Respi Q&a

Ch.
26 Respiratory NCLEX Questions

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To promote the release of surfactant, the

nurse encourages the patient to
A. Take deep breaths

B. Cough 5 times per hour to prevent
alveolar collapse A. Take deep breaths
C. Decrease fluid intake to reduce fluid
accumulation in the alveoli
D. Sit with head of bed elevated to pro-
mote air movement through the pores of
Kohn
A patient with a respiratory condition
asks "How does air get into my lungs?"
The nurse bases her answer on her
knowledge that air moves into the lungs
because of
A. Contraction of the accessory abdom- D. Decrease in intrathoracic pressure rel-

inal muscles ative to pressure at the airway
B. Increased carbon dioxide and de-
creased oxygen in the blood
C. Stimulation of the respiratory muscles
by the chemoreceptors
D. Decrease in intrathoracic pressure rel-
ative to pressure at the airway
The nurse can best determine adequate
arterial oxygenation of the blood by as-
sessing
C. Arterial oxygen tension
A. Heart rate
B. Hemoglobin level
C. Arterial oxygen tension
D. Arterial carbon dioxide tension
When teaching a patient about the most
important respiratory defense mecha-
nism distal to the respiratory bronchi-
oles, which topic would the nurse dis-
cuss?
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Ch. 26 Respiratory NCLEX Questions
A. Alveolar macrophages
B. Impaction of particles A. Alveolar macrophages
C. Reflex bronchoconstriction
D. Mucociliary clearance mechanism
A student nurse asks the RN what can
be measured by arterial blood gases.
The RN tells the student that ABGs can
measure (select all that apply) A. Acid-base balance
B. Oxygenation status
A. Acid-base balance C. Acidity of the blood
B. Oxygenation status E. Bicarbonate (HCO3) in arterial blood
C. Acidity of the blood
D. Glucose bound to hemoglobin
E. Bicarbonate (HCO3) in arterial blood
To detect early signs or symptoms of in-
adequate oxygenation, the nurse would
examine the patient for
A. Dyspnea and hypotension B. Apprehension and restlessness

B. Apprehension and restlessness
C. Cyanosis and cool, clammy skin
D. Increased urine output and diaphore-
sis
During the respiratory assessment of the
older adult, the nurse would expect to
find (select all that apply)
A. A vigorous cough C. Increased residual volume

B. Increased chest expansion E. Increased anteroposterior (AP) chest
C. Increased residual volume diameter
D. increased breath sounds in the lung
apices
E. Increased anteroposterior (AP) chest
diameter
When assessing activity-exercise pat-
terns related to respiratory health, the
nurse inquires about
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Ch. 26 Respiratory NCLEX Questions
A. Dyspnea during rest or exercise

B. Recent weight loss or weight gain
A. Dyspnea during rest or exercise
C. Ability to sleep through the entire night
D. Willingness to wear oxygen equip-
ment in public
When auscultating the chest of an older
adult patient in respiratory distress, it is
best to
A. Begin listening at the apices B. Begin listening at the lung bases

B. Begin listening at the lung bases
C. Begin listening on the anterior chest
D. Ask the patient to breathe through the
nose with the mouth closed
Which assessment finding of the respira-
tory system does the nurse interpret as
abnormal?
A. Inspiratory chest expansion on 1 in

D. Bronchial breath sounds in the lower
B. Percussion resonance over the lung
lung fields
bases
C. Symmetric chest expansion and con-
traction
D. Bronchial breath sounds in the lower
lung fields
The nurse is preparing the patient for a
diagnostic procedure to remove pleural
fluid for analysis. The nurse would pre-
pare the patient for which test?
A. Thoracentesis
A. Thoracentesis
B. Bronchoscopy
C. Pulmonary angiography
S. Sputum culture and sensitivity
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ANS: B
When a patient has severe respirato-
ry distress, only information pertinent to
A patient with acute shortness of breath the current episode is obtained, and a
is admitted to the hospital. Which action more thorough assessment is deferred
should the nurse take during the initial until later. Obtaining a comprehensive
assessment of the patient? health history or full physical examina-
a. Ask the patient to lie down to complete tion is unnecessary until the acute dis-
a full physical assessment. tress has resolved. Brief questioning and
b. Briefly ask specific questions about a focused physical assessment should
this episode of respiratory distress. be done rapidly to help determine the
c. Complete the admission database to cause of the distress and suggest treat-
check for allergies before treatment. ment. Checking for allergies is impor-
d. Delay the physical assessment to first tant, but it is not appropriate to complete
complete pulmonary function tests the entire admission database at this
time. The initial respiratory assessment
must be completed before any diagnos-
tic tests or interventions can be ordered.
The nurse prepares a patient with a
left-sided pleural effusion for a thoracen- ANS: D
tesis. How should the nurse position the The upright position with the arms sup-
patient? ported increases lung expansion, allows
a. Supine with the head of the bed ele- fluid to collect at the lung bases, and
vated 30 degrees expands the intercostal space so that
b. In a high-Fowler's position with the left access to the pleural space is easier. The
arm extended other positions would increase the work
c. On the right side with the left arm of breathing for the patient and make it
extended above the head more difficult for the health care provider
d. Sitting upright with the arms support- performing the thoracentesis.
ed on an over bed table
A diabetic patient's arterial blood gas ANS: B
(ABG) results are pH 7.28; PaCO2 34 Kussmaul (deep and rapid) respira-
mm Hg; PaO2 85 mm Hg; HCO3- 18 tions are a compensatory mechanism
mEq/L. The nurse would expect which for metabolic acidosis. The low pH and
finding? low bicarbonate result indicate metabol-
a. Intercostal retractions ic acidosis. Intercostal retractions, a low
b. Kussmaul respirations oxygen saturation rate, and a decrease
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c. Low oxygen saturation (SpO2) in venous O2 pressure would not be
d. Decreased venous O2 pressure caused by acidosis.
On auscultation of a patient's lungs,
ANS: A
the nurse hears low-pitched, bubbling
Crackles are low-pitched, bubbling
sounds during inhalation in the lower
sounds usually heard on inspiration.
third of both lungs. How should the nurse
Wheezes are high-pitched sounds. They
document this finding?
can be heard during the expiratory or
a. Inspiratory crackles at the bases
inspiratory phase of the respiratory cy-
b. Expiratory wheezes in both lungs
cle. The lower third of both lungs are the
c. Abnormal lung sounds in the apices of
bases, not apices. Pleural friction rubs
both lungs
are grating sounds that are usually heard
d. Pleural friction rub in the right and left
during both inspiration and expiration.
lower lobes
ANS: B
A patient with a chronic cough has
Risk for aspiration and maintaining an
a bronchoscopy. After the procedure,
open airway is the priority. Because a
which intervention by the nurse is most
local anesthetic is used to suppress
appropriate?
the gag/cough reflexes during bron-
a. Elevate the head of the bed to 80 to 90
choscopy, the nurse should monitor for
degrees.
the return of these reflexes before allow-
b. Keep the patient NPO until the gag
ing the patient to take oral fluids or food.
reflex returns.
Blood-tinged mucus is not uncommon
c. Place on bed rest for at least 4 hours
after bronchoscopy. The patient does not
after bronchoscopy.
need to be on bed rest, and the head
d. Notify the health care provider about
of the bed does not need to be in the
blood-tinged mucus.
high-Fowler's position.
The nurse completes a shift assessment
ANS: C
on a patient admitted in the early phase
Fine crackles are likely to be heard in
of heart failure. When auscultating the
the early phase of heart failure. Fine
patient's lungs, which finding would the
crackles are discontinuous, high-pitched
nurse most likely hear?
sounds of short duration heard on in-
a. Continuous rumbling, snoring, or rat-
spiration. Rhonchi are continuous rum-
tling sounds mainly on expiration
bling, snoring, or rattling sounds main-
b. Continuous high-pitched musical
ly on expiration. Course crackles are a
sounds on inspiration and expiration
series of long-duration, discontinuous,
c. Discontinuous, high-pitched sounds of
low-pitched sounds during inspiration.
short duration heard on inspiration
Wheezes are continuous high-pitched
d. A series of long-duration, discontinu-
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ous, low-pitched sounds during inspira- musical sounds on inspiration and expi-
tion ration.
ANS: C
The nurse observes a student who is
Listening only during inspiration indi-
listening to a patient's lungs who is hav-
cates the student needs a review of
ing no problems with breathing. Which
respiratory assessment skills. At each
action by the student indicates a need to
placement of the stethoscope, listen to at
review respiratory assessment skills?
least one cycle of inspiration and expira-
a. The student starts at the apices of the
tion. During chest auscultation, instruct
lungs and moves to the bases.
the patient to breathe slowly and a little
b. The student compares breath sounds
deeper than normal through the mouth.
from side to side avoiding bony areas.
Auscultation should proceed from the
c. The student places the stethoscope
lung apices to the bases, comparing op-
over the posterior chest and listens dur-
posite areas of the chest, unless the pa-
ing inspiration.
tient is in respiratory distress or will tire
d. The student instructs the patient to
easily. If so, start at the bases (see Fig.
breathe slowly and a little more deeply
26-7). Place the stethoscope over lung
than normal through the mouth.
tissue, not over bony prominences.
ANS: A
A patient is admitted to the emergency Spiral computed tomography (CT) scans
department complaining of sudden on- are the most commonly used test to di-
set shortness of breath and is diagnosed agnose pulmonary emboli, and contrast
with a possible pulmonary embolus. How media may be given IV. A chest x-ray
should the nurse prepare the patient for may be ordered but will not be diagnostic
diagnostic testing to confirm the diagno- for a pulmonary embolus. Preparation for
sis? a chest x-ray includes undressing and
a. Start an IV so contrast media may be removing any metal. Bronchoscopy is
given. used to detect changes in the bronchial
b. Ensure that the patient has been NPO tree, not to assess for vascular changes,
for at least 6 hours. and the patient should be NPO 6 to
c. Inform radiology that radioactive glu- 12 hours before the procedure. Positron
cose preparation is needed. emission tomography (PET) scans are
d. Instruct the patient to undress to the most useful in determining the presence
waist and remove any metal objects. of malignancy, and a radioactive glucose
preparation is used.
A patient with acute dyspnea is sched- ANS: A
uled for a spiral computed tomography Because iodine-based contrast media
(CT) scan. Which information obtained is used during a spiral CT, the patient
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may need to have the CT scan with-
by the nurse is a priority to communicate
out contrast or be premedicated before
to the health care provider before the
injection of the contrast media. The in-
CT?
creased pulse, low oxygen saturation,
a. Allergy to shellfish
and tachypnea all indicate a need for
b. Apical pulse of 104
further assessment or intervention but
c. Respiratory rate of 30
do not indicate a need to modify the CT
d. Oxygen saturation of 90%
procedure.
The nurse analyzes the results of a
patient's arterial blood gases (ABGs). ANS: D
Which finding would require immediate All the values are abnormal, but the low
action? PaO2 indicates that the patient is at the
a. The bicarbonate level (HCO3-) is 31 point on the oxyhemoglobin dissociation
mEq/L. curve where a small change in the PaO2
b. The arterial oxygen saturation (SaO2) will cause a large drop in the O2 satura-
is 92%. tion and a decrease in tissue oxygena-
c. The partial pressure of CO2 in arterial tion. The nurse should intervene imme-
blood (PaCO2) is 31 mm Hg. diately to improve the patient's oxygena-
d. The partial pressure of oxygen in arte- tion.
rial blood (PaO2) is 59 mm Hg.
ANS: C
A patient in metabolic alkalosis is admit-
Although the O2 saturation is adequate,
ted to the emergency department, and
the left shift in the oxyhemoglobin disso-
pulse oximetry (SpO2) indicates that
ciation curve will decrease the amount
the O2 saturation is 94%. Which action
of oxygen delivered to tissues, so high
should the nurse take next?
oxygen concentrations should be giv-
a. Administer bicarbonate.
en. Bicarbonate would worsen the pa-
b. Complete a head-to-toe assessment.
tient's condition. A head-to-toe assess-
c. Place the patient on high-flow oxygen.
ment and repeat ABGs may be imple-
d. Obtain repeat arterial blood gases
mented. However, the priority interven-
(ABGs).
tion is to give high-flow oxygen.
After the nurse has received
change-of-shift report, which patient
ANS: B
should the nurse assess first?
Because the cough and gag are de-
a. A patient with pneumonia who has
creased after bronchoscopy, this patient
crackles in the right lung base
should be assessed for airway paten-
b. A patient with possible lung can-
cer who has just returned after bron-
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choscopy
c. A patient with hemoptysis and a
16-mm induration with tuberculin skin cy. The other patients do not have clin-
testing ical manifestations or procedures that
d. A patient with chronic obstructive pul- require immediate assessment by the
monary disease (COPD) and pulmonary nurse.
function testing (PFT) that indicates low
forced vital capacity
The laboratory has just called with the
arterial blood gas (ABG) results on four
patients. Which result is most important
for the nurse to report immediately to the
ANS: D
health care provider?
These ABGs indicate uncompensated
a. pH 7.34, PaO2 82 mm Hg, PaCO2 40
respiratory acidosis and should be re-
mm Hg, and O2 sat 97%
ported to the health care provider. The
b. pH 7.35, PaO2 85 mm Hg, PaCO2 45
other values are normal or close to nor-
mal.
c. pH 7.46, PaO2 90 mm Hg, PaCO2 32
d. pH 7.31, PaO2 91 mm Hg, PaCO2 50
A patient is scheduled for a computed
tomography (CT) of the chest with con- ANS: B, E
trast media. Which assessment findings Because the contrast media is io-
should the nurse immediately report to dine-based and may cause dehydration
the health care provider (select all that and decreased renal blood flow, asking
apply)? about iodine allergies (such as allergy to
a. Patient is claustrophobic. shellfish) and monitoring renal function
b. Patient is allergic to shellfish. before the CT scan are necessary. The
c. Patient recently used a bronchodilator other actions are not contraindications
inhaler. for CT of the chest, although they may
d. Patient is not able to remove a wed- be for other diagnostic tests, such as
ding band. magnetic resonance imaging (MRI) or
e. Blood urea nitrogen (BUN) and serum pulmonary function testing (PFT).
creatinine levels are elevated.
A nurse obtains a health history from a ANS: A
patient who has a 35 pack-year smoking Prolonged alcohol use and smoking
history. The patient complains of hoarse- are associated with the development
5/7
ness and tightness in the throat and diffi- of laryngeal cancer, which the patient's
culty swallowing. Which question is most symptoms and history suggest. Family
important for the nurse to ask? history is not a risk factor for head or
a. "How much alcohol do you drink in an neck cancer. Frequent antihistamine use
average week?" would be asked about if the nurse sus-
b. "Do you have a family history of head pected allergic rhinitis, but the patient's
or neck cancer?" symptoms are not suggestive of this di-
c. "Have you had frequent streptococcal agnosis. Streptococcal throat infections
throat infections?" also may cause these clinical manifesta-
d. "Do you use antihistamines for upper tions, but patients with this type of infec-
airway congestion?" tion will also have pain and a fever.
ANS: B
Activated partial thromboplastin time
(aPTT) assesses intrinsic coagulation by
measuring factors I, II, V, VIII, IX, X, XI,
The nurse is reviewing laboratory re-
XII. aPTT is increased (prolonged) in he-
sults and notes an aPTT level of 28 sec-
parin administration.
onds. The nurse should notify the health
aPTT is used to monitor whether heparin
care provider in anticipation of adjusting
is at a therapeutic level (needs to be
which medication?
greater than the normal range of 25 to
a. Aspirin
35 sec). Prothrombin time (PT) and inter-
b. Heparin
national normalized ratio (INR) are most
c. Warfarin
commonly used to test for therapeutic
d. Erythropoietin
levels of warfarin (Coumadin). Aspirin af-
fects platelet function. Erythropoietin is
used to stimulate red blood cell produc-
tion.
A patient who has been receiving a he-
parin infusion and warfarin (Coumadin)
ANS: D
for a deep vein thrombosis (DVT) is di-
All heparin is discontinued when the
agnosed with heparin-induced thrombo-
HIT is diagnosed. The patient should
cytopenia (HIT) when her platelet level
be instructed to never receive heparin
drops to 110,000/µL. Which action will
or LMWH. Warfarin is usually not given
the nurse include in the plan of care?
until the platelet count has returned to
a. Use low-molecular-weight heparin
150,000/µL. The platelet count does not
(LMWH) only.
drop low enough in HIT for a platelet
b. Administer the warfarin (Coumadin) at
the scheduled time.
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c. Teach the patient about the purpose of
platelet transfusions. transfusion, and platelet transfusions in-
d. Discontinue heparin and flush inter- crease the risk for thrombosis.
mittent IV lines using normal saline.
Which laboratory result will the nurse
ANS: D
expect to show a decreased value if a
Platelet aggregation in HIT causes neu-
patient develops heparin-induced throm-
tralization of heparin, so that the acti-
bocytopenia (HIT)?
vated partial thromboplastin time will be
a. Prothrombin time
shorter and more heparin will be needed
b. Erythrocyte count
to maintain therapeutic levels. The other
c. Fibrinogen degradation products
data will not be affected by HIT.
d. Activated partial thromboplastin time
7/7
Respiratory NCLEX Questions
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Nursing managment of a patient with

the diagnosis of pumonary tuberculosis
would include:
A. placing a client in contact precautions
B. health care personnel in contact with
B. health care personnel in contact with
the patient using the HEPA respirator
the patient using the HEPA respirator
masks
masks
C. ensuring meal trays have disposable
utensils
D. increasing the activity level o f a pa-
tient as much as possible during the ac-
tive phase of the illness
A nurse is reinforcing instructions to a
hospitalized client with a diagnosis of
emphysema about positions that will en-
hance the effectiveness of breathing dur-
ing dyspneic episodes, Which position
sitting on the side of the bed, leaning on should the nurse instruct the client to
an overbed table assume?
A. side-laying in bed
B. sitting in a recliner chair
C.sitting up in bed at a 90 degree angle
D.sitting on the side of the bed, leaning
on a overbed table
The nurse is gathering data on a client
with a diagnosis of tuberculosis(TB). The
nurse should review the results of which
diagnostic test to confirm diagnosis?
sputum culture
A. Chest x-ray
B. Bronchoscopy
C.Sputum Culture
D. Tuberculin skin test
* TEST* *Which identified the route of
transmission of tuberculosis(TB)?*
A. Hand to mouth
airborne route
B. the enteric route
C. airborne route
D. blood and body fluids
1 / 16
The nurse is preparing a list of home
care instructions for the client who has
been hospitalized and treated for tuber-
culosis. Which instructions should the
nurse reinforce? select all that apply
A. Activities should be resumed gradual-
ly
A. Activities should be resumed gradual- B. avoid contact with other individuals
ly except family members, for atleast 6
C. a sputum culture is needed every 2 months
to 4 weeks once medication therapy has C.a sputum culture is needed every 2
started to 4 weeks once medications therapy is
E. Cover the mouth and nose when initiated
coughing of sneezing and confine used D. Respiratory isolation is not necessary
tissues to plastic bags because family members have already
been exposed
E. Cover the mouth and nose when
coughing or sneezing and confine used
tissues to plastic bags
F. When one sputum culture is negative,
the client is no longer considered infec-
tious and can usually return to work
The nurse is instructing a client about
pursed lip breathing, and the client asks
the nurse about its purpose. The nurse
should tell the client that the *prima-
ry* purpose of pursed lip breathing is
promote carbon dioxide elimination
which?
A. promote oxygen intake
B.strengthen the diaphragm
C. strengthen the intercostal muscles
D. promote carbon dioxide elimination
The low-pressure alarm sounds on the
ventilator. The nurse checks the client
and the attempts to determine the cause
ventilate the client manually
of the alarm but its unsuccessful. Which
*intial* action should the nurse take?
A. administer oxygen
2 / 16
B.ventilate the client manually
C.check the clients vital signs
D. start cardiopulmonary resuscitation
(CPR)
The nurse is assigned to care for a client
after a left pneumonectomy. Which posi-
tion is contraindicated for this client?
A. lateral position
lateral position
B. low fowlers position
C. semi-fowlers postion
D. head of the bed elevation to 40 de-
grees
The nurse is caring for a client after a
pulmonary angiography via catheter in-
sertion into the left groin. The nurse mon-
itors for allergic reaction to the contrast
medium by observing for the presence of
respiratory disress
which?
A. hypothermia
B. respiratory distress
C. hematoma in the left groin
D.discomfort in left groin
The nurse is reinforcing discharge in-
structions to the client with pulmonary
sarcoidosis. The nurse knows that the
client understands the information if the
client verbalizes which *early* sign of ex-
shortness of breath
acerbation?
A. fever
B. fatigue
C. weight loss
D. shortness of breath
The nurse is caring for several clients
with respiratory disorders. Which client is
atleast risk for developing a tuberculosis
infection?
A. an uninsured man who is homeless
B. a women newly immigrated from ko-
3 / 16
rea
C.a man who is an inspector for the U.S
a man who is an inspector for the postal
postal service
service
D. an older women admitted from a
long-term care facility
*TEST* *The nurse is reading the re-
sults of a tuberculin skin test on a client
with no documented health problems.
The site has no induration and a 1-mm
area of ecchymosis. Which interpretation
Negative should the nurse make of these results?
*
A. Positive
B. Negative
C. Uncertain
D. Borderline
The nurse notes that a hospitalized client
has experience a positive reaction to the
tuberculin skin test. Which action by the
nurse is priority?
A.report the findings
report the findings B. document the findings in the clients
record
C. call the employee health service de-
partment
D. call the radiology department for a
chest x-ray
A client being discharged from the hos-
pital to home with a diagnosis of TB is
worried about the possibility of infecting
family members and others. Which infor-
mation should reassure the client that
contaminating family members and oth-
ers is not likely?
A. The family does not need therapy,
and client will not be contagious after 1
month of medication therapy
B. The family does not need therapy, and
4 / 16
the client will not be contagious after 6
consecutive weeks of medication thera-
py
C. The family will receive prophylactic
The family will receive prophylactic ther- therapy, and the client will not be conta-
apy and the client will not be contagious gious after 1 continuous week of medica-
after 2 to 3 weeks of medication therapy tion therapy
D. The family will receive prophylactic
therapy, and the client will not be conta-
gious after 2 to 3 weeks of medication
therapy
The nurse is reinforcing discharge teach-
ing with a client diagnosed with TB and
has been on medication for 1 and a half
weeks. The nurse knows that the client
has understood the information if which
statement is made?
" I should not be contagious after 2 to 3 A. " I can't shop at the mall for the next 6
weeks of medication therapy." months"
B. " I need to continue medication thera-
py for 2 months."
C. " I can return to work if a sputum
culture comes back negative."
D. " I should not be contagious after 2 to
3 weeks of medication therapy."
The nurse is caring for a client with em-
physema receiving oxygen. The nurse
should check the oxygen flow rate to
ensure the client does not exceed how
2 many L/minute of oxygen?
A. 1
B. 2
C. 6
D. 10
A client with tuberculosis is being start-
ed on antituberculosis therapy with iso-
niazid. Before giving the client the first
dose, the nurse ensures that which
5 / 16
baseline study has been completed?
A. electrolyte levels
liver enzyme levels B. coagulation levels
C. liver enzymes levels
D. serum creatinine level
For which of these reasons is it particu-
larly important for older adults to receive
influenza immunizations?
A. They tend to live alone.
they are more susceptible to upper res- B. They cannot tolerate changes in tem-
piratory infections. perature.
C. They tend not to seek medical assis-
tance soon enough.
D. They are more susceptible to upper
respiratory infections.
The nurse is caring for a patient who has
had a partial laryngectomy and is expe-
riencing difficulty swallowing. For which
complication is this patient most at risk?
aspiration
A. Aspiration
B. Epiglottitis
C. Esophageal varicosities
D. Paralysis of the vocal cords
*TEST* A patient's nose begins to bleed.
Which action should the LPN/LVN take?*
A. Tell the patient to keep swallowing.
B. Apply warm compresses to the nose
Have the patient apply direct pressure by
and face.
pinching his nose for 10 to 15 minutes
C. Encourage the patient to blow his
nose at frequent intervals.
D. Have the patient apply direct pressure
by pinching his nose for 10 to 15 minutes
A patient with a sore throat is to have a
throat culture to establish whether the in-
fection is being caused by Streptococcus
Glomerulonephritis
pyogenes. If it is a streptococcal infection
and the patient is not treated, what may
the patient be at risk for?
6 / 16
A. Cystitis
B. Hepatitis
C. Glaucoma
D. Glomerulonephritis
The nurse is caring for a patient going to
surgery for a tracheostomy. What is the
purpose of a tracheostomy?
inserting a tube for breathing A. Inserting a tube for feeding
B. Inserting a tube for breathing
C. Inserting a tube for bile drainage
D. Inserting a tube for gastric drainage
What are some commonly prescribed
drugs used for allergic rhinitis and sinusi-
tis?
A. Antihistamines, beta blockers, and
aspirin
Antihistamines, corticosteroids, and de-
B. corticosteriods, anginals, and antico-
congestants
agulants
C. Corticosteroids, alpha antagonists,
and aspirin
D. Antihistamines, corticosteroids, and
decongestants
A patient presents at the emergency
room complaining of severe throat pain
"that's so bad I can hardly swallow. It
feels like there's a huge lump in my
throat." The patient is diagnosed with se-
vere pharyngitis. What would the nurse
include in patient teaching regarding this
increase fluid intake to 2500 ml a day condition?
A. Increase fluid intake to 2500 mL a day.
B. Refrain from taking hot baths or show-
ers.
C. Limit the amount of fruit juice in the
patient's diet.
D. Decrease the humidity in the patient's
environment
7 / 16
The nurse is performing an admission
assessment on a patient who is sched-
uled for several diagnostic respiratory
procedures. Which symptom(s) reported
by the patient would make the nurse
persistent hoarseness suspect the patient may have laryngeal
cancer?
A. Anemia
B. Difficulty swallowing
C. Persistent hoarseness
D. Sleep apnea and snoring
The nurse is caring for a patient follow-
ing a total laryngectomy. Which interven-
tions should the nurse anticipate will be
preform tracheostomy care needed? (Select all that apply.)
maintain aspiration precautions A. Administer oral feedings.
develop an alternate communication B. Perform tracheostomy care.
method C. Maintain aspiration precautions.
D. Maintain neutropenic precautions.
E. Develop an alternate communication
method.
The nurse is caring for a patient with
epistaxis who is to be taken for x-rays
of the skull and face. What nursing inter-
vention(s) will be necessary? (Select all
monitoring airway patency that apply.)
keeping the patient sitting forward A. Monitoring airway patency
compressing the bleeding nostril against B. Administering a narcotic analgesic
the septum and apply ice C. Keeping the patient sitting forward
D. Encouraging the patient to take sips of
water
E. Compressing the bleeding nostril
against the septum and applying ice
The nurse assesses a patient with em-
physema and notes a barrel chest. What
Hyperinflation of the lungs is the reason for this patient's chest
anomaly?
8 / 16
A. Collapse of distal alveoli
B. Use of accessory muscles
C. Hyperinflation of the lungs
D. Long-term, chronic hypoxia
The nurse notes that the respiratory
symptoms of the patient with chronic
obstructive pulmonary disease (COPD)
have affected his nutrition. Which would
most help improve the patient's nutri-
tion?
Extra protein is required to repair dam-
A. Eat three large meals to increase
age tissues
stomach fullness.
B. Extra protein is required to repair
damaged tissues.
C. Exercise before eating each meal
three times a day.
D. Drink six to eight glasses of caffeinat-
ed fluids each day.
A patient with COPD asks the nurse to
turn his oxygen up from 3 L/min via nasal
cannula to 5 L/min. The nurse explains to
the patient that she cannot turn his oxy-
gen up this high. What is the reason the
oxygen cannot be increased to 5 L/min?
Hypoxic drive is necessary for breathing. A. Hypoxic drive is necessary for breath-
ing.
B. Hypercapnic drive is necessary for
breathing.
C. Higher concentrations may result in a
severe headache.
D. Higher levels will be required later for
arterial blood gases (ABGs).
A patient taking aminophylline tells the
nurse that he is going to begin a
smoking cessation program when he
is discharged from the hospital. Why
9 / 16
should the nurse tell this patient to no-
tify his physician if his smoking pattern
changes?
A. The patient will need his amino-

The patient will need his aminophylline phylline dosage adjusted.
dosage adjusted B. The patient will not derive as much
benefit from inhaler use.
C. The patient will require an increase in
antitussive medication.
D. The patient will no longer require an-
nual influenza immunization.
A patient with emphysema may lose
weight despite having an adequate
caloric intake. What advice should the
nurse give the patient regarding ways to
maintain an optimal weight?
A. Increase activity level to stimulate
increase calories, proteins, vitamins and
appetite.
minerals
B. Increase calories, protein, vitamins,
and minerals.
C. Continue the same caloric intake but
increase fat intake.
D. increase amounts of complex carbo-
hydrates and decrease fats.
The student nurse is caring for a pa-
tient with a restrictive respiratory dis-
ease. Which description demonstrates
the student's knowledge of the disease?
A. "The disease is characterized by in-

"The disease is characterized by de-
creased lung volumes."
creased lung expansion."
B. "The disease is characterized by de-
creased lung expansion."
C. "The disease is characterized by an
obstruction in the lungs."
D. "The disease is characterized by nar-
rowed tracheobronchial tree openings."
10 / 16
A patient who experienced high fever
and chills, a productive cough, chest
pain, general malaise, and aching mus-
cles during the past week is admitted
to the hospital. The nurse realizes these
symptoms correspond most closely with
Pneumonia
which disease?
A. Pneumonia
B. Type A influenza
C. Pleurisy with effusion
D. Streptococcus empyema
*TEST* *A patient with asthma is sud-
denly experiencing difficulty breathing,
tachypnea, and wheezing. Which med-
ication listed on the medication adminis-
tration record, administered through an
inhaler, should the nurse administer to
Albuterol
this patient?*
A.Albuterol
B. Cromolyn
C. Salmeterol
D. Formoterol
viral pneumonia. Which intervention(s)
should the nurse expect to be included
in the care plan? (Select all that apply.)
A. Providing adequate rest periods
B. Maintaining adequate fluid intake
A. Providing adequate rest periods
D. Monitoring vital signs and respiratory
B. Maintaining adequate fluid intake
status
C. administering organism-specific an-
E. Providing oral hygiene before and af-
tibiotics
ter meals
D. Monitoring vital signs and respiratory
status
E. Providing oral hygiene before and
after meals
11 / 16
The student nurse is preparing a report
about COPD. The student would be cor-
rect in including which disease(s) in the
report? (Select all that apply.)
emphysema
chronic bronchitis A. Emphysema
B. Bronchial asthma
C. Chronic bronchitis
D. Pleurisy with effusion
E. Pulmonary tuberculosis
*TEST* *A nurse is caring for several
patients who are scheduled for diagnos-
tic testing for respiratory disorders. The
patient who needs postprocedural care
that includes frequent vital signs is the
bronchoscopy
patient who had: *
A. capnography
B. D-Dimer test
C. a ventilation and perfusion scan
D. bronchoscopy
A nurse is caring for a patient who has
asthma. Which lung sound would the
nurse expect to hear when auscultating
this patients lung fields?
wheezes
A. fine crackles
B. stridor
C. pleural friction rub
D. wheezes
A nurse should observe for and report
which abnormal breathing pattern that
is most likely to occur in patients with
increased intracranial pressure?
biots respiration
A. cheyne-stokes respiration
B. kussmauls respiration
C. biot's respiration
D. apnustic respiration
*TEST* *The nurse is suctioning a pa-
tient who is unable to expectorate res-
12 / 16
piratory secretions from his tracheoto-
my. How can the nurse avoid the seri-
ous consequences of removing oxygen
when suctioning this patient?*
A. Keep suction pressure between 110
Do not suction the patient for more than and 120 mm Hg.
10 to 15 seconds B. Avoid giving the patient oxygen just
before suctioning.
C. Apply suction as the catheter is ad-
vanced into the trachea.
D. Do not suction the patient for more
than 10 to 15 seconds.
Which finding in a female patient should
indicate to the LPN/LVN that the patient
is likely to have a respiratory problem?
clubbing of the fingers A. Clubbing of the fingers

B. Inverted breast nipples
C. Inability to rotate the shoulder joint
A. A fine maculopapular rash over the
anterior of her chest
A patient is to have a bronchoscopy. The
LPN/LVN should expect which finding in
the postprocedure period?
blood- tinged sputum
A.Difficulty breathing
B. Blood-tinged sputum
C. Elevated temperature
D. Elevated blood pressure
The patient tells the LPN/LVN that she
has been hoarse for the past 2½ weeks.
Which response by the nurse is most
appropriate?
" You should see your primary health
care provider"
A."Try to talk as little as possible."
B. "Gargle with warm, slightly salted wa-
ter."
C. "You should see your primary health
13 / 16
care provider."
D. "Use a high-humidity vaporizer two or
three times a day."
It is appropriate to teach patients to ob-
tain sufficient rest to help decrease the
frequency with which they contract up-
per respiratory infections. How does rest
help prevent respiratory infections?
rest assists in keeping the immune sys- A. Rest enhances the functioning of the
tem healthy cough reflex.
B. Rest assists in keeping the immune
system healthy.
C. Rest allows the body to produce more
red blood cells.
D. Rest reduces the amount of vitamin C
that the body excretes.
To defend against exposure to foreign
particles, the mucous membrane of the
respiratory tract contains tiny, hairlike
projections. What are these called?
Cilia
A. Cilia
B. Alveoli
C. Surfactants
D. Chemoreceptors
The nurse is caring for a patient who is
going to have a thoracentesis performed.
How should the nurse position the pa-
tient for this procedure?
Sitting, facing the side of the bed
A.Flat, prone
B. Flat, supine
C. Sitting, facing the side of the bed
D. Sitting, facing the front of the bed
What structure allows for gas exchange
with the pulmonary capillaries during
respiration?
14 / 16
A. Lungs
Alveoli B. Alveoli
C. Bronchi
D. Trachea
Early Symptoms of acute bronchitis in-
clude:
A. Large amounts of sputum
Dry, hacking cough
B.high fever
C. Muscle soreness
D. Dry , hacking cough
Common signs and symptoms that
should alert the nurse to the possibility
of pneumonia include:
fever and chills A. Fever and chills
B. Nonproductive cough
C. Night sweats
D. Clubbed fingers
Diseases that are considered to be ob-
structive pulmonary disorders that cause
chronic airflow limitatons(CAL) include:
A. emphysema A.emphysema
B. acute bronchitis
C. pleurisy
D. pulmonary tuberculosis
Nutritonal therapy for the patient with
chronic obstructive pulmonary disease
(COPD) should include increasing fluids
to keep mucus thin, resting before eat-
ing, eating 4 to 6 small means a day and:
A. ensuring sufficient calcium intake to A. ensuring sufficient calcium intake to
prevent osteoporosis from use of steroid prevent osteoporosis from use of steroid
medications medications
B. increasing intake of caffeine in order
to boost energy levels
C. lying down immediately after meals to
allow for adequate rest
D. increasing sodium intake
15 / 16
Two of the most prevalent causative fac-

tors for the development of COPD are
cigarette smoking and:
A. high serum alpha-antitrypsin
C. rising levels of air pollution
B. exposure to mycobacterium tubercu-
losis
C. rising levels of air pollution
D. frequent upper respiratory infections
If a patient is exhibiting sudden chest
pain or tightness, dyspnea, increase
pulse and respirations, decreased BP,
and absence of normal chest move-
ments and breath sounds the patient is
B. pneumothorax
probably experencing an:
A. myocardial infarction
B. pneumothorax
C. acute tonsilitis
D. acute asthma attack
16 / 16
Respiratory Disorders NCLEX questions
Study online at https://quizlet.com/_2jw48e
A male patient has a sucking stab wound

to the chest. Which action should the
nurse take first?
ADrawing blood for a hematocrit and he-
moglobin level B
BApplying a dressing over the wound
and taping it on three sides
CPreparing a chest tube insertion tray
DPreparing to start an I.V. line
A male patient is admitted to the health
care facility for treatment of chronic
obstructive pulmonary disease. Which
nursing diagnosis is most important for
this patient?
AActivity intolerance related to fatigue
D
BAnxiety related to actual threat to
health status
CRisk for infection related to retained
secretions
DImpaired gas exchange related to air-
flow obstruction
A male adult patient hospitalized for D. The patient with respiratory alkalo-
treatment of a pulmonary embolism de- sis may complain of lightheadedness or
velops respiratory alkalosis. Which clin- paresthesia (numbness and tingling in
ical findings commonly accompany res- the arms and legs). Nausea, vomiting,
piratory alkalosis? abdominal pain, and diarrhea may ac-
A Nausea or vomiting company respiratory acidosis. Hallucina-
BAbdominal pain or diarrhea tions and tinnitus rare are associated
CHallucinations or tinnitus with respiratory alkalosis or any other
DLightheadedness or paresthesia acid-base imbalance.
D. Ephedrine is not recommended for el-
Before administering ephedrine, Nurse derly patients, who are particularly sus-
Tony assesses the patient's history. Be- ceptible to CNS reactions (such as con-
cause of ephedrine's central nervous fusion and anxiety) and to cardiovas-
system (CNS) effects, it is not recom- cular reactions (such as increased sys-
mended for: tolic blood pressure, coldness in the ex-
A Patients with an acute asthma attack tremities, and anginal pain). Ephedrine
is used for its bronchodilator effects with
1 / 13
acute and chronic asthma and occasion-
B Patients with narcolepsy
ally for its CNS stimulant actions for nar-
C Patients under age 6
colepsy. It can be administered to chil-
D Elderly patients
dren age 2 and older.
A female patient suffers adult respiratory
distress syndrome as a consequence of A. Conditions that trigger the high pres-
shock. The patient's condition deterio- sure alarm include kinking of the ventila-
rates rapidly, and endotracheal intuba- tor tubing, bronchospasm or pulmonary
tion and mechanical ventilation are initi- embolus, mucus plugging, water in the
ated. When the high pressure alarm on tube, coughing or biting on endotra-
the mechanical ventilator, alarm sounds, cheal tube, and the patient's being out
the nurse starts to check for the cause. of breathing rhythm with the ventilator. A
Which condition triggers the high pres- disconnected ventilator tube or an endo-
sure alarm? tracheal cuff leak would trigger the low
A Kinking of the ventilator tubing pressure alarm. Changing the oxygen
B A disconnected ventilator tube concentration without resetting the oxy-
C An endotracheal cuff leak gen level alarm would tigger the oxygen
D A change in the oxygen concentration alarm.
without resetting the oxygen level alarm
D.Pancuronium, a nondepolarizing
blocking agent, is used for muscle relax-
A male adult patient on mechanical ven- ation and paralysis. It assists mechanical
tilation is receiving pancuronium bro- ventilation by promoting encdotracheal
mide (Pavulon), 0.01 mg/kg I.V. as need- intubation and paralyzing the patient so
ed. Which assessment finding indicates that the mechanical ventilator can do its
that the patient needs another pancuro- work. Fighting the ventilator is a sign that
nium dose? the patient needs another pancuronium
A Leg movement dose. The nurse should administer 0.01
B Finger movement to 0.02 mg/kg I.V. every 20 to 60 minutes.
C Lip movement Movement of the legs, or lips has no ef-
D Fighting the ventilator fect on the ventilator and therefore is not
used to determine the need for another
dose.
B. In pneumothorax, the alveoli are de-
On auscultation, which finding suggests
flated and no air exchange occurs in
a right pneumothorax?
the lungs. Therefore, breath sounds in
A Bilateral inspiratory and expiratory
the affected lung field are absent. None
crackles
of the other options are associated with
2 / 13
pneumothorax. Bilateral crackles may re-
B Absence of breaths sound in the right
sult from pulmonary congestion, inspira-
thorax
tory wheezes may signal asthma, and a
C Inspiratory wheezes in the right thorax
pleural friction rub may indicate pleural
D Bilateral pleural friction rub
inflammation.
Rhea, confused and short breath, is
brought to the emergency department
by a family member. The medical history
B.A lowercase "a" in an ABG value rep-
reveals chronic bronchitis and hyperten-
resents arterial blood. For instance, the
sion. To learn more about the current
abbreviation PaO2 refers to the partial
respiratory problem, the doctor orders a
pressure of oxygen in arterial blood. The
chest x-ray and arterial blood gas (ABG)
pH value reflects the acid base balance
analysis. When reviewing the ABG re-
in arterial blood. Sa02 indicates arteri-
port, the nurses sees many abbrevia-
al oxygen saturation. An uppercase "A"
tions. What does a lowercase "a" in ABG
represents alveolar conditions: for exam-
value present?
ple, PA02 indicates the partial pressure
A Acid-base balance
of oxygen in the alveoli.
B Arterial Blood
C Arterial oxygen saturation
D Alveol
D. The trachea will shift according to the
pressure gradients within the thoracic
Nurse Ruth assessing a patient for tra-
cavity. In tension pneumothorax and he-
cheal displacement should know that the
mothorax, accumulation of air or fluid
trachea will deviate toward the:
causes a shift away from the injured side.
A Contralateral side in a simple pneu-
If there is no significant air or fluid accu-
mothorax
mulation, the trachea will not shift. Tra-
B Affected side in a hemothorax
cheal deviation toward the contralater-
C Affected side in a tension pneumotho-
al side in simple pneumothorax is seen
rax
when the thoracic contents shift in re-
D Contralateral side in hemothorax
sponse to the release of normal thoracic
pressure gradients on the injured side.
After undergoing a left pneumonectomy, C. When caring for a patient who is
a female patient has a chest tube in recovering from a pneumonectomy, the
place for drainage. When caring for this nurse should encourage coughing and
patient, the nurse must: deep breathing to prevent pneumonia in
A Monitor fluctuations in the water-seal the unaffected lung. Because the lung
chamber has been removed, the water-seal cham-
3 / 13
ber should display no fluctuations. Rein-
B Clamp the chest tube once every shift
flation is not the purpose of chest tube.
C Encourage coughing and deep breath-
Chest tube milking is controversial and
ing
should be done only to remove blood
D Milk the chest tube every 2 hours
clots that obstruct the flow of drainage
C. The patient with COPD retains car-
bon dioxide, which inhibits stimulation
of breathing by the medullary center in
the brain. As a result, low oxygen levels
in the blood stimulate respiration, and
For a patient with advance chronic ob-
administering unspecified, unmonitored
structive pulmonary disease (COPD),
amounts of oxygen may depress ven-
which nursing action best promotes ad-
tilation. To promote adequate gas ex-
equate gas exchange?
change, the nurse should use a Venturi
A Encouraging the patient to drink three
mask to deliver a specified, controlled
glasses of fluid daily
amount of oxygen consistently and ac-
B Keeping the patient in semi-fowler's
curately. Drinking three glasses of fluid
position
daily would not affect gas exchange or
C Using a high-flow venturi mask to de-
be sufficient to liquefy secretions, which
liver oxygen as prescribe
are common in COPD. Patients with
D Administering a sedative, as prescribe
COPD and respiratory distress should
be places in high-Fowler's position and
should not receive sedatives or other
drugs that may further depress the res-
piratory center.
C. ARDS results from increased pul-
A male patient's X-ray result reveals bi-
monary capillary permeability, which
lateral white-outs, indicating adult respi-
leads to noncardiogenic pulmonary ede-
ratory distress syndrome (ARDS). This
ma. In cardiogenic pulmonary ede-
syndrome results from:
ma, pulmonary congestion occurs sec-
A Cardiogenic pulmonary edema
ondary to heart failure. In the initial stage
B Respiratory alkalosis
of ARDS, respiratory alkalosis may arise
C Increased pulmonary capillary perme-
secondary to hyperventilation; however,
ability
it does not cause ARDS. Renal failure
D Renal failure
does not cause ARDS, either.
Nurse Lei caring for a client with a pneu- A. Continuous gentle bubbling should be
mothorax and who has had a chest tube noted in the suction control chamber. Op-
inserted notes continues gentle bubbling tion b is incorrect. Chest tubes should
4 / 13
in the suction control chamber. What ac-
only be clamped to check for an air leak
tion is appropriate?
or when changing drainage devices (ac-
A Do nothing, because this is an expect-
cording to agency policy). Option c is
ed finding
incorrect. Bubbling should be continuous
B Immediately clamp the chest tube and
and not intermittent. Option d is incor-
notify the physician
rect because bubbling should be gentle.
C Check for an air leak because the
Increasing the suction pressure only in-
bubbling should be intermittent
creases the rate of evaporation of water
D Increase the suction pressure so that
in the drainage system.
the bubbling becomes vigorous
Nurse Maureen has assisted a physi-
B. The presence of fluctuation of the fluid
cian with the insertion of a chest tube.
level in the water seal chamber indicates
The nurse monitors the client and notes
a patent drainage system. With normal
fluctuation of the fluid level in the water
breathing, the water level rises with in-
seal chamber after the tube is inserted.
spiration and falls with expiration. Fluc-
Based on this assessment, which action
tuation stops if the tube is obstructed, if
would be appropriate?
a dependent loop exists, if the suction is
A Inform the physician
not working properly, or if the lung has
B Continue to monitor the client
reexpanded. Options A, C, and D are
C Reinforce the occlusive dressing
incorrect.
D Encourage the client to deep-breathe
B. If the chest drainage system is discon-
Nurse Reynolds caring for a client with
nected, the end of the tube is placed in
a chest tube turns the client to the side,
a bottle of sterile water held below the
and the chest tube accidentally discon-
level of the chest. The system is replaced
nects. The initial nursing action is to:
if it breaks or cracks or if the collection
A Call the physician
chamber is full. Placing a sterile dress-
B Place the tube in bottle of sterile water
ing over the disconnection site will not
C Immediately replace the chest tube
prevent complications resulting from the
system
disconnection. The physician may need
D Place a sterile dressing over the dis-
to be notified, but this is not the initial
connection site
action.
D. When the chest tube is removed, the
A nurse is assisting a physician with
client is asked to perform the Valsalva
the removal of a chest tube. The nurse
maneuver (take a deep breath, exhale,
should instruct the client to:
and bear down). The tube is quickly with-
A Exhale slowly
drawn, and an airtight dressing is taped
B Stay very still
in place. An alternative instruction is to
5 / 13
ask the client to take a deep breath and
C Inhale and exhale quickly hold the breath while the tube is re-
D Perform the Valsalva maneuver moved. Options A, B, and C are incorrect
client instructions.
While changing the tapes on a tra-
cheostomy tube, the male client coughs B. If the tube is dislodged accidentally,
and tube is dislodged. The initial nursing the initial nursing action is to grasp the
action is to: retention sutures and spread the open-
A Call the physician to reinsert the tube ing. If agency policy permits, the nurse
B Grasp the retention sutures to spread then attempts immediately to replace the
the opening tube. Covering the tracheostomy site will
C Call the respiratory therapy depart- block the airway. Options A and C will
ment to reinsert the tracheotomy delay treatment in this emergency situ-
D Cover the tracheostomy site with a ation.
sterile dressing to prevent infection
Nurse Oliver is caring for a client imme- A. The nurse reports stridor to the physi-
diately after removal of the endotracheal cian immediately. This is a high-pitched,
tube. The nurse reports which of the fol- coarse sound that is heard with the
lowing signs immediately if experienced stethoscope over the trachea. Stridor in-
by the client? dicates airway edema and places the
A Stridor client at risk for airway obstruction. Op-
B Occasional pink-tinged sputum tions B, C, and D are not signs that re-
C A few basilar lung crackles on the right quire immediate notification of the physi-
D Respiratory rate 24 breaths/min cian.
B. This client has sustained a blunt or
An emergency room nurse is assessing
a closed chest injury. Basic symptoms
a male client who has sustained a blunt
of a closed pneumothorax are short-
injury to the chest wall. Which of these
ness of breath and chest pain. A larg-
signs would indicate the presence of a
er pneumothorax may cause tachypnea,
pneumothorax in this client?
cyanosis, diminished breath sounds, and
A A low respiratory rate
subcutaneous emphysema. Hyperreso-
B Diminished breath sounds
nance also may occur on the affected
C The presence of a barrel chest
side. A sucking sound at the site of injury
D A sucking sound at the site of injury
would be noted with an open chest injury.
Nurse Reese is caring for a client hospi-
talized with acute exacerbation of chron- B. Clinical manifestations of chronic ob-
ic obstructive pulmonary disease. Which structive pulmonary disease (COPD) in-
of the following would the nurse expect
6 / 13
to note on assessment of this client?
clude hypoxemia, hypercapnia, dyspnea
A Hypocapnia
on exertion and at rest, oxygen desat-
B A hyperinflated chest noted on the
uration with exercise, and the use of
chest x-ray
accessory muscles of respiration. Chest
C Increased oxygen saturation with ex-
x-rays reveal a hyperinflated chest and
ercise
a flattened diaphragm if the disease is
D A widened diaphragm noted on the
advanced.
chest x-ray
An oxygen delivery system is prescribed
for a male client with chronic obstructive
pulmonary disease to deliver a precise
oxygen concentration. Which of the fol-
lowing types of oxygen delivery systems
B. The Venturi mask delivers the most
would the nurse anticipate to be pre-
accurate oxygen concentration
scribed?
A Face tent
B Venturi mask
C Aerosol mask
D Tracheostomy collar
Blessy, a community health nurse is
conducting an educational session with
community members regarding tubercu-
losis. The nurse tells the group that one D. One of the first pulmonary symptoms
of the first symptoms associated with tu- is a slight cough with the expectoration
berculosis is: of mucoid sputum. Options A, B, and C
A Dyspnea are late symptoms and signify cavitation
B Chest pain and extensive lung involvement.
C A bloody, productive cough
D A cough with the expectoration of mu-
coid sputum
B. Tuberculosis is definitively diagnosed
A nurse performs an admission assess-
through culture and isolation of My-
ment on a female client with a diagnosis
cobacterium tuberculosis. A presumptive
of tuberculosis. The nurse reviews the
diagnosis is made based on a tuberculin
result of which diagnosis test that will
skin test, a sputum smear that is positive
confirm this diagnosis?
for acid-fast bacteria, a chest x-ray, and
A Bronchoscopy
histological evidence of granulomatous
B Sputum culture
disease on biopsy.
7 / 13
C Chest x-ray
D Tuberculin skin test
A nurse is caring for a male client with
B. Oxygen is used cautiously and should
emphysema who is receiving oxygen.
not exceed 2 L/min. Because of the
The nurse assesses the oxygen flow rate
long-standing hypercapnia that occurs in
to ensure that it does not exceed:
emphysema, the respiratory drive is trig-
A 1 L/min
gered by low oxygen levels rather than
B 2 L/min
increased carbon dioxide levels, as is the
C 6 L/min
case in a normal respiratory system.
D 10 L/min
A nurse instructs a female client to use
the pursed-lip method of breathing and D. Pursed-lip breathing facilitates maxi-
the client asks the nurse about the pur- mal expiration for clients with obstructive
pose of this type of breathing. The nurse lung disease. This type of breathing al-
responds, knowing that the primary pur- lows better expiration by increasing air-
pose of pursed-lip breathing is to: way pressure that keeps air passages
A Promote oxygen intake open during exhalation. Options A, B,
B Strengthen the diaphragm and C are not the purposes of this type
C Strengthen the intercostal muscles of breathing.
D Promote carbon dioxide elimination
A nurse is caring for a male client with B. The earliest clinical sign of acute
acute respiratory distress syndrome. respiratory distress syndrome is an in-
Which of the following would the nurse creased respiratory rate. Breathing be-
expect to note in the client? comes labored, and the client may exhib-
A Pallor it air hunger, retractions, and cyanosis.
B Low arterial PaO2 Arterial blood gas analysis reveals in-
C Elevated arterial PaO2 creasing hypoxemia, with a PaO2 lower
D Decreased respiratory rate than 60 mm Hg.
B. To obtain a sputum specimen, the
A nurse is preparing to obtain a sputum
client should rinse the mouth to reduce
specimen from a male client. Which of
contamination, breathe deeply, and then
the following nursing actions will facili-
cough into a sputum specimen contain-
tate obtaining the specimen?
er. The client should be encouraged to
ALimiting fluid
cough and not spit so as to obtain spu-
BHaving the client take deep breaths
tum. Sputum can be thinned by fluids
CAsking the client to spit into the collec-
or by a respiratory treatment such as
tion container
inhalation of nebulized saline or water.
8 / 13
DAsking the client to obtain the speci- The optimal time to obtain a specimen is
men after eating on arising in the morning.
C. If a biopsy was performed during a
Nurse Joy is caring for a client after a bronchoscopy, blood-streaked sputum is
bronchoscopy and biopsy. Which of the expected for several hours. Frank blood
following signs, if noticed in the client, indicates hemorrhage. A dry cough may
should be reported immediately to the be expected. The client should be as-
physician? sessed for signs of complications, which
A Dry cough would include cyanosis, dyspnea, stri-
B Hermaturia dor, bronchospasm, hemoptysis, hy-
CBronchospasm potension, tachycardia, and dysrhyth-
DBlood-streaked sputum mias. Hematuria is unrelated to this pro-
cedure.
A nurse is suctioning fluids from a male
C. Hypoxemia can be caused by pro-
client via a tracheostomy tube. When
longed suctioning, which stimulates the
suctioning, the nurse must limit the suc-
pacemaker cells in the heart. A vasova-
tioning time to a maximum of:
gal response may occur, causing brady-
A1 minute
cardia. The nurse must preoxygenate the
B5 seconds
client before suctioning and limit the suc-
C10 seconds
tioning pass to 10 seconds.
D30 seconds
A nurse is suctioning fluids from a fe-
male client through an endotracheal
C. During suctioning, the nurse should
tube. During the suctioning procedure,
monitor the client closely for side effects,
the nurse notes on the monitor that the
including hypoxemia, cardiac irregulari-
heart rate is decreasing. Which if the
ties such as a decrease in heart rate
following is the appropriate nursing inter-
resulting from vagal stimulation, mucos-
vention?
al trauma, hypotension, and paroxysmal
AContinue to suction
coughing. If side effects develop, espe-
BNotify the physician immediately
cially cardiac irregularities, the proce-
C Stop the procedure and reoxygenate
dure is stopped and the client is reoxy-
the client
genated.
DEnsure that the suction is limited to 15
seconds
A male adult client is suspected of hav-
ing a pulmonary embolus. A nurse as-
sesses the client, knowing that which of
the following is a common clinical mani-
9 / 13
festation of pulmonary embolism?
A Dyspnea A. The common clinical manifestations
B Bradypnea of pulmonary embolism are tachypnea,
C Bradycardia tachycardia, dyspnea, and chest pain.
D Decreased respirations
A.When percussing the chest wall, the
nurse expects to elicit resonant sounds
A slightly obese female client with a his- — low-pitched, hollow sounds heard
tory of allergy-induced asthma, hyper- over normal lung tissue. Hyperresonant
tension, and mitral valve prolapse is ad- sounds indicate increased air in the
mitted to an acute care facility for elec- lungs or pleural space; they're loud-
tive surgery. The nurse obtains a com- er and lower pitched than resonant
plete history and performs a thorough sounds. Although hyperresonant sounds
physical examination, paying special at- occur in such disorders as emphysema
tention to the cardiovascular and res- and pneumothorax, they may be nor-
piratory systems. When percussing the mal in children and very thin adults. Dull
client's chest wall, the nurse expects to sounds, normally heard only over the
elicit: liver and heart, may occur over dense
A Resonant sounds lung tissue, such as from consolidation
B Hyperresonant sounds or a tumor. Dull sounds are thudlike and
C Dull sounds of medium pitch. Flat sounds, soft and
D Flat sounds high-pitched, are heard over airless tis-
sue and can be replicated by percussing
the thigh or a bony structure.
Which phrase is used to describe the
volume of air inspired and expired with Tidal volume
a normal breath?
A male client abruptly sits up in bed,
reports having difficulty breathing and
has an arterial oxygen saturation of 88%. B. A non-rebreather mask can deliver
Which mode of oxygen delivery would levels of the fraction of inspired oxygen
most likely reverse the manifestations? (FIO2) as high as 100%. Other modes —
A Simple mask simple mask, face tent, and nasal cannu-
B Non-rebreather mask la — deliver lower levels of FIO2.
C Face tent
D Nasal cannula
C. Decreased hearing acuity indicates
ototoxicity, a serious adverse effect of
10 / 13
streptomycin therapy. The client should
A female client must take streptomycin
notify the physician immediately if it oc-
for tuberculosis. Before therapy begins,
curs so that streptomycin can be dis-
the nurse should instruct the client to no-
continued and an alternative drug can
tify the physician if which health concern
be prescribed. The other options aren't
occurs?
associated with streptomycin. Impaired
A Impaired color discrimination
color discrimination indicates color blind-
B Increased urinary frequency
ness; increased urinary frequency and
C Decreased hearing acuity
increased appetite accompany diabetes
D Increased appetite
mellitus.
A male client is asking the nurse a ques-
tion regarding the Mantoux test for tu- B.The Mantoux test doesn't differentiate
berculosis. The nurse should base her between active and dormant infections.
response on the fact that the: If a positive reaction occurs, a sputum
A Area of redness is measured in 3 days smear and culture as well as a chest
and determines whether tuberculosis is X-ray are necessary to provide more in-
present. formation. Although the area of redness
B Skin test doesn't differentiate between is measured in 3 days, a second test may
active and dormant tuberculosis infec- be needed; neither test indicates that tu-
tion. berculosis is active. In the Mantoux test,
C Presence of a wheal at the injection an induration 5 to 9 mm in diameter in-
site in 2 days indicates active tuberculo- dicates a borderline reaction; a larger
sis. induration indicates a positive reaction.
D Test stimulates a reddened response The presence of a wheal within 2 days
in some clients and requires a second doesn't indicate active tuberculosis.
test in 3 months.
B. Initially, the nurse should plug the
opening in the tracheostomy tube for 5
A female adult client has a tracheostomy
to 20 minutes, then gradually lengthen
but doesn't require continuous mechan-
this interval according to the client's res-
ical ventilation. When weaning the client
piratory status. A client who doesn't re-
from the tracheostomy tube, the nurse
quire continuous mechanical ventilation
initially should plug the opening in the
already is breathing without assistance,
tube for:
at least for short periods; therefore, plug-
ging the opening of the tube for only 15
A15 to 60 seconds
to 60 seconds wouldn't be long enough
B 5 to 20 minutes
to reveal the client's true tolerance to
the procedure. Plugging the opening for
11 / 13
more than 20 minutes would increase
C30 to 40 minutes the risk of acute respiratory distress be-
D 45 to 60 minutes cause the client requires an adjustment
period to start breathing normally.
C. Constant bubbling in the chamber in-
Nurse Oliver observes constant bubbling dicates an air leak and requires immedi-
in the water-seal chamber of a closed ate intervention. The client with a pneu-
chest drainage system. What should the mothorax will have intermittent bubbling
nurse conclude? in the water-seal chamber. Clients with-
AThe system is functioning normally out a pneumothorax should have no ev-
B The client has a pneumothorax idence of bubbling in the chamber. If the
C The system has an air leak tube is obstructed, the nurse should no-
D The chest tube is obstructed tice that the fluid has stopped fluctuating
in the water-seal chamber.
A black client with asthma seeks emer-
gency care for acute respiratory distress.
Because of this client's dark skin, the
nurse should assess for cyanosis by in-
specting the: B
A Lips
B Mucous membranes
C Nail beds
D Earlobes
For a male client with an endotracheal
(ET) tube, which nursing action is most A.For a client with an ET tube, the most
essential? important nursing action is auscultating
A Auscultating the lungs for bilateral the lungs regularly for bilateral breath
breath sounds sounds to ensure proper tube placement
B Turning the client from side to side and effective oxygen delivery. Although
every 2 hours the other options are appropriate for this
C Monitoring serial blood gas values client, they're secondary to ensuring ad-
every 4 hours equate oxygenation.
D Providing frequent oral hygiene
C. In a client with COPD, an ineffective
cough impedes secretion removal. This,
A male client with chronic obstructive
in turn, causes mucus plugging, which
pulmonary disease (COPD) is recov-
leads to localized airway obstruction —
a known cause of atelectasis. An ineffec-
12 / 13
tive cough doesn't cause pleural effusion
ering from a myocardial infarction. Be- (fluid accumulation in the pleural space).
cause the client is extremely weak and Pulmonary edema usually results from
can't produce an effective cough, the left-sided heart failure, not an ineffective
nurse should monitor closely for: cough. Although many noncardiac con-
A Pleural effusion ditions may cause pulmonary edema,
B Pulmonary edema an ineffective cough isn't one of them.
C Atelectasis Oxygen toxicity results from prolonged
D Oxygen toxicity administration of high oxygen concentra-
tions, not an ineffective cough.
A.Pursed-lip breathing helps prevent
The nurse in charge is teaching a early airway collapse. Learning this tech-
client with emphysema how to perform nique helps the client control respira-
pursed-lip breathing. The client asks the tion during periods of excitement, anx-
nurse to explain the purpose of this iety, exercise, and respiratory distress.
breathing technique. Which explanation To increase inspiratory muscle strength
should the nurse provide? and endurance, the client may need
to learn inspiratory resistive breathing.
A It helps prevent early airway collapse To decrease accessory muscle use and
B It increases inspiratory muscle thus reduce the work of breathing, the
strength client may need to learn diaphragmat-
C It decreases use of accessory breath- ic (abdominal) breathing. In pursed-lip
ing muscles breathing, the client mimics a normal in-
D It prolongs the inspiratory phase of spiratory-expiratory (I:E) ratio of 1:2. (A
respiration client with emphysema may have an I:E
ratio as high as 1:4.)
D In respiratory acidosis, ABG analysis
A client with Guillain-Barré syndrome reveals an arterial pH below 7.35 and
develops respiratory acidosis as a result partial pressure of arterial carbon diox-
of reduced alveolar ventilation. Which ide (PaCO2) above 45 mm Hg. There-
combination of arterial blood gas (ABG) fore, the combination of a pH value of
values confirms respiratory acidosis? 7.25 and a PaCO2 value of 50 mm Hg
confirms respiratory acidosis. A pH value
A pH, 5.0; PaCO2 30 mm Hg of 5.0 with a PaCO2 value of 30 mm Hg
B pH, 7.40; PaCO2 35 mm Hg indicates respiratory alkalosis. Options
C pH, 7.35; PaCO2 40 mm Hg B and C represent normal ABG values,
D pH, 7.25; PaCO2 50 mm Hg reflecting normal gas exchange in the
lungs.
13 / 13
NUR310 Chapter 26: Respiratory System NCLEX Questions
Study online at https://quizlet.com/_1gg1vl
1. Have trouble falling asleep?; Awaken

abruptly during the night?; Need to sleep
When assessing a patient's sleep-rest with the head elevated?
pattern related to respiratory health, a. The patient with sleep apnea may
what should the nurse ask the patient have insomnia and/or abrupt awaken-
about (select all that apply)? ings. Patients with cardiovascular dis-
1. Have trouble falling asleep? ease (e.g., heart failure that may affect
2. Need to urinate during the night? respiratory health) may need to sleep
3. Awaken abruptly during the night? with the head elevated on several pillows
4. Sleep more than 8 hours per night? (orthopnea). Sleeping more than 8 hours
5. Need to sleep with the head elevated? per night or needing to urinate during the
night is not indicative of impaired respi-
ratory health.
What should the nurse inspect when 2. Fingernails and their base
assessing a patient with shortness of a. Clubbing, a sign of long-standing hy-
breath for evidence of long-standing hypoxemia, is evidenced by an increase
poxemia? in the angle between the base of the
1. Chest excursion nail and the fingernail to 180 degrees
2. Spinal curvatures or more, usually accompanied by an in-
3. Respiratory pattern crease in the depth, bulk, and spongi-
4. Fingernails and their base ness of the end of the finger.
3. 5 minutes
chronic obstructive pulmonary disorder
a. After obtaining blood for an arteri-
(COPD) and pneumonia who has an or-
al blood gas measurement, the nurse
der for arterial blood gases to be drawn.
should hold pressure on the puncture
What is the minimum length of time the
site for 5 minutes by the clock to be sure
nurse should plan to hold pressure on
that bleeding has stopped. An artery
the puncture site?
is an elastic vessel under much high-
1. 2 minutes
er pressure than veins, and significant
2. 5 minutes
blood loss or hematoma formation could
3. 10 minutes
occur if the time is insufficient.
4. 15 minutes
4. Positron emission tomography (PET)
A patient with a recent history of a dry
a. ET is used to distinguish benign and
cough has had a chest x-ray that re-
malignant pulmonary nodules. Because
vealed the presence of nodules. In an
malignant lung cells have an increased
effort to determine whether the nodules
uptake of glucose, the PET scan (which
are malignant or benign, what is the pri-
uses an IV radioactive glucose prepara-
1/6
mary care provider likely to order? tion) can demonstrate increased uptake
1. Thoracentesis of glucose in malignant lung cells. This
2. Pulmonary angiogram differentiation cannot be made using CT,
3. CT scan of the patient's chest a pulmonary angiogram, or thoracente-
4. Positron emission tomography (PET) sis.
A patient with recurrent shortness of
5. Monitor the patient for laryngeal ede-
breath has just had a bronchoscopy.
ma.
What is a priority nursing action imme-
a. Priorities for assessment are the pa-
diately following the procedure?
tient's airway and breathing, both of
1. Monitor the patient for laryngeal ede-
which may be compromised after bron-
ma.
choscopy by laryngeal edema. These
2. Assess the patient's level of con-
assessment parameters supersede the
sciousness.
importance of loss of consciousness
3. Monitor and manage the patient's level
(LOC), pain, heart rate, and blood pres-
of pain.
sure, although the nurse should also be
4. Assess the patient's heart rate and
assessing these.
blood pressure.
After assisting at the bedside with a tho- 6. Pneumothorax
racentesis, the nurse should continue to a. Because thoracentesis involves the
assess the patient for signs and symp- introduction of a catheter into the pleur-
toms of what? al space, there is a risk of pneumoth-
1. Bronchospasm orax. Thoracentesis does not carry a
2. Pneumothorax significant potential for causing bron-
3. Pulmonary edema chospasm, pulmonary edema, or respi-
4. Respiratory acidosis ratory acidosis.
7. Atelectasis
a. Postoperatively there is an increased
The patient had abdominal surgery yes- risk for atelectasis from anesthesia as
terday. Today the lung sounds in the well as restricted breathing from pain.
lower lobes have decreased. The nurse Without deep breathing to stretch the
knows this could be due to what occur- alveoli, surfactant secretion to hold the
ring? alveoli open is not promoted. Pneumo-
1. Pain nia will occur later after surgery. Pleur-
2. Atelectasis al effusion occurs because of blockage
3. Pneumonia of lymphatic drainage or an imbalance
4. Pleural effusion between intravascular and oncotic fluid
pressures, which is not expected in this
case.
2/6
The patient's arterial blood gas results
8. Restlessness, tachypnea, tachycar-
show the PaO2 at 65 mmHg and the
dia, and diaphoresis
SaO2 at 80%. What early manifestations
a. With inadequate oxygenation, ear-
should the nurse expect to observe in
ly manifestations include restlessness,
this patient?
tachypnea, tachycardia, and diaphore-
1. Restlessness, tachypnea, tachycar-
sis, decreased urinary output, and unex-
dia, and diaphoresis
plained fatigue. The unexplained confu-
2. Unexplained confusion, dyspnea at
sion, dyspnea at rest, hypotension, and
rest, hypotension, and diaphoresis
diaphoresis; combativeness, retractions
3. Combativeness, retractions with
with breathing, cyanosis, and decreased
breathing, cyanosis, and decreased out-
urinary output; coma, accessory muscle
put
use, cool and clammy skin, and unex-
4. Coma, accessory muscle use, cool
plained fatigue occur as later manifesta-
and clammy skin, and unexplained fa-
tions of inadequate oxygenation.
tigue
9. Rapid respiratory rate
When the patient is experiencing meta-
a. When a patient with type 1 diabetes
bolic acidosis secondary to type 1 di-
has hyperglycemia and ketonemia caus-
abetes mellitus, what physiologic re-
ing metabolic acidosis, the physiologic
sponse should the nurse expect to as-
response is to increase the respiratory
sess in the patient?
rate and tidal volume to blow off the ex-
1. Vomiting
cess CO2. Vomiting and increased urina-
2. Increased urination
tion may occur with hyperglycemia, but
3. Decreased heart rate
not as physiologic responses to metabol-
4. Rapid respiratory rate
ic acidosis. The heart rate will increase.
10. Decreased respiratory defense
mechanisms
After swallowing, a 73-year-old patient a. These manifestations are associated
is coughing and has a wet voice. What with aspiration, which more easily occur
changes of aging could be contributing in the right lung as the right mainstem
to this abnormality? bronchus is shorter, wider, and straighter
1. Decreased response to hypercapnia than the left mainstem bronchus. Aspi-
2. Decreased number of functional alve- ration occurs more easily in the older
oli patient related to decreased respiratory
3. Increased calcification of costal carti- defense mechanisms (e.g., decreases in
lage immunity, ciliary function, cough force,
sensation in pharynx). Changes of ag-
ing include a decreased response to hy-
3/6
percapnia, decreased number of func-
4. Decreased respiratory defense mech- tional alveoli, and increased calcification
anisms of costal cartilage, but these do not in-
crease the risk of aspiration.
11. Arterial blood gases
a. Arterial blood gases are used to as-
sess the efficiency of gas transfer in the
lung and tissue oxygenation as is pulse
The patient is hospitalized with pneu-
oximetry. Thoracentesis is used to obtain
monia. Which diagnostic test should be
specimens for diagnostic evaluation, re-
used to measure the efficiency of gas
move pleural fluid, or instill medication
transfer in the lung and tissue oxygena-
into the pleural space. Bronchoscopy
tion?
is used for diagnostic purposes, to ob-
1. Thoracentesis
tain biopsy specimens, and to assess
2. Bronchoscopy
changes resulting from treatment. Pul-
3. Arterial blood gases
monary function tests measure lung
4. Pulmonary function tests
volumes and airflow to diagnose pul-
monary disease, monitor disease pro-
gression, evaluate disability, and evalu-
ate response to bronchodilators.
12. Coarse crackles
a. Coarse crackles are a se-
ries of long-duration, discontinuous,
low-pitched sounds caused by air pass-
ing through an airway intermittently oc-
The nurse, when auscultating the lower cluded by mucus, an unstable bronchial
lungs of the patient, hears these breath wall, or a fold of mucosa. Coarse crack-
sounds. How should the nurse document les are evident on inspiration and at
these sounds? times expiration. Stridor is a continu-
1. Stridor ous crowing sound of constant pitch
2. Rhonchi from partial obstruction of larynx or tra-
3. Coarse crackles chea. Rhonchi are a continuous rum-
4. Bronchovesicular bling, snoring, or rattling sound from ob-
struction of large airways with secre-
tions. Bronchovesicular sounds are nor-
mal sounds heard anteriorly over the
mainstem bronchi on either side of the
sternum and posteriorly between the
4/6
scapulae with a medium pitch and inten-
sity.
13. Cough sound, sputum production,
pattern
a. The sound of the cough, sputum pro-
duction and description, as well as pat-
tern of the cough's occurrence (includ-
The patient is calling the clinic with ing acute or chronic) and what its oc-
a cough. What assessment should be currence is related to are the first as-
made first before the nurse advises the sessments to be made to determine the
patient? severity. Frequency of the cough will not
1. Cough sound, sputum production, pat- provide a lot of information. Family histo-
tern ry can help to determine a genetic cause
2. Frequency, a family history, he- of the cough. Hematemesis is vomiting
matemesis blood and not as important as hemop-
3. Smoking, medications, residence lo- tysis. Smoking is an important risk fac-
cation tor for COPD and lung cancer and may
4. Weight loss, activity tolerance, orthop- cause a cough. Medications may or may
nea not contribute to a cough as does res-
idence location. Weight loss, activity in-
tolerance, and orthopnea may be related
to respiratory or cardiac problems, but
are not as important when dealing with
a cough.
14. Trachea moved to the left
During the assessment in the ED, the a. Tracheal deviation is a medical emer-
nurse is palpating the patient's chest. gency when it is caused by a tension
Which finding is a medical emergency? pneumothorax. Tactile fremitus increas-
1. Trachea moved to the left es with pneumonia or pulmonary edema
2. Increased tactile fremitus and decreases in pleural effusion or lung
3. Decreased tactile fremitus hyperinflation. Diminished chest move-
4. Diminished chest movement ment occurs with barrel chest, restrictive
disease, and neuromuscular disease.
The patient with Parkinson's disease 15. Motion
has a pulse oximetry reading of 72%, a. Motion is the most likely cause of the
but he is not displaying any other signs low SpO2 for this patient with Parkin-
of decreased oxygenation. What is most son's disease. Anemia, dark skin color,
likely contributing to his low SpO2 level? and thick acrylic nails as well as low
5/6
perfusion, bright fluorescent lights, and
1. Motion
intravascular dyes may also cause an in-
2. Anemia
accurate pulse oximetry result. There is
3. Dark skin color
no mention of these or reason to suspect
4. Thick acrylic nails
these in this question
16. Tripod position; Accessory muscle
use
a. Tripod position and accessory muscle
In assessment of the patient with acute use indicate moderate to severe respi-
respiratory distress, what should the ratory distress. Cyanosis may be related
nurse expect to observe (select all that to anemia, decreased oxygen transfer in
apply)? the lungs, or decreased cardiac output.
1. Cyanosis Therefore it is a nonspecific and unre-
2. Tripod position liable indicator of only respiratory dis-
3. Kussmaul respirations tress. Kussmaul respirations occur when
4. Accessory muscle use the patient is in metabolic acidosis to
5. Increased AP diameter increase CO2 excretion. Increased AP
diameter occurs with lung hyperinflation
from COPD, cystic fibrosis, or with ad-
vanced age.
6/6
Study online at https://quizlet.com/_25qruk
Nurse Reese is caring for a client hospi- B. A hyperinflated chest noted on the
talized with acute exacerbation of chron- chest x-ray
ic obstructive pulmonary disease. Which Explanation:
of the following would the nurse expect Clinical manifestations of chronic ob-
to note on assessment of this client? structive pulmonary disease (COPD) in-
A. Hypocapnia clude hypoxemia, hypercapnia, dyspnea
B. A hyperinflated chest noted on the on exertion and at rest, oxygen desat-
chest x-ray uration with exercise, and the use of
C. Increased oxygen saturation with ex- accessory muscles of respiration. Chest
ercise x-rays reveal a hyperinflated chest and
D. A widened diaphragm noted on the a flattened diaphragm if the disease is
chest x-ray advanced.
C. Use diaphragmatic breathing
Explanation:
In chronic bronchitis the diaphragm is
The nurse is teaching a male client with
flat and weak. Diaphragmatic breathing
chronic bronchitis about breathing exer-
helps to strengthen the diaphragm and
cises. Which of the following should the
maximizes ventilation. Exhalation should
nurse include in the teaching?
be longer than inhalation to prevent col-
A. Make inhalation longer than exhala-
lapse of the bronchioles. The client with
tion
chronic bronchitis should exhale through
B. Exhale through an open mouth
pursed lips to prolong exhalation, keep
C. Use diaphragmatic breathing
the bronchioles from collapsing, and pre-
D. Use chest breathing
vent air trapping. Diaphragmatic breath-
ing — not chest breathing — increases
lung expansion.
A male client abruptly sits up in bed,
reports having difficulty breathing and B. Non-rebreather mask
has an arterial oxygen saturation of 88%. Explanation:
Which mode of oxygen delivery would A non-rebreather mask can deliver levels
most likely reverse the manifestations? of the fraction of inspired oxygen (FIO2)
A. Simple mask as high as 100%. Other modes — simple
B. Non-rebreather mask mask, face tent, and nasal cannula —
C. Face tent deliver lower levels of FIO2.
D. Nasal cannula
A. Inflamed lung tissue
Explanation:
The common feature of all types of pneu-
1 / 12
monia is an inflammatory pulmonary re-
sponse to the offending organism or
agent. Although most types of pneumo-
A male client with pneumococcal pneu-
nia have a sudden onset, a few (such as
monia is admitted to an acute care facil-
anaerobic bacterial pneumonia and my-
ity. The client in the next room is being
coplasmal pneumonia) have an insidious
treated for mycoplasmal pneumonia. De-
onset. Antibiotic therapy is the primary
spite the different causes of the various
treatment for most types of pneumonia;
types of pneumonia, all of them share
however, the antibiotic must be specific
which feature?
for the causative agent, which may not
A. Inflamed lung tissue
be responsive to penicillin. A few types
B. Sudden onset
of pneumonia, such as viral pneumonia,
C. Responsiveness to penicillin
aren't treated with antibiotics. Although
D. Elevated white blood cell (WBC) count
pneumonia usually causes an elevated
WBC count, some types, such as my-
coplasmal pneumonia, don't.
C. Teaching the patient how to perform
For a female patient with chronic
controlled coughing
obstructive pulmonary disease, which
Explanation:
nursing intervention would help maintain
Controlled coughing helps maintain a
a patent airway?
patent airway by helping to mobilize and
A. Restricting fluid intake to 1,000 ml per
remove secretions. A moderate fluid in-
day
take (usually 2 L or more daily) and mod-
B. Enforcing absolute bed rest
erate activity help liquefy and mobilize
C. Teaching the patient how to perform
secretions. Bed rest and sedatives may
controlled coughing
limit the patient's ability to maintain a
D. Administering prescribe sedatives
patent airway, causing a high risk for in-
regularly and in large amounts
fection from pooled secretions.
C. The system has an air leak
Nurse Oliver observes constant bubbling Explanation:
in the water-seal chamber of a closed Constant bubbling in the chamber indi-
chest drainage system. What should the cates an air leak and requires immediate
nurse conclude? intervention. The client with a pneumoth-
A. The system is functioning normally orax will have intermittent bubbling in the
B. The client has a pneumothorax water-seal chamber. Clients without a
C. The system has an air leak pneumothorax should have no evidence
D. The chest tube is obstructed of bubbling in the chamber. If the tube is
obstructed, the nurse should notice that
2 / 12
the fluid has stopped fluctuating in the
water-seal chamber.
C. Using a high-flow venturi mask to de-
liver oxygen as prescribed
Explanation:
The patient with COPD retains car-
bon dioxide, which inhibits stimulation
of breathing by the medullary center in
For a patient with advance chronic ob- the brain. As a result, low oxygen levels
structive pulmonary disease (COPD), in the blood stimulate respiration, and
which nursing action best promotes ad- administering unspecified, unmonitored
equate gas exchange? amounts of oxygen may depress ven-
A. Encouraging the patient to drink three tilation. To promote adequate gas ex-
glasses of fluid daily change, the nurse should use a Venturi
B. Keeping the patient in semi-fowler's mask to deliver a specified, controlled
position amount of oxygen consistently and ac-
C. Using a high-flow venturi mask to de- curately. Drinking three glasses of fluid
liver oxygen as prescribe daily would not affect gas exchange or
D. Administering a sedative, as prescribe be sufficient to liquefy secretions, which
are common in COPD. Patients with
COPD and respiratory distress should
be places in high-Fowler's position and
should not receive sedatives or other
drugs that may further depress the res-
piratory center.
C. Encourage coughing and deep
After undergoing a left pneumonectomy, breathing
a female patient has a chest tube in Explanation:
place for drainage. When caring for this When caring for a patient who is recov-
patient, the nurse must: ering from a pneumonectomy, the nurse
A. Monitor fluctuations in the water-seal should encourage coughing and deep
chamber breathing to prevent pneumonia in the
B. Clamp the chest tube once every shift unaffected lung. Because the lung has
C. Encourage coughing and deep been removed, the water-seal chamber
breathing should display no fluctuations. Reinfla-
D. Milk the chest tube every 2 hours tion is not the purpose of chest tube.
Chest tube milking is controversial and
3 / 12
should be done only to remove blood
clots that obstruct the flow of drainage.
B. Skin test doesn't differentiate between
A male client is asking the nurse a ques- active and dormant tuberculosis infec-
tion regarding the Mantoux test for tu- tion.
berculosis. The nurse should base her Explanation:
response on the fact that the: The Mantoux test doesn't differentiate
A. Area of redness is measured in 3 days between active and dormant infections.
and determines whether tuberculosis is If a positive reaction occurs, a sputum
present. smear and culture as well as a chest
B. Skin test doesn't differentiate between X-ray are necessary to provide more in-
active and dormant tuberculosis infec- formation. Although the area of redness
tion. is measured in 3 days, a second test may
C. Presence of a wheal at the injection be needed; neither test indicates that tu-
site in 2 days indicates active tuberculo- berculosis is active. In the Mantoux test,
sis. an induration 5 to 9 mm in diameter in-
D. Test stimulates a reddened response dicates a borderline reaction; a larger
in some clients and requires a second induration indicates a positive reaction.
test in 3 months. The presence of a wheal within 2 days
doesn't indicate active tuberculosis.
D. Contralateral side in hemothorax
Explanation:
The trachea will shift according to the
Nurse Ruth assessing a patient for tra-
pressure gradients within the thoracic
cheal displacement should know that the
cavity. In tension pneumothorax and he-
trachea will deviate toward the:
mothorax, accumulation of air or fluid
A. Contralateral side in a simple pneu-
causes a shift away from the injured side.
mothorax
If there is no significant air or fluid accu-
B. Affected side in a hemothorax
mulation, the trachea will not shift. Tra-
C. Affected side in a tension pneumoth-
cheal deviation toward the contralater-
orax
al side in simple pneumothorax is seen
D. Contralateral side in hemothorax
when the thoracic contents shift in re-
sponse to the release of normal thoracic
pressure gradients on the injured side.
B. Applying a dressing over the wound
A male patient has a sucking stab wound and taping it on three sides
to the chest. Which action should the Explanation:
The nurse immediately should apply a
4 / 12
dressing over the stab wound and tape
nurse take first? it on three sides to allow air to escape
A. Drawing blood for a hematocrit and and to prevent tension pneumothorax
hemoglobin level (which is more life-threatening than an
B. Applying a dressing over the wound open chest wound). Only after covering
and taping it on three sides and taping the wound should the nurse
C. Preparing a chest tube insertion tray draw blood for laboratory tests, assist
D. Preparing to start an I.V. line with chest tube insertion, and start an I.V.
line.
C. Atelectasis
Explanation:
In a client with COPD, an ineffective
cough impedes secretion removal. This,
A male client with chronic obstructive
in turn, causes mucus plugging, which
pulmonary disease (COPD) is recov-
leads to localized airway obstruction —
ering from a myocardial infarction. Be-
a known cause of atelectasis. An ineffec-
cause the client is extremely weak and
tive cough doesn't cause pleural effusion
can't produce an effective cough, the
(fluid accumulation in the pleural space).
nurse should monitor closely for:
Pulmonary edema usually results from
A. Pleural effusion
left-sided heart failure, not an ineffective
B. Pulmonary edema
cough. Although many noncardiac con-
C. Atelectasis
ditions may cause pulmonary edema,
D. Oxygen toxicity
an ineffective cough isn't one of them.
Oxygen toxicity results from prolonged
administration of high oxygen concentra-
tions, not an ineffective cough.
C. Bronchospasm
Nurse Joy is caring for a client after a Explanation:
bronchoscopy and biopsy. Which of the If a biopsy was performed during a bron-
following signs, if noticed in the client, choscopy, blood-streaked sputum is ex-
should be reported immediately to the pected for several hours. Frank blood in-
physician? dicates hemorrhage. A dry cough may
A. Dry cough be expected. The client should be as-
B. Hermaturia sessed for signs of complications, which
C. Bronchospasm would include cyanosis, dyspnea, stri-
D. Blood-streaked sputum dor, bronchospasm, hemoptysis, hy-
potension, tachycardia, and dysrhyth-
5 / 12
mias. Hematuria is unrelated to this pro-
cedure.
D. pH, 7.25; PaCO2 50 mm Hg
Explanation:
In respiratory acidosis, ABG analysis re-
A client with Guillain-Barré syndrome
veals an arterial pH below 7.35 and par-
develops respiratory acidosis as a result
tial pressure of arterial carbon dioxide
of reduced alveolar ventilation. Which
(PaCO2) above 45 mm Hg. Therefore,
combination of arterial blood gas (ABG)
the combination of a pH value of 7.25
values confirms respiratory acidosis?
and a PaCO2 value of 50 mm Hg con-
A. pH, 5.0; PaCO2 30 mm Hg
firms respiratory acidosis. A pH value of
B. pH, 7.40; PaCO2 35 mm Hg
5.0 with a PaCO2 value of 30 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
indicates respiratory alkalosis. Options
D. pH, 7.25; PaCO2 50 mm Hg
B and C represent normal ABG values,
reflecting normal gas exchange in the
lungs.
C. Tidal volume
Explanation:
Tidal volume refers to the volume of
Which phrase is used to describe the
air inspired and expired with a normal
volume of air inspired and expired with
breath. Total lung capacity is the maximal
a normal breath?
amount of air the lungs and respiratory
A. Total lung capacity
passages can hold after a forced inspira-
B. Forced vital capacity
tion. Forced vital capacity is the vital ca-
C. Tidal volume
pacity performed with a maximally forced
D. Residual volume
expiration. Residual volume is the maxi-
mal amount of air left in the lung after a
maximal expiration.
A male adult client is suspected of hav-
ing a pulmonary embolus. A nurse as-
sesses the client, knowing that which of A. Dyspnea
the following is a common clinical mani- Explanation:
festation of pulmonary embolism? The common clinical manifestations of
A. Dyspnea pulmonary embolism are tachypnea,
B. Bradypnea tachycardia, dyspnea, and chest pain.
C. Bradycardia
D. Decreased respirations
6 / 12
Explanation:
B. Diminished breath sounds
This client has sustained a blunt or
a male client who has sustained a blunt
a closed chest injury. Basic symptoms
injury to the chest wall. Which of these
of a closed pneumothorax are short-
signs would indicate the presence of a
ness of breath and chest pain. A larg-
A. A low respiratory rate
cyanosis, diminished breath sounds, and
B. Diminished breath sounds
subcutaneous emphysema. Hyperreso-
C. The presence of a barrel chest
nance also may occur on the affected
D. A sucking sound at the site of injury
side. A sucking sound at the site of injury
D. Albuterol (Proventil)
Explanation:
The client is hypoxemic because of
bronchoconstriction as evidenced by
At 11 p.m., a male client is admitted wheezes and a subnormal arterial oxy-
to the emergency department. He has gen saturation level. The client's great-
a respiratory rate of 44 breaths/minute. est need is bronchodilation, which can
He's anxious, and wheezes are audible. be accomplished by administering bron-
The client is immediately given oxygen chodilators. Albuterol is a beta2 adren-
by face mask and methylprednisolone ergic agonist, which causes dilation of
(Depo-medrol) I.V. At 11:30 p.m., the the bronchioles. It's given by nebulization
client's arterial blood oxygen saturation or metered-dose inhalation and may be
is 86% and he's still wheezing. The nurse given as often as every 30 to 60 minutes
should plan to administer: until relief is accomplished. Alprazolam
A. Alprazolam (Xanax) is an anxiolytic and central nervous sys-
B. Propranolol (Inderal) tem depressant, which could suppress
C. Morphine the client's breathing. Propranolol is con-
D. Albuterol (Proventil) traindicated in a client who's wheezing
because it's a beta2 adrenergic antag-
onist. Morphine is a respiratory center
depressant and is contraindicated in this
situation.
A nurse performs an admission assess- B. Sputum culture
ment on a female client with a diagnosis Explanation:
of tuberculosis. The nurse reviews the Tuberculosis is definitively diagnosed
result of which diagnosis test that will through culture and isolation of My-
7 / 12
cobacterium tuberculosis. A presumptive
confirm this diagnosis?
diagnosis is made based on a tuberculin
A. Bronchoscopy
skin test, a sputum smear that is positive
B. Sputum culture
for acid-fast bacteria, a chest x-ray, and
C. Chest x-ray
histological evidence of granulomatous
D. Tuberculin skin test
disease on biopsy.
A. It helps prevent early airway collapse
Explanation:
Pursed-lip breathing helps prevent ear-
The nurse in charge is teaching a
ly airway collapse. Learning this tech-
client with emphysema how to perform
nique helps the client control respira-
pursed-lip breathing. The client asks the
tion during periods of excitement, anx-
nurse to explain the purpose of this
iety, exercise, and respiratory distress.
breathing technique. Which explanation
To increase inspiratory muscle strength
should the nurse provide?
and endurance, the client may need
A. It helps prevent early airway collapse
to learn inspiratory resistive breathing.
B. It increases inspiratory muscle
To decrease accessory muscle use and
strength
thus reduce the work of breathing, the
C. It decreases use of accessory breath-
client may need to learn diaphragmat-
ing muscles
ic (abdominal) breathing. In pursed-lip
D. It prolongs the inspiratory phase of
breathing, the client mimics a normal in-
respiration
spiratory-expiratory (I:E) ratio of 1:2. (A
client with emphysema may have an I:E
ratio as high as 1:4.)
C. Increased pulmonary capillary perme-
ability
A male patient's X-ray result reveals bi- Explanation:
lateral white-outs, indicating adult respi- ARDS results from increased pulmonary
ratory distress syndrome (ARDS). This capillary permeability, which leads to
syndrome results from: noncardiogenic pulmonary edema. In
A. Cardiogenic pulmonary edema cardiogenic pulmonary edema, pul-
B. Respiratory alkalosis monary congestion occurs secondary
C. Increased pulmonary capillary per- to heart failure. In the initial stage of
meability ARDS, respiratory alkalosis may arise
D. Renal failure secondary to hyperventilation; however,
it does not cause ARDS. Renal failure
does not cause ARDS, either.
8 / 12
A male patient is admitted to the health
care facility for treatment of chronic D. Impaired gas exchange related to air-
obstructive pulmonary disease. Which flow obstruction
nursing diagnosis is most important for Explanation:
this patient? A patient airway and an adequate
A. Activity intolerance related to fatigue breathing pattern are the top priority for
B. Anxiety related to actual threat to any patient, making "impaired gas ex-
health status change related to airflow obstruction" the
C. Risk for infection related to retained most important nursing diagnosis. The
secretions other options also may apply to this pa-
D. Impaired gas exchange related to air- tient but less important.
flow obstruction
A black client with asthma seeks emer-
gency care for acute respiratory distress. B. Mucous membranes
Because of this client's dark skin, the Question 51 Explanation:
nurse should assess for cyanosis by in- Skin color doesn't affect the mucous
specting the: membranes. The lips, nail beds, and
A. Lips earlobes are less reliable indicators of
B. Mucous membranes cyanosis because they're affected by
C. Nail beds skin color.
D. Earlobes
Blessy, a community health nurse is
conducting an educational session with
D. A cough with the expectoration of mu-
community members regarding tubercu-
coid sputum
losis. The nurse tells the group that one
Explanation:
of the first symptoms associated with tu-
One of the first pulmonary symptoms is
berculosis is:
a slight cough with the expectoration of
A. Dyspnea
mucoid sputum. Options A, B, and C are
B. Chest pain
late symptoms and signify cavitation and
C. A bloody, productive cough
extensive lung involvement.
D. A cough with the expectoration of mu-
coid sputum
C. Decreased hearing acuity
A female client must take streptomycin Explanation:
for tuberculosis. Before therapy begins, Decreased hearing acuity indicates
the nurse should instruct the client to no- ototoxicity, a serious adverse effect of
tify the physician if which health concern streptomycin therapy. The client should
notify the physician immediately if it oc-
9 / 12
curs so that streptomycin can be dis-
continued and an alternative drug can
occurs?
be prescribed. The other options aren't
A. Impaired color discrimination
associated with streptomycin. Impaired
B. Increased urinary frequency
color discrimination indicates color blind-
C. Decreased hearing acuity
ness; increased urinary frequency and
D. Increased appetite
increased appetite accompany diabetes
mellitus.
D. Chest movements
Question 54 Explanation:
The nurse observes respiratory excur-
sion to help assess chest movements.
A female client is undergoing a complete Normally, thoracic expansion is symmet-
physical examination as a requirement rical; unequal expansion may indicate
for college. When checking the client's pleural effusion, atelectasis, pulmonary
respiratory status, the nurse observes embolus, or a rib or sternum fracture.
respiratory excursion to help assess: The nurse assesses vocal sounds to
A. Lung vibrations evaluate air flow when checking for tac-
B. Vocal sounds tile fremitus; after asking the client to
C. Breath sounds say "99," the nurse palpates the vibra-
D. Chest movements tions transmitted from the bronchopul-
monary system along the solid surfaces
of the chest wall to the nurse's palms.
The nurse assesses breath sounds dur-
ing auscultation.
A. Apnea
A male client admitted to an acute care Explanation:
facility with pneumonia is receiving sup- Hypoxia is the main breathing stimulus
plemental oxygen, 2 L/minute via nasal for a client with COPD. Excessive oxy-
cannula. The client's history includes gen administration may lead to apnea
chronic obstructive pulmonary disease by removing that stimulus. Anginal pain
(COPD) and coronary artery disease. results from a reduced myocardial oxy-
Because of these history findings, the gen supply. A client with COPD may have
nurse closely monitors the oxygen flow anginal pain from generalized vasocon-
and the client's respiratory status. Which striction secondary to hypoxia; howev-
complication may arise if the client re- er, administering oxygen at any con-
ceives a high oxygen concentration? centration dilates blood vessels, easing
anginal pain. Respiratory alkalosis re-
10 / 12
sults from alveolar hyperventilation, not
excessive oxygen administration. In a
A. Apnea
client with COPD, high oxygen concen-
B. Anginal pain
trations decrease the ventilatory drive,
C. Respiratory alkalosis
leading to respiratory acidosis, not alka-
D. Metabolic acidosis
losis. High oxygen concentrations don't
cause metabolic acidosis.
The nurse assesses a male client's res- B. Use of accessory muscles
piratory status. Which observation indi- Explanation:
cates that the client is experiencing diffi- The use of accessory muscles for res-
culty breathing? piration indicates the client is having
A. Diaphragmatic breathing difficulty breathing. Diaphragmatic and
B. Use of accessory muscles pursed-lip breathing are two controlled
C. Pursed-lip breathing breathing techniques that help the client
D. Controlled breathing conserve energy.
B. Low arterial PaO2
A nurse is caring for a male client with Explanation:
acute respiratory distress syndrome. The earliest clinical sign of acute respira-
Which of the following would the nurse tory distress syndrome is an increased
expect to note in the client? respiratory rate. Breathing becomes la-
A. Pallor bored, and the client may exhibit air
B. Low arterial PaO2 hunger, retractions, and cyanosis. Arter-
C. Elevated arterial PaO2 ial blood gas analysis reveals increasing
D. Decreased respiratory rate hypoxemia, with a PaO2 lower than 60
mm Hg.
D. Lightheadedness or paresthesia
A male adult patient hospitalized for Explanation:
treatment of a pulmonary embolism de- The patient with respiratory alkalosis
velops respiratory alkalosis. Which clin- may complain of lightheadedness or
ical findings commonly accompany res- paresthesia (numbness and tingling in
piratory alkalosis? the arms and legs). Nausea, vomiting,
A. Nausea or vomiting abdominal pain, and diarrhea may ac-
B. Abdominal pain or diarrhea company respiratory acidosis. Hallucina-
C. Hallucinations or tinnitus tions and tinnitus rare are associated
D. Lightheadedness or paresthesia with respiratory alkalosis or any other
acid-base imbalance.
D. Administer prescribed supplemental
oxygen
11 / 12
Which of the following would be most ap-
Explanation:
propriate for a male client with an arterial
The ABG results reveal respiratory alka-
blood gas (ABG) of pH 7.5, PaCO2 of
losis. The best intervention to raise the
26 mm Hg, O2 saturation level of 96%,
PaCO2 level would be to have the client
HCO3 of 24 mEq/L, and PaO2 of 94%?
breathe into a paper bag. All of the other
A. Administer a prescribed decongestant
options-such as administer a prescribed
B. Instruct the client to breathe into a
decongestant, offer the client fluids fre-
paper bag
quently, or administer prescribed supple-
C. Offer the client fluids frequently
mental oxygen would do nothing to raise
D. Administer prescribed supplemental
the PaCO2 level.
oxygen
12 / 12
NCLEX Practice Questions Saunders - Respiratory System
Study online at https://quizlet.com/_3jvnxq
2. Diminished breath sounds

The emergency department nurse is as-
Rationale: This client has sustained
sessing a client who has sustained a
a blunt or closed-chest injury. Basic
blunt injury to the chest wall. Which find-
symptoms of a closed pneumothorax
ing would indicate the presence of a
are shortness of breath and chest
pain. A larger pneumothorax may cause
tachypnea, cyanosis, diminished breath
1. A low respiratory rate
sounds, and subcutaneous emphysema.
2. Diminished breath sounds
Hyperresonance also may occur on the
3. The presence of a barrel chest
affected side. A sucking sound at the site
4. A sucking sound at the site of injury
of injury would be noted with an open
chest injury.
The nurse is caring for a client hospital- 2. A hyperinflated chest noted on the
ized with acute exacerbation of chron- chest x-ray
ic obstructive pulmonary disease. Which 3. Decreased oxygen saturation with
finding would the nurse expect to note on mild exercise
assessment of this client? Select all that
apply. Rationale: Clinical manifestations of
chronic obstructive pulmonary disease
1. Hypocapnia (COPD) include hypoxemia, hypercap-
2. A hyperinflated chest noted on the nia, dyspnea on exertion and at rest, oxy-
chest x-ray gen desaturation with exercise, and the
3. Decreased oxygen saturation with use of accessory muscles of respiration.
mild exercise Chest x-rays reveal a hyperinflated chest
4. A widened diaphragm noted on the and a flattened diaphragm if the disease
chest x-ray is advanced. Pulmonary function tests
5. Pulmonary function tests that demon- will demonstrate decreased vital capaci-
strate increased vital capacity ty.
The nurse instructs a client to use the
4. Promote carbon dioxide elimination
pursed-lip method of breathing and the
client asks the nurse about the purpose
Rationale: Pursed-lip breathing facili-
of this type of breathing. The nurse re-
tates maximal expiration for clients with
sponds, knowing that the primary pur-
obstructive lung disease. This type of
pose of pursed-lip breathing is to pro-
breathing allows better expiration by in-
mote which outcome?
creasing airway pressure that keeps air
passages open during exhalation. Op-
1. Promote oxygen intake
1/9
2. Strengthen the diaphragm
tions 1, 2, and 3 are not the purposes of
3. Strengthen the intercostal muscles
this type of breathing.
4. Promote carbon dioxide elimination
1. Activities should be resumed gradual-
ly.
3. A sputum culture is needed every 2
to 4 weeks once medication therapy is
initiated.
4. Respiratory isolation is not necessary
The nurse is preparing a list of home
because family members already have
care instructions for a client who has
been exposed.
been hospitalized and treated for tuber-
5. Cover the mouth and nose when
culosis. Which instructions should the
coughing or sneezing and put used tis-
nurse include on the list? Select all that
sues in plastic bags.
apply.
Rationale: The nurse should provide the
1. Activities should be resumed gradual-
client and family with information about
ly.
tuberculosis and allay concerns about
2. Avoid contact with other individuals,
the contagious aspect of the infection.
except family members, for at least 6
Instruct the client to follow the medica-
months.
tion regimen exactly as prescribed and
3. A sputum culture is needed every 2
always to have a supply of the medica-
to 4 weeks once medication therapy is
tion on hand. Advise the client of the
initiated.
side effects of the medication and ways
4. Respiratory isolation is not necessary
of minimizing them to ensure compli-
because family members already have
ance. Reassure the client that after 2
been exposed.
to 3 weeks of medication therapy, it is
5. Cover the mouth and nose when
unlikely that the client will infect anyone.
coughing or sneezing and put used tis-
Inform the client that activities should be
sues in plastic bags.
resumed gradually and about the need
6. When one sputum culture is negative,
for adequate nutrition and a well-bal-
the client is no longer considered infec-
anced diet that is rich in iron, protein,
tious and usually can return to former
and vitamin C to promote healing and
employment.
prevent recurrence of infection. Inform
the client and family that respiratory iso-
lation is not necessary because family
members already have been exposed.
Instruct the client about thorough hand
washing and to cover the mouth and
2/9
nose when coughing or sneezing and to
put used tissues into plastic bags. Inform
the client that a sputum culture is need-
ed every 2 to 4 weeks once medication
therapy is initiated. When the results of
three sputum cultures are negative, the
client is no longer considered infectious
and can usually return to former employ-
ment.
3. Bronchospasm
The nurse is caring for a client after a Rationale: If a biopsy was performed
bronchoscopy and biopsy. Which finding, during a bronchoscopy, blood-streaked
if noted in the client, should be reported sputum is expected for several hours.
immediately to the health care provider? Frank blood indicates hemorrhage. A
dry cough may be expected. The client
1. Dry cough should be assessed for signs/symp-
2. Hematuria toms of complications, which would in-
3. Bronchospasm clude cyanosis, dyspnea, stridor, bron-
4. Blood-streaked sputum chospasm, hemoptysis, hypotension,
tachycardia, and dysrhythmias. Hema-
turia is unrelated to this procedure.
The nurse is preparing to suction a 3. 10 seconds
client via a tracheostomy tube. The nurse
should plan to limit the suctioning time to Rationale: Hypoxemia can be caused
a maximum of which time period? by prolonged suctioning, which stimu-
lates the pacemaker cells in the heart.
1. 1 minute A vasovagal response may occur, caus-
2. 5 seconds ing bradycardia. The nurse must preoxy-
3. 10 seconds genate the client before suctioning and
4. 30 seconds limit the suctioning pass to 10 seconds.
The nurse is suctioning a client via an 3. Stop the procedure and reoxygenate
endotracheal tube. During the suction- the client.
ing procedure, the nurse notes on the
monitor that the heart rate is decreasing. Rationale: During suctioning, the nurse
Which nursing intervention is most ap- should monitor the client closely for side
propriate? effects, including hypoxemia, cardiac ir-
regularities such as a decrease in heart
3/9
1. Continue to suction.
rate resulting from vagal stimulation, mu-
2. Notify the health care provider imme-
cosal trauma, hypotension, and paroxys-
diately.
mal coughing. If adverse effects devel-
3. Stop the procedure and reoxygenate
op, especially cardiac irregularities, the
the client.
procedure is stopped and the client is
4. Ensure that the suction is limited to 15
reoxygenated.
seconds.
4. Pain, especially with inspiration
The nurse is assessing the respiratory Rationale: Rib fractures are a common
status of a client who has suffered a injury, especially in the older client, and
fractured rib. The nurse should expect to result from a blunt injury or a fall. Typical
note which finding? signs and symptoms include pain and
tenderness localized at the fracture site
1. Slow deep respirations that is exacerbated by inspiration and
2. Rapid deep respirations palpation, shallow respirations, splinting
3. Paradoxical respirations or guarding the chest protectively to
4. Pain, especially with inspiration minimize chest movement, and possible
bruising at the fracture site. Paradoxical
respirations are seen with flail chest.
3. Paradoxical chest movement
Rationale: Flail chest results from multi-

A client with a chest injury has suffered
ple rib fractures. This results in a "float-
flail chest. The nurse assesses the client
ing" section of ribs. Because this section
for which
is unattached to the rest of the bony rib
most distinctive sign of flail chest?
cage, this segment results in paradox-
ical chest movement. This means that
1. Cyanosis
the force of inspiration pulls the fractured
2. Hypotension
segment inward, while the rest of the
3. Paradoxical chest movement
chest expands. Similarly, during exhala-
4. Dyspnea, especially on exhalation
tion, the segment balloons outward while
the rest of the chest moves inward. This
is a characteristic sign of flail chest.
1. Right pneumothorax
A client has been admitted with chest
trauma after a motor vehicle crash and Rationale: Pneumothorax is character-
ized by restlessness, tachycardia, dys-
4/9
pnea, pain with respiration, asymmet-
has undergone subsequent intubation. rical chest expansion, and diminished
The nurse checks the client when the or absent breath sounds on the affect-
high-pressure alarm on the ventilator ed side. Pneumothorax can cause in-
sounds, and notes that the client has creased airway pressure because of re-
absence of breath sounds in the right sistance to lung inflation. Acute respira-
upper lobe of the lung. The nurse imme- tory distress syndrome and pulmonary
diately assesses for other signs of which embolism are not characterized by ab-
condition? sent breath sounds. An endotracheal
tube that is inserted too far can cause
1. Right pneumothorax absent breath sounds, but the lack of
2. Pulmonary embolism breath sounds most likely would be on
3. Displaced endotracheal tube the left side because of the degree of
4. Acute respiratory distress syndrome curvature of the right and left mainstem
bronchi.
4. Increased respiratory rate
The nurse is assessing a client with mul-
tiple trauma who is at risk for develop-
Rationale: The earliest detectable sign
ing acute respiratory distress syndrome.
of acute respiratory distress syndrome is
The nurse should assess for which ear-
an increased respiratory rate, which can
liest sign of acute respiratory distress
begin from 1 to 96 hours after the initial
syndrome?
insult to the body. This is followed by
increasing dyspnea, air hunger, retrac-
1. Bilateral wheezing
tion of accessory muscles, and cyanosis.
2. Inspiratory crackles
Breath sounds may be clear or consist of
3. Intercostal retractions
fine inspiratory crackles or diffuse coarse
4. Increased respiratory rate
crackles.
The nurse is discussing the techniques
of chest physiotherapy and postural 2. Percussion and vibration
drainage (respiratory treatments) to a
client having expectoration problems be- Rationale: Chest physiotherapy of per-
cause of chronic thick, tenacious mucus cussion and vibration helps loosen se-
production in the lower airway. The nurse cretions in the smaller lower airways.
explains that after the client is positioned Postural drainage positions the client so
for postural drainage the nurse will per- that gravity can help mucus moving from
form which action to help loosen secre- smaller airways to larger ones to support
tions? expectoration of the mucus. Options 1,
5/9
1. Palpation and clubbing
2. Percussion and vibration
3, and 4 are not actions that will loosen
3. Hyperoxygenation and suctioning
secretions.
4. Administer a bronchodilator and mon-
itor peak flow
The nurse has conducted discharge
teaching with a client diagnosed with 4. "I should not be contagious after 2 to
tuberculosis, who has been receiving 3 weeks of medication therapy."
medication for 1 1D2 weeks. The nurse de-
termines that the client has understood Rationale: The client is continued on
the information if the client makes which medication therapy for 6 to 12 months,
statement? depending on the situation. The client
generally is considered noncontagious
1. "I need to continue drug therapy for 2 after 2 to 3 weeks of medication therapy.
months." The client is instructed to wear a mask
2. "I can't shop at the mall for the next 6 if there will be exposure to crowds until
months." the medication is effective in preventing
3. "I can return to work if a sputum cul- transmission. The client is allowed to re-
ture comes back negative." turn to work when the results of three
4. "I should not be contagious after 2 to sputum cultures are negative.
3 weeks of medication therapy."
The nurse is preparing to give a bed bath 2. Particulate respirator, gown, and
to an immobilized client with tuberculo- gloves
sis. The nurse should wear which item
when performing this care? Rationale: The nurse who is in contact
with a client with tuberculosis should
1. Surgical mask and gloves wear an individually fitted particulate
2. Particulate respirator, gown, and respirator. The nurse also would wear
gloves gloves as per standard precautions. The
3. Particulate respirator and protective nurse wears a gown when the possibili-
eyewear ty exists that the clothing could become
4. Surgical mask, gown, and protective contaminated, such as when giving a
eyewear bed bath.
A client has experienced pulmonary em- 3. Chest pain that occurs suddenly
bolism. The nurse should assess for
which symptom, which is most common- Rationale: The most common initial
ly reported? symptom in pulmonary embolism is
chest pain that is sudden in onset. The
6/9
next most commonly reported symptom
1. Hot, flushed feeling
is dyspnea, which is accompanied by
2. Sudden chills and fever
an increased respiratory rate. Other typ-
3. Chest pain that occurs suddenly
ical symptoms of pulmonary embolism
4. Dyspnea when deep breaths are tak-
include apprehension and restlessness,
en
tachycardia, cough, and cyanosis.
1. Positive
Rationale: The client with human immun-

A client who is human immunodeficiency
odeficiency virus (HIV) infection is con-
virus (HIV)-positive has had a tuberculin
sidered to have positive results on tu-
skin test (TST). The nurse notes a 7-mm
berculin skin testing with an area of in-
area of induration at the site of the skin
duration larger than 5 mm. The client
test and interprets the result as which
without HIV is positive with an induration
finding?
larger than 10 mm. The client with HIV
is immunosuppressed, making a smaller
1. Positive
area of induration positive for this type of
2. Negative
client. It is possible for the client infected
3. Inconclusive
with HIV to have false-negative readings
4. Need for repeat testing
because of the immunosuppression fac-
tor. Options 2, 3, and 4 are incorrect in-
terpretations.
1. Dyspnea
A client with acquired immunodeficien-
Rationale: Histoplasmosis is an oppor-
cy syndrome (AIDS) has histoplasmosis.
tunistic fungal infection that can occur
The nurse should assess the client for
in the client with acquired immunodefi-
which expected finding?
ciency syndrome (AIDS). The infection
begins as a respiratory infection and can
1. Dyspnea
progress to disseminated infection. Typ-
2. Headache
ical signs and symptoms include fever,
3. Weight gain
dyspnea, cough, and weight loss. En-
4. Hypothermia
largement of the client's lymph nodes,
liver, and spleen may occur as well.
The nurse is giving discharge instruc-
tions to a client with pulmonary sarcoido- 4. Shortness of breath
sis. The nurse concludes that the client
understands the information if the client
7/9
indicates to report which early sign of
exacerbation? Rationale: Dry cough and dyspnea
are typical early manifestations of pul-
1. Fever monary sarcoidosis. Later manifesta-
2. Fatigue tions include night sweats, fever, weight
3. Weight loss loss, and skin nodules.
4. Shortness of breath
The nurse is taking the history of a client
1. Mask
with occupational lung disease (silico-
sis). The nurse should assess whether
Rationale: Silicosis results from chronic,
the client wears which item during peri-
excessive inhalation of particles of free
ods of exposure to silica particles?
crystalline silica dust. The client should
wear a mask to limit inhalation of this
1. Mask
substance, which can cause restrictive
2. Gown
lung disease after years of exposure. Op-
3. Gloves
tions 2, 3, and 4 are not necessary.
4. Eye protection
2. Venturi mask
An oxygen delivery system is prescribed
for a client with chronic obstructive pul-
Rationale: The Venturi mask delivers the
monary disease to deliver a precise oxy-
most accurate oxygen concentration. It
gen concentration. Which oxygen deliv-
is the best oxygen delivery system for
ery system would the nurse anticipate to
the client with chronic airflow limita-
be prescribed?
tion because it delivers a precise oxy-
gen concentration. The face tent, aerosol
1. Face tent
mask, and tracheostomy collar are also
2. Venturi mask
high-flow oxygen delivery systems but
3. Aerosol mask
most often are used to administer high
4. Tracheostomy collar
humidity.
The nurse is instructing a hospitalized
client with a diagnosis of emphysema 4. Sitting on the side of the bed and
about measures that will enhance the ef- leaning on an overbid table
fectiveness of breathing during dyspneic
periods. Which position should the nurse Rationale: Positions that will assist the
instruct the client to assume? client with emphysema with breathing
include sitting up and leaning on an
1. Sitting up in bed overbed table, sitting up and resting the
2. Side-lying in bed
8/9
3. Sitting in a recliner chair
elbows on the knees, and standing and
4. Sitting on the side of the bed and
leaning against the wall.
leaning on an overbed table
The community health nurse is conduct-
ing an educational session with commu-
4. A cough with the expectoration of mu-
nity members regarding the symptoms
coid sputum
associated with tuberculosis. Which is
one of the first manifestations associat-
Rationale: One of the first pulmonary
ed with tuberculosis?
manifestations of tuberculosis is a slight
cough with the expectoration of mucoid
1. Dyspnea
sputum. Options 1, 2, and 3 are late
2. Chest pain
manifestations and signify cavitation and
3. A bloody, productive cough
extensive lung involvement.
4. A cough with the expectoration of mu-
coid sputum
The nurse performs an admission as- 3. Sputum culture
sessment on a client with a diagnosis of
tuberculosis. The nurse should check the Rationale: Tuberculosis is definitively di-
results of which diagnostic test that will agnosed through culture and isolation
confirm this diagnosis? of Mycobacterium tuberculosis. A pre-
sumptive diagnosis is made based on
1. Chest x-ray a tuberculin skin test, a sputum smear
2. Bronchoscopy that is positive for acid-fast bacteria, a
3. Sputum culture chest x-ray, and histological evidence of
4. Tuberculin skin test granulomatous disease on biopsy.
3. Ventilate the client manually
The low-pressure alarm sounds on a
ventilator. The nurse assesses the client Rationale: If at any time an alarm is
and then attempts to determine the sounding and the nurse cannot quickly
cause of the alarm. If unsuccessful in ascertain the problem, the client is dis-
determining the cause of the alarm, the connected from the ventilator and man-
nurse should take what initial action? ual resuscitation is used to support res-
pirations until the problem can be cor-
1. Administer oxygen rected. No reason is given to begin car-
2. Check the client's vital signs diopulmonary resuscitation. Checking vi-
3. Ventilate the client manually tal signs is not the initial action. Although
4. Start cardiopulmonary resuscitation oxygen is helpful, it will not provide ven-
tilation to the client.
9/9
Respiratory System NCLEX questions
Study online at https://quizlet.com/_1nedk0
The most important action the nurse

should do before and after suctioning a
client is:
a. Placing the client in a supine position d. Hyperventilating the client with 100%
b. Making sure that suctioning takes only oxygen
10-15 seconds
c. Evaluating for clear breath sounds
d. Hyperventilating the client with 100%
oxygen
a. Fowler's
The position of a conscious client during
suctioning is: Position a conscious person who has a
functional gag reflex in the semi fowler's
a. Fowler's position with the head turned to one side
b. Supine position for oral suctioning or with the neck hy-
c. Side-lying per extended for nasal suctioning. If the
d. Prone client is unconscious place the patient a
lateral position facing you.
Presence of overdistended and
Answer: B.
non-functional alveoli is a condition
called:
An overdistended and non-functional
alveoli is a condition called emphysema.
a. Bronchitis
Atelectasis is the collapse of a part or the
b. Emphysema
whole lung. Empyema is the presence of
c. Empyema
pus in the lung.
d. Atelectasis
23. The accumulation of fluids in the
pleural space is called:
a. Pleural effusion a. Pleural effusion

b. Hemothorax
c. Hydrothorax
d. Pyothorax
Answer A.
2. Nurse Kim is caring for a client with a
pneumothorax and who has had a chest
Continuous gentle bubbling should be
1 / 15
noted in the suction control chamber.
tube inserted notes continuous gentle
bubbling in the suction control chamber. Option B is incorrect. Chest tubes should
What action is appropriate? only be clamped to check for an air leak
or when changing drainage devices (ac-
a. Do nothing, because this is an expect- cording to agency policy).
ed finding.
b. Immediately clamp the chest tube and Option C is incorrect. Bubbling should be
notify the physician. continuous and not intermittent.
c. Check for an air leak because the
bubbling should be intermittent. Option D is incorrect because bubbling
d. Increase the suction pressure so that should be gentle. Increasing the suction
bubbling becomes vigorous. pressure only increases the rate of evap-
oration of water in the drainage system.
Answer B.
4. The nurse caring for a male client with
a chest tube turns the client to the side,
If the chest drainage system is discon-
and the chest tube accidentally discon-
nected, the end of the tube is placed in
nects. The initial nursing action is to:
a bottle of sterile water held below the
level of the chest. The system is replaced
a. Call the physician.
if it breaks or cracks or if the collection
b. Place the tube in a bottle of sterile
chamber is full. Placing a sterile dress-
water.
ing over the disconnection site will not
c. Immediately replace the chest tube
prevent complications resulting from the
system.
disconnection. The physician may need
d. Place the sterile dressing over the dis-
to be notified, but this is not the initial
connection site.
action.
While changing the tapes on a tra-
cheostomy tube, the male client coughs
and the tube is dislodged. The initial
nursing action is to:
b. Grasp the retention sutures to spread
a. Call the physician to reinsert the tube. the opening.
b. Grasp the retention sutures to spread
the opening.
c. Call the respiratory therapy depart-
ment to reinsert the tracheotomy.
2 / 15
d. Cover the tracheostomy site with a
sterile dressing to prevent infection.
A nurse is caring for a male client imme- Answer A.
diately after removal of the endotracheal
tube. The nurse reports which of the fol- The nurse reports stridor to the physi-
lowing signs immediately if experienced cian immediately. This is a high-pitched,
by the client? coarse sound that is heard with the
stethoscope over the trachea.
a. Stridor
b. Occasional pink-tinged sputum Stridor indicates airway edema and
c. A few basilar lung crackles on the right places the client at risk for airway ob-
d. Respiratory rate of 24 breaths/min struction
Answer B.
a female client who has sustained a blunt This client has sustained a blunt or
injury to the chest wall. Which of these a closed chest injury. Basic symptoms
signs would indicate the presence of a of a closed pneumothorax are short-
pneumothorax in this client? ness of breath and chest pain. A larg-
a. A low respiratory cyanosis, diminished breath sounds, and
b. Diminished breathe sounds subcutaneous emphysema. Hyperreso-
c. The presence of a barrel chest nance also may occur on the affected
d. A sucking sound at the site of injury side. A sucking sound at the site of injury
A nurse is caring for a male client hospi- Answer B.
talized with acute exacerbation of chron-
ic obstructive pulmonary disease. Which Clinical manifestations of chronic ob-
of the following would the nurse expect structive pulmonary disease (COPD) in-
to note on assessment of this client? clude hypoxemia, - hypercapnia,
- dyspnea on exertion and at rest
a. Hypocapnia - oxygen desaturation with exercise
b. A hyperinflated chest noted on the - and the use of accessory muscles of
chest x-ray respiration.
c. Increase oxygen saturation with exer-
cise Chest x-rays reveal a hyperinflated chest
d. A widened diaphragm noted on the and a flattened diaphragm if the disease
chest x-ray is advanced.
3 / 15
A community health nurse is conducting
an educational session with communi-
Answer D.
ty members regarding tuberculosis. The
nurse tells the group that one of the first
One of the first pulmonary symptoms is
symptoms associated with tuberculosis
a slight cough with the expectoration of
is:
mucoid sputum.
a. Dyspnea
Options A, B, and C are late symptoms
b. Chest pain
and signify cavitation and extensive lung
c. A bloody, productive cough
involvement.
d. A cough with the expectoration of mu-
coid sputum
Answer B.
A nurse is caring for a male client with
emphysema who is receiving oxygen. Oxygen is used cautiously and should
The nurse assesses the oxygen flow rate not exceed 2 L/min.
to ensure that it does not exceed:
Because of the long-standing hypercap-
a. 1 L/min nia that occurs in emphysema, the res-
b. 2 L/min piratory drive is triggered by low oxygen
c. 6 L/min levels rather than increased carbon diox-
d. 10 L/min ide levels, as is the case in a normal
respiratory system.
Answer D.
A nurse instructs a female client to use
the pursed-lip method of breathing and Pursed-lip breathing facilitates maximal
the client asks the nurse about the pur- expiration for clients with obstructive
pose of this type of breathing. The nurse lung disease.
responds, knowing that the primary pur-
pose of pursed-lip breathing is to: This type of breathing allows better expi-
ration by increasing airway pressure that
a. Promote oxygen intake. keeps air passages open during exhala-
b. Strengthen the diaphragm. tion.
c. Strengthen the intercostal muscles.
d. Promote carbon dioxide elimination. Options A, B, and C are not the purposes
of this type of breathing.
Answer B.
4 / 15
To obtain a sputum specimen, the client
should rinse the mouth to reduce con-
Nurse Hannah is preparing to obtain a
tamination, breathe deeply, and then
sputum specimen from a client. Which
cough into a sputum specimen contain-
of the following nursing actions will facil-
er.
itate obtaining the specimen?
The client should be encouraged to
a. Limiting fluids
cough and not spit so as to obtain spu-
b. Having the clients take three deep
tum.
breaths
c. Asking the client to split into the collec-
Sputum can be thinned by fluids or by a
tion container
respiratory treatment such as inhalation
d. Asking the client to obtain the speci-
of nebulized saline or water. The optimal
men after eating
time to obtain a specimen is on arising in
the morning
Answer C.
If a biopsy was performed during a bron-

A nurse is caring for a female client after
choscopy, blood-streaked sputum is ex-
a bronchoscope and biopsy. Which of
pected for several hours.
the following signs, if noted in the client,
should be reported immediately to the
Frank blood indicates hemorrhage. A dry
physicians?
cough may be expected.
a. Dry cough
The client should be assessed for
b. Hematuria
signs of complications, which would in-
c. Bronchospasm
clude cyanosis, dyspnea, stridor, bron-
d. Blood-streaked sputum
chospasm, hemoptysis, hypotension,
tachycardia, and dysrhythmias. Hema-
turia is unrelated to this procedure.
A nurse is suctioning fluids from a male Answer C. Hypoxemia can be caused
client via a tracheostomy tube. When by prolonged suctioning, which stimu-
suctioning, the nurse must limit the suc- lates the pacemaker cells in the heart.
tioning time to a maximum of: A vasovagal response may occur, caus-
ing bradycardia. The nurse must preoxy-
a. 1 minute genate the client before suctioning and
b. 5 seconds limit the suctioning pass to 10 seconds.
5 / 15
c. 10 seconds
d. 30 seconds
A nurse is suctioning fluids from a fe-
male client through an endotracheal Answer C.
tube. During the suctioning procedure,
the nurse notes on the monitor that the During suctioning, the nurse should
heart rate is decreasing. Which of the monitor the client closely for side effects,
following is the appropriate nursing inter- including hypoxemia, cardiac irregulari-
vention? ties such as a decrease in heart rate
resulting from vagal stimulation, mucos-
a. Continue to suction. al trauma, hypotension, and paroxysmal
b. Notify the physician immediately. coughing. If side effects develop, espe-
c. Stop the procedure and reoxygenate cially cardiac irregularities, the proce-
the client. dure is stopped and the client is reoxy-
d. Ensure that the suction is limited to 15 genated.
seconds.
An unconscious male client is admitted
to an emergency room. Arterial blood
gas measurements reveal a pH of 7.30,
a low bicarbonate level, a normal carbon Answer A.
dioxide level, a normal oxygen level, and
an elevated potassium level. These re- In an acidotic condition, the pH would be
sults indicate the presence of: low, indicating the acidosis. In addition,
a low bicarbonate level along with the
a. Metabolic acidosis low pH would indicate a metabolic state.
b. Respiratory acidosis Therefore, options B, C, and D are incor-
c. Overcompensated respiratory acido- rect.
sis
d. Combined respiratory and metabolic
acidosis
A female client is suspected of having a
pulmonary embolus. A nurse assesses
Answer A.
the client, knowing that which of the fol-
lowing is a common clinical manifesta-
The common clinical manifestations
tion of pulmonary embolism?
of pulmonary embolism are tachypnea,
tachycardia, dyspnea, and chest pain
a. Dyspnea
b. Bradypnea
6 / 15
c. Bradycardia
d. Decreased respiratory
A nurse teaches a male client about the
use of a respiratory inhaler. Which action
by the client indicates a need for further Answer A.
teaching?
The client should be instructed to hold
a. Inhales the mist and quickly exhales his or her breath for at least 10 to 15
b. Removes the cap and shakes the in- seconds before exhaling the mist.
haler well before use
c. Presses the canister down with the Options B, C, and D are accurate instruc-
finger as he breathes in tions regarding the use of the inhaler.
d. Waits 1 to 2 minutes between puffs if
more than one puff has been prescribed
A female client has just returned to a Answer D.
nursing unit following bronchoscopy. A
nurse would implement which of the After bronchoscopy, the nurse keeps the
following nursing interventions for this client on NPO status until the gag reflex
client? returns because the preoperative seda-
tion and local anesthesia impair swallow-
a. Administering atropine intravenously ing and the protective laryngeal reflexes
b. Administering small doses of midazo- for a number of hours. Additional fluids
lam (Versed) are unnecessary because no contrast
c. Encouraging additional fluids for the dye is used that would need flushing
next 24 hours from the system. Atropine and midazo-
d. Ensuring the return of the gag reflex lam would be administered before the
before offering food or fluids procedure, not after.
Answer D.
A nurse is assessing the respiratory sta- Rib fractures are a common injury, espe-
tus of a male client who has suffered a cially in the older client, and result from
fractured rib. The nurse would expect to a blunt injury or a fall.
note which of the following?
Typical signs and Sx include
a. Slow deep respirations - pain and tenderness localized at the
b. Rapid deep respirations fracture site and exacerbated by inspira-
tion and palpation
- shallow respirations
7 / 15
- splinting or guarding the chest pro-
tectively to minimize chest movement,
c. Paradoxical respirations
and possible bruising at the fracture site.
d. Pain, especially with inspiration
Paradoxical respirations are seen with
flail chest.
Answer A.
Pneumothorax is characterized by rest-

lessness, tachycardia, dyspnea, pain
A male client has been admitted with
with respiration, asymmetrical chest ex-
chest trauma after a motor vehicle acci-
pansion, and diminished or absent
dent and has undergone subsequent in-
breath sounds on the affected side.
tubation. A nurse checks the client when
the high-pressure alarm on the ventilator
Pneumothorax can cause increased air-
sounds, and notes that the client has ab-
way pressure because of resistance
sence of breathe sounds in right upper
to lung inflation. Acute respiratory dis-
lobe of the lung. The nurse immediately
tress syndrome and pulmonary em-
assesses for other signs of:
bolism are not characterized by absent
breath sounds.
a. Right pneumothorax
b. Pulmonary embolism
An endotracheal tube that is inserted too
c. Displaced endotracheal tube
far can cause absent breath sounds, but
d. Acute respiratory distress syndrome
the lack of breath sounds most likely
would be on the left side because of the
degree of curvature of the right and left
main stem bronchi.
Answer C.
A nurse is teaching a male client with
chronic respiratory failure how to use
Instructions for using a metered-dose in-
a metered-dose inhaler correctly. The
haler include
nurse instructs the client to:
- shaking the canister,
- holding it right side up,
a. Inhale quickly
- inhaling slowly and evenly through the
b. Inhale through the nose
mouth,
c. Hold the breath after inhalation
- delivering one spray per breath,
d. Take two inhalations during one breath
- and holding the breath after inhalation.
Answer D.
8 / 15
The earliest detectable sign of acute
A nurse is assessing a female client with respiratory distress syndrome is an in-
multiple trauma who is at risk for decreased respiratory rate, which can be-
veloping acute respiratory distress syn- gin from 1 to 96 hours after the initial
drome. The nurse assesses for which insult to the body. T
earliest sign of acute respiratory distress
syndrome? his is followed by increasing dyspnea, air
hunger, retraction of accessory muscles,
a. Bilateral wheezing and cyanosis.
b. Inspiratory crackles
c. Intercostal retractions Breath sounds may be clear or consist of
d. Increased respiratory rate fine inspiratory crackles or diffuse coarse
crackles.
A nurse is assessing a male client with Answer A.
chronic airflow limitations and notes that
the client has a "barrel chest." The nurse The client with emphysema has hyper-
interprets that this client has which of the inflation of the alveoli and flattening of
following forms of chronic airflow limita- the diaphragm. These lead to increased
tions? anteroposterior diameter, referred to as
"barrel chest."
a. Emphysema
b. Bronchial asthma The client also has dyspnea with pro-
c. Chronic obstructive bronchitis longed expiration and has hyperreso-
d. Bronchial asthma and bronchitis nant lungs to percussion.
A nurse is caring for a female client diag-
nosed with tuberculosis. Which assess- Answer B.
ment, if made by the nurse, is inconsis-
tent with the usual clinical presentation The client with tuberculosis USUAL-
of tuberculosis and may indicate the de- LY experiences cough (productive or
velopment of a concurrent problem? nonproductive), fatigue, anorexia, weight
loss, dyspnea, hemoptysis, chest dis-
a. Cough comfort or pain, chills and sweats (which
b. High-grade fever may occur at night), and a low-grade
c. Chills and night sweats fever
d. Anorexia and weight loss
How often should a nurse assess the The nurse should assess the client's
skin and nares of the patient with a nasal nares and ears for skin breakdown every
cannula? 6 hours.
9 / 15
What does central cyanosis indicate? Hypoexmia
weight gain
Describe the clinical signs of RIGHT distended neck veins
sided heart failure. hepatomegaly and splenomegaly
dependent peripheral edema
Fraction of Inspired oxygen concentra-
What does FIO2 stand for?
tion
collapse of the alveoli in the lung
prevents normal exchange of O2 and
What is atelectasis?
co2
hypoventilation occurs
Assessment
• In-depth history of the client's normal
and present cardiopulmonary function
• Past impairments in circulatory or res-
piratory functioning
• Patient history including a review of
Identify what is included during the as-
drug, food, and other allergies
sessment phase of the nursing process
• Physical examination of the client's car-
for a cardiopulmonary focus.
diopulmonary status reveals the extent
of existing signs and symptoms.
• Use PQRST for pain / HPI for other
symptoms
• Review of laboratory and diagnostic
test results
respirations > 35
clinical significance/contributing factors:
- respiratory failure
- response to fever
Describe Tachypnea - anemia
- pain
- respiratory infection
- anxiety
(emergencies SNS system kicks in)
- fatigue
- breathlessness
- dizziness
10 / 15
Identify initial assessment findings for a - confusion
patient with EARLY STAGE LEFT sided as a result of tissue hypoxia from the
heart failure diminished CO
A seven-month-pregnant female is sit-
ting quietly in the waiting room, and her
respiratory rate is 20 and shallow. What
does this finding suggest to the nurse?
c. Nothing. This is normal.

a. She has a history of smoking.
b. She is using accessory muscles to
breathe.
b. She is in pending respiratory failure.
c. Nothing. This is normal.
The nurse is planning to assess the apex
of a client's lungs. Which area of the
body will the nurse be assessing?
b. Above the clavicles
a. Left of the sternum, third intercostal
The apex of each lung is slightly superior
space
to the inner third of the clavicle.
b. Above the clavicles
c. Below the scapula
d. Right of the sternum, sixth intercostal
space
A client with a strained trapezius muscle
complains of having occasional short-
ness of breath. What might be the rea-
son for this symptom?
a. The strained muscle is an accessory

a. The strained muscle is an accessory muscle of respiration.
muscle of respiration.
b. The diaphragm muscle is also injured.
c. There is an undiagnosed heart prob-
lem.
d. There is a blood clot in his lung.
11 / 15
During a physical assessment, the nurse
documents eupnea on the client's med-
ical record. What does this finding sug-
gest?
a. Normal respirations
a. Normal respirations
b. Slow respirations
c. Irregular respirations
d. Rapid respirations
Prior to listening to a client's lung
sounds, the nurse palpates the sternum
and feels a horizontal bump on the bone.
What does this finding suggest to the
nurse?
a. This is the angle of Louis.
a. This is the angle of Louis.
b. The manubrium is damaged.
c. The costal angle is greater than nor-
mal.
d. The xiphoid process is misshaped.
The nurse is assessing the client's lung
bases posteriorly. At which area can the
nurse assess this portion of the lung?
b. Scapular line
a. Right anterior axillary line
b. Scapular line
c. Midsternal line
d. Left midclavicular line
The mother of a four-year-old child tells
the nurse, "I think there's something
wrong with him; his chest is round like
a ball." Which of the following would be
an appropriate response for the nurse to
make to the mother?
12 / 15
a. I see what you mean. That seems

odd.
b. The chest of a child appears round and
b. The chest of a child appears round
is normal.
and is normal.
c. I wouldn't worry about that.
d. Did you tell the doctor about this?
After examining a 75-year-old male
client, the nurse writes down "barrel
chest." What does this finding suggest?
d. This is a change associated with ag-

a. The client has a history of smoking.
ing.
b. The client has osteoporosis.
c. The client has long-standing respira-
tory disease.
d. This is a change associated with ag-
ing.
A 57-year-old client tells the nurse, "I
need two to three pillows to sleep." How
should this information be documented?
a. Two to three pillow orthopnea

a. Two to three pillow orthopnea
b. Dyspnea on excursion
c. Resting apnea
d. Dyspnea at rest
The client tells the nurse he sometimes
coughs up "thick yellow mucous." What
does this information suggest to the
c. He might have episodic lung infections
nurse?
Rationale: The color and odor of any mu-
cus is associated with specific diseases
a. He might have an allergy.
or problems. Green or yellow mucus of-
b. He might have a fungal infection.
ten signals a lung infection.
c. He might have episodic lung infec-
tions.
d. He might have tuberculosis.
13 / 15
a 48-year-old client doesn't smoke ciga-
rettes yet is demonstrating signs of lung
irritation. Which of the following ques-
tions could help with the assessment of
this client?
a. Do you smoke or inhale marijuana or
other herbal products?
a. Do you smoke or inhale marijuana or
other herbal products?
b. Have you had allergy testing?
c. Have you received a flu or pneumonia
vaccination?
d. Have you tried to stop smoking?
After inspecting a client's thorax, the
nurse writes "AP:T 1:2, bilateral symmet-
rical movements, sternum midline, res-
piratory rate 16 and regular." What do
these findings suggest?
a. Nothing. These findings are normal.
a. Nothing. These findings are normal.

b. The client has pneumonia.
c. The client has a respiratory illness.
d. The client has allergies.
While palpating the posterior thorax of a
client, the nurse notes increased fremi-
tus. What does this finding suggest to the
nurse?
c. The client could either have fluid in the
lungs or have an infection.
a. The client needs to speak up.
b. The client has a thick chest wall.
c. The client could either have fluid in the
lungs or have an infection.
d. Nothing. This is a normal finding.
The nurse sees that the client will
breathe deeply and then stop breathing
for a short while. Which of the following
14 / 15
does this observation suggest?
a. This client is hyperventilating. d. This is seen in aging people, people

b. This client is in a diabetic coma. with heart failure, and people who have
c. This client has pneumonia. suffered brain damage.
d. This is seen in aging people, people
with heart failure, and people who have
suffered brain damage.
In planning a patient education session,
the nurse sees one area of focus for
Healthy People 2010 is chronic obstruc-
tive pulmonary disease (COPD). Which
of the following information should the
nurse include in the education session to
address this focus area? b. Smoking cessation
a. Screening for environmental triggers

b. Smoking cessation
c. Develop action plans
d. Identify those at risk
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Ch.

26 Respiratory NCLEX Questions

To promote the release of surfactant, the

A. Take deep breaths

A. Contraction of the accessory abdom- D. Decrease in intrathoracic pressure rel-

A. Dyspnea and hypotension B. Apprehension and restlessness

A. A vigorous cough C. Increased residual volume

A. Dyspnea during rest or exercise

A. Begin listening at the apices B. Begin listening at the lung bases

A. Inspiratory chest expansion on 1 in

Nursing managment of a patient with

A. The patient will need his amino-

A. "The disease is characterized by in-

clubbing of the fingers A. Clubbing of the fingers

Two of the most prevalent causative fac-

A male patient has a sucking stab wound

1. Have trouble falling asleep?; Awaken

2. Diminished breath sounds

Rationale: Flail chest results from multi-

Rationale: The client with human immun-

The most important action the nurse

a. Pleural effusion a. Pleural effusion

If a biopsy was performed during a bron-

Pneumothorax is characterized by rest-

c. Nothing. This is normal.

a. The strained muscle is an accessory

a. I see what you mean. That seems

d. This is a change associated with ag-

a. Two to three pillow orthopnea

a. Nothing. These findings are normal.

a. This client is hyperventilating. d. This is seen in aging people, people

a. Screening for environmental triggers

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