Adult Health - Respiratory.txt

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bamaguh1988
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Adult Health - Respiratory.txt
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2015-01-08 17:09:04
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  1. The nurse caring for a client with a chest tube turns the client to the side and the chest tube accidentally disconnects from the water seal chamber. Which initial nursing action should the nurse take? 
    1. Call the health care provider (HCP). 
    2. Place the tube in a bottle of sterile water. 
    3. Replace the chest tube system. 
    4. Place a sterile dressing over the disconnection site.
    2. Place the tube in a bottle of sterile water.
  2. The nurse is assessing the functioning of a chest tube drainage system in a client who has just returned from the recovery room following a thoracotomy with wedge resection. Which are the expected assessment findings? Select all that apply. 
    1. Excessive bubbling in the water seal chamber 
    2. Vigorous bubbling in the suction control chamber 
    3. Drainage system maintained below the client's chest 
    4. 50 mL of drainage in the drainage collection chamber 
    5. Occlusive dressing in place over the chest tube insertion site 
    6. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation
    • 3. Drainage system maintained below the client's chest 
    • 4. 50 mL of drainage in the drainage collection chamber 
    • 5. Occlusive dressing in place over the chest tube insertion site 
    • 6. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation
  3. The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? 
    1. Exhale slowly. 
    2. Stay very still. 
    3. Inhale and exhale quickly. 
    4. Perform the Valsalva maneuver.
    4. Perform the Valsalva maneuver.
  4. While changing the tapes on a tracheostomy tube, the client coughs and the tube is dislodged. Which is the initial nursing action? 
    1. Call the health care provider to reinsert the tube. 
    2. Grasp the retention sutures to spread the opening. 
    3. Call the respiratory therapy department to reinsert the tracheotomy. 
    4. Cover the tracheostomy site with a sterile dressing to prevent infection.
    2. Grasp the retention sutures to spread the opening.
  5. The nurse is caring for a client immediately after removal of the endotracheal tube. The nurse should report which sign immediately if experienced by the client? 
    1. Stridor 
    2. Occasional pink-tinged sputum 
    3. Respiratory rate of 24 breaths/minute 
    4. A few basilar lung crackles on the right
    1. Stridor
  6. The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is most appropriate? 
    1. Do nothing, because this is an expected finding. 
    2. Check for an air leak because the bubbling should be intermittent. 
    3. Increase the suction pressure so that the bubbling becomes vigorous. 
    4. Immediately clamp the chest tube and notify the health care provider.
    1. Do nothing, because this is an expected finding.
  7. The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the client? 
    1. Coma 
    2. Flushing 
    3. Dizziness 
    4. Tachycardia
    2. Flushing
  8. The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding would indicate the presence of a pneumothorax in this client? 
    1. A low respiratory rate 
    2. Diminished breath sounds 
    3. The presence of a barrel chest 
    4. A sucking sound at the site of injury
    2. Diminished breath sounds
  9. The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? Select all that apply. 
    1. Hypocapnia 
    2. A hyperinflated chest noted on the chest x-ray 
    3. Decreased oxygen saturation with mild exercise 
    4. A widened diaphragm noted on the chest x-ray 
    5. Pulmonary function tests that demonstrate increased vital capacity
    • 2. A hyperinflated chest noted on the chest x-ray 
    • 3. Decreased oxygen saturation with mild exercise
  10. The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome? 
    1. Promote oxygen intake 
    2. Strengthen the diaphragm 
    3. Strengthen the intercostal muscles 
    4. Promote carbon dioxide elimination
    4. Promote carbon dioxide elimination
  11. The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 
    1. Activities should be resumed gradually. 
    2. Avoid contact with other individuals, except family members, for at least 6 months. 
    3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 
    4. Respiratory isolation is not necessary because family members already have been exposed. 
    5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 
    6. When one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
    • 1. Activities should be resumed gradually. . 
    • 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 
    • 4. Respiratory isolation is not necessary because family members already have been exposed. 
    • 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
  12. The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider? 
    1. Dry cough 
    2. Hematuria 
    3. Bronchospasm 
    4. Blood-streaked sputum
    3. Bronchospasm
  13. The nurse is preparing to suction a client via a tracheostomy tube. The nurse should plan to limit the suctioning time to a maximum of which time period? 
    1. 1 minute 
    2. 5 seconds 
    3. 10 seconds 
    4. 30 seconds
    3. 10 seconds
  14. The nurse is suctioning a client via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which nursing intervention is most appropriate? 
    1. Continue to suction. 
    2. Notify the health care provider immediately. 
    3. Stop the procedure and reoxygenate the client. 
    4. Ensure that the suction is limited to 15 seconds.
    3. Stop the procedure and reoxygenate the client.
  15. The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding? 
    1. Slow deep respirations 
    2. Rapid deep respirations 
    3. Paradoxical respirations 
    4. Pain, especially with inspiration
    4. Pain, especially with inspiration
  16. A client with a chest injury has suffered flail chest. The nurse assesses the client for which mostdistinctive sign of flail chest? 
    1. Cyanosis 
    2. Hypotension 
    3. Paradoxical chest movement 
    4. Dyspnea, especially on exhalation
    3. Paradoxical chest movement
  17. A client has been admitted with chest trauma after a motor vehicle crash and has undergone subsequent intubation. The nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breath sounds in the right upper lobe of the lung. The nurse immediately assesses for other signs of which condition? 
    1. Right pneumothorax 
    2. Pulmonary embolism 
    3. Displaced endotracheal tube 
    4. Acute respiratory distress syndrome
    1. Right pneumothorax
  18. The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? 
    1. Bilateral wheezing 
    2. Inspiratory crackles 
    3. Intercostal retractions 
    4. Increased respiratory rate
    4. Increased respiratory rate
  19. The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions? 
    1. Palpation and clubbing 
    2. Percussion and vibration 
    3. Hyperoxygenation and suctioning 
    4. Administer a bronchodilator and monitor peak flow.
    2. Percussion and vibration
  20. The nurse has conducted discharge teaching with a client diagnosed with tuberculosis, who has been receiving medication for 1½ weeks. The nurse determines that the client has understood the information if the client makes which statement? 
    1. "I need to continue drug therapy for 2 months." 
    2. "I can't shop at the mall for the next 6 months." 
    3. "I can return to work if a sputum culture comes back negative." 
    4. "I should not be contagious after 2 to 3 weeks of medication therapy."
    4. "I should not be contagious after 2 to 3 weeks of medication therapy."
  21. The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which item when performing this care? 
    1. Surgical mask and gloves 
    2. Particulate respirator, gown, and gloves 
    3. Particulate respirator and protective eyewear 
    4. Surgical mask, gown, and protective eyewear
    2. Particulate respirator, gown, and gloves
  22. A client has experienced pulmonary embolism. The nurse should assess for which symptom, which ismost commonly reported? 
    1. Hot, flushed feeling 
    2. Sudden chills and fever 
    3. Chest pain that occurs suddenly 
    4. Dyspnea when deep breaths are taken
    3. Chest pain that occurs suddenly
  23. A client who is human immunodeficiency virus (HIV)–positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 
    1. Positive 
    2. Negative 
    3. Inconclusive 
    4. Need for repeat testing
    1. Positive
  24. A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. The nurse should assess the client for which expected finding? 
    1. Dyspnea 
    2. Headache 
    3. Weight gain 
    4. Hypothermia
    1. Dyspnea
  25. The nurse is giving discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client indicates to report which early sign of exacerbation? 
    1. Fever 
    2. Fatigue 
    3. Weight loss 
    4. Shortness of breath
    4. Shortness of breath
  26. The nurse is taking the history of a client with occupational lung disease (silicosis). The nurse should assess whether the client wears which item during periods of exposure to silica particles? 
    1. Mask 
    2. Gown 
    3. Gloves 
    4. Eye protection
    1. Mask
  27. An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? 
    1. Face tent 
    2. Venturi mask 
    3. Aerosol mask 
    4. Tracheostomy collar
    2. Venturi mask
  28. The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? 
    1. Sitting up in bed 
    2. Side-lying in bed 
    3. Sitting in a recliner chair 
    4. Sitting on the side of the bed and leaning on an overbed table
    4. Sitting on the side of the bed and leaning on an overbed table
  29. The community health nurse is conducting an educational session with community members regarding the symptoms associated with tuberculosis. Which is one of the first manifestations associated with tuberculosis? 
    1. Dyspnea 
    2. Chest pain 
    3. A bloody, productive cough 
    4. A cough with the expectoration of mucoid sputum
    4. A cough with the expectoration of mucoid sputum
  30. The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? 
    1. Chest x-ray 
    2. Bronchoscopy 
    3. Sputum culture 
    4. Tuberculin skin test
    3. Sputum culture
  31. The low-pressure alarm sounds on a ventilator. The nurse assesses the client and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should take what initial action? 
    1. Administer oxygen. 
    2. Check the client's vital signs. 
    3. Ventilate the client manually. 
    4. Start cardiopulmonary resuscitation.
    3. Ventilate the client manually.
  32. The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client to avoid which position that could aggravate breathing? 
    1. Sitting up and leaning on a table 
    2. Standing and leaning against a wall 
    3. Sitting up with the elbows resting on knees 
    4. Lying on the back in a low-Fowler's position
    4. Lying on the back in a low-Fowler's position
  33. A client is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours postoperatively, what type of drainage should the nurse expect? 
    1. Serous 
    2. Bloody 
    3. Serosanguineous 
    4. Bloody, with frequent small clots
    2. Bloody
  34. A client has had radical neck dissection and begins to hemorrhage at the incision site. The nurse should take which actions in this situation? Select all that apply. 
    1. Monitor vital signs. 
    2. Monitor the client's airway. 
    3. Apply manual pressure over the site. 
    4. Lower the head of the bed to a flat position. 
    5. Call the health care provider (HCP) immediately.
    • 1. Monitor vital signs. 
    • 2. Monitor the client's airway. 
    • 3. Apply manual pressure over the site. 
    • 5. Call the health care provider (HCP) immediately.
  35. The nurse is preparing to care for a client who will be weaned from a cuffed tracheostomy tube. The nurse is planning to use a tracheostomy plug and plans to insert it into the opening in the outer cannula. Which nursing action is required before plugging the tube? 
    1. Deflate the cuff on the tube. 
    2. Place the inner cannula into the tube. 
    3. Ensure that the client is able to speak. 
    4. Ensure that the client is able to swallow.
    1. Deflate the cuff on the tube.
  36. The nurse is caring for a client who is on strict bed rest and develops a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is mosthelpful in preventing these disorders from developing? 
    1. Restricting fluids 
    2. Placing a pillow under the knees 
    3. Encouraging active range-of-motion exercises 
    4. Applying a heating pad to the lower extremities
    3. Encouraging active range-of-motion exercises
  37. The nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal chamber. Which is the most appropriate nursing action? 
    1. Check for an air leak. 
    2. Document the findings. 
    3. Notify the health care provider. 
    4. Change the chest tube drainage system.
    2. Document the findings.
  38. The nurse caring for a client who is mechanically ventilated is monitoring for complications of mechanical ventilation. Which assessment finding, if noted by the nurse, indicates the need for follow-up? 
    1. Muscle weakness in the arms and legs 
    2. A temperature of 98.6° F decreased from 99.0° F 
    3. A blood pressure of 90/60 mm Hg decreased from 112/78 mm Hg 
    4. A heart rate of 80 beats per minute decreased from 85 beats per minute
    3. A blood pressure of 90/60 mm Hg decreased from 112/78 mm Hg
  39. The nurse has assisted a health care provider (HCP) with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water-seal chamber after the tube is inserted. Based on this assessment, which action is most appropriate? 
    1. Inform the HCP. 
    2. Continue to monitor the client. 
    3. Reinforce the occlusive dressing. 
    4. Encourage the client to deep breathe.
    2. Continue to monitor the client.
  40. The nurse has assisted the health care provider and the anesthesiologist with placement of an endotracheal (ET) tube for a client in respiratory distress. What is the initial nursing action to evaluate proper ET tube placement? 
    1. Tape the ET tube in place, and note the centimeter marking at the lip line. 
    2. Ask the radiology department to obtain a stat portable radiograph at the client's bedside. 
    3. Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds. 
    4. Attach the ET tube to the ventilator and determine whether the client is able to tolerate the tidal volume prescribed.
    3. Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds.
  41. The nurse is preparing to perform suctioning for a client with a tracheostomy tube and gathers the supplies needed for the procedure. What is the initial nursing action? 
    1. Hyperoxygenate the client. 
    2. Set the suction pressure range at 150 mm Hg. 
    3. Place the catheter into the tracheostomy tube. 
    4. Apply suction on the catheter, and insert it into the tracheostomy tube.
    1. Hyperoxygenate the client.
  42. The nursing instructor is observing a nursing student suctioning a client through a tracheostomy tube. Which observation by the nursing instructor indicates an action by the student requiring the need for further instruction? 
    1. Suctioning the client every hour 
    2. Applying suction only during withdrawal of the catheter 
    3. Hyperventilating the client with 100% oxygen before suctioning 
    4. Applying suction intermittently during withdrawal of the catheter
    1. Suctioning the client every hour
  43. The nurse is changing the tracheostomy ties on a client with a tracheostomy and is assessing the security of the ties. Which method is used to ensure that the ties are not too tightly placed? 
    1. The ties leave no marks on the neck. 
    2. The nurse places two fingers between the tie and the neck. 
    3. The tracheotomy can be pulled slightly away from the neck. 
    4. The nurse uses a 12-inch tie that is tightly affixed with hook-and-loop closures.
    2. The nurse places two fingers between the tie and the neck.
  44. The nurse is preparing for removal of an endotracheal (ET) tube from a client. In assisting the health care provider in this procedure, which is the initial nursing action? 
    1. Deflate the cuff. 
    2. Suction the ET tube. 
    3. Turn off the ventilator. 
    4. Obtain a code cart, and place it at the bedside.
    2. Suction the ET tube.
  45. The nurse is caring for a client who is mechanically ventilated, and the high-pressure ventilator alarm is sounding. The nurse understands that which complications may cause this alarm? Select all that apply. 
    1. Water or a kink in the tubing 
    2. Biting on the endotracheal tube 
    3. Increased secretions in the airway 
    4. Disconnection or leak in the system 
    5. The client stops spontaneous breathing.
    • 1. Water or a kink in the tubing 
    • 2. Biting on the endotracheal tube 
    • 3. Increased secretions in the airway
  46. The nurse is performing nasotracheal suctioning of a client. The nurse determines that the client is adequately tolerating the procedure if which observation is made? 
    1. The skin color becomes cyanotic. 
    2. Secretions are becoming bloody. 
    3. Coughing occurs with suctioning. 
    4. Heart rate decreases from 78 to 54 beats per minute.
    3. Coughing occurs with suctioning.
  47. A client with a tracheostomy tube who is on a ventilator is at risk for impaired gas exchange. The nurse should assess for which finding as the best indicator of adequate ongoing respiratory status? 
    1. Oxygen saturation of 89% 
    2. Respiratory rate of 16 breaths per minute 
    3. Moderate amounts of tracheobronchial secretions 
    4. Small to moderate amounts of frank blood suctioned from the tube
    2. Respiratory rate of 16 breaths per minute
  48. The nurse is monitoring the respiratory status of a client after creation of a tracheostomy. The nurse understands that oxygen saturation measurements obtained by pulse oximetry may be inaccurate if the client has which coexisting problem? 
    1. Fever
    2. Epilepsy 
    3. Hypotension 
    4. Respiratory failure
    3. Hypotension
  49. The nurse is monitoring the function of a client's chest tube that is attached to a Pleur-Evac drainage system. The nurse notes that the fluid in the water-seal chamber rises with inspiration and falls with expiration. The nurse determines that which is occurring? 
    1. The system is patent. 
    2. There is a leak in the system. 
    3. The client has residual pneumothorax. 
    4. Suction should be added to the system.
    1. The system is patent.
  50. A client is diagnosed with a rib fracture and asks the nurse why strapping of the ribs is not being done. Which response by the nurse is most appropriate? 
    1. "Strapping is useful only if the ribs are fractured in several places at once." 
    2. "That's a good idea. I'll ask the health care provider for a prescription for the needed supplies." 
    3. "That isn't done because people often would develop pneumonia from the constricting effect on the lungs." 
    4. "That might help you to breathe better, but this facility does not carry the necessary supplies in the stockroom. When you get home, you can purchase them at the medical supply store."
    3. "That isn't done because people often would develop pneumonia from the constricting effect on the lungs."
  51. The nurse is caring for a postoperative pneumonectomy client. Which finding on assessment of the client is an adverse sign or symptom indicating pulmonary edema? 
    1. Lung crackles 
    2. Pain with deep breathing 
    3. Increased chest tube drainage 
    4. Respiratory rate of 20 breaths per minute
    1. Lung crackles
  52. The nurse reads a client's tuberculin (Mantoux) skin test as positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation? 
    1. Systemic tuberculosis 
    2. Pulmonary tuberculosis 
    3. Exposure to tuberculosis 
    4. No evidence of tuberculosis
    3. Exposure to tuberculosis
  53. The nurse is caring for a client with tuberculosis who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness? 
    1. Allow the client to deal with the disease in an individual fashion. 
    2. Ask family members whether they wish a psychiatric consultation. 
    3. Encourage the client to visit with the pastoral care department chaplain. 
    4. Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.
    4. Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.
  54. A client diagnosed with tuberculosis is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? 
    1. This is expected and will last for at least 1 year. 
    2. This is expected, and the client should gradually increase activity as tolerated. 
    3. This is an unexpected finding with tuberculosis, but it should resolve within 1 month or so. 
    4. This is a short-lived problem that should be gone within 1 week after beginning drug therapy.
    2. This is expected, and the client should gradually increase activity as tolerated.
  55. The nurse is assessing a client with the typical clinical manifestations of tuberculosis. The nurse should expect the client to report having fatigue and cough that have been present for how long? 
    1. 1 or 2 days 
    2. 1 to 2 weeks 
    3. Almost 1 week 
    4. Several weeks to months
    4. Several weeks to months
  56. The nurse is suctioning an unconscious client who has a tracheostomy. The nurse should perform which actions when performing this procedure? Select all that apply. 
    1. Keeping a supply of suction catheters at the bedside 
    2. Auscultating breath sounds to determine the need for suctioning  
    3. Hyperoxygenating the client before, during, and after suctioning 
    4. Intermittently suctioning during insertion of the suction catheter 
    5. Placing suction on the catheter for at least 30 seconds to ensure that all secretions are removed
    • 1. Keeping a supply of suction catheters at the bedside 
    • 2. Auscultating breath sounds to determine the need for suctioning 
    • 3. Hyperoxygenating the client before, during, and after suctioning
  57. The clinic nurse administers a tuberculin (Mantoux) skin test to a client. The nurse tells the client to return to the clinic for reading the results in how long? 
    1. 6 to 12 hours 
    2. 12 to 24 hours 
    3. 24 to 28 hours 
    4. 48 to 72 hours
    4. 48 to 72 hours
  58. A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse should implement which activities? Select all that apply. 
    1. Suctioning the client as needed 
    2. Encouraging coughing every 2 hours 
    3. Placing the bed in low Fowler's position 
    4. Supporting the neck incision when the client coughs 
    5. Monitoring the respiratory status frequently as prescribed
    • 1. Suctioning the client as needed 
    • 2. Encouraging coughing every 2 hours
    • 4. Supporting the neck incision when the client coughs 
    • 5. Monitoring the respiratory status frequently as prescribed
  59. The clinic nurse is providing instructions to a client with a diagnosis of pharyngitis. The nurse provides which instruction to the client? 
    1. Drink hot tea throughout the day. 
    2. Drink hot cocoa in place of coffee. 
    3. Avoid foods that are highly seasoned. 
    4. Restrict fluid intake to 1000 mL daily.
    3. Avoid foods that are highly seasoned.
  60. A client arrives in the hospital emergency department with a bloody nose. What is the initial nursing action? 
    1. Place the client in supine position. 
    2. Apply an ice collar around the client's neck. 
    3. Assist the client to a sitting position with the head tilted forward. 
    4. Instruct the client to swallow the blood until the bleeding can be controlled.
    3. Assist the client to a sitting position with the head tilted forward.
  61. The nurse provides instructions to a client after a total laryngectomy. Which statement by the client indicates a need for further instruction? 
    1. "I need to protect the stoma from water." 
    2. "Soaps should be avoided near the stoma." 
    3. "I should use diluted alcohol on the stoma to clean it." 
    4. "I should apply a non–oil-based ointment to the skin surrounding the stoma."
    3. "I should use diluted alcohol on the stoma to clean it."
  62. The nurse is caring for a client with a tracheostomy tube who is receiving mechanical ventilation. The nurse is monitoring for complications related to the tracheostomy and suspects tracheoesophageal fistula when which occurs? 
    1. Suctioning is required frequently. 
    2. The client's skin and mucous membranes are light pink. 
    3. Aspiration of gastric contents occurs during suctioning. 
    4. Excessive secretions are suctioned from the tube and stoma.
    3. Aspiration of gastric contents occurs during suctioning.
  63. The nurse is caring for a client on a mechanical ventilator. The high-pressure alarm sounds. The nurse assesses the client and attempts to determine the cause of the alarm. Which initial nursing action would be appropriate if the nurse is unable to determine the cause of ventilator alarm? 
    1. Shut the alarm off and call for help. 
    2. Call the respiratory therapy department to fix the problem. 
    3. Call the health care provider (HCP) for further instructions. 
    4. Disconnect the client from the ventilator and manually ventilate the client with a resuscitation device.
    4. Disconnect the client from the ventilator and manually ventilate the client with a resuscitation device.
  64. The low-exhaled volume alarm sounds on a mechanical ventilator of a client with an endotracheal tube. The nurse determines that the cause for alarm activation may be which complication? 
    1. Excessive secretions 
    2. Kinks in the ventilator tubing 
    3. The presence of a mucous plug 
    4. Displacement of the endotracheal tube
    4. Displacement of the endotracheal tube
  65. The nurse is caring for a client with an endotracheal tube attached to a mechanical ventilator. The high-pressure alarm sounds, and the nurse assesses the client. The nurse determines that the cause of the alarm is most likely to be due to which complication? 
    1. A kink in the ventilator circuit 
    2. A leak in the endotracheal tube cuff 
    3. Displacement of the endotracheal tube 
    4. A disconnection of the ventilator tubing
    1. A kink in the ventilator circuit
  66. A health care provider writes a prescription to begin to wean the client from the mechanical ventilator by use of intermittent mandatory ventilation/synchronized intermittent mandatory ventilation (IMV/SIMV). The nurse determines that the process of weaning will occur by which mechanism? 
    1. Gradually decreasing the respiratory rate until the client can assume the work of breathing without ventilatory assistance 
    2. Attaching a T-piece to the ventilator and providing supplemental oxygen at a concentration that is 10% higher than the ventilator setting 
    3. Providing pressure support to decrease the workload of breathing and increase the client's ability to initiate spontaneous breathing efforts 
    4. Removing the ventilator from the client and closely monitoring the client's ability to breathe spontaneously for a predetermined amount of time
    1. Gradually decreasing the respiratory rate until the client can assume the work of breathing without ventilatory assistance
  67. The nurse is preparing to wean a client from a ventilator by the use of a T-piece. Which would be a component of the plan of care with this type of weaning process? Select all that apply. 
    1. Pressure support is added to the oxygen system. 
    2. The T-piece is connected to the client's artificial airway. 
    3. The client is removed from the mechanical ventilator for a short period of time. 
    4. The respiratory rate on the ventilator is gradually decreased until the client can do all of the work of breathing on his or her own. 
    5. Supplemental oxygen is provided through the T-piece at a fraction of inspired oxygen that is 10% higher than a ventilator setting.
    • 1. Pressure support is added to the oxygen system. 
    • 2. The T-piece is connected to the client's artificial airway. 
    • 3. The client is removed from the mechanical ventilator for a short period of time.
    • 5. Supplemental oxygen is provided through the T-piece at a fraction of inspired oxygen that is 10% higher than a ventilator setting.
  68. The nurse is reviewing the ventilator settings on a client with an endotracheal tube attached to mechanical ventilation. The nurse notes that the tidal volume is set at 700 mL and determines that the tidal volume indicates which factor? 
    1. The amount of air delivered with each set breath 
    2. A breath that has a greater volume than the preset tidal volume 
    3. The number of breaths that the client will receive per minute by the ventilator 
    4. The fraction of inspired oxygen (Fio2) that is delivered to the client through the ventilator
    1. The amount of air delivered with each set breath
  69. The nurse is providing an educational session to community members regarding histoplasmosis. The nurse should provide which information about this disease? 
    1. It is caused by a tick bite. 
    2. It is caused by contamination from cat feces. 
    3. It can be caused by the inhalation of spores from bird droppings. 
    4. It can be contagious by respiratory contact with an infected person.
    3. It can be caused by the inhalation of spores from bird droppings.
  70. A client who is intubated and receiving mechanical ventilation has a problem of risk for infection. The nurse should include which measures in the care of this client? Select all that apply. 
    1. Monitor the client's temperature. 
    2. Use sterile technique when suctioning. 
    3. Use the closed-system method of suctioning. 
    4. Monitor sputum characteristics and amounts. 
    5. Drain water from the ventilator tubing into the humidifier bottle.
    • 1. Monitor the client's temperature. 
    • 2. Use sterile technique when suctioning. 
    • 3. Use the closed-system method of suctioning. 
    • 4. Monitor sputum characteristics and amounts.
  71. A health care provider (HCP) tells the nurse that a client's chest tube is to be removed. The nurse should bring which dressing materials to the bedside for the HCP's use? 
    1. Telfa dressing and Neosporin ointment 
    2. Petrolatum gauze and sterile 4 × 4 gauze 
    3. Benzoin spray and a hydrocolloid dressing 
    4. Sterile 4 × 4 gauze, Neosporin ointment, and tape
    2. Petrolatum gauze and sterile 4 × 4 gauze
  72. The nurse enters a client's room with a pulse oximetry machine and tells the client that the health care provider (HCP) has prescribed continuous oxygen saturation readings. The client's facial expression changes to one of apprehension. The nurse can quickly and most effectively alleviate the client's anxiety by providing which information about pulse oximetry? 
    1. It is painless and safe. 
    2. It causes only mild discomfort at the site. 
    3. It requires insertion of only a very small catheter. 
    4. It has an alarm to signal dangerous drops in oxygen saturation levels.
    1. It is painless and safe.
  73. A young adult client has never had a chest x-ray examination before and expresses to the nurse a fear of experiencing some form of harm from the test. Which statement by the nurse should provide valid reassurance to the client? 
    1. "You'll wear a lead shield to partially protect your organs from harm." 
    2. "The amount of x-ray exposure is not sufficient to cause DNA damage." 
    3. "The test isn't harmful at all. The most frustrating part is the long wait in radiology." 
    4. "The x-ray exam itself is painless, and a lead shield protects you from the minimal radiation."
    4. "The x-ray exam itself is painless, and a lead shield protects you from the minimal radiation."
  74. The nurse is developing a plan of care for a client at risk for acute respiratory distress syndrome (ARDS). As part of the plan, the nurse will check for which item to detect an early sign of this disorder? 
    1. Edema 
    2. Dyspnea 
    3. Frothy sputum 
    4. Diminished breath sounds
    2. Dyspnea
  75. The nurse caring for a client with a closed chest drainage system notes that the fluctuation (tidaling) in the water-seal compartment has stopped. On the basis of this assessment finding, the nurse would suspect which occurrence? 
    1. The system needs changing. 
    2. Suction needs to be increased. 
    3. Suction needs to be decreased. 
    4. The chest tubes are obstructed.
    4. The chest tubes are obstructed.
  76. The nurse is providing instructions to a client being discharged from the hospital following removal of a chest tube that was inserted after thoracic surgery. Which statement, if made by the client, indicates a need for further teaching? 
    1. "I should avoid heavy lifting for at least 4 to 6 weeks." 
    2. "I should remove the chest tube site dressing as soon as I get home." 
    3. "If I have any difficulty in breathing, I should call the health care provider." 
    4. "If I note any signs of infection, I should contact the health care provider (HCP)."
    2. "I should remove the chest tube site dressing as soon as I get home."
  77. A nursing student is developing a plan of care for a client with a chest tube that is attached to a Pleur-Evac drainage system. Which intervention in the care plan indicates the need for further teaching for the student? 
    1. Position the client in semi-Fowler's position. 
    2. Add water to the suction chamber as it evaporates. 
    3. Instruct the client to avoid coughing and deep breathing. 
    4. Tape the connection sites between the chest tube and the drainage system.
    3. Instruct the client to avoid coughing and deep breathing.
  78. The nurse is preparing to assist a client with a cuffed tracheostomy tube to eat. What intervention is the priority before the client is permitted to drink or eat? 
    1. Inflate the cuff on the tracheostomy tube. 
    2.Deflate the cuff on the tracheostomy tube. 
    3.  Maintain the head of the bed in low Fowler's position. 
    4. Place the tray in a comfortable position in front of the client.
    1. Inflate the cuff on the tracheostomy tube.
  79. The nurse has provided discharge instructions to the client who has had a pneumonectomy. Which statement, if made by the client, indicates an understanding of appropriate home care measures? 
    1. "I should restrict my fluid intake for 2 weeks." 
    2. "I should perform arm exercises two or three times a day." 
    3. "If I experience any soreness in my chest or shoulder, I should notify the health care provider." 
    4. "If I experience any numbness or altered sensation around the incision, I should contact the health care provider (HCP)."
    2. "I should perform arm exercises two or three times a day."
  80. A client with a history of recent upper respiratory infection comes to the urgent care center complaining of chest pain. The nurse determines that the pain is most likely of a respiratory origin if the client makes which statement about the pain? 
    1. "It hurts more when I breathe in." 
    2. "I have never had this pain before." 
    3. "It hurts on the left side of my chest." 
    4. "The pain is about a 6 on a scale of 1 to 10."
    1. "It hurts more when I breathe in."
  81. A client with a fat embolus is experiencing respiratory distress. The nurse plans to assist with which therapies? 
    1. Administration of plasma expanders, low-flow oxygen, and suctioning 
    2. Administration of bronchodilators, intubation, and mechanical ventilation 
    3. Administration of oxygen, intubation, and mechanical ventilation with positive end-expiratory pressure 
    4. Administration of antihypertensives, high-flow oxygen, and continuous positive airway pressure mask
    3. Administration of oxygen, intubation, and mechanical ventilation with positive end-expiratory pressure
  82. A nurse is caring for a client on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, which nursing action is appropriate? 
    1. Document the findings. 
    2. Reassess the pH in 4 hours. 
    3. Instill 30 mL of sterile water. 
    4. Administer a dose of a prescribed antacid.
    4. Administer a dose of a prescribed antacid.
  83. A nurse is caring for a client on a mechanical ventilator. The high-pressure alarm on the ventilator sounds. The nurse suspects that the most likely cause of the alarm is which finding? 
    1. A disconnection of the ventilator tubing 
    2. An exaggerated client inspiratory effort 
    3. Accumulation of respiratory secretions 
    4. Generation of extreme negative pressure by the client
    3. Accumulation of respiratory secretions
  84. A nurse is caring for a client on a mechanical ventilator. The low-pressure alarm sounds. The nurse suspects that the most likely cause of the alarm is which finding? 
    1. A tubing obstruction or kink 
    2. The accumulation of secretions 
    3. Disconnection of the ventilator tubing 
    4. Condensation of water in the ventilator tubing
    3. Disconnection of the ventilator tubing
  85. A nurse is caring for a client with a chest tube drainage system. While the client is being assisted to sit up in bed in preparation for ambulation, the chest drainage system accidentally disconnects. Which is the initial nursing action? 
    1. Call a respiratory therapist. 
    2. Contact the health care provider (HCP). 
    3. Encourage the client to perform the Valsalva maneuver. 
    4. Place the end of the chest tube in a container of sterile water.
    4. Place the end of the chest tube in a container of sterile water.
  86. A nurse is caring for a client with a chest tube drainage system. During repositioning of the client, the chest tube accidentally pulls out of the pleural cavity. Which is the initial nursing action? 
    1. Apply an occlusive dressing. 
    2. Reinsert the chest tube quickly. 
    3. Contact the respiratory therapist. 
    4. Contact the health care provider (HCP).
    1. Apply an occlusive dressing.
  87. A client who experiences frequent upper respiratory infections (URIs) asks the nurse why food does not seem to have any taste during illness. In formulating a response, the nurse understands that this is owing to which symptom? 
    1. Anorexia, triggered by the infectious organism 
    2. Lack of client energy to cook wholesome meals 
    3. Blocked nasal passages that impair the sense of smell 
    4. Infection, which blocks sensation in the taste buds of the tongue
    3. Blocked nasal passages that impair the sense of smell
  88. A registered nurse who is orienting a new nursing graduate to the hospital emergency department instructs the new graduate to monitor a client for one-sided chest movement on the right side while the client is being intubated by the health care provider. This instruction is based on the understanding that the endotracheal tube could enter which respiratory structures? 
    1. Left main bronchus if inserted too far 
    2. Right main bronchus if inserted too far 
    3. Left main bronchus if not inserted far enough 
    4. Right main bronchus if not inserted far enough
    2. Right main bronchus if inserted too far
  89. A client who is mouth breathing is receiving oxygen by face mask. The unlicensed assistive personnel (UAP) asks the registered nurse (RN) why a water bottle is attached to the oxygen tubing near the wall oxygen outlet. The RN responds that this feature facilitates which purpose? 
    1. Prevents the client from getting a nosebleed 
    2. Gives the client added fluid via the respiratory tree 
    3. Humidifies the oxygen that is bypassing the client's nose 
    4. Prevents fluid loss from the lungs during mouth breathing
    3. Humidifies the oxygen that is bypassing the client's nose
  90. A nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit? 
    1. Dilate the major bronchi. 
    2. Increase surfactant production. 
    3. Maintain inflation of the alveoli. 
    4. Enhance ciliary action in the tracheobronchial tree.
    3. Maintain inflation of the alveoli.
  91. A nurse and an unlicensed assistive personnel (UAP) are assisting the respiratory therapist to position a client for postural drainage. The UAP asks the nurse how the respiratory therapist selects the position to be used for the procedure. The nurse responds that a position is chosen that will use gravity to help drain secretions from which primary areas? 
    1. Lobes 
    2. Alveoli 
    3. Trachea 
    4. Main bronchi
    1. Lobes
  92. A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 to 4 L/min. The nurse responds that this would be harmful because a higher oxygen flow rate could lead to which physical responses? 
    1. Drying of nasal passages 
    2. Decrease in the client's oxygen-based respiratory drive 
    3. Increase for the risk of pneumonia from drier air passages 
    4. Decrease in the client's carbon dioxide–based respiratory drive
    2. Decrease in the client's oxygen-based respiratory drive
  93. A client who is experiencing respiratory difficulty asks the nurse, "Why it is so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses? 
    1. Air flows by gravity. 
    2. The respiratory muscles relax. 
    3. The respiratory muscles contract. 
    4. Air is flowing against a pressure gradient.
    2. The respiratory muscles relax.
  94. A client who has been diagnosed with pleurisy tells the nurse that it is painful to inhale. The nurse responds that this is an expected finding owing to which physical response to this disorder? 
    1. The stretch receptors in the lungs are irritated. 
    2. The diaphragm is weak and is difficult to move. 
    3. This condition causes nerve endings to be especially sensitive. 
    4. The inflamed pleurae cannot glide against each other as they normally do.
    4. The inflamed pleurae cannot glide against each other as they normally do.
  95. A nurse who is participating in a client care conference with other members of the health care team is discussing the condition of a client with acute respiratory distress syndrome (ARDS). The health care provider states that as a result of fluid in the alveoli, surfactant production is falling. The nurse understands that which is the natural consequence of insufficient surfactant? 
    1. Atelectasis and viral infection 
    2. Bronchoconstriction and stridor 
    3. Collapse of alveoli and decreased compliance 
    4. Decreased ciliary action and retained secretions
    3. Collapse of alveoli and decreased compliance
  96. A nurse is caring for a hospitalized client who is retaining carbon dioxide (CO2) because of respiratory disease. The nurse plans care, anticipating that which physical response will initially occur? 
    1. The client's pH will fall. 
    2. The client will lose consciousness. 
    3. The client's sodium and chloride level will rise. 
    4. The client will complain of facial numbness and tingling.
    1. The client's pH will fall.
  97. A nurse reads in the progress notes for a client with pneumonia that areas of the client's lungs are being perfused but are not being ventilated. The nurse interprets this occurrence correctly as the presence of which physical response? 
    1. Shunt unit 
    2. Anatomical dead space 
    3. Physiological dead space 
    4. Ventilation-perfusion matching
    1. Shunt unit
  98. A nurse is monitoring the status of a client who is being treated for dyspnea. The nurse is aware that which factor will decrease the work of breathing for this client? 
    1. Bronchodilation 
    2. Increased airway resistance 
    3. Increased mucus production 
    4. Interstitial pulmonary edema
    1. Bronchodilation
  99. A nurse is providing instructions to a client about diaphragmatic breathing. The nurse tells the client that this technique is helpful because, in normal respiration, as the diaphragm contracts, it takes which action? 
    1. Aids in exhalation 
    2. Moves up and inward 
    3. Moves downward and out 
    4. Makes the thoracic cage smaller
    3. Moves downward and out
  100. A nurse is reading the report for a chest x-ray study in a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The nurse determines that the tube is positioned above which area of the respiratory system? 
    1. The first tracheal cartilaginous ring 
    2. The bifurcation of the right and left main bronchi 
    3. The point at which the larynx connects to the trachea 
    4. The area connecting the oropharynx to the laryngopharynx
    2. The bifurcation of the right and left main bronchi
  101. A nurse is told that a client will have an arterial blood gas sample drawn on room air. The nurse is asked to complete the laboratory requisition. The nurse documents on the requisition that the client was receiving how much oxygen for the procedure? 
    1. 16% 
    2. 21% 
    3. 30% 
    4. 40%
    2. 21%
  102. A nurse is teaching a client with pulmonary disease about fundamental concepts of gas exchange. When asked for further details by the client, the nurse explains that gas exchange occurs through which process? 
    1. Osmosis 
    2. Diffusion 
    3. Ionization 
    4. Active transport
    2. Diffusion
  103. A nurse is caring for a client who has just returned from the postanesthesia care unit after radical neck dissection. The nurse should assess for which characteristic of wound drainage expected in the immediate postoperative period? 
    1. Serous 
    2. Grossly bloody 
    3. Serosanguineous 
    4. Serous with sputum
    3. Serosanguineous
  104. A nurse has provided a client with tuberculosis (TB) instructions on proper handling and disposal of respiratory secretions. The nurse determines that the client demonstrates understanding of the instructions when the client makes which statement? 
    1. "I will discard used tissues in a plastic bag." 
    2. "I need to wash my hands at least four times a day." 
    3. "I will brush my teeth and rinse my mouth once a day." 
    4. "I will turn my head to the side if I need to cough or sneeze."
    1. "I will discard used tissues in a plastic bag."
  105. A nurse is caring for a client who had tuberculin skin testing (Mantoux test) 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority? 
    1. Contact the health care provider (HCP). 
    2. Document the finding in the client's record. 
    3. Call the employee health service department. 
    4. Call the radiology department for a chest radiographic study to be done.
    1. Contact the health care provider (HCP).
  106. A client has a chest tube attached to a water seal drainage system. As part of routine nursing care, the nurse should ensure that which intervention is implemented? 
    1. The water seal chamber has continuous bubbling, and assessment for crepitus is done once a shift. 
    2. The amount of drainage into the chest tube is noted and recorded every 24 hours in the client's record. 
    3. The suction control chamber has sterile water added every shift, and the system is kept below waist level. 
    4. The connection between the chest tube and the drainage system is taped, and an occlusive dressing is maintained at the insertion site.
    4. The connection between the chest tube and the drainage system is taped, and an occlusive dressing is maintained at the insertion site.
  107. A nurse is planning care for a client who is scheduled for a tracheostomy procedure. What equipment should the nurse plan to have at the bedside when the client returns from surgery? 
    1. Obturator 
    2. Oral airway 
    3. Epinephrine (Adrenalin) 
    4. Tracheostomy set with the next larger size
    1. Obturator
  108. A nurse is caring for a client with a tracheostomy tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse should plan to perform which action? 
    1. Suction the client. 
    2. Evaluate the cuff for a leak. 
    3. Assess for a disconnection. 
    4. Notify the respiratory therapist.
    1. Suction the client.
  109. A nurse is caring for a client with a chest tube drainage system. The nurse notes a fluctuating water level on inspiration and expiration in the submerged tube in the water seal chamber of the chest tube system. Which nursing action is appropriate? 
    1. Suction the client. 
    2. Increase the suction. 
    3. Document the findings. 
    4. Encourage coughing and deep breathing.
    3. Document the findings.
  110. A nurse is caring for a client with a chest tube drainage system and notes constant bubbling in the water seal chamber. Which nursing action is appropriate? 
    1. Reposition the client. 
    2. Notify the health care provider (HCP). 
    3. Change the chest tube drainage system. 
    4. No action is necessary because this is a normal expected finding.
    2. Notify the health care provider (HCP).
  111. A nurse in an ambulatory clinic is preparing to administer a tuberculin skin test (Mantoux test) to a client who may have been exposed to a person with tuberculosis (TB). The client reports having received the bacille Calmette-Guérin (bCG) vaccine before moving to the United States from a foreign country. Which interpretation should the nurse make? 
    1. The client has no risk of acquiring TB and needs no further workup. 
    2. The client is at increased risk for acquiring TB and needs immediate medication therapy. 
    3. The client's test result will be negative, and a sputum culture will be required for diagnosis. 
    4. The client's test result will be positive, and a chest x-ray study will be required for evaluation.
    4. The client's test result will be positive, and a chest x-ray study will be required for evaluation.
  112. A nurse is caring for a client who is receiving feedings by nasogastric tube. The client suddenly begins to vomit, and the nurse quickly repositions the client. The client is coughing and having difficulty breathing, and the nurse suspects that the client has aspirated the feeding. What is the nurse's priority action? 
    1. Call a code. 
    2. Suction the client. 
    3. Check the client's vital signs. 
    4. Call the health care provider (HCP).
    2. Suction the client.
  113. A client arrives at the emergency department with a nosebleed. On assessment, the nurse determines that the nosebleed began suddenly and for no apparent reason. What is the initial nursing action? 
    1. Insert nasal packing. 
    2. Prepare a nasal balloon for insertion. 
    3. Place the client in a semi-Fowler's position, and apply ice packs to the nose. 
    4. Ask the client to sit down and lean forward, and apply pressure to the nose for 5 to 10 minutes.
    4. Ask the client to sit down and lean forward, and apply pressure to the nose for 5 to 10 minutes.
  114. A client being mechanically ventilated after experiencing a fat embolism is visibly anxious. What is the best nursing action? 
    1. Ask a family member to stay with the client at all times. 
    2. Ask the health care provider for a prescription for succinylcholine. 
    3. Encourage the client to sleep until arterial blood gas results improve. 
    4. Provide reassurance to the client and give small doses of morphine sulfate intravenously as prescribed.
    4. Provide reassurance to the client and give small doses of morphine sulfate intravenously as prescribed.
  115. A client has been treated for pleural effusion with a thoracentesis. The nurse determines that this procedure has been effective if the nurse notes which assessment finding? 
    1. Absence of dyspnea 
    2. Increased severity of cough 
    3. Dull percussion notes over lung tissue 
    4. Decreased tactile fremitus over lung tissue
    1. Absence of dyspnea
  116. A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem? 
    1. Pleural pain and fever 
    2. Decreased respiratory rate 
    3. Diaphoresis during the day 
    4. Hyperresonant breath sounds over the left thorax
    1. Pleural pain and fever
  117. A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse should place the client in which position? 
    1. Sims 
    2. Supine 
    3. Side-lying 
    4. Semi-Fowler's
    4. Semi-Fowler's
  118. A client who experiences frequent upper respiratory infections (URIs) asks the nurse why food does not seem to have any taste during illness. In formulating a response, the nurse understands that this effect is caused by which problem? 
    1. Anorexia is triggered by the infectious organism. 
    2. Blocked nasal passages impair the senses of smell and taste. 
    3. Infection blocks sensation from the taste buds of the tongue. 
    4. The client does not have enough energy to cook wholesome meals.
    2. Blocked nasal passages impair the senses of smell and taste.
  119. The nurse assesses for one-sided chest movement on the right while a client is being intubated by the health care provider. The nurse's action is based on the possibility that which could occur with the endotracheal tube? 
    1. It could enter the left main bronchus if inserted too far. 
    2. It could enter the right main bronchus if inserted too far. 
    3. It could enter the left main bronchus if not inserted far enough. 
    4. It could enter the right main bronchus if not inserted far enough.
    2. It could enter the right main bronchus if inserted too far.
  120. The nurse is assisting a respiratory therapist to position a client for postural drainage. The nurse understands that a position is chosen that will use gravity to help drain which areas? 
    1. Lobes 
    2. Alveoli 
    3. Trachea 
    4. Main bronchi
    1. Lobes
  121. A client's baseline vital signs are as follows: temperature 98.8° F oral, pulse 74 beats/min, respirations 18 breaths/min, and blood pressure 124/76 mm Hg. The client's temperature suddenly spikes to 103° F. Which corresponding respiratory rate should the nurse anticipate in this client as part of the body's response to the change in status? 
    1. Respiratory rate of 12 breaths/min 
    2. Respiratory rate of 16 breaths/min 
    3. Respiratory rate of 18 breaths/min 
    4. Respiratory rate of 22 breaths/min
    4. Respiratory rate of 22 breaths/min
  122. A nurse is caring for a client experiencing dyspnea. The nurse plans care, knowing that which factor will decrease the work of breathing? 
    1. Bronchodilation 
    2. Increased airway resistance 
    3. Interstitial pulmonary edema 
    4. Increased mucus production
    1. Bronchodilation
  123. A nurse is instructing a client in diaphragmatic breathing. To reinforce the need for this technique, the nurse teaches the client that in normal respiration, which is an action of the diaphragm? 
    1. Aids in exhalation as it contracts 
    2. Moves up and inward as it contracts 
    3. Moves downward and out as it contracts 
    4. Makes the thoracic cage smaller as it contracts
    3. Moves downward and out as it contracts
  124. A nurse is reading the chest x-ray report for a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. What should the nurse interpret that the tube is positioned above? 
    1. The first tracheal cartilaginous ring 
    2. The bifurcation of the right and left main bronchi 
    3. The point at which the larynx connects to the trachea 
    4. The area connecting the oropharynx to the laryngopharynx
    2. The bifurcation of the right and left main bronchi
  125. A chest x-ray report for a client indicates the presence of a left apical pneumothorax. The nurse would assess the status of breath sounds in that area by placing the stethoscope in which location? 
    1. Just under the left clavicle 
    2. Midsternum, 1 inch to the left 
    3. Over the fifth intercostal space 
    4. Midsternum, 1 inch to the right
    1. Just under the left clavicle
  126. A client with a history of silicosis is admitted to the hospital with respiratory distress and impending respiratory failure. Which item(s) should the nurse place at the client's bedside? 
    1. Code cart 
    2. Intubation tray 
    3. Thoracentesis tray 
    4. Chest tube and drainage system
    2. Intubation tray
  127. A client begins to experience drainage of small amounts of bright red blood from the tracheostomy tube 24 hours after a supraglottic laryngectomy. Which is the best nursing action? 
    1. Notify the health care provider (HCP). 
    2. Increase the frequency of suctioning. 
    3. Add moisture to the oxygen delivery system. 
    4. Document the character and amount of drainage.
    1. Notify the health care provider (HCP).
  128. The nurse has completed care for a client whose tracheostomy tube has a nondisposable inner cannula. Which action should the nurse perform prior to reinserting the inner cannula? 
    1. Suction the client's airway. 
    2. Wipe the inner cannula off with a clean washcloth. 
    3. Dry the inner cannula thoroughly with sterile gauze. 
    4. Allow the inner cannula to dry after washing it with sterile water.
    4. Allow the inner cannula to dry after washing it with sterile water.
  129. An ambulatory care nurse is assessing a client with chronic sinusitis. The nurse would expect to note which assessment findings in this client? Select all that apply. 
    1. Anosmia 
    2. Chronic cough 
    3. Purulent nasal discharge 
    4. Intolerance to strong aromas
    • 1. Anosmia 
    • 2. Chronic cough 
    • 3. Purulent nasal discharge
  130. A clinic nurse notes that large numbers of clients present with flu-like symptoms. Which recommendations should the nurse include in the plan of care for these clients? Select all that apply. 
    1. Get plenty of rest. 
    2. Increase intake of liquids. 
    3. Take antipyretics for fever. 
    4. Get a flu shot immediately. 
    5. Eat fruits and vegetables high in vitamin C.
    • 1. Get plenty of rest. 
    • 2. Increase intake of liquids. 
    • 3. Take antipyretics for fever. 
    • 5. Eat fruits and vegetables high in vitamin C.
  131. The nurse is providing care for a client recently admitted with new onset pleurisy. Upon auscultation of the client's lungs, the nurse notes the absence of the pleural friction rub, which was documented on previous assessments. What is the most likely indication for this change in the client's lung sounds? 
    1. Effectiveness of medication therapy 
    2. The deep breaths that the client is taking 
    3. Decreased inflammatory reaction at the site 
    4. Accumulation of pleural fluid in the inflamed area
    4. Accumulation of pleural fluid in the inflamed area
  132. The nurse is performing a cardiovascular assessment on a client. Which parameter would the nurse assess to gain the best information about the client's left-sided heart function? 
    1. Breath sounds 
    2. Peripheral edema 
    3. Hepatojugular reflux 
    4. Jugular vein distention
    1. Breath sounds
  133. The nurse is caring for a group of clients on the clinical nursing unit. The nurse interprets that which of these clients is at most risk for the development of pulmonary embolism? 
    1. A 25-year-old woman with diabetic ketoacidosis 
    2. A 65-year-old man out of bed 1 day after prostate resection 
    3. A 73-year-old woman who has just had pinning of a hip fracture 
    4. A 38-year-old man with pulmonary contusion sustained in an automobile crash
    3. A 73-year-old woman who has just had pinning of a hip fracture
  134. The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation? 
    1. Cyanosis 
    2. Hyperinflated chest 
    3. Rapid, shallow respirations 
    4. Coarse crackles auscultated bilaterally
    3. Rapid, shallow respirations
  135. The nurse is providing immediate postprocedure care to a client who had a thoracentesis to relieve a tension pneumothorax that resulted from rib fractures. The goal is that the client will exhibit normal respiratory functioning, and the nurse provides instructions to assist the client toward this goal. Which client statement indicates that further instruction is needed? 
    1. "I will lie on the affected side for an hour." 
    2. "I can expect a chest x-ray exam to be done shortly." 
    3. "I will let you know at once if I have trouble breathing." 
    4. "I will notify you if I feel a crackling sensation in my chest."
    1. "I will lie on the affected side for an hour."
  136. The client is admitted to the hospital with a diagnosis of Legionnaires' disease. The nurse is providing information regarding the disease and treatment expectations. Which statement by the client indicates an understanding of the disease and treatments? 
    1. "I should avoid all contact with my family." 
    2. "I should avoid large crowds for at least 3 weeks." 
    3. "I cannot give Legionnaires' disease to other people." 
    4. "I will have to take antibiotics until my symptoms disappear."
    3. "I cannot give Legionnaires' disease to other people."
  137. The nurse is planning care for an 81-year-old unresponsive client admitted to the hospital with a medical diagnosis of pneumonia. The nurse has identified the problem of inability to clear the airway related to retained secretions. Which intervention is most appropriate? 
    1. Initiate and maintain supplemental oxygen as prescribed. 
    2. Plan activities with rest periods to conserve oxygen needs. 
    3. Provide nasotracheal suctioning as needed to remove secretions. 
    4. Monitor oxygenation (the oxygen saturation [SaO2]) during activity.
    3. Provide nasotracheal suctioning as needed to remove secretions.
  138. A client with chronic obstructive pulmonary disease (COPD) has a respiratory rate of 24 breaths per minute, bilateral crackles, and cyanosis and is coughing but is unable to expectorate sputum. Which problem is the priority? 
    1. Low cardiac output secondary to cor pulmonale 
    2. Gas exchange alteration related to ventilation-perfusion mismatch 
    3. Altered breathing pattern secondary to increased work of breathing 
    4. Inability to clear the airway related to inability to expectorate sputum
    4. Inability to clear the airway related to inability to expectorate sputum
  139. The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client to avoid which position, which would aggravate breathing? 
    1. Sitting up and leaning on a table 
    2. Standing and leaning against a wall 
    3. Lying on the back in a low-Fowler's position 
    4. Sitting up with the elbows resting on the knees
    3. Lying on the back in a low-Fowler's position
  140. The nurse should provide which home care instructions to a client who had a laryngectomy and has a stoma? Select all that apply. 
    1. Increase the humidity in the home. 
    2. Obtain and wear a Medic-Alert bracelet. 
    3. Wear clothing that does not cover the stoma. 
    4. Stay away from people who have a respiratory infection. 
    5. Be careful with showering to avoid water from entering the stoma. 
    6. Decrease fluid intake to prevent excessive secretions from the stoma.
    • 1. Increase the humidity in the home. 
    • 2. Obtain and wear a Medic-Alert bracelet. 
    • 4. Stay away from people who have a respiratory infection. 
    • 5. Be careful with showering to avoid water from entering the stoma.
  141. The client is returned to the nursing unit following thoracic surgery with chest tubes in place. During the first few hours postoperatively, the nurse assesses for drainage and expects to note which characteristics? 
    1. The drainage is serous. 
    2. The drainage is bloody. 
    3. The drainage is serosanguineous. 
    4. The drainage is bloody, with frequent small clots.
    2. The drainage is bloody.
  142. The client who has had radical neck dissection begins to hemorrhage at the incision site. Which action by the nurse would be contraindicated? 
    1. Monitoring the client's airway 
    2. Applying manual pressure over the site 
    3. Lowering the head of the bed to a flat position 
    4. Calling the health care provider (HCP) immediately
    3. Lowering the head of the bed to a flat position
  143. A nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal compartment. Which is the most appropriate action? 
    1. Check for an air leak. 
    2. Document the findings. 
    3. Notify the health care provider. 
    4. Change the chest tube drainage system.
    2. Document the findings. 3.Notify the health care provid
  144. A nurse is caring for the client who is suspected of having lung cancer. The nurse should assess the client for which most frequent early symptom of lung cancer? 
    1. Cough 
    2. Hoarseness 
    3. Hemoptysis 
    4. Pleuritic pain
    1. Cough
  145. A nurse is caring for a client with acute respiratory distress syndrome. What should the nurse expect to note in the client? 
    1. Pallor 
    2. Low arterial Pao2 
    3. Elevated arterial Pao2 
    4. Decreased respiratory rate
    2. Low arterial Pao2
  146. A nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply. 
    1. Cough 
    2. Dyspnea 
    3. Weight gain 
    4. High-grade fever 
    5. Chills and night sweats
    • 1. Cough 
    • 2. Dyspnea 
    • 5. Chills and night sweats
  147. A client with uncomplicated or simple silicosis is being monitored yearly at the health care clinic. In this type of silicosis, which symptom should the nurse expect that the client will exhibit? 
    1. No symptoms 
    2. Severe dyspnea 
    3. Anorexia and weight loss 
    4. Malaise and extreme fatigue
    1. No symptoms
  148. A client tells the nurse that a health care provider has stated a diagnosis of uncomplicated or simple silicosis and asks the nurse exactly what this means. What knowledge should the nurse use in formulating a response? 
    1. The client has mild ventilation restriction and fibrosis on chest x-ray. 
    2. There is evidence of silica in the bloodstream but no clinical symptoms. 
    3. The client has normal pulmonary function studies but has shortness of breath. 
    4. Massive pulmonary fibrosis is visible on chest x-ray, but no extrapulmonary symptoms are apparent.
    1. The client has mild ventilation restriction and fibrosis on chest x-ray.
  149. A nurse is reading a tuberculin skin test for a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. How should the nurse interpret the result? 
    1. Positive 
    2. Negative 
    3. Uncertain 
    4. Borderline
    2. Negative
  150. A client is suspected of having a pulmonary embolus. The nurse assesses the client, knowing that which is a common clinical manifestation of pulmonary embolism? 
    1. Dyspnea 
    2. Bradypnea 
    3. Bradycardia 
    4. Decreased respirations
    1. Dyspnea
  151. A nurse is caring for a client with emphysema who has chronic hypercarbia and is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed which value? 
    1. 1 L/min 
    2. 2 L/min 
    3. 6 L/min 
    4. 10 L/min
    2. 2 L/min
  152. A nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse should determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis? 
    1. An uninsured man who is homeless 
    2. A newly immigrated woman from Korea 
    3. A man who is an inspector for the US Postal Service 
    4. An older woman admitted from a long-term care facility
    3. A man who is an inspector for the US Postal Service
  153. The nurse is caring for a client with a respiratory disorder who is attempting to stop smoking. The health care provider has recommended nicotine (Nicorette) gum. When reviewing this treatment with the client, the nurse should provide which instruction to the client? 
    1. Drink water while chewing the gum.
    2. Only chew the gum for a maximum of 10 minutes. 
    3. Hold the gum between the cheek and teeth periodically. 
    4. Eat a light snack immediately before chewing the gum.
    3. Hold the gum between the cheek and teeth periodically.
  154. A client is on continuous mechanical ventilation (CMV), and the low-pressure alarm sounds. The nurse should take which action? 
    1. Make sure that the client is not lying on the ventilator tubing. 
    2. Determine if there are any disconnections in the ventilator tubing. 
    3. Check to see if the client is biting on the endotracheal tube (ETT). 
    4. Auscultate the lungs to determine if the client needs to be suctioned.
    2. Determine if there are any disconnections in the ventilator tubing.
  155. A client is on continuous mechanical ventilation (CMV) and the high-pressure alarm sounds. Which action should the nurse take to eliminate the problem? 
    1. Silence the alarm to avoid disturbing the client. 
    2. Check the ventilator circuit for any disconnections. 
    3. Inflate the cuff of the endotracheal tube to a pressure of 25 mm Hg. 
    4. Empty excess accumulated water from the ventilatory circuit tubing.
    4. Empty excess accumulated water from the ventilatory circuit tubing.
  156. The nurse determines the client with a chest tube to a closed drainage system is experiencing an air leak. Which finding is indicative of this? 
    1. Tidaling is absent. 
    2. Gentle bubbling is observed in the suction control chamber. 
    3. Vacillation of water in the water seal chamber occurs during respiration. 
    4. Continuous bubbling is observed in the water seal during inspiration and expiration.
    4. Continuous bubbling is observed in the water seal during inspiration and expiration.
  157. Which should the nurse do when caring for a client with chest tubes attached to a chest drainage system? 
    1. Empty the drainage collection chamber every shift. 
    2. Ensure the water level in the water seal chamber is at the 2-cm level. 
    3. Maintain the drainage collection device at the level of the client's chest. 
    4. Clamp the chest tube before moving the client from the bed to the chair.
    2. Ensure the water level in the water seal chamber is at the 2-cm level.
  158. The nurse determines that a client with a tracheostomy tube needs suctioning if which finding is noted? 
    1. Rhonchi are auscultated. 
    2. Pleural friction rub is heard. 
    3. Fine crackles are auscultated. 
    4. Pulse oximetry reading is 96%.
    1. Rhonchi are auscultated.
  159. A client is returning from surgery after a pulmonary lobectomy. Which pieces of equipment should the nurse have at the bedside? Select all that apply. 
    1. Clamp 
    2. Code cart 
    3. Central line kit 
    4. Vaseline gauze 
    5. Tracheotomy set 
    6. Suction equipment
    • 1. Clamp 
    • 4. Vaseline gauze 
    • 6. Suction equipment
  160. A client is admitted to the hospital with difficulty breathing. Which is the best approach for the nurse to use in obtaining the client's health history? 
    1. Focus only on the physical examination. 
    2. Obtain all information from family members. 
    3. Use the health care provider's medical history. 
    4. Plan short sessions with the client to obtain data.
    4. Plan short sessions with the client to obtain data.
  161. Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply. 
    1. Reduce fluid intake to less than 1500 mL/day. 
    2. Teach diaphragmatic and pursed-lip breathing. 
    3. Encourage alternating activity with rest periods. 
    4. Teach the client techniques of chest physiotherapy. 
    5. Keep the client in a supine position as much as possible.
    • 2. Teach diaphragmatic and pursed-lip breathing. 
    • 3. Encourage alternating activity with rest periods. 
    • 4. Teach the client techniques of chest physiotherapy.
  162. A client with chronic obstructive pulmonary disease (COPD) is being evaluated for lung transplantation. The nurse performs the initial physical assessment. Which findings should the nurse anticipate in this client? Select all that apply. 
    1. Dyspnea at rest 
    2. Clubbed fingers 
    3. Muscle retractions 
    4. Decreased respiratory rate 
    5. Increased body temperature 
    6. Prolonged expiratory breathing phase
    • 1. Dyspnea at rest 
    • 2. Clubbed fingers 
    • 3. Muscle retractions 
    • 6. Prolonged expiratory breathing phase
  163. Which position would best help the breathing of a client with chronic obstructive pulmonary disease (COPD)? 
    1. Sitting position 
    2. Tripod position 
    3. Supine position 
    4. High Fowler's position
    2. Tripod position
  164. A client with an endotracheal tube attached to mechanical ventilation begins to cough, and his face appears flushed. Which action should the nurse take first? 
    1. Call respiratory therapy.
    2. Contact the health care provider. 
    3. Check the client's blood pressure. 
    4. Suction the client through the endotracheal tube.
    4. Suction the client through the endotracheal tube.
  165. The nurse is monitoring a client who has a closed chest tube drainage system. The nurse notes fluctuation of the fluid level in the water-seal chamber during inspiration and expiration. On the basis of this finding, the nurse should make which interpretation? 
    1. There is a leak in the system. 
    2. The chest tube is functioning as expected. 
    3. The amount of suction needs to be decreased. 
    4. The occlusive dressing at the insertion site needs reinforcement.
    2. The chest tube is functioning as expected.
  166. A nurse is providing morning care to a client who has a closed chest tube drainage system to treat a pneumothorax. When the nurse turns the client to the side, the chest tube is accidentally dislodged from the chest. The nurse immediately applies sterile gauze over the chest tube insertion site. Which is the nurse's next action? 
    1. Call the health care provider. 
    2. Replace the chest tube system. 
    3. Obtain a pulse oximetry reading. 
    4. Place the client in a Trendelenburg position.
    1. Call the health care provider.
  167. The nurse instructs a client regarding pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly? 
    1. The client breathes in through the mouth. 
    2. The client breathes out slowly through the mouth. 
    3. The client avoids using the abdominal muscles to breathe out. 
    4. The client puffs out the cheeks when breathing out through the mouth.
    2. The client breathes out slowly through the mouth.
  168. A nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note? 
    1. High fever 
    2. Flushed skin 
    3. Complaints of weight gain 
    4. Complaints of night sweats
    4. Complaints of night sweats
  169. A nurse is performing a respiratory assessment on a client with a left lower lobe lung mass. Chest auscultation over the posterior left lower lobe reveals these breath sounds.The nurse would interpret this as which sound? 
    1. Pleural friction rub 
    2. Vesicular breath sounds 
    3. Bronchial breath sounds 
    4. Bronchovesicular breath sounds
    3. Bronchial breath sounds
  170. An emergency department nurse is performing a respiratory assessment on a client who is complaining of painful breathing. On palpation the nurse notes a coarse grating sensation during inspiration, and on auscultation the nurse hears this breath sound. The nurse interprets these findings as characteristic of which condition? 
    1. Asthma 
    2. Pleurisy 
    3. Emphysema 
    4. Pulmonary edema
    2. Pleurisy
  171. A nurse is auscultating breath sounds in a hospitalized client with emphysema and hears these sounds. The nurse should document this finding as which sound? 
    1. Crackles 
    2. High-pitched wheezes 
    3. Bronchial breath sounds 
    4. Bronchovesicular breath sounds
    2. High-pitched wheezes
  172. A client is experiencing severe dyspnea, and the nurse listens to the client's breath sounds and hears this sound. The nurse should document this finding as which sound? 
    1. Crackles 
    2. Rhonchi 
    3. Stridor 
    4. High-pitched wheezes
    3. Stridor
  173. A nurse is caring for a client who is anxious and is experiencing dyspnea and restlessness from hypoxemia associated with pulmonary edema. Auscultation of the lungs reveals these breath sounds. The nurse determines that these breath sounds are usually caused by which condition? 
    1. Obstruction of the bronchus 
    2. Inflammation of the pleural surfaces 
    3. Passage of air through a narrowed airway 
    4. Opening of small airways that contain fluid
    4. Opening of small airways that contain fluid
  174. A client with frequent upper respiratory infections (URIs) asks the nurse why food doesn't seem to have any taste during illness. The nurse understands that this occurs as a result of which factor? 
    1. Anorexia, triggered by the infectious organism 
    2. Blocked nasal passages that impair the senses of smell and taste 
    3. The infection, which blocks sensation from the taste buds of the tongue 
    4. The client's medication therapy, which causes changes in the normal flora of the mouth
    2. Blocked nasal passages that impair the senses of smell and taste
  175. A nurse providing instructions to a client using an incentive spirometer tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that the primary benefit is to have which effect? 
    1. Dilate the major bronchi. 
    2. Increase surfactant production. 
    3. Maintain inflation of the alveoli. 
    4. Enhance ciliary action in the tracheobronchial tree.
    3. Maintain inflation of the alveoli.
  176. A nurse understands that increasing the flow of oxygen to more than 2 L/min in the client with chronic obstructive pulmonary disease (COPD) could be harmful because it has which effect? 
    1. Is drying to nasal mucosal passages 
    2. Decreases diaphragmatic excursion and depth 
    3. Increases the risk of pneumonia and atelectasis 
    4. Decreases the client's oxygen-based respiratory drive
    4. Decreases the client's oxygen-based respiratory drive
  177. A nurse participating in a client care conference with other health team members is discussing the condition of a client with adult respiratory distress syndrome (ARDS). The health care provider states that because of fluid in the alveoli, surfactant production is falling. The nurse understands that insufficient surfactant causes which effect? 
    1. Atelectasis and viral infection 
    2. Bronchoconstriction and stridor 
    3. Collapse of alveoli and decreased compliance 
    4. Decreased ciliary action and retained secretions
    3. Collapse of alveoli and decreased compliance
  178. A nurse caring for a client with chronic obstructive pulmonary disease (COPD) anticipates which arterial blood gas (ABG) findings? 
    1. pH, 7.40; Pao2, 90 mm Hg; CO2, 39 mEq/L; HCO3, 23 mEq/L 
    2. pH, 7.32; Pao2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L 
    3. pH, 7.47; Pao2, 82 mm Hg; CO2, 30 mEq/L; HCO3, 31 mEq/L 
    4. pH, 7.31; Pao2, 95 mm Hg; CO2, 22 mEq/L; HCO3, 19 mEq/L
    2. pH, 7.32; Pao2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L
  179. The chest x-ray report for a client states that the client has a left apical pneumothorax. The nurse would monitor the status of breath sounds in that area by placing the stethoscope in which location? 
    1. Near the lateral 12th rib 
    2. In the fifth intercostal space 
    3. Just under the left-sided clavicle 
    4. Posteriorly, under the left-sided scapula
    3. Just under the left-sided clavicle
  180. A nurse should determine that tracheal suctioning is needed if which is noted? 
    1. Arterial oxygen level of 90 mm Hg 
    2. 2 hours elapsed since the last suctioning 
    3. Congested breath sounds in the lung fields 
    4. Respiratory rate of 18 breaths/min, up from 16 breaths/min
    3. Congested breath sounds in the lung fields
  181. A client with chronic obstructive pulmonary disease (COPD) is experiencing exacerbation of the disease. The nurse should determine that which finding documented in the client's record is an expected finding with this client? 
    1. Increased oxygen saturation with ambulation 
    2. A widened diaphragm documented by chest x-ray 
    3. Hyperinflation of lungs documented by chest x-ray 
    4. A shortened expiratory phase of the respiratory cycle
    3. Hyperinflation of lungs documented by chest x-ray
  182. A nurse is teaching a client with chronic airflow limitation (CAL) about positions that help breathing during dyspneic episodes. Which position, assumed by the client, would indicate that the client needs additional teaching regarding positioning? 
    1. Sitting up and leaning on a table 
    2. Standing and leaning against a wall 
    3. Sitting up with elbows resting on knees 
    4. Lying on his or her back in a low Fowler's position
    4. Lying on his or her back in a low Fowler's position
  183. A nurse is assisting the health care provider (HCP) with insertion of a chest tube. The nurse notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this observation, the nurse should take which action? 
    1. Ensure that suction is turned on. 
    2. Reinforce the occlusive dressing. 
    3. Encourage the client to breathe deeply. 
    4. Document the accurate functioning of the tube.
    4. Document the accurate functioning of the tube.
  184. A health care provider (HCP) is about to remove a chest tube from a client. After the dressing is removed and the sutures have been cut, the nurse assisting the health care provider should ask the client to perform which procedure? 
    1. Take a deep breath. 
    2. Exhale immediately. 
    3. Breathe in and out quickly. 
    4. Perform the Valsalva maneuver.
    4. Perform the Valsalva maneuver.
  185. A nurse is assisting in caring for a client after removal of an endotracheal tube. Which finding should be reported to the health care health care provider (HCP) immediately? 
    1. Stridor
    2. Lung congestion 
    3. Occasional pink-tinged sputum 
    4. Respiratory rate of 26 breaths/min
    1. Stridor
  186. The nurse is doing volunteer work in a homeless shelter. The nurse should monitor the individuals for which initialsigns/symptoms of tuberculosis (TB)? Select all that apply. 
    1. Fatigue 
    2. Lethargy 
    3. Chest pain 
    4. Morning cough 
    5. Low-grade fever 
    6. Labored breathing
    • 1. Fatigue 
    • 2. Lethargy 
    • 4. Morning cough 
    • 5. Low-grade fever
  187. A nurse caring for a client who has a pneumothorax notes continuous bubbling in the water seal chamber of the client's closed-chest drainage system. How should the nurse interpret this finding? 
    1. The drainage chamber is full. 
    2. The pneumothorax is resolving. 
    3. The suction chamber system is shut off. 
    4. There is an air leak somewhere in the system.
    4. There is an air leak somewhere in the system.
  188. A nurse is providing preoperative teaching with the client about the use of an incentive spirometer in the postoperative period. Which instructions should the nurse include? Select all that apply. 
    1. Sit upright in the bed or in a chair. 
    2. Inhale deeply and quickly as possible. 
    3. Hold the device in a downward position. 
    4. Place the mouthpiece in your mouth and seal your lips tightly around it. 
    5. After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.
    • 1. Sit upright in the bed or in a chair. 
    • 4. Place the mouthpiece in your mouth and seal your lips tightly around it. 
    • 5 . After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.

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