1. a. b. c. d. 2. a. b. c. d.

A nurse notices that a clients chest tube is accidentally disconnected. The nurse should place the end of the chest tube in a container of sterile saline. apply an occlusive dressing and notify the physician. clamp the chest tube immediately. secure the chest tube with tape. The most common complication of an elderly client admitted with influenza is Septicemia Pneumonia Meningitis Pulmonary edema

3. When weaning off a client from the tracheostomy tube, the nurse initially should plug the opening in the tube for a. 15 to 60 seconds. b. 5 to 20 minutes. c. 30 to 40 minutes. d. 45 to 60 minutes. 4. A community care nurse visits a client with advanced lung cancer found the client wheezing, has bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with a. Hypoxia b. Delirium c. Hyperventilation d. Semiconsciousness 5. The arterial blood gas (ABG) values which confirms respiratory acidosis as a result of reduced alveolar ventilation is a. pH, 5.0; PaCO2 30 mm Hg b. pH, 7.40; PaCO2 35 mm Hg c. pH, 7.35; PaCO2 40 mm Hg d. pH, 7.25; PaCO2 50 mm Hg 6. A client with interstitial lung disease prescribed with prednisone to control inflammation is advised not to discontinue prednisone abruptly to prevent a. hyperglycemia and glycosuria. b. acute adrenocortical insufficiency. c. GI bleeding. d. restlessness and seizures. 7. The nursing diagnosis important for a client admitted for treatment of chronic obstructive pulmonary disease is a. activity intolerance related to fatigue b. anxiety related to actual threat to health status c. risk for infection related to retained secretions d. impaired gas exchange related to airflow obstruction 8. A client abruptly sits up in bed, has breathing difficulty and oxygen saturation is 88%. The mode of oxygen delivery likely to reverse the manifestations is a. Simple mask b. Non-rebreather mask

c. Face tent d. Nasal cannula 9. Chest physiotherapy prescribed for a client with cystic fibrosis and acute respiratory infection should be performed a. immediately before a meal b. at least 2 hours after a meal c. when bronchospasms occur d. when secretions have mobilized 10. A client on mechanical ventilator is monitored for his arterial oxygen saturation (SaO2). An abnormal vital sign that may alter pulse oximetry values is a. Fever b. Tachypnea c. Tachycardia d. Hypotension 11. a. b. c. d. The nursing care for a client who recently underwent a tracheostomy is to help him communicate. keep his airway patent. encourage him to perform activities of daily living. prevent him from developing an infection.

12. The nursing intervention to maintain a patent airway for a client with chronic obstructive pulmonary disease is to a. restrict fluid intake to 1,000 ml/day b. enforce absolute bed rest c. educate the client to perform controlled coughing d. administer prescribed sedatives regularly and in large amounts 13. a. b. c. d. 14. a. b. c. d. 15. a. b. c. d. The amount of air inspired and expired with each breath is called tidal volume. residual volume. vital capacity. dead-space volume. The amount of air inspired and expired with each breath is called tidal volume. residual volume. vital capacity. dead-space volume The following statement is true concerning purified protein derivative (PPD) test. A positive reaction indicates that the client has active tuberculosis (TB). A positive reaction indicates that the client has been exposed to the disease. A negative reaction always excludes the diagnosis of TB. The PPD can be read within 12 hours after the injection.

16. A client with emphysema was administers albuterol (Proventil), as prescribed. The drug is considered effective if the client has a a. respiratory rate of 22 breaths/minute b. dilated and reactive pupils

c. urine output of 40 ml/hour d. heart rate of 100 beats/minute 17. a. b. c. d. The normal pH range for arterial blood is 7 to 7.49 7.35 to 7.45 7.50 to 7.60 7.55 to 7.65

18. Before weaning a client from a ventilator, the nurse should review the following parameter. a. Fluid intake for the last 24 hours b. Baseline arterial blood gas (ABG) levels c. Prior outcomes of weaning d. Electrocardiogram (ECG) results 19. The following would be appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg? a. Administer a prescribed decongestant. b. Instruct the client to breathe into a paper bag. c. Offer the client fluids frequently. d. Administer prescribed supplemental oxygen. 20. A client is receiving supplemental oxygen. The arterial blood gas value to determine effectiveness of oxygen therapy is a. pH b. Bicarbonate (HCO3) c. Partial pressure of arterial oxygen (PaO2) d. Partial pressure of arterial carbon dioxide (PaCO2) 21. a. b. c. d. A nursing intervention likely to lower the arterial blood oxygen saturation is endotracheal suctioning encouragement of coughing use of cooling blanket incentive spirometry

22. The nursing intervention included while caring for a client with a chest tube connected to a closed water-seal drainage system is to a. measure and document the drainage in the collection chamber b. maintain continuous bubbling in the water-seal chamber c. keep the collection chamber at chest level d. strip the chest tube every hour 23. The nursing diagnosis of a client with chronic bronchitis is Activity intolerance related to inadequate oxygenation and dyspnea. To minimize this problem, the client should avoid a. drinking more than 1,500 ml of fluid daily. b. being overweight. c. eating a high-protein snack at bedtime. d. eating more than three large meals a day. 24. A dark skin client with asthma seeks emergency care for acute respiratory distress. Due to the clients dark skin, the nurse assess for cyanosis by inspecting the

a. b. c. d.

lips. mucous membranes. nail beds. earlobes.

25. A client with asthma receives theophylline preparation to promote bronchodilation. The normal therapeutic theophylline concentration falls within a. 1 to 2 mcg/ml b. 2 to 5 mcg/ml c. 5 to 10 mcg/ml d. 10 to 20 mcg/ml 26. When administering an intravenous vancomycin (Vancocin), the nurse should remember that vancomycin a. should be infused over 60 to 90 minutes in a large volume of fluid. b. may cause irreversible neutropenia. c. should be administered rapidly in a large volume of fluid. d. should be administered over 1 to 2 minutes as an I.V. bolus. 27. a. b. c. d. A predisposing factor for a client with respiratory alkalosis is Myasthenia gravis Type 1 diabetes mellitus Extreme anxiety Narcotic overdose

28. At 11 p.m., a client is admitted to the emergency department. He is anxious, respiratory rate is 44 breaths/minute and wheezing is audible. Oxygen by face mask and intravenous methylprednisolone (Depo-medrol) is prescribed. At 11:30 p.m., the clients arterial blood oxygen saturation is 86% and hes still wheezing. The nurse should plan to administer a. alprazolam (Xanax). b. propranolol (Inderal) c. morphine. d. albuterol (Proventil). 29. To promote adequate gas exchange for a client with Pulmonary disease (COPD) is to a. encourage client to drink three glasses of fluid daily b. keep the client in semi-Fowlers position c. Use a high-flow Venturi mask to deliver oxygen as prescribed d. Administer a sedative as prescribed 30. a. b. c. d. A client with emphysema is informed that breathing through pursed-lip will help prevent early airway collapse. increase inspiratory muscle strength decrease use of accessory breathing muscles. prolong inspiratory phase of respiration.

31. A client on theophylline medication for chronic obstructive pulmonary disease is to be discharged. The nurse, during discharge teaching needs to stress on medication therapy compliance if the clients baseline theophylline level was a. 10 mcg/mL b. 12 mcg/mL

c. 15 mcg/mL d. 18mcg/mL 32. A client with pneumothorax has a chest tube inserted and continuous gentle bubbling in the suction control chamber was noted. The next action is to a. do nothing, because this is an expected finding. b. Immediately clamp the chest tube and notify the physician. c. check for an air leak because the bubbling should be intermittent. d. increase the suction pressure so that bubbling becomes vigorous. 33. The nurse notice there is fluctuation of fluid level in the water seal chamber of a client with chest tube inserted. The next nursing action would be to a. inform the physician. b. continue to monitor the client. c. reinforce the occlusive dressing. d. encourage the client to deep-breathe. 34. The nurse caring for a male client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to: a. Call the physician. b. Place the tube in a bottle of sterile water. c. Immediately replace the chest tube system. d. Place the sterile dressing over the disconnection site. 35. a. b. c. d. While assisting a physician with removal of a chest tube, the nurse instructs the client to exhale slowly. stay very still. inhale and exhale quickly. perform Valsalva maneuver.

36. While changing a clients a tracheostomy tube tape, the tube is dislodged. The nurse should a. do nothing as this is normal b. call the physician to reinsert the tube. c. grasp the retention sutures to spread the tracheotomy. d. cover the tracheostomy site with a sterile dressing to prevent infection. 37. After removal of the endotracheal tube, the nurse should report immediately if the following signs are experienced by the client. a. Stridor b. Occasional pink-tinged sputum c. A few basilar lung crackles on the right d. Respiratory rate of 24 breaths/min 38. The following would indicate the presence of a pneumothorax in a client with chest wall blunt injury. a. A low respiratory rate b. Diminished breathe sounds c. The presence of a barrel chest d. A sucking sound at the site of injury

39. The following nursing assessment would indicate that a client has acute exacerbation of chronic obstructive pulmonary disease. a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray 40. A community health nurse informs the public that one of the first symptoms associated with tuberculosis is a. dyspnea b. chest pain c. a bloody, productive cough d. a cough with the expectoration of mucoid sputum 41. a. b. c. d. 42. a. b. c. d. 43. a. b. c. d. 44. a. b. c. d. 45. a. b. c. d. The diagnostic test to confirm tuberculosis is bronchoscopy sputum culture chest x-ray tuberculin skin test Tuberculosis is transmitted by hand and mouth airborne route fecal-oral route blood and body fluids When administering oxygen to a client with emphysema, the flow rate should not exceed 1 L/min 2 L/min 6 L/min 10 L/min The primary purpose of pursed-lip breathing is to promote oxygen intake. strengthen the diaphragm. strengthen the intercostal muscles. promote carbon dioxide elimination. The following nursing action facilitates obtaining a sputum specimen from a client. Limiting fluids Having the clients take three deep breaths Asking the client to split into the collection container Asking the client to obtain the specimen after eating

46. Following a bronchoscopy and biopsy, the nurse should inform doctor immediately if the client is noted to have a. Dry cough b. Hematuria c. Bronchospasm d. Blood-streaked sputum

47. a. b. c. d.

When perform suctioning via a tracheostomy tube, the maximum suctioning time limit is 1 minute 5 seconds 10 seconds 30 seconds

48. When performing suctioning via an endotracheal tube, a clients heart rate decreases. The nurse should a. continue to suction. b. notify the physician immediately. c. stop the procedure and reoxygenate the client. d. ensure that the suction is limited to 15 seconds. 49. An unconscious client admitted to an emergency room has an arterial blood gas result of a pH 7.30, a low bicarbonate level, a normal carbon dioxide and oxygen level, and an elevated potassium level. These results indicate the presence of a. metabolic acidosis b. respiratory acidosis c. overcompensated respiratory acidosis d. combined respiratory and metabolic acidosis 50. a. b. c. d. A common clinical manifestation of a client with suspected pulmonary embolism is dyspnea bradypnea bradycardia decreased respiratory

51. The following statement indicates that a client needs further teaching on the use of a respiratory inhaler when the client a. inhales the mist and quickly exhales b. removes the cap and shakes the inhaler well before use c. presses the canister down with the finger as he breathes in d. waits 1 to 2 minutes between puffs if more than one puff has been prescribed 52. a. b. c. d. 53. a. b. c. d. 54. a. b. c. d. The nursing intervention for a client just after bronchoscopy is to administer atropine intravenously administer small doses of midazolam encourage additional fluids for the next 24 hours ensure the return of gag reflex before offering food or fluids A nurse assessing the respiratory status of a client with a fractured rib would expect slow deep respirations rapid deep respirations paradoxical respirations pain, especially with inspiration The distinctive sign of a client with chest injury with flail chest is cyanosis hypotension paradoxical chest movement dyspnea, especially on exhalation

55. A client admitted with chest trauma after a motor vehicle accident was intubated. The ventilators high-pressure alarm sounded and there was an absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of a. right pneumothorax b. pulmonary embolism c. displaced endotracheal tube d. acute respiratory distress syndrome 56. A client with chronic respiratory failure is taught how to use a metered-dose inhaler correctly by a. inhaling quickly b. inhaling through the nose c. holding the breath after inhalation d. taking two inhalations during one breath 57. a. b. c. d. The earliest sign of acute respiratory distress syndrome of a client with multiple trauma is bilateral wheezing inspiratory crackles intercostal retractions increased respiratory rate

58. The pulmonary artery catheter measurements of a client with acute respiratory distress syndrome is 12mm Hg. The nurse interprets that this readings is a. high and expected b. low and unexpected c. normal and expected d. uncertain and unexpected 59. A client noted to have barrel chest with chronic airflow limitations may have a. emphysema b. bronchial asthma c. chronic obstructive bronchitis d. bronchial asthma and bronchitis 60. A nursing assessment made found inconsistency in the usual clinical presentation of tuberculosis. This may indicate the development of a concurrent problem. a. Cough b. High-grade fever c. Chills and night sweats d. Anorexia and weight loss 61. A mantoux test reading which signifies exposure to Mycobacterium Tubercle Bacilli. should be made after a. 1 hour b. 12-24 hours c. 48-72 hours d. 2 hours 62. A mantoux test is given via a. Intradermal b. Intramuscular

c. Subcutaneous d. IM with the use of Z-track method 63. a. b. c. d. 64. a. b. c. d. 65. a. b. c. d. 66. a. b. c. d. 67. a. b. c. d. 68. a. b. c. d. A client is considered positive with HIV when the Mantoux test result has an induration of More than 10 mm 3mm 4 mm 5 mm The following should be done before a nurse sends a client for a chest x-ray. Secure a written consent Instruct the client not to eat anything at the night before the procedure Instruct the client to remove metals from the chest Administer atropine sulfate and valium before the procedure Pre bronchography preparation of a client includes all of the following EXCEPT Assist the client in a side-lying position Checking for allergies Instructing the client to be on NPO for 6-8 hours Administer atropine sulfate After thoracentesis, the client should be placed on the affected side unaffected side prone position supine position An important action the nurse should do before and after suctioning a client is to place the client in a supine position make sure that suctioning takes only 10-15 seconds evaluate for clear breath sounds hyperventilate the client with 100% oxygen The position of a conscious client during suctioning is Fowlers Supine position Side-lying Prone

69. A client is on chest tube with a three-way bottle system. The suction bottle will normally have the following characteristics. a. Intermittent bubbling b. Continuous bubbling c. No bubbling d. None of the above 70. Before the nurses shift ended, the water seal bottle is observed to have an intermittent suctioning. The nurse should a. check for an air leak b. check for kinks in the tube c. inform the physician immediately d. ensure that the bottle is at least 2-3 feet below the level of the chest

71. a. b. c. d. 72. a. b. c. d.

The following items should be prepared for removal of chest tube EXCEPT sterile gauze suture removal kit empty bottles adhesive tape While the chest tube is removed the nurse should instruct the patient to exhale deeply inhale deeply lie at the abdomen hyperextend the neck

73. A client is brought to ER with complaints of stuffy nose, pain above the eyebrows, persistent cough, fever and post-nasal drip. The diagnosis is sinusitis. The sinuses affected are a. maxillary b. frontal c. ethmoid d. sphenoid 74. The following medications is avoided in sinusitis to prevent the risk of developing nasal polyps. a. Codeine b. Amoxicillin c. ASA d. Anti-infectives 75. a. b. c. d. The following intervention is least likely done for sinutis. Increase fluid intake Cold wet packs Hot wet packs Rest

76. A client with sinusitis had undergone Caldwell-Luc Surgery. Post procedure instruction includes a. chewing on the unaffected side only. b. wearing dentures 5 days after. c. avoiding sneezing for a week after surgery d. all of the above 77. A teenager diagnosed with inflamed tonsils (tonsillitis) has a history of recurrent tonsillitis for about 6 times in the same year. An appropriate intervention for the patient is to a. promote rest b. increase fluid intake c. give warm saline gargle d. Go for surgery 78. a. b. c. d. The following data is crucial for the nurse to assess before a tonsillectomy is performed. Degree of pain URTI Drainage on the ears Respiration pattern

79. a. b. c. d. 80. a. b. c. d.

The following are nursing interventions to promote comfort post tonsillectomy EXCEPT application of ice collar assist the client to a semi-fowlers position with pillow support assess for frequent swallowing of the patient administration of acetaminophen Two days after tonsillectomy, Mark reported that his stool is black. The nurse should inform the physician document the findings obtain stool for analysis check the clients vital signs

81. Asthma are caused by extrinsic and intrinsic factors which triggers the release of chemical mediators which does not include a. serotonin b. prostaglandin c. bradykinin d. adrenaline 82. a. b. c. d. 83. a. b. c. d. 84. a. b. c. d. 85. a. b. c. d. Presence of over distended and non-functional alveoli is a condition called Bronchitis Emphysema Empyema Atelectasis The accumulation of fluids in the pleural space is called pleural effusion hemothorax hydrothorax pyothorax A client with chronic obstructive pulmonary disease should follow a high carbohydrate, low calorie and high protein diet protein, high calorie and low carbohydrate diet carbohydrate, low protein and high calorie diet protein, high carbohydrate and high caloric diet Bronchodilators include the following EXCEPT Theophyline Terbutaline Metaproterenol Dipenhydramine