
d. Oxygen toxicity
d. Controlled breathing
In a client with COPD, an ineffective cough impedes
The use of accessory muscles for respiration
secretion removal. This, in turn, causes mucus
indicates the client is having difficulty breathing.
plugging, which leads to localized airway obstruction
Diaphragmatic and pursed-lip breathing are two
a known cause of atelectasis. An ineffective cough
controlled breathing techniques that help the client
doesnt cause pleural effusion (fluid accumulation in
conserve energy.
the pleural space). Pulmonary edema usually results
48. A female client is undergoing a complete physical from left-sided heart failure, not an ineffective
examination as a requirement for college. When cough. Although many noncardiac conditions may
checking the clients respiratory status, the nurse cause pulmonary edema, an ineffective cough isnt
observes respiratory excursion to help assess: one of them. Oxygen toxicity results from prolonged
administration of high oxygen concentrations, not an
a. Lung vibrations ineffective cough.
b. Vocal sounds
c. Breath sounds 51. The nurse in charge is teaching a client with
d. Chest movements emphysema how to perform pursed-lip breathing.
The client asks the nurse to explain the purpose of
The nurse observes respiratory excursion to help this breathing technique. Which explanation should
assess chest movements. Normally, thoracic the nurse provide?
expansion is symmetrical; unequal expansion may
indicate pleural effusion, atelectasis, pulmonary a. It helps prevent early airway collapse
embolus, or a rib or sternum fracture. The nurse b. It increases inspiratory muscle strength
assesses vocal sounds to evaluate air flow when c. It decreases use of accessory breathing
checking for tactile fremitus; after asking the client muscles
to say 99, the nurse palpates the vibrations d. It prolongs the inspiratory phase of
transmitted from the bronchopulmonary system respiration
along the solid surfaces of the chest wall to the
Pursed-lip breathing helps prevent early airway
nurses palms. The nurse assesses breath sounds
collapse. Learning this technique helps the client
during auscultation.
control respiration during periods of excitement,
49. A male client comes to the emergency anxiety, exercise, and respiratory distress. To
department complaining of sudden onset of increase inspiratory muscle strength and endurance,
diarrhea, anorexia, malaise, cough, headache, and the client may need to learn inspiratory resistive
recurrent chills. Based on the clients history and breathing. To decrease accessory muscle use and
thus reduce the work of breathing, the client may d. It alters diaphragm movement, increasing
need to learn diaphragmatic (abdominal) breathing. chest expansion and enhancing the lungs
In pursed-lip breathing, the client mimics a normal capacity for gas exchange
inspiratory-expiratory (I:E) ratio of 1:2. (A client with
Anhydrous theophylline and other methylxanthine
emphysema may have an I:E ratio as high as 1:4.)
agents make the central respiratory center more
52. After receiving an oral dose of codeine for an sensitive to CO2 and stimulate the respiratory drive.
intractable cough, the male client asks the nurse, Inhibition of phosphodiesterase is the drugs
How long will it take for this drug to work? How mechanism of action in treating asthma and other
should the nurse respond? reversible obstructive airway diseases not COPD.
Methylxanthine agents inhibit rather than stimulate
a. In 30 minutes
adenosine receptors. Although these agents reduce
b. In 1 hour
diaphragmatic fatigue in clients with chronic
c. In 2.5 hours
bronchitis or emphysema, they dont alter
d. In 4 hours
diaphragm movement to increase chest expansion
Codeines onset of action is 30 minutes. Its peak and enhance gas exchange.
concentration occurs in about 1 hour; its half-life, in
55. A male client with pneumococcal pneumonia is
2.5 hours; and its duration of action is 4 to 6 hours.
admitted to an acute care facility. The client in the
53. A male client suffers adult respiratory distress next room is being treated for mycoplasmal
syndrome as a consequence of shock. The clients pneumonia. Despite the different causes of the
condition deteriorates rapidly, and endotracheal (ET) various types of pneumonia, all of them share which
intubation and mechanical ventilation are initiated. feature?
When the high-pressure alarm on the mechanical
a. Inflamed lung tissue
ventilator sounds, the nurse starts to check for the
b. Sudden onset
cause. Which condition triggers the high-pressure
c. Responsiveness to penicillin
alarm?
d. Elevated white blood cell (WBC) count
a. Kinking of the ventilator tubing
The common feature of all types of pneumonia is an
b. A disconnected ventilator tube
inflammatory pulmonary response to the offending
c. An ET cuff leak
organism or agent. Although most types of
d. A change in the oxygen concentration
pneumonia have a sudden onset, a few (such as
without resetting the oxygen level alarm
anaerobic bacterial pneumonia and mycoplasmal
Conditions that trigger the high-pressure alarm pneumonia) have an insidious onset. Antibiotic
include kinking of the ventilator tubing, therapy is the primary treatment for most types of
bronchospasm or pulmonary embolus, mucus pneumonia; however, the antibiotic must be specific
plugging, water in the tube, coughing or biting on the for the causative agent, which may not be responsive
ET tube, and the clients being out of breathing to penicillin. A few types of pneumonia, such as viral
rhythm with the ventilator. A disconnected pneumonia, arent treated with antibiotics. Although
ventilator tube or an ET cuff leak would trigger the pneumonia usually causes an elevated WBC count,
low-pressure alarm. Changing the oxygen some types, such as mycoplasmal pneumonia, dont.
concentration without resetting the oxygen level
56. A client with Guillain-Barr syndrome develops
alarm would trigger the oxygen alarm.
respiratory acidosis as a result of reduced alveolar
54. A female client with chronic obstructive ventilation. Which combination of arterial blood gas
pulmonary disease (COPD) takes anhydrous (ABG) values confirms respiratory acidosis?
theophylline, 200 mg P.O. every 8 hours. During a
a. pH, 5.0; PaCO2 30 mm Hg
routine clinic visit, the client asks the nurse how the
b. pH, 7.40; PaCO2 35 mm Hg
drug works. What is the mechanism of action of
c. pH, 7.35; PaCO2 40 mm Hg
anhydrous theophylline in treating a nonreversible
d. pH, 7.25; PaCO2 50 mm Hg
obstructive airway disease such as COPD?
In respiratory acidosis, ABG analysis reveals an
a. It makes the central respiratory center more
arterial pH below 7.35 and partial pressure of arterial
sensitive to carbon dioxide and stimulates
carbon dioxide (PaCO2) above 45 mm Hg. Therefore,
the respiratory drive
the combination of a pH value of 7.25 and a PaCO2
b. It inhibits the enzyme phosphodiesterase,
value of 50 mm Hg confirms respiratory acidosis. A
decreasing degradation of cyclic adenosine
pH value of 5.0 with a PaCO2 value of 30 mm Hg
monophosphate, a bronchodilator
indicates respiratory alkalosis. Options B and C
c. It stimulates adenosine receptors, causing
represent normal ABG values, reflecting normal gas
bronchodilation
exchange in the lungs.
57. A male client admitted to an acute care facility 59. After undergoing a thoracotomy, a male client is
with pneumonia is receiving supplemental oxygen, 2 receiving epidural analgesia. Which assessment
L/minute via nasal cannula. The clients history finding indicates that the client has developed the
includes chronic obstructive pulmonary disease most serious complication of epidural analgesia?
(COPD) and coronary artery disease. Because of
a. Heightened alertness
these history findings, the nurse closely monitors the
b. Increased heart rate
oxygen flow and the clients respiratory status.
c. Numbness and tingling of the extremities
Which complication may arise if the client receives a
d. Respiratory depression
high oxygen concentration?
Respiratory depression is the most serious
a. Apnea
complication of epidural analgesia. Other potential
b. Anginal pain
complications include hypotension, decreased
c. Respiratory alkalosis
sensation and movement of the extremities, allergic
d. Metabolic acidosis
reactions, and urine retention. Typically, epidural
Hypoxia is the main breathing stimulus for a client analgesia causes central nervous system depression
with COPD. Excessive oxygen administration may (indicated by drowsiness) as well as a decreased
lead to apnea by removing that stimulus. Anginal heart rate and blood pressure.
pain results from a reduced myocardial oxygen
60. The nurse in charge formulates a nursing
supply. A client with COPD may have anginal pain
diagnosis of Activity intolerance related to
from generalized vasoconstriction secondary to
inadequate oxygenation and dyspnea for a client
hypoxia; however, administering oxygen at any
with chronic bronchitis. To minimize this problem,
concentration dilates blood vessels, easing anginal
the nurse instructs the client to avoid conditions that
pain. Respiratory alkalosis results from alveolar
increase oxygen demands. Such conditions include:
hyperventilation, not excessive oxygen
administration. In a client with COPD, high oxygen a. Drinking more than 1,500 ml of fluid daily
concentrations decrease the ventilatory drive, b. Being overweight
leading to respiratory acidosis, not alkalosis. High c. Eating a high-protein snack at bedtime
oxygen concentrations dont cause metabolic d. Eating more than three large meals a day
acidosis.
Conditions that increase oxygen demands include
58. At 11 p.m., a male client is admitted to the obesity, smoking, exposure to temperature
emergency department. He has a respiratory rate of extremes, and stress. A client with chronic bronchitis
44 breaths/minute. Hes anxious, and wheezes are should drink at least 2,000 ml of fluid daily to thin
audible. The client is immediately given oxygen by mucus secretions; restricting fluid intake may be
face mask and methylprednisolone (Depo-medrol) harmful. The nurse should encourage the client to
I.V. At 11:30 p.m., the clients arterial blood oxygen eat a high-protein snack at bedtime because protein
saturation is 86% and hes still wheezing. The nurse digestion produces an amino acid with sedating
should plan to administer: effects that may ease the insomnia associated with
chronic bronchitis. Eating more than three large
a. Alprazolam (Xanax)
meals a day may cause fullness, making breathing
b. Propranolol (Inderal)
uncomfortable and difficult; however, it doesnt
c. Morphine
increase oxygen demands. To help maintain
d. Albuterol (Proventil)
adequate nutritional intake, the client with chronic
The client is hypoxemic because of bronchitis should eat small, frequent meals (up to six
bronchoconstriction as evidenced by wheezes and a a day).
subnormal arterial oxygen saturation level. The
clients greatest need is bronchodilation, which can
be accomplished by administering bronchodilators.
Albuterol is a beta2 adrenergic agonist, which causes
dilation of the bronchioles. Its given by nebulization
or metered-dose inhalation and may be given as
often as every 30 to 60 minutes until relief is
accomplished. Alprazolam is an anxiolytic and central
nervous system depressant, which could suppress
the clients breathing. Propranolol is contraindicated
in a client whos wheezing because its a beta2
adrenergic antagonist. Morphine is a respiratory
center depressant and is contraindicated in this
situation.

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