Physiological Integrity Oxygenation/Respiratory RN

1 The nurse has received change-of-shift report about these four patients. Which
one will the nurse plan to assess first?

A. A 23-year-year-old patient with cystic fibrosis who has pulmonary function testing scheduled
in 30 minutes.
B. A 35-year-old patient with bacterial pneumonia and has a temperature of 100.2 F
C. A 46-year-old patient who is complaining of dyspnea after having a thoracentesis an hour ago.
D. A 77-year-old patient with TB who has three antitubercular medications due in 15 minutes.

2 The nurse performs post op assessment on a patient who had a total

laryngectomy and radical neck dissection. In which order should the nurse
address the following problems? List in order:

A. The NG tube is disconnected from suction and clamped off.

B. The patient is coughing blood-tinged secretions from the tracheostomy.
C. The patient is lying in a lateral position with the head of the bed flat.
D. The Hemovac in the neck incision contains 200 ml of bloody drainage

3. The picture illustrates assessment of the patients respiratory system. The

nurse uses this method/ technique to evaluate:

A. Chest expansion.
B. Tactile fremitus.
C. Accessory muscle use.
D. Barrel chest.

4. A patient is admitted to the emergency department with a sudden onset

shortness of breath and diagnosed with R/O pulmonary embolus. The nurse will
prepare the patient for a

A. Chest x-ray.
B. Spiral CT scan.
C. Bronchoscopy.
D. PET scan.

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5. The nurse evaluates a patient with an acute asthma attack. Which
statement by the patient may be of concern regarding medication use?

A. The patient has been using the albuterol inhaler more frequently over the last 4 days.
B. The patient became very short of breath an hour before coming to the hospital.
C. The patient has been taking acetaminophen 650 mg every 6 hours for chest-wall pain.
D. The patient says there have been no acute asthma attacks during the last year.

6. The nurse admits a newborn male baby admitted to the nursery and notes
a family history of cystic fibrosis. The nurse should be alert for which of the
following conditions?

A. Poor thermoregulation.
B. Phenylketonuria.
C. Meconium ileus.
D. Cryptorchidism.

7. A patient who has sleep apnea has been using CPAP for 2 weeks returns
to the sleep clinic and tells the nurse, My sleep has not improved at all.
Which response by the nurse is most appropriate?

A. CPAP takes more than a few weeks to achieve the maximum effect.
B. Have you been using the CPAP every night?
C. Do you want to talk to the doctor about surgery?
D. Perhaps the CPAP pressure should be increased to a higher level.

8. You are observing a nursing student who is suctioning a hospitalized

patient with a tracheostomy in place. Which action by the student requires
you to intervene?

A. The student pre oxygenates the patient for 2 minutes before suctioning.

B. The student applies suction for 10 seconds while withdrawing the catheter.
C. The student puts on clean gloves and uses a sterile catheter to suction.
D. The student inserts the catheter about 5 inches into the tracheostomy tube.

9. When the nurse is deflating the cuff of a tracheostomy tube to evaluate

the patients ability to swallow, it is important to

A. Suction the patients mouth and trachea before deflation of the cuff.
B. Measure the amount of air removed from the cuff during deflation.
C. Deflate the cuff during the inhalation phase of the respiratory cycle.
D. Clean the inner cannula of the tracheostomy tube before deflation.

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10. A patient with an un-cuffed tracheostomy tube coughs violently during
suctioning and dislodges the tracheostomy tube. The nurses first action
should be to

A. Assess the patients oxygen saturation and call the health care provider.
B. Ventilate the patient with a manual bag mask until the health care provider arrives.
C. Insert the obturator and attempt to reinsert the tracheostomy tube.
D. Position the patient in an upright position with the neck extended.

11. A patient with laryngeal cancer has received teaching about radiation
therapy. Which statement by the patient indicates that the teaching has
been effective?

A. I will need to buy a water bottle to carry with me.

B. Until the radiation is complete, I may have diarrhea.
C. Alcohol-based mouthwashes will help prevent oral ulcers.
D. I can use lotions to moisturize the skin on my throat.

12. A patient admitted with mycoplasma pneumonia; temp of 101.6 F,

productive cough and chest pain rated 7 on10-point scale. Which of these
ordered medications should the nurse give first?

A. Azithromycin
B. Acetaminophen
C. Guaifenesin
D. Codeine phosphate

13. The nurse is caring for a client with cystic fibrosis who has difficulty
coughing up phlegm. What should you do?

A. Document and continue to monitor the patient.

B. Contact the physician
C. Order more frequent chest physiotherapy
D. Place the patient on respiratory precautions

14. A patient with active TB has just been started on drug therapy for TB.
The nurse informs the patient that isolation will end when:

A. The chest x-ray shows resolution of the tuberculosis.

B. Three sputum smears for acid-fast bacilli are negative.
C. TB medications have been taken for 6 months.
D. Sputum cultures on 3 consecutive days are negative.

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15. A patient is receiving Isoniazid (INH). Which information will the nurse
include in the patient teaching plan?

A. Take vitamin B6 daily to prevent peripheral nerve damage.

B. Read a newspaper daily to check for changes in vision.
C. Schedule an audiometric examination to monitor for hearing loss.
D. Avoid wearing soft contact lenses to avoid orange staining.

16. A client has a TB skin test of 16-mm induration. Chest X-ray is negative
and no symptoms of TB. The community health nurse will plan on teaching
about the:

A. Medication administration and side effects of INH.

B. A blood test to rule out drug resistance
C. Need for annual repeat TB skin testing
D. Recommendation guidelines for bacillus Calmette-Gurin (BCG) vaccine.

17. The nurse is performing TB screening in a clinic that has many patients
who have immigrated to the United States. Before doing a TB skin test on a
patient, which question is most important for the nurse to ask?

A. How long have you lived in the United States?

B. Is there any family history of TB?
C. Have you received the BCG vaccine for TB?
D. Do you take any over-the-counter (OTC) medications?

18. One hour post op left upper lobectomy, a patient rates incisional pain
level 7 out of 10 and has decreased left-sided breath sounds. The pleural
drainage system has 100 ml of bloody drainage and a continuous air leak.
Which action should the nurse take first?

A. Assist the patient to deep breathe and cough.

B. Milk the chest tube gently to remove any clots.
C. Medicate the patient with the ordered morphine.
D. Notify the surgeon about the large air leak.

19. The emergency department nurse will suspect a tension pneumothorax

in a patient who has been in an automobile accident if

A. The breath sounds on one side are decreased.

B. There are wheezes audible throughout both lungs.
C. There is a sucking sound with each patient breath.
D. Paradoxical movement of the chest is noted.

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20. Which clinical manifestation noted by the nurse is consistent with the
cor pulmonale diagnosis for a 68-year-old mans history of COPD?

A. Audible crackles at both lung bases

B. 3+ edema in the lower extremities
C. Loud murmur at the mitral area
D. Splenomegaly on abdominal palpation

21. A patient admitted with pneumonic plague (Yersinia pestis). Based on

the nursing conference you attended, the nurse should first:

A. Wear a mask when listening to the patients lungs.

B. Check the patients O2 saturation.
C. Prepare to administer the vaccine.
D. Notify the Center for Disease Control.
E. Prepare to administer the prescribed antibiotics.

22. The nurse who is caring for a patient receiving subcutaneous heparin
injections to treat a pulmonary embolus. Which assessment data is most
important to communicate to the health care provider?

A. The patient has many abdominal bruises.

B. The patients BP is 90/46.
C. The activated partial thromboplastin time is 2 times the patient baseline.
D. The patients stool is dark green and liquid.

23. The nurse is planning a staff development conference about infection

control in health care settings. Which of the following content should the
nurse include for prevention of Ventilator associated pneumonia? SATA

A. Hand hygiene.
B. Ventilator bundle sets.
C. Hourly blood gases.
D. Head of bed elevation______.
E. Oral care_________when_________with________
F. Pulmonary hygiene/chest physiotherapy/turning

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24. The high pressure alarm goes off on a client who is on mechanical
ventilation. What is the first action by the nurse?

A. Disconnect the client from the ventilator and use manual resuscitation.
B. Perform a quick assessment of the client's condition.
C. Call the respiratory therapist for help.
D. Press the alarm reset button on the ventilator

25. A client returns from the PACU with chest tube drainage. What would
you do first if there are no fluctuations in the water seal?

A. Check for an air leak.

B. Check for kinks.
C. Strip the chest tube
D. Clamp the chest tube momentarily.

26. Which of the following vitamins will you teach the parent of a child with
cystic fibrosis to supplement in the childs daily diet?

A. Folic acid.
B. Biotin.
C. Niacin.
D. Vitamin A.

27. You are caring for an 8 year old who had a tonsillectomy. Which of the
following interventions should you question? Select all that apply:

A. Assist the client to cough and use the incentive spirometer hourly.
B. Place the client semi prone position to facilitate drainage.
C. Offer fluids that a child likes: chocolate milk and red ice pops.
D. Administer the prescribed antibiotic on time.
E. Use a straw to give cool fluids, like apple juice.

28. Pedro is brought to the urgent care with a recent onset fever and sore
throat. His voice is muffled with drooling and nasal flaring as he leans
forward. Select from the following your priority nursing actions if ordered
by the physician :( First, second and third)

A___ Get an oral temperature

B___ Perform a pulse oximetry
C___ Nasal cannula oxygen
D___ Obtain a throat culture
E___ Have the mother hold child upright

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29. A client is receiving oxygen via a non-rebreather mask. You know that
the equipment is functioning properly when:

A. The reservoir bag collapses when the client inhales.

B. Valves should be closed during exhalation.
C. The reservoir bag does not collapse when the patient breathes in.
D. The valves and flaps do not move during the breathing cycle.

30. You are evaluating the homecare aide who cares for a client with active
TB. The reports are negative for three sputum tests for AFB. You know the
aide understood your directions when:

A. A mask is worn when bathing the client

B. Gloves are worn when changing soiled linen.
C. A gown is worn when emptying the catheter bag.
D. The door is kept closed when the client watches TV.

31. After the physician intubated the client with an endotracheal tube, the
nurse should first check for tube placement by:

A. Requesting a portable chest x-ray.

B. Auscultating for bilateral lung sounds.
C. Obtaining arterial blood gases.
D. Performing pulse oximetry.

32. A client in a psychiatric group home is receiving Haloperidol tells the

direct care worker that I see milk coming out of my breast, what is going
on? The community health nurse recognizes the client behavior as:

A. Positive sign of schizophrenia, delusion

B. Dysthymia and confabulation thoughts
C. Seeking attention.
D. An adverse effect of the medication.

33. The nurse would document which of the following as positive finding in
a client with AIDS (acquired immune deficiency syndrome) who had a TB
skin test 2 days ago?

A. An induration of 6mm.
B. An erythema of 10mm
C. Small, purple, brown lesions 4mm.
D. Blister like vesicles of 3mm.

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34. Which of the following statements during a conference on physical
appraisal would a nurse expect the student nurse to identify as correct
sequence for a focused thoracic assessment?
A. ___Auscultate the anterior/posterior chest
B. ___Percuss for tympani
C. ___Palpate for tactile/vocal fremitus
D. ___Inspect for symmetry
E. ___Perform a pulse oximetry

35. After a care conference with student nurses during their pediatric
rotation on epiglottitis, LTB-croup, RSV, bronchitis, the students noted that
a common treatment modality is:

A. Antibiotics given parentally.

B. Airborne precautions.
C. Cool humidified oxygen.
D. Nebulized epinephrine treatments.

36. A 36 year old female comes to the ED with chest pain. She has a Pa02 of
60 mm Hg and a PaC02 of 35 mm Hg. Meds used: Ibuprofen & Depo Provera,
tobacco. You should anticipate treatment for?

A. Pleural effusion.
B. Emphysema.
C. Gastro esophageal reflux.
D. Pulmonary emboli.
E. Pneumonia

37. The nurse receives a telephone report on four clients. Which client
should be of immediate concern?

A. TB client who was diagnosed four weeks ago and has not received treatment.
B. TB client who has three negative sputum cultures.
C. TB client who is an alcoholic and last had a drink six hours ago.
D. TB client who has been treated for laryngeal cancer.

38. A client who has COPD is concerned about getting a flu shot and the
pneumonia vaccine. Which statement by the nurse is accurate?
A. "If you got the flu shot last year, you will not need one this year."
B. "Because the flu shot is good for five years you will not need one this year."
C. "You should receive the flu shot annually; the pneumonia vaccine is good for five years."
D. "We will give you both injections in the same arm to minimize discomfort."

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39. Which of the following clients is most at risk for developing community
acquired pneumonia?

A. 40 year old with exercise induced asthma.

B. 50 years old who teaches kindergarten classes.
C. 60 years old who smokes and is an alcoholic.
D. 70 years old vegetarian with osteoporosis.

40. How does the expected course of treatment for TB differ for children and
pregnant women compared to an adult client with tuberculosis?

A. The length of the treatment.

B. INH is used with Vitamin B6.
C. Ethambutol is contraindicated.
D. Twelve months of Rifampin is required.

41. Which of these nursing priorities should the nurse perform on a 34 week
gestation who is on Terbutaline for pre term labor?

A. Avoid performing the Leopold maneuver.

B. Draw blood gases for respiratory evaluation.
C. Increase fluids with sips of water hourly.
D. Monitor the heart rate and blood pressure.

42. Albuterol and Fluticasone are prescribed via MDI (metered dose
inhaler). How will the nurse instruct the client on the correct
administration?

A. "Take the medications when your chest feels tight and you have difficulty breathing."
B. "Take the Fluticasone first, rinse your mouth and wait three minutes and take the 2 puffs of
Proventil as prescribed"
C. "Take one puff of the Albuterol wait at least one minute, take the second puff, and wait again
, take the Fluticasone one puff and rinse out your mouth and the mouthpiece."
D. "Shake both your inhalers, remove the cap, attach the spacer, and inhale deeply with your
lips on the spacer mouthpiece at the same time press down on the inhaler and exhale slowly."

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43. The nurse measures the head circumference and chest circumference of
an 18 month-old infant. The nurse compares the two measurements to each
other and notes they are approximately the same. What action should the
nurse take?

A. Feel the posterior fontanel

B. Notify the health care provider
C. Palpate the anterior fontanel
D. Record the findings in the chart

44. Which of the following diagnostic studies is most helpful in determining

the presence of asthma?

A. Large number of eosinophils in the blood

B. Incentive spirometer
C. Pulmonary function tests (PFTs)
D. Spirometer

45. A patient has been instructed in pursed-lip breathing. The patient asks
the nurse the purpose behind this breathing pattern. The nurse's best
response to this question would be:

A. "Pursed-lip breathing prevents airway collapse and enhances effective breathing."

B. "You will be more comfortable if you use pursed-lip breathing techniques."
C. "Pursed-lip breathing exercises help to prevent the accumulation of secretions."
D. "Pursed-lip breathing increases the strength of the respiratory muscles."

46. The nurse is caring for a client whose chest tube is accidentally
disconnected, what should the nurse plan to do first?

A. Place the end of the chest tube in a container of sterile saline.

B. Apply an occlusive dressing and notify the physician.
C. Clamp the chest tube immediately.
D. Secure the chest tube with tape.

47. Which of the following would be most appropriate for a 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.

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48. At 11 p.m., a male client is admitted to the emergency department. He
has a respiratory rate of 44 breaths/minute. Hes anxious, and wheezes are
audible. The client is immediately given oxygen by face mask and
Methylprednisolone (Depo-Medrol) I.V. 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).

49. A male client is to receive I.V. vancomycin (Vancocin). When preparing

to administer this drug, the nurse should keep in mind that:

A. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

B. vancomycin may cause irreversible neutropenia.
C. vancomycin should be administered rapidly in a large volume of fluid.
D. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

50. A black male client with asthma seeks emergency care for acute
respiratory distress. Because of this clients dark skin, the nurse should
assess for cyanosis by inspecting the:

A. Lips.
B. Mucous membranes.
C. Nail beds.
D. Earlobes.

51. The physician has ordered O2 at 3 liters/minute via nasal cannula. O2

amounts greater than 3 liters / minute are contraindicated in the client with
COPD because:

A. Higher concentrations result in severe headache.

B. Hypercapnic drive is necessary for breathing.
C. Higher levels will be required later to raise the pO2.

D. Hypoxia is the normal stimulus for breathing

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52. The client has been receiving Garamycin 65 mg IVPB every 8 hours for
the past 6 days. Which lab result indicates an adverse reaction to the
medication?

A. WBC 7500
B. Serum glucose 98
C. Protein 3.5
D. Serum creatinine 2.0

53. The morning meds for a client with cystic fibrosis are about to be
administered. The client ask if it can be mixed with applesauce. You will:

A. Contact the physician for a new order

B. Sprinkle it on the applesauce
C. Remind the client it must be given on an empty stomach
D. Consult the dietician and pharmacist as a referral

54. A client who weighs 175 lbs. (79.4 kg) is receiving aminophylline (400
mg in 500 ml) at 50 ml/hour. The aminophylline level is reported as 6
mcg/ml. The nurse calls the physician orders the nurse to change the
dosage to 0.45 mg/kg/hour. The nurse should:

A. Question the order because its too low.

B. Question the order because its too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the Theophylline measurement.

55. You attend a nursing conference on immunizations. What condition can

the Haemophilus influenzae type B, or Hib, vaccine help prevent?

A. Bronchitis
B. SIDS
C. Epiglottitis
D. Pneumothorax

56. You attended a conference on severe acute respiratory syndrome. Which

of the following should be implemented to prevent the spread of SARS?
Select all that apply

A. Hand washing
B. Keeping the door closed
C. Contact precautions
D. Upon leaving the room, remove goggles, gown, mask and then gloves
E. Patient does not need to wear a mask when leaving room

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 57. A nurse is gathering data on a client with a diagnosis of TB. The nurse
reviews the results of which diagnostic test is most sensitive and rapid that
will confirm tuberculosis?

A. Chest X-ray and physical exam

B. Bronchoscopy
C. Sputum culture for acid-fast bacillus
D. TB skin test two step purified protein derivative
E. Blood analysis using QuantiFERON-TB-Gold (QFT-G)

58. A client has a cuffed tracheostomy tube in place following. To prevent

tracheal necrosis, which of these actions should a nurse perform a regular
intervals?

A. Keeping an obturator at the bedside.

B. Monitoring cuff pressure.
C. Suctioning the inner cannula.
D. Removing dried secretions from the stoma.

59. The physician orders IV aminophylline infusion at 30mg/hour. The

pharmacy sends a 1000ml bag containing 500mg of aminophylline. In order
to administer the30 mg/hr. dose, the RN will set the infusion pump rate at:
Show your work

A. 30ml/hour
B. 40mllhr
C. 50mllhr
D. 60ml/hr

60. You just finished suctioning a client with MRSA. When/where do you
Take off your gloves?

61. The hospital plans a disaster preparedness training. In conjunction with

the CDC, indicate which precaution/Tx should be used for the following:

A.____ Anthrax (Bacillus anthracis); Tx_________

B. ___ Botulism (Clostridium botulinum)Tx___________
C. ___ Bubonic plague (Yersinia pestis);Tx____________
D. ___Smallpox (Variola virus):Tx_______________

AP=Airborne; CP=Contact; DP=Droplet; SP=Standard

Od/1/16

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