Respi-questions.docx

KABC – RESPI QUESTIONS

1.

The emergency department nurse is assessing a client who has

a.

Continue to suction.

sustained a blunt injury to the chest wall. Which finding indicates

b.

Notify the health care provider immediately.

the presence of a pneumothorax in this client?

c.

Stop the procedure and re-oxygenate the client.

d.

Ensure that the suction is limited to 15 seconds.

a.

A low respiratory rate

b.

Diminished breath sounds

c.

The presence of a barrel chest

d.

A sucking sound at the site of injury

8.

The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding?

2.

3.

The nurse is caring for a client hospitalized with acute exacerbation

a.

Slow, deep respirations

of chronic obstructive pulmonary disease. Which findings would the

b.

Rapid, deep respirations

nurse expect to note on assessment of this client? Select all that

c.

Paradoxical respirations

apply.

d.

Pain, especially with inspiration

The

a.

A low arterial PCo2 level

b.

A hyperinflated chest noted on the chest x -ray

c.

Decreased oxygen saturation with mild exercise

d.

A widened diaphragm noted on the chest x-ray

a.

Cyanosis

e.

Pulmonary function tests that demonstrate

b.

Hypotension

f.

increased vital capacity

c.

Paradoxical chest movement

d.

Dyspnea, especially on exhalation

nurse

instructs

a client

to

use

the

pursed-lip

9.

assesses the client for which most distinctive sign of flail chest?

method

of

breathing and evaluates the teaching by asking the client about the

4.

10.

A client has been admitted with chest trauma after a motor vehicle

purpose of this type of breathing. The nurse determines that the

crash and has undergone subsequent intubation. The nurse checks

client understands if the client states that the primary purpose of

the client when the high-pressure alarm on the ventilator sounds,

pursed-lip breathing is to promote which outcome?

and notes that the client has absence of breath sounds in the right

a.

Promote oxygen intake

upper lobe of the lung. The nurse immediately assesses for other

b.

Strengthen the diaphragm

signs of which condition?

c.

Strengthen the intercostal muscles

a.

Right pneumothorax

d.

Promote carbon dioxide elimination

b.

Pulmonary embolism

c.

Displaced endotracheal tube

d.

Acute respiratory distress syndrome

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for

tuberculosis. Which

instructions should the nurse include on the list? Select all that

11.

apply. Activities should be resumed gradually.

b.

Avoid

d.

contact

with

other

individuals,

assess for which earliest sign of acute respiratory distress syndrome? except

a.

Bilateral wheezing

members, for at least 6 months.

b.

Inspiratory crackles

A sputum culture is needed every 2 to 4 weeks once

c.

Intercostal retractions

medication therapy is initiated.

d.

Increased respiratory rate

Respiratory isolation is not necessary because

family

family

members already have been exposed. e.

f.

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should

a.

c.

5.

A client with a chest injury has suffered flail chest. The nurse

12.

The nurse is discussing the techniques of chest physiotherapy and

Cover the mouth and nose when coughing or sneezing and

postural

put used tissues in plastic bags.

expectoration problems because of chronic thick, tena cious mucus

drainage

(respiratory

treatments)

to

a

client

When 1 sputum culture is negative, the client is no longer

production in the lower airway. The nurse explains that after the

considered infectious and usually can return to former

client is positioned for postural drainage the nurse will perform

employment.

which action to help loosen secretions? a.

Palpation and clubbing

The nurse is caring for a client after a bronchoscopy and biopsy.

b.

Percussion and vibration

Which finding, if noted in the client, should be reported immediately

c.

Hyperoxygenation and suctioning

to the health care provider?

d.

Administer a bronchodilator and monitor peak flow

having

a.

Dry cough

b.

Hematuria

c.

Bronchospasm

with tuberculosis who has been receiving medication for 2 weeks.

d.

Blood-streaked sputum

The nurse determines that the client has understood the inform ation

13.

The nurse has conducted discharge teaching with a client diagnosed

if the client makes which statement? 6.

The nurse is preparing to suction a client via a tracheostomy tube.

a.

“I need to continue medication therapy for 1 month.”

The nurse should plan to limit the suctioning time to a maximum of

b.

“I can’t shop at the mall for the next 6 months.”

which time period?

c.

“I can return to work if a sputum culture comes back

a.

5 seconds

b.

10 seconds

d.

negative.” “I should not be contagious after 2 to 3 weeks of

c.

30 seconds

e.

medication therapy.”

d.

60 seconds 14.

7.

The nurse is preparing to give a bed bath to an immobilized client

The nurse is suctioning a client via an endotracheal tube. During the

with

suctioning procedure, the nurse notes on the monitor that the heart

performing this care?

rate is decreasing. Which nursing intervention is appropriate?

tuberculosis.

a.

-1-

The

nurse

should

Surgical mask and gloves

wear

which

items

when

KABC – RESPI QUESTIONS

15.

b.

Particulate respirator, gown, and gloves

associated with tuberculosis. The nurse informs the participants tha t

c.

Particulate respirator and protective eyewear

tuberculosis

d.

Surgical mask, gown, and protective eyewear

symptoms are present? Select all that apply.

is

considered

a.

Dyspnea

A client has experienced pulmonary embolism. The nurse should

b.

Headache

assess for which symptom, which is most commonly reported?

c.

Night sweats

as

a

diagnosis

if

which

signs

a.

Hot, flushed feeling

d.

A bloody, productive cough

b.

Sudden chills and fever

e.

A cough with the expectoration of mucoid sputum

c.

Chest pain that occurs suddenly

d.

Dyspnea when deep breaths are taken

23.

and

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of

16.

A client who is human immunodeficiency virus (HIV)–positive has had

which diagnostic test that will confirm this diagnosis?

a tuberculin skin test (TST). The nurse notes a 7-mm area of

a.

Chest x-ray

induration at the site of the skin test and interprets the result as

b.

Bronchoscopy

which finding?

c.

Sputum culture

d.

Tuberculin skin test

a.

Positive

b.

Negative

c.

Inconclusive

d.

Need for repeat testing

24.

The low-pressure alarm sounds on a ventilator. The nurse assesses the client and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should

17.

A

client

with

acquired

histoplasmosis.

The

immunodeficiency

nurse

should

assess

syndrome the

(AIDS)

client

for

has

take what initial action?

which

expected finding?

Administer oxygen

b.

Check the client’s vital signs

a.

Dyspnea

c.

Ventilate the client manuall y

b.

Headache

d.

Start cardiopulmonary resuscitation

c.

Weight gain

d.

Hypothermia

25.

A client has a prescription to take guaifenesin. The nurse determines that

18.

a.

the

client

understands

the

proper

administration

of

this

The nurse is giving discharge instructions to a client with pulmonary

medication if the client states that he or she will perform which

sarcoidosis. The nurse concludes that the client understands the

action?

information if the client indicates to report which early sign of

a.

Take an extra dose if fever develops

exacerbation?

b.

Take the medication with meals only

a.

Fever

c.

Take the tablet with a full glass of water

b.

Fatigue

d.

Decrease the amount of daily fluid intake

c.

Weight loss

d.

Shortness of breath

26.

The

nurse

is

preparing

to

administer

a

dose

of

naloxone

intravenously to a client with an opioid overdose. Which supportive 19.

The nurse is taking the history of a client with occupational lung

medical equipment should the nurse plan to have at the client’s

disease (silicosis). The nurse should assess whether the client wears

bedside if needed?

which item during periods of exposure to silica particles?

a.

Nasogastric tube

a.

Mask

b.

Paracentesis tray

b.

Gown

c.

Resuscitation equipment

c.

Gloves

d.

Central line insertion tray

d.

Eye protection 27.

20.

The nurse teaches a client about the effects of diphenhydramine,

An oxygen delivery system is p rescribed for a client with chronic

which has been prescribed

obstructive

determines that the client needs further instruction if the client

pulmonary

concentration.

Which

disease oxygen

to

deliver

delivery

system

a

precise would

the

oxygen nurse

as

a cough suppressant. The nurse

makes which statement?

prepare for the client?

a.

“I will take the medication on an empty stomach.”

a.

Face tent

b.

“I won’t drink alcohol while taking this medication.”

b.

Venturi mask

c.

“I won’t do activities that require mental alertness while

c.

Aerosol mask

d.

Tracheostomy collar

taking this medication.” d.

“I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth.”

21.

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of

22.

28.

Acromolyn sodium inhaler is prescribed for a client with allergic

breathing during dyspneic periods. Which position should the nurse

asthma. The

instruct the client to assume?

effects of this medication and should tell the client that which

a.

Sitting up in bed

b.

Side-lying in bed

a.

Insomnia

c.

Sitting in a recliner chair

b.

Constipation

d.

Sitting up and leaning on an overbed table

c.

Hypotension

d.

Bronchospasm

community

members

regarding

undesirable effect is associated with this medication?

The community health nurse is conducting an educational session with

nurse provides instructions

regarding

the

signs

and

symptoms

-2-

the

adverse

KABC – RESPI QUESTIONS

29.

Terbutaline is prescribed for a client with bronch itis. The nurse

c.

Alternating a single puff of each, beginning with the

checks the client’s medical history for which disorder in which the

beclomethasone

medication should be used with caution?

30.

a.

Osteoarthritis

b.

Hypothyroidism

37.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse

c.

Diabetes mellitus

effects of the medication should the nurse monitor? Select all that

d.

Polycystic disease

apply. a.

Signs of hepatitis

Zafirlukast is prescribed for a client with bronchial asthma. Which

b.

Flulike syndrome

laboratory test does the nurse expect to be prescribed before the

c.

Low neutrophil count

administration of this medication?

d.

Vitamin B6 deficiency

a.

Platelet count

e.

Ocular pain or blurred vision

b.

Neutrophil count

f.

Tingling and numbness of the fingers

c.

Liver function tests

d.

Complete blood count

38.

A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking

31.

A client has been taking isoniazid for 2 months. The client complains

this medication?

to the nurse about numbness, paresthesias, and tingling in the

a.

Coffee, cola, and chocolate

extremities. The nurse interprets that the client is experiencing

b.

Oysters, lobster, and shrimp

which problem?

c.

Melons, oranges, and pineapple

d.

Cottage cheese, cream cheese, and dairy creamers

a.

Hypercalcemia

b.

Peripheral neuritis

c.

Small blood vessel spasm

d.

Impaired peripheral circulation

39.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect?

32.

A client is to begin a 6-month course of therapy with isoniazid. The

a.

“I have a severe headache.”

nurse should plan to teach the client to take which action?

b.

“My feet are quite swollen.”

a.

Use alcohol in small amounts only.

c.

“I am nauseated and may vomit.”

b.

Report yellow eyes or skin immediately.

d.

“My lips and tongue are swollen.”

c.

Increase intake of Swiss or aged cheeses.

d.

Avoid vitamin supplements during the rapy.

40.

The nurse is caring for a client with a diagnosis of influenza who first began

33.

to

experience

symptoms

is

the

medication?

understanding of the instructions?

therapy.

Which

statement

by

the

client

indicates

a.

Should always be taken with food or antacids

a.

“I must take the medication exactly as prescribed.”

b.

Should be double-dosed if 1 dose is forgotten

b.

“Once

c.

Causes orange discoloration of sweat, tears, urine, and

I

start

the

c.

May be discontinued independently if symptoms are gone

the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding ? Impaired sense of hearing Gastrointestinal side effects

c.

Orange-red discoloration of body secretions

d.

Difficulty in discriminating the color red from green

A client with tuberculosis is being started on anti -tuberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? a.

Electrolyte levels

b.

Coagulation times

c.

Liver enzyme levels

d.

Serum creatinine level

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone di propionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a.

Beclomethasone first and then the sal meterol

b.

Salmeterol first and then the beclomethasone Alternating

will

no

longer

be

“I will not get any colds or infections while taking this

“This medication has minimal side effects and I can return to normal activities.”

b.

I

medication.” d.

The nurse has given a client taking ethambutol information about

a.

medication,

an

contagious.”

in 3 months

36.

the rapy

nurse should provide which information to the client about the

feces

35.

Antiviral

prescribed and the nurse provides instructions to the client about

d.

34.

yesterday.

A client has been started on long -term therapy with rifampin. The

a single puff of each, beginning with the salmeterol

-3-

KABC – RESPI QUESTIONS

1.

2.

B

8.

D

This client has sustained a blunt or closed -chest injury. Basic

Rib fractures result from a blunt injury or a fall. Typical

symptoms of a closed pneumothorax are shortness of breath and

signs and symptoms include pain and tenderness localized at the

chest pain. A larger pneumothorax may cause tachypne a, cyanosis,

fracture site

diminished

emphysema.

shallow respirations, splinting or guarding the chest protectively to

Hyperresonance also may occur on the affected side. A sucking sound

minimize chest movement, and possible bruising at the fracture site.

at the site of injury would be noted with an open chest injury.

Paradoxical respirations are seen with flail chest.

breath

sounds,

and

subcutaneous

B, C

9.

that is exacerbated by inspiration and palpation,

C

Clinical manifestations of chronic obstructive pulm onary disease

Flail chest results from multiple rib fractures. This results in a

(COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at

“floating” section of ribs. Because this section is unattached to the

rest, oxygen desaturation with exercise, and the use of accessory

rest of the bony rib cage, this segment results in paradoxical chest

muscles of respiration. Chest x -rays reveal a hyperinflated chest and

movement. This

a flattened diaphragm if the disease is advanced. Pulmonary function

fractured segment inward, while the rest of the chest expands.

tests will demonstrate decreased vital capacity.

Similarly, during exhalation, the segment balloons outward while the

means that the

force

of

inspiration pulls

the

rest of the chest moves inward. This is a characteristic sign of flail 3.

D

chest.

Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung

disease. This type of breathing

allows better

10.

A.

expiration by increasing airway pressure that keeps air passages

Pneumothorax

open during exhalation. Options A, B, and C are not the purposes of

dyspnea, pain with respiration, asymmetrical chest expansion, and

this type of breathing.

diminished

or

Pneumothorax 4.

is

characterized

absent can

breath

cause

by

restlessness,

sounds

increased

on

airway

the

tachycardia,

affected

pressure

side.

because

of

A, C, D, E

resistance to lung inflation. Acute respiratory distress syndrome and

The nurse should provide the client and family with information

pulmonary embolism are not characterized by absent breath sounds.

about tuberculosis and allay concerns about the contagious aspec t

An endotracheal tube that is inserted too far can cause abse nt breath

of the infection. The client needs to follow the medication regimen

sounds, but the lack of breath sounds most likely would be on the

exactly as prescribed and always have a supply of the medication on

left side because of the degree of curvature of the right and left

hand. Side and adverse effects of the medication and ways of

mainstem bronchi.

minimizing them to ensure compliance should be explained. After 2 to 3 weeks of medication therapy, it is unlikely that the client will

11.

D

infect anyone. Activities should be resumed gradually and a well -

The earliest detectable sign of acute respiratory distress syndrome

balanced diet that is rich in iron, protein, and vitamin C to promote

is an increased respiratory rate, which can begin from 1 to 96 hours

healing and prevent recurrence of infectio n should be consumed.

after the initial insult to the body. This is followed by increasing

Respiratory isolation is not necessary because family members

dyspnea, air hunger, retraction of accessory muscles, and cyanosis.

already have been exposed. Instruct the client about thorough hand

Breath sounds may be clear or consist of fine inspiratory crackles or

washing, to cover the mouth and nose when coughing or sneezing,

diffuse coarse crackles.

and to put used tissues into plastic bags . A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. When the

12.

B.

results of 3 sputum cultures are negative, the client is no longer

Chest physiotherapy of percussion and vibration helps to loosen

considered infectious and can usually return to former employment.

secretions in the smaller lower airways. Postural drainage positions the client so that gravity can help mucus move from smaller airways

5.

C

to larger ones to support expectoration of the mucus. Options A, C,

If a biopsy was performed during a bronchoscopy, blood-streaked sputum

is

expected

for

several

hours.

Frank

blood

and D are not actions that will loosen secretions.

indicates

hemorrhage. A dry cough may be expected. The client should be

13.

D

assessed for signs of complications, which would include cyanosis,

The client is continued on medication therapy for up to 12 months,

dyspnea,

depending on the situation. The client generally

stridor,

tachycardia,

and

bronchosp asm,

dysrhythmias.

hemoptysis,

Hematuria

is

hypotension,

unrelated

to

this

is considered

noncontagious after 2 to 3 weeks of medication therapy. The client

procedure.

is instructed to wear a mask if there will be exposure to crowds until the medication is effective in preventing transmission. The client is

6.

B

allowed to return to work when the results of 3 sputum cultures are

Hypoxemia can be caused by prolonged suctioning, which stimulates

negative.

the pacemaker cells in the heart. A vasovagal response may occur, causing bradycardia. The nurse must preoxygenate the client before

14.

suctioning and limit the suctioning pass to 10 seconds.

B The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also

7.

C

would wear gloves as per standard precautions. The nurse wears a

During suctioning, the nurse should monitor the client closely for

gown when the possibility exists that the clothing could become

adverse effects, including hypoxemia, cardiac irregularities such as

contaminated, such as when giving a bed bath.

a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If adverse effects

15.

C

develop, especially cardiac irregularities, the procedure is stopped

The most common initial symptom in pulmonary embolism is chest

and the client is reoxygenated.

pain that is sudden in onset. The next most commonly reported symptom

-4-

is

dyspnea,

which

is

accompanied

by

an

increased

KABC – RESPI QUESTIONS

respiratory rate. Other typical symptoms of pulmonary embolism include

apprehension and restlessness,

24.

tachycardia, cough, and

C If at any time an alarm is sounding and the nur se cannot quickly

cyanosis.

ascertain the problem, the client is disconnected from the ventilator and manual resuscitation is used to support respirations until the

16.

A

problem

The client with HIV infection is considered to have positive results

cardiopulmonary resuscitation. Checking vital signs is not the initial

can

be

corrected.

No

reason

is

given

to

begin

on tuberculin skin testing with an area of induration larger than 5

action. Although oxygen is helpful, it will not provide ventilation to

mm. The client without HIV is positive with an induration larger than

the client.

10 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false -negative readings because of the immunosuppression factor. Options B, C, and D are incorrect

25.

interpretations.

C Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should

17.

A

not be taken. The client should contact the health care provider if

Histoplasmosis is an opportunistic fungal infection that can occur in

the cough lasts longer than 1 week or is accompanied by fever, rash,

the client with AIDS. The infection begins as a respiratory infection

sore throat, or persistent headache. Fluids are needed to decrease

and can

the viscosity of secretions. The medication does not have to be taken

progress to

symptoms

include

disseminated infection.

fever,

dyspnea,

cough,

Typical and

signs and

weight

loss.

with meals.

Enlargement of the client’s lymph nodes, liver, and spleen may occur as well.

26.

C The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support

18.

D

naloxone therapy if it is needed. Other adjuncts that may be needed

Dry cough and dyspnea are typical early manifestations of pulmonary

include oxygen, a mechanical ventilator, and vasopressors.

sarcoidosis. Later manifestations include night sweats, fever, weight loss, and skin nodules.

27.

A Diphenhydramine has several uses, including as an antihistamine,

19.

A.

antitussive, antidyskinetic, and sedativehypnotic. Instructions for

Silicosis results from chronic, excessive inhalation of particles of

use include taking with food or milk to decrease gastrointestinal

free crystalline silica dust. The client should wear a mask to limit

upset and using oral rinses, sugarless gum, or hard candy to minimize

inhalation of this substance, which can cause restrictive lung disease

dry mouth. Because the medication causes drowsiness, the client

after years of exposure. Options B, C, and D are not necessary.

should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental

20.

B

awareness during use.

The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic

28.

D

airflow limitation such as chronic obstructive pulmonary disease,

Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a

because it delivers a precise oxygen concentration. The face tent,

mast cell stabilizer. Undesirable effects associated with inhalation

aerosol mask, and tracheostomy collar are also high-flow oxygen

therapy

delivery

congestion, throat irritation, and wheezing. Clients r eceiving this

systems

but

most

often

are

used

to

administer

high

humidity.

of

cromolyn

sodium

are

bronchospasm,

cough,

nasal

medication orally may experience pruritus, nausea, diarrhea, and myalgia.

21.

D Positions that will assist the client with emphysema with breathing

29.

C

include sitting up and leaning on an overbed table, sitting up and

Terbutaline is a bronchodilator and is contraindicated in clients with

resting the elbows on the knees, and standing and leaning against

hypersensitivity

the wall.

caution in clients with impaired cardiac function, diabetes mellitus, hypertension,

22.

A, C, D, E

to

sympathomimetics.

hyperthyroidism,

or

a

It

should

history

of

be

used

seizures.

with

The

medication may increase blood glucose levels.

Tuberculosis should be considered for any clients with a persistent cough, weight loss, anorexia, night sweats, hemoptysis, shortness of breath,

fever,

or

chills.

The

client’s

previous

exposure

30.

C

to

Zafirlukast

tuberculosis should also be assessed and correlated with the clinical

prophylaxis

is

a

leukotriene

receptor

long-term

treatment

manifestations.

Zafirlukast is used with caution in clients with impaired hepatic

and

antagonist of

used

bronchial

in

the

asthma.

function. Liver function laboratory tests should be performed to 23.

C

obtain

Tuberculosis is definitively diagnosed through culture

administration of the medication. It is not necessary to perform the

and

isolation

of

Mycobacterium

tuberculosis.

A

presumptive

a baseline,

and

the

levels

should

be

monitored

during

other laboratory tests before administration of the medication.

diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy. Test-Taking Strategy: Focus on the subject, confirming the diagnosis of tuberculosis.

31.

Confirmation is made by identifying the bacteria, M. tuberculosis.

B Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling,

-5-

KABC – RESPI QUESTIONS

and paresthesias in the extremities. T his can be minimized with

numbness and tingling in the extremities are associated with the use

pyridoxine

of isoniazid.

(vitamin

B6)

intake.

Options

A,

C,

and

D

are

not

associated with the information in the question. 38. 32.

A

B

Theophylline is a methylxanthine bronchodilator. The nurse teaches

Isoniazid is hepatotoxic, and therefore the client is taught to report

the client to limit the intake of xanthine containing foods while

signs and symptoms of hepatitis immediately, which include yellow

taking

skin and sclera. For the same reason, alcohol should be avoided

chocolate.

this

medication.

These

foods

include

coffee,

cola,

and

during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause

39.

D

a reaction characterized by redness and itching of the skin, flushing,

Omalizumab is an antiinflammatory used for longterm control of

sweating, tachycardia, headache, or lightheadedness. The client can

asthma. Anaphylactic reactions can occur with the administration of

avoid developing peripheral neuritis by increasing the intake of

omalizumab. The nurse administering the medication should monitor

pyridoxine (vitamin B6) during the course of isoniazid

for adverse reactions of the medication. Swelling of the lips and

therapy.

tongue are an indication of an anaphylaxis. The client statements in options A, B, and C are not indicative of an adverse reaction.

33.

C Rifampin causes orange-red discoloration of body secretions and will

34.

40.

Antiviral

exactly as directed. Doses should not be doubled or skipped. The

prescribed. These medications do not prevent the spread of influenza

client should not stop therapy until directed to do so by a health care

and clients are usually contagious for up to 2 days after the initiation

provider. It is best to administer the medication on an empty

of antiviral medications. Secondary bacterial infections may occur

stomach unless it causes gastrointestinal upset, and then it may be

despite

taken with food. Antacids, if prescribed, should be taken at least 1

medications and may necessitate a change in activities, especially

hour before the medication.

when driving or operating machinery if dizziness occurs.

D Ethambutol causes optic neuritis , which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal

upset

occurs.

Impaired

hearing

results

from

antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

35.

C Isoniazid therapy can cause an elevation of hepat ic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests i n options A, B, and D are not necessary.

36.

B Salmeterol

is

an

adrenergic

type

of

bronchodilator

and

beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

37.

A

stain soft contact lenses permanently. Rifampin should be taken

A, B, C, E Rifabutin may be prescribed for a client with active MAC disease and tuberculosis.

It

inhibits

mycobacterial

DNA-dependent

RNA

polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil

count),

redorange –

colored

body

secretions,

uveitis

(blurred vision and eye pain), myositis, ar thralgia, hepatitis, chest pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and

-6-

medications

antiviral

for

influenza

treatment.

Side

must

be

effects

taken

occur

exactly

with

as

these

KABC – RESPI QUESTIONS

1.

Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with

sees many abbreviations. What does a lowercase “a” in ABG value

newly diagnose asthma. When teaching the patient about this drug,

present?

the nurse should explain that it may cause:

a.

Acid-base balance

a.

Nasal congestion

b.

Arterial Blood

b.

Nervousness

c.

Arterial oxygen saturation

c.

Lethargy

d.

Alveoli

d.

Hyperkalemia 9.

2.

A male patient is admitted to the healthcare facility for treatment

Miriam, a college student with acute rhinitis sees the campus nurse

of chronic obstructive pulmonary disease. Which nursing diagnosis

because of excessive nasal drainage. The nurse asks the patient

is most important for this patient?

about the color of the drainage. In acute rhinitis, nasal drainage

a.

Activity intolerance related to fatigue

normally is:

b.

Anxiety related to actual threat to health status

a.

Yellow

c.

Risk for infection related to retained secretions

b.

Green

d.

Impaired gas exchange related to airflow obstruction

c.

Clear

d.

Gray

10.

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

3.

A male adult patient hospitalized for treatment of a pulmonary

a.

Contralateral side in a simple pneumothorax

embolism develops respiratory alkalosis. Which clinical findings

b.

Affected side in a hemothorax

commonly accompany respiratory alkalosis?

c.

Affected side in a tension pneumothorax

d.

Contralateral side in hemothorax

a.

Nausea or vomiting

b.

Abdominal pain or diarrhea

c.

Hallucinations or tinnitus

d.

Lightheadedness or paresthesia

11.

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

4.

4. Before administering ephedri ne, Nurse Tony assesses the patient’s

a.

Monitor fluctuations in the water -seal chamber

history.

b.

Clamp the chest tube once every shift

c.

Encourage coughing and deep breathing

d.

Milk the chest tube every 2 hours

Because

of

ephedrine’s

central

nervous

system

(CNS)

effects, it is not recommended for:

5.

a.

Patients with an acute asthma attack

b.

Patients with narcolepsy

c.

Patients under age 6

d.

Elderly patients

12.

When

male

patient

who

has

just

had

Encourage oral feeding as soon as possible

b.

Develop an alternative communication method

consequence of shock. The patient’s condition deteriorates rapidly,

c.

Keep the tracheostomy cuff fully inflated

and

d.

Keep the patient flat in bed

endotracheal When

intubation the

and

mechanical

high-pressure

alarm

on

ventilation the

are

13.

total

A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

a.

Kinking of the ventilator tubing

b.

A disconnected ventilator tube

a.

Drawing blood for a hematocrit and hemoglobin level

c.

An endotracheal cuff leak

b.

Applying a dressing over the wound and taping it on three

d.

A change in the oxygen concentration without resetting

sides

the oxygen level alarm

A

a

mechanical

Which condition triggers the high -pressure alarm?

male

adult

patient

on

mechanical

ventilation

is

assessment

finding

indicates

that

the

patient

c.

Preparing a chest tube insertion tray

d.

Preparing to start an I.V. line

receiving

pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which needs

14.

another

For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

pancuronium dose?

a.

Encouraging the patient to drink three glasses of fluid

a.

Leg movement

b.

Finger movement

b.

daily Keeping the patient in semi -Fowler’s position

c.

Lip movement

c.

Using a high-flow venture mask to deliver oxygen as

d.

Fighting the ventilator

prescribe d.

8.

a

a.

ventilator, alarm sounds, the nurse starts to check for the cause.

7.

for

A female patient suffers adult respiratory distress syndrome as a

initiated.

6.

caring

laryngectomy, the nurse should plan to:

Administering a sedative, as prescribe

On auscultation, which finding suggests a right pneumothorax? a.

Bilateral inspiratory and expiratory crackles

b.

Absence of breaths sound in the right thorax

15.

A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results

c.

Inspiratory wheezes in the right thorax

from:

d.

Bilateral pleural friction rub.

a.

Cardiogenic pulmonary edema

b.

Respiratory alkalosis

Rhea, confused and short breath, is brought to the emergency

c.

Increased pulmonary capillary permeability

department by a family member. The medical history reveals chronic

d.

Renal failure

bronchitis

and

hypertension. To

learn

more

about

the

current

respiratory problem, the doctor orders a chest x -ray and arterial

16.

blood gas (ABG) analysis. When reviewing the ABG report, the nurses

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

-7-

KABC – RESPI QUESTIONS

a.

Restricting fluid intake to 1,000 ml per day

b.

Enforcing absolute bed rest

24.

exacerbation of chronic obstructive pulmonary disease. Which of the

c.

Teaching the patient how to perform controlled coughing

following would the nurse expect to note on assessment of this

d.

Administering prescribe sedative s regularly and in large

client?

amounts

17.

Nurse

Reese

is

caring

for

a

client

hospitalized

with

a.

Hypocapnia

b.

A hyperinflated chest noted on the ches t x-ray

Nurse Lei caring for a client with a pneumothorax and who has had a

c.

Increased oxygen saturation with exercise

chest tube inserted notes continues gentle bubbling in the suction

d.

A widened diaphragm noted on the chest x -ray

acute

control chamber. What action is appropriate? a.

Do nothing, because this is an expected fi nding

b.

Immediately clamp the chest tube and notify the physician

chronic obstructive pulmonary disease to deliver a precise oxygen

c.

Check for an air leak because the bubbling should be

concentration. Which of the fol lowing types of oxygen delivery

intermittent

systems would the nurse anticipate to be prescribed?

d.

Increase

the

suction

pressure

so

that

the

25.

bubbling

becomes vigorous

18.

Nurse Maureen has assisted a physician with the insertion of a chest

An oxygen delivery system is prescribed for a male client with

a.

Face tent

b.

Venturi mask

c.

Aerosol mask

d.

Tracheostomy collar

tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on

26.

this assessment, which action would be appropriate?

19.

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosi s. The nurse

a.

Inform the physician

tells the group that one of the first symptoms associated with

b.

Continue to monitor the client

tuberculosis is:

c.

Reinforce the occlusive dressing

a.

Dyspnea

d.

Encourage the client to deep breathe

b.

Chest pain

c.

A bloody, productive cough

d.

A cough with the expectoration of mucoid sputum

Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

20.

27.

A nurse performs an admission assessment on a female client with a

a.

Call the physician

diagnosis of tuberculosis. The nurse reviews the result of which

b.

Place the tube in bottle of sterile water

diagnosis test that will confirm this diagnosis?

c.

Immediately replace the chest tube system

a.

Bronchoscopy

d.

Place a sterile dressing over the disconnection site

b.

Sputum culture

c.

Chest x-ray

d.

Tuberculin skin test

A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

21.

a.

Exhale slowly

b.

Stay very still

28.

oxygen. The nurse assesses the oxygen flow rate to ensure that it

c.

Inhale and exhale quickly

does not exceed:

d.

Perform the Valsalva maneuver

a.

1 L/min

b.

2 L/min

While changing the tapes on a tracheostomy tube, the male client

c.

6 L/min

coughs and tube is dislodged. The initial nursing action is to:

d.

10 L/min

a.

Call the physician to reinsert the tube

b.

Grasp the rete ntion sutures to spread the opening

c.

Call the respiratory therapy department to reinsert the

breathing and the client asks the nurse about the purpose of this

tracheotomy

type of breathing. The nurse responds, knowing that the primary

Cover the tracheostomy site with a sterile dressing to

purpose of pursed-lip breathing is to:

d.

29.

prevent infection

22.

A nurse is caring for a male client with emphysema who is receiving

A nurse instructs a female client to use the pursed -lip method of

a.

Promote oxygen intake

b.

Strengthen the diaphragm

Nurse Oliver is caring for a client immediately after removal of the

c.

Strengthen the intercostal muscles

endotracheal tube. The nurse reports which of the following signs

d.

Promote carbon dioxide elimination

immediately if experienced by the client?

23.

a.

Stridor

b.

Occasional pink-tinged sputum

30.

A nurse is caring for a male client with acute respira tory distress syndrome. Which of the following would the nurse expect to note in

c.

A few basilar lung crackles on the right

the client?

d.

Respiratory rate 24 breaths/min

a.

Pallor

b.

Low arterial PaO2

a male c lient who has

c.

Elevated arterial PaO2

sustained a blunt injury to the chest wall. Which of these signs would

d.

Decreased respiratory rate

An emergency room nurse is assessing

indicate the presence of a pneumothorax in this client? a.

A low respiratory rate

b.

Diminished breath sounds

31.

Which of the following nursing actions will facilitate obtaining the

c.

The presence of a barrel chest

specimen?

d.

A sucking sound at the site of injury

-8-

A nurse is preparing to obtain a sputum specimen from a male client.

a.

Limiting fluid

b.

Having the client take deep breaths

KABC – RESPI QUESTIONS

32.

c.

Asking the client to spit into the collection container

d.

Asking the client to obtain the specimen after eating

39.

Which phrase is used to describe the volume of air inspired and expired with a normal breath?

Nurse Joy is caring for a client after a bronchoscopy and biopsy.

a.

Total lung capacity

Which of the following signs, if noticed in the client, should be

b.

Forced vital capacity

reported immediately to the physician?

c.

Tidal volume

d.

Residual volume

a.

Dry cough

b.

Hematuria

c.

Bronchospasm

d.

Blood-streaked sputum

40.

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

33.

A nurse is suctioning fluids from a male client via a tracheos tomy

a.

Simple mask

tube. When suctioning, the nurse must limit the suctioning time to a

b.

Non-rebreather mask

maximum of:

c.

Face tent

a.

1 minute

d.

Nasal cannula

b.

5 seconds

c.

10 seconds

d.

30 seconds

41.

A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

34.

A

nurse

is

suctioning

fluids

from

a

female

client

through

an

a.

Impaired color discrimination

endotracheal tube. During the suctioning procedure, the nurse notes

b.

Increased urinary frequency

on the monitor that the heart rate is decreasing. Which if the

c.

Decreased hearing acuity

following is the appropriate nursing intervention?

d.

Increased appetite

a.

Continue to suction

b.

Notify the physician immediately

c.

Stop the procedure and reoxygenate the client

test for tuberculosis. The nurse should base her response on the fact

d.

Ensure that the suction is limited to 15 s econds

that the:

42.

A male client is asking the nurse a question regarding the Mantoux

a. 35.

A male adult client is suspected of having a pulmonary embolus. A

whether tuberculosis is present.

nurse assesses the client, knowing that which of the following is a

b.

common clinical manifestation of pulmonary embolism?

36.

a.

Dyspnea

b.

Bradypnea

c.

Bradycardia

d.

Decreased respirations

Area of redness is measured in 3 days and determines

Skin

test

doesn’t

differentiate

between

active

and

dormant tuberculosis infection. c.

Presence of

a wheal

at the injection site in 2 days

indicates active tuberculosis. d.

Test stimulates a reddened response in some clients and requires a second test in 3 months.

A slightly obese female client with a history of allergy -induced

43.

A female

adult client has

a tracheostomy but doesn’t require

asthma, hypertension, and mitral valve prolapse is admitted to an

continuous mechanical ventilation. When weaning the client from

acute care facility for elective surgery. The nurse obtains a complete

the tracheostomy tube, the nurse initially should plug the opening

history

in the tube for:

and

performs

a

thorough

physical

examination,

pa ying

special attention to the cardiovascular and respiratory systems.

a.

15 to 60 seconds.

When percussing the client’s chest wall, the nurse expects to elicit:

b.

5 to 20 minutes.

a.

Resonant sounds.

c.

30 to 40 minutes.

b.

Hyperresonant sounds.

d.

45 to 60 minutes.

c.

Dull sounds.

d.

Flat sounds.

44.

Nurse Oliver observes constant bubbling in the water -seal chamber of a closed chest drainage system. What should the nurse conclude?

37.

A male client who weighs 175 lb (79.4 kg) is recei ving aminophylline

a.

The system is functioning normally

(Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline

b.

The client has a pneumothorax.

level is reported as 6 mcg/ml. The nurse calls the physician who

c.

The system has an air leak.

instructs the nurse to change the dosage to 0.45 mg/kg/hour. The

d.

The chest tube is obstructed.

nurse should:

38.

a.

Question the order because it’s too low.

b.

Question the order because it’s too high.

45.

A

respiratory distress. Because of this client’s dark skin, the nurse

black

client

with

asthma

seeks

emergency

care

for

acute

c.

Set the pump at 45 ml/hour.

should assess for cyanosis by inspecting the:

d.

Stop the infusion and have the laboratory repeat the

a.

Lips.

theophylline measurement.

b.

Mucous membranes.

The nurse is teaching a male client with chronic bronchitis about

c.

Nail beds.

breathing exercises. Which of the following should the nurse include

d.

Earlobes.

in the teaching? a.

Make inhalation longer than exhalation.

b.

Exhale through an open mouth.

46.

For a male client with an endotracheal (ET) tube, which nursing

c.

Use diaphragmatic breathing.

a.

Auscultating the lungs for bilateral breath sounds

d.

Use chest breathing.

b.

Turning the client from side to side every 2 hours

c.

Monitoring serial blood gas values every 4 hours

d.

Providing frequent oral hygiene

action is most essential?

-9-

KABC – RESPI QUESTIONS

d. 47.

The

nurse

assesses

a

observation indicates

male that

client’s

the

respiratory

client

is

status.

experiencing

Which

the oxygen level alarm

difficulty

breathing?

54.

A female client with chronic obstructive pulmonary disease (COPD)

a.

Diaphragmatic breathing

takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a

b.

Use of accessory muscles

routine clinic visit, the client asks the nurse how the drug works.

c.

Pursed-lip breathing

What is the mechanism of action of anhydrous theophylline in

d.

Controlled breathing

treating a nonreversible obstructive airway disease such as COPD? a.

48.

A change in the oxygen concentration without resetting

A female client is undergoing a complete physical examination as a

carbon dioxide and stimulates the respiratory drive.

requirement for college. When checking the client’s respiratory

b.

status, the nurse observes respiratory excursio n to help assess: a.

Lung vibrations.

b.

Vocal sounds.

c.

Breath sounds.

d.

Chest movements.

It makes the central respiratory center more sensitive to

It

inhibits

the

degradation

of

enzyme cyclic

phosphodiesterase, adenosine

decreasing

monop hosphate,

a

bronchodilator. c.

It

stimulates

adenosine

receptors,

causing

bronchodilation. d.

It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.

49.

A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and

55.

A male client with pneumococcal pneumonia is admitted to an acute

recurrent chills. Based on the client’s histo ry and physical findings,

care facility. The client in the next room is being treated for

the

mycoplasmal pneumonia. Despite the different causes of the various

physician

suspects

legionnaires’

disease.

While

awaiting

diagnostic test results, the client is admitted to the facility and

types of pneumonia, all of them share which feature?

started on antibiotic therapy. What is the drug of choice for treating

a.

Inflamed lung tissue

legionnaires’ disease?

b.

Sudden onset

a.

Erythromycin (Erythrocin)

c.

Responsiveness to penicillin.

b.

Rifampin (Rifadin)

d.

Elevated white blood cell (WBC) count

c.

Amantadine (Symmetrel)

d.

Amphotericin B (Fungizone)

56.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of

50.

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because

arterial blood gas (ABG) values confirms respiratory acidosis?

the client is

a.

pH, 5.0; PaCO2 30 mm Hg

extremely weak and can’t produce an e ffective cough, the nurse

b.

pH, 7.40; PaCO2 35 mm Hg

should monitor closely for:

c.

pH, 7.35; PaCO2 40 mm Hg

d.

pH, 7.25; PaCO2 50 mm Hg

a.

Pleural effusion.

b.

Pulmonary edema.

c.

Atelectasis.

d.

Oxygen toxicity.

57.

A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history

51.

52.

53.

and

includes

coronary

chronic

obstructive

pulmonary

(COPD)

perform pursed-lip breathing. The client asks the nurse to explain

findings, the nurse closely monitors the oxygen flow and the client’s

the purpose of this breathing technique. Which explanation should

respiratory

the nurse provide?

receives a high oxygen concentration?

status.

artery disease. Because

Which

complication

a.

It helps prevent early airway collapse.

a.

Apnea

b.

It increases inspiratory muscle strength.

b.

Anginal pain

c.

It decreases use of accessory breathing muscles.

c.

Respiratory alkalosis

d.

It prolongs the inspiratory phase of respira tion.

d.

Metabolic acidosis

After receiving an oral dose of codeine for an intractable cough, the

58.

may

of

aris e

these

disease

The nurse in charge is teaching a client with emphysema how to

if

the

history

client

At 11 p.m., a male client is admitted to the emergency department.

male client asks the nurse, “How long will it take for this drug to

He has a respiratory rate of 44 breaths/minute. He’s anxious, and

work?” How should the nurse respond?

wheezes are audible. The client is immediately given oxygen by face

a.

In 30 minutes

mask and methylprednisolone (Depo -medrol) I.V. At 11:30 p.m., the

b.

In 1 hour

client’s arterial blood

c.

In 2.5 hours

wheezing. The nurse should plan to administer:

d.

In 4 hours

oxygen saturation is 86% and he’s still

a.

Alprazolam (Xanax).

b.

Propranolol (Inderal)

A male client suffers adult respiratory distress syndrome as a

c.

Morphine.

consequence of shock. The client’s condition deteriorates rapidly,

d.

Albuterol (Proventil).

and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high -pressure alarm on the mechanical ventilator

59.

After undergoing a thoracotomy, a male client is receiving epidural

sounds, the nurse starts to check for the cause. Which condition

analgesia. Which assessment finding indicates that the client has

triggers the high-pressure alarm?

developed the most serious complication of epidural analgesia?

a.

Kinking of the ventilator tubing

a.

Heightened alertness

b.

A disconnected ventilator tube

b.

Increased heart rate

c.

An ET cuff leak

c.

Numbness and tingling of the extremities

d.

Respiratory depression

- 10 -

KABC – RESPI QUESTIONS

60.

The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs

the

client

to

avoid

conditions

that

increase

oxygen

demands. Such conditions include: a.

Drinking more than 1,500 ml of fluid daily.

b.

Being overweight.

c.

Eating a high-protein snack at bedtime.

d.

Eating more than three large meals a day.

- 11 -

KABC – RESPI QUESTIONS

1.

Answer: B. Nervousness

9.

Answer: D. Impaired gas exchange related to airflow obstruction

Albuterol may cause nervousness. The inhaled form of the drug may

A patient airway and an adequate breathing pattern are the top

cause dryness and irritation of the nose and throat, not nasal

priority for any patient, making “impaired gas exchange related to

congestion; insomnia, not lethargy; and h ypokalemia (with high

airflow obstruction” the most important nursing diagnosis. The other

doses), not hyperkalemia. Other adverse effects of albuterol include

options also may apply to this patient but less important.

tremor,

dizziness,

headache,

tachycardia,

palpitations,

hypertension, heartburn, nausea, vomiting and muscle cramps.

10.

Answer: D. Contralateral side in hemothorax The trachea will shift according to the pressure gradients within the

2.

Answer: C. Clear

thoracic

Normally, nasal drainage in acute rhinitis is clear. Yellow or green

accumulation of air or fluid causes a shift away from the injured side.

cavity.

In

tension

pneumothorax

and

hemothorax,

drainage indicates spread of the infection to the sinuses. Gray

If there is no significant air or fluid accumulation, the trachea will

drainage may indicate a secondary infection.

not shift. Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response

3.

Answer: D. Lightheadedness or paresthesia The

patient

with

respiratory

to the release of normal thoracic pressure gradients on the injured

alkalosis

may

complain

of

side.

lightheadedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may

11.

Answer: C. Encourage coughing and deep breathing

accompany respiratory acidosis. Hallucinations and tinnitus rare are

When caring for a patient who is recovering from a pneumonectomy,

associated

the nurse should encourage coughing and deep breathing to prevent

with

respiratory

alkalosis

or

any

other

acid -base

imbalance.

pneumonia in the unaffected lung. Because the lung has been removed, the water-seal chamber should display no fluctuations.

4.

Answer: D. Elderly patients Ephedrine

is

not

Reinflation is not the purpose of chest tube. Chest tube milking is

recommended

for

elderly

patients,

who

are

controversial and should be done only to remove blood clots that

particularly susceptible to CNS reactions (such as confusion and

obstruct the flow of drainage.

anxiety) and to cardiovascular reactions (such as increased systolic blood pressure, coldness in the extremities, and anginal pain).

12.

Answer: B. Develop an alternative communication method

Ephedrine is used for its bronchodilator effects with acute and

A patient with a laryngectomy cannot speak, yet still needs to

chronic asthma and occasionally for its CNS stimulant actions for

communicate.

narcolepsy. It can be administered to children age 2 and older.

alternative communication method. After a laryngectomy, edema

Therefore,

the

nurse

should

plan

to

develop

an

interferes with the ability to swallow and necessitates tube (enteral) 5.

Answer: A. Kinking of the ventilator tubing

feedings. To prevent injury to the tracheal mucosa, th e nurse should

Conditions that trigger the high -pressure alarm include kinking of

deflate the tracheostomy cuff or use the minimal leak technique. To

the ventilator tubing, bronchospasm or pulmonary embolus, mucus

decrease edema, the nurse should place the patient in semi -Fowler’s

plugging, water in the tube, coughing or biting on endotracheal tube,

position.

and the patient’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an endotracheal cuff leak would

13.

Answer: B. Applying a dressing over the wound and taping it on

trigger the low pressure alarm. Changing the oxygen concentration

three sides

without resetting the oxygen level alarm would trigger the oxygen

The nurse immediately should apply a dressing over the stab wound

alarm.

and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life -threatening than an open

6.

Answer: D. Fighting the ventilator

chest wound). Only after covering and taping the wound should the

Pancuronium, a nondepolarizing blocking agent, is used for muscle

nurse

relaxation

insertion, and start an I.V. line.

and

paralysis.

It

assists

mechanical

ventilation

by

draw

blood

for

laboratory

tests,

assist with

chest

tube

promoting endotracheal intubation and paralyzing the patient so that

7.

the

mechanical

ventilator

can

do

its

wor k.

Fighting

the

14.

Answer: C. Using a high-flow venture mask to deliver oxygen as

ventilator is a sign that the patient needs another pancuronium dose.

prescribed

The nurse should administer 0.01 to 0.02 mg/kg I.V. every 20 to 60

The

minutes. Movement of the legs, or lips has no effect on the ventilator

stimulation of breathing by the med ullary center in the brain. As a

and therefore is not used to determine the need for another dose.

result, low oxygen levels in the blood stimulate respiration, and

Answer: B. Absence of breaths sound in the right thorax

administering unspecified, unmonitored amounts of oxygen may

In pneumothorax, the alveoli are deflated and no air exchange occurs

depress ventilation. To promote adequate gas exchange, the nurse

in the lungs. Therefore, breath sounds in the affected lung field are

should use a Venturi mask to de liver a specified, controlled amount

absent. None of the other o ptions are associated with pneumothorax.

of oxygen consistently and accurately. Drinking three glasses of fluid

Bilateral crackles may result from pulmonary congestion, inspiratory

daily would not affect gas exchange or be sufficient to liquefy

wheezes may signal asthma, and a pleural friction rub may indicate

secretions, which are common in COPD. Patients with COPD and

pleural inflammation.

respiratory distress should be places in high -Fowler’s position and

patient

with

COPD

retains

carbon

dioxide,

which

inhibits

should not receive sedatives or other drugs that may further depress 8.

Answer: B. Arterial Blood

the respiratory center.

A lowercase “a” in an ABG valu e represents arterial blood. For instance, the abbreviation PaO2 refers to the partial pressure of

15.

Answer: C. Increased pulmonary capillary permeability

oxygen in arterial blood. The pH value reflects the acid -base balance

ARDS results from increased pulmonary capillary permeability, w hich

in arterial blood. Sa02 indicates arterial oxygen saturation. An

leads to noncardiogenic pulmonary edema. In cardiogenic pulmonary

uppercase “A” represents alveolar conditions: for example, PA02

edema, pulmonary congestion occurs secondary to heart failure. In

indicates the partial pressure of oxygen in the alveoli.

the initial stage of ARDS, respiratory alkalosis may arise secondary

- 12 -

KABC – RESPI QUESTIONS

16.

to hyperventilation; however, it does not cause AR DS. Renal failure

Hyperresonance also may occur on the affected side. A sucking sound

does not cause ARDS, either .

at the site of injury would be noted with an open chest injury.

Answer:

C.

Teaching

the

patient

how

to

perform

controlled

24.

Answer: B. A hyperinflated chest noted on the chest x -ray

coughing

Clinical manifestations of chronic obstructive pulmonary disease

Controlled coughing helps maintain a patent airway by helping to

(COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at

mobilize and remove secretions. A moderate fluid intake (usually 2 L

rest, oxygen desaturation with exercise, and the use of accessory

or more daily) and moderate activity help liquefy and mobilize

muscles of respiration. Chest x -rays reveal a hyperinflated chest and

secretions. Bed rest and sedatives may limit the patient’s ability to

a flattened diaphragm if the disease is advanced.

maintain a patent airway, causing a high risk for infection from pooled secretions.

25.

Answer: B. Venturi mask The Venturi mask delivers the most accurate oxygen concentration.

17.

Answer: A. Do nothing, because this is an exp ected finding

It is the best oxygen delivery system for the client with chronic

Continuous gentle bubbling should be noted in the suction control

airflow

chamber. Option b is incorrect. Chest tubes should only be clamped

concentration. The face tent, aerosol mask, and tracheostomy collar

to check for an air leak or when changing drainage devices (according

are also high-flow oxygen delivery systems but most often are used

to

to administer high humidity.

agency

policy).

Option

c

is

incorrec t.

Bubbling

should

be

limitation

because

it

delivers

a

precise

oxygen

continuous and not intermittent. Option d is incorrect because bubbling should be gentle. Increasing the suction pressure only

26.

increases the rate of evaporation of water in the drainage system.

Answer: D. A cough with the expectoration of mucoid sputum One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, an d C are late

18.

Answer: B. Continue to monitor the client

symptoms and signify cavitation and extensive lung involvement.

The presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system. With normal breathing,

27.

Answer: B. Sputum culture

the water level rises with inspiration and falls with expiration.

Tuberculosis is definitively diagnosed through culture and isolation

Fluctuation stops if the tube is obstructed, if a d ependent loop

of Mycobacterium tuberculosis. A presumptive diagnosis is made

exists, if the suction is not working properly, or if the lung has

based on a tuberculin skin test, a sputum smear that is positive for

reexpanded. Options A, C, and D are incorrect.

acid-fast

bacteria,

a chest

x-ray, and

histological

evidence

of

granulomatous disease on biopsy. 19.

Answer: B. Place the tube in bottle of sterile water If the chest drainage system is disconnected, the end of the tube is

20.

28.

Answer: B. 2 L/min

placed in a bottle of sterile water held below the level of the chest.

Oxygen is used cautiously and should not exceed 2 L/min. Because of

The system is replaced if it breaks or cracks or if the collection

the

chamber is full. Placing a sterile dressing over the disconnection site

respiratory drive is triggered by low oxygen levels rather than

will not prevent complications resulting from the d isconnection. The

increased carbon dioxide levels, as is the case in a normal respiratory

physician may need to be notified, but this is not the initial action.

system.

Answer: D. Perform the Valsalva maneuver

29.

long-standing

hypercapnia

that

occurs

in

emphysema,

the

Answer: D. Promote carbon dioxide elimination

When the chest tube is removed, the client is asked to perform the

Pursed-lip breathing facilitates maximal expiration for clients with

Valsalva maneuver (take a deep breath, exhale, and bear do wn). The

obstructive lung

tube is quickly withdrawn, and an airtight dressing is taped in place.

expiration by increasing airway pressure that keeps air passages

An alternative instruction is to ask the client to take a deep breath

open during exhalation. Options A, B, and C are not the purposes of

and hold the breath while the tube is removed. Options A, B, and C

this type of breathing.

disease. This type of breathing

allows better

are incorrect client instructions. 30. 21.

Answer: B. Low arterial PaO2

Answer: B. Grasp the retention sutures to spread the opening

The earliest clinical sign of acute respiratory distress syndrome is an

If the tube is dislodged accidentally, the initial nursing action is to

increased respiratory rate. Breathing becomes labored, and the

grasp the retention sutures and spread the opening. If agency policy

client may exhibit air hunger, retractions, and cyanosis. Arterial

permits, the nurse then attempts immediately to replace t he tube.

blood gas analysis reveals increasing hypoxemia, with a PaO2 lower

Covering the tracheostomy site will block the airway. Options A and

than 60 mm Hg.

C will delay treatment in this emergency situation. 31. 22.

Answer: B. Having the client take deep breaths

Answer: A. Stridor

To obtain a sputum specimen, the client should rinse the mouth to

The nurse reports stridor to the physician immediately. This is a

reduce contamination, breathe deeply, and then cough into a sputum

high-pitched, coarse sound that is heard with the stethoscope over

specimen container. The client should be encouraged to cough and

the trachea. Stridor indicates airway edema and places the client at

not spit so as to obtain sputum. Sputum can be thinned by fluids or

risk for airway obstruction. Options B, C, and D are not signs that

by a respiratory treatment such as inhalation of nebulized saline or

require immediate notification of the physician.

water. The optimal time to obtain a specimen is on arising in th e morning.

23.

Answer: B. Diminished breath sounds This client has sustained a blunt or a closed chest injury. Basic

32.

Answer: C. Bronchospasm

symptoms of a closed pneumothorax are shortness of breath and

If a biopsy was performed during a bronchoscopy, blood -streaked

chest pain. A larger pneumothorax may cause tachypnea, cyanosis,

sputum

diminished

hemorrhage. A dry cough may be expected. The client should be

breath

sounds,

and

subcutaneous

emphysema.

is

expected

for

several

hours.

Frank

blood

indicates

assessed for signs of complication s, which would include cyanosis,

- 13 -

KABC – RESPI QUESTIONS

dyspnea,

stridor,

tachycardia,

and

bronchospasm,

dysrhythmias.

hemoptysis,

Hematuria

is

hypotension,

unrelated

to

41.

this

Answer: C. Decreased hearing acuity Decreased hearing acuity indicates ototoxicity, a serious adverse

procedure.

effect

of

streptomycin

therapy.

The

client

should

notify

the

physician immediately if it occurs so that streptomycin can be 33.

Answer: C. 10 seconds

discontinued and an alternative drug can be prescribed. The other

Hypoxemia can be caused by prolonged suctioning, which stimulates

options

the pacemaker cells in the heart. A vasovagal response may occur,

discrimination indicates color blindness; increased urinary frequency

causing bradycardia. The nurse must preoxygenate the client before

and increased appetite accompany diabetes mellitus.

aren’t

associated

with

streptomycin.

Impaired

colo r

suctioning and limit the suctioning pass to 10 seconds. 42. 34.

Answer: B. Skin test doesn’t differentiate between active and

Answer: C. Stop the procedure and reoxygenate the client

dormant tuberculosis infection.

During suctioning, the nurse should monitor the client closely for

The Mantoux test doesn’t differentiat e between active and dormant

side effects, including hypoxemia, cardiac irregularities such as a

infections. If a positive reaction occurs, a sputum smear and culture

decrease in heart rate resulting from vagal stimulation, mucosal

as well as a chest X-ray are necessary to provide more information.

trauma, hypotension, and

effects

Although the area of redness is measured in 3 days, a second test

develop, especially cardiac irregularities, the procedure is stopped

may be needed; neither test indicates that tuberculosis is active. In

and the client is reoxygenated.

the Mantoux test, an induration 5 to 9 mm in diameter indicates a

paroxysmal

coughing. If

side

borderline reaction; a larger induration indicates a positive reaction. 35.

Answer: A. Dyspnea

The presence of a wheal within 2 days doesn’t indicate active

The common clinical manifestations of pulmonary embolism are

tuberculosis.

tachypnea, tachycardia, dyspnea, and chest pain. 43. 36.

Answer: B. 5 to 20 minutes.

Answer: A. Resonant sounds.

Initially, the nurse should plug the opening in the tracheostomy tube

When percussing the chest wall, the nurse expects to elicit resonant

for 5 to 20 minutes, then gradually lengthen this interval according

sounds — low-pitched, hollow sounds heard over normal lung tissue.

to the client’s respiratory status. A client who doesn’t require

Hyperresonant sounds indicate increased air in the lungs or pleural

continuous

space; they’re louder and lower pitched than resonant s ounds.

assistance, at least for

Although

as

opening of the tube for only 15 to 60 seconds wouldn’t be long

emphysema and pneumothorax, they may be normal in children and

enough to reveal the client’s true tolerance to the procedure.

very thin adults. Dull sounds, normally heard only over the liver and

Plugging the opening for more than 20 minutes would inc rease the

heart, may occur over dense lung tissue, such as from conso lidation

risk of acute respiratory distress because the client requires an

or a tumor. Dull sounds are thudlike and of medium pitch. Flat

adjustment period to start breathing normally.

hyperresonant

sounds

occur

in

such

disorders

mechanical

ventilation already is breathi ng

without

short periods; therefore, plugging

the

sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

44.

Answer: C. The system has an air leak. Constant bubbling in the chamber indicates an air leak and requires

37.

Answer: A. Question the order because it’s too low.

immediate intervention. The client with a pneumothorax will have

A therapeutic theophylline level is 10 to 20 mcg/ml. The client is

intermittent bubbling in the water -seal chamber. Clients without a

currently receiving 0.5 mg/kg/hour of aminophylline. Because the

pneumothorax should have no evidence of bubbling in the chamber.

client’s theophylline level is sub -therapeutic, reducing the dose

If the tube is obstructed, the nurse should notice that the fluid has

(which

stopped fluctu ating in the water-seal chamber.

is

what

the

physician’s

order

would

do)

would

be

inappropriate. Therefore, the nurse should question the order. 45. 38.

Answer: C. Use diaphragmatic breathing.

Answer: B. Mucous membranes. Skin color doesn’t affect the mucous membranes. The lips, nail beds,

In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic

and earlobes are less reliable indicators of cyanosis because they’re

breathing

affected by skin color.

helps

to

strengthen

the

diaphragm

and

maximizes

ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale

through

to

For a client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral breath sounds to ensure

Diaphragmatic breathing — not chest breathing — increases lung

proper tube placement and effective oxygen delivery. Although the

expansion.

other options are appropriate for this client, they’re secondary to

collapsing,

prolong and

exhalation,

prevent

air

keep

Answer: A. Auscultating the l ungs for bilateral breath sounds

trapping.

from

lips

46.

the

bronchioles

pursed

ensuring adequate oxygenation. 39.

Answer: C. Tidal volume Tidal volume refers to the volume of air inspired and expired with a

47.

Answer: B. Use of accessory muscles

normal breath. Total lung capacity is the maximal amount of air the

The use of accessory muscles for respiration indicates the client is

lungs and respiratory passages can hold after a forced inspiration.

having difficulty breathing. Diaphragmatic and pursed -lip breathing

Forced

are

vital

capacity

is

the

vital

capacity

performed

with

a

maximally forced expiration. Residual volume is the maximal amount

two

controlled

breathing

techniques

that

help

the

client

conserve energy.

of air left in the lung after a maximal expiration. 48. 40.

Answer: D. Chest movements.

Answer: B. Non-rebreather mask

The

A non-rebreather mask can deliver levels of the fraction of inspired

movements. Normally, thoracic expansion is symmetrical; unequal

nurse observes respiratory

excursion to

help

assess chest

oxygen (FIO2) as high as 100%. Other modes — simple mask, face

expansion may indicate pleural effusion, atelectasis, pulmonary

tent, and nasal cannula — deliver lower levels of FIO2.

embolus, or a rib or sternum fracture. The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after

- 14 -

KABC – RESPI QUESTIONS

asking the client to say “99,” the nurse palpates the vibrations

anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an

transmitted from the bronchopulmonary system along the solid

insidious onset. Antibiotic therapy is the primary treatment for most

surfaces of the chest wall to the nurse’s palms. The nurse assesses

types of pneumonia; however, the antibiotic must be specific for the

breath sounds during auscultation.

causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with

49.

Answer: A. Erythromycin (Erythrocin)

antibiotics. Although pneumonia usually causes an elevated WBC

Erythromycin is the drug of choice for treating legionnaires’ disease.

count, some types, such as mycoplasmal pneumonia, don ’t.

Rifampin may be added to the regimen if erythromycin alone is ineffective; however, it isn’t administered first. Amantadine, an antiviral

agent,

ineffective

and

against

amphotericin legionnaires’

B,

an

antifungal

disease,

which

is

56.

Answer: D. pH, 7.25; PaCO2 50 mm Hg

agent,

are

In respiratory acidosis, ABG analysis reveals an arterial pH below

caused

by

7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45

bacterial infection.

mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0

50.

Answer: C. Atelectasis.

with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis.

In a client with COPD, an ineffective cough impedes secretion

Options B and C represent normal ABG values, reflecting normal gas

removal. This, in turn, causes mucus plugging, which leads to

exchange in the lungs.

localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause pleural effusion (fluid accumulation

51.

57.

Answer: A. Apnea

in the pleural space). Pulmonary edema usually results from left -

Hypoxia is the main breathing stimulus for a client with COPD.

sided

many

Excessive oxygen administration may lead to apnea by removing that

noncardiac conditions may cause pulmonary edema, an ineffective

stimulus. Anginal pain results from a reduced myocardial oxygen

cough isn’t one of them. Oxygen toxicity results from prolonged

supply. A client with COPD may have anginal pain from generalized

administration of high oxygen concentrations, not an ineffective

vasoconstriction

cough.

oxygen at any concentration dilates blood vessels, easing anginal

Answer: A. It helps prevent early airway collapse.

pain. Respiratory alkalosis results from alveolar hyperventilation,

Pursed-lip breathing helps prevent early airway collapse. Learning

not excessive oxygen administration. In a client with COPD, high

this technique helps the client control respiration during periods of

oxygen concentrations decrease the ventilatory drive, leading to

excitement, anxiety, exercise, and respiratory distress. To increase

respiratory acidosis, not alkalosis. High oxygen concentrations don’t

inspiratory muscle strength and endurance, the client may need to

cause metabolic acidosis.

heart

failure,

not

an

ineffective

cough.

Although

secondary

to

hypoxia;

however,

administering

learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to

58.

Answer: D. Albuterol (Proventil).

learn diaphragmatic (abdominal) breathing. In pursed -lip breathing,

The client is hypoxemic because of bronchoconstriction as evidenced

the client mimics a normal inspiratory -expiratory (I:E) ratio of 1:2.

by wheezes and a subnormal arterial oxygen saturation level. The

(A client with emphysema may have an I:E ratio as high as 1: 4.)

client’s greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic

52.

Answer: A. In 30 minutes

agonist, which causes dilation of the bronchioles. It’s giv en by

Codeine’s onset of action is 30 minutes. Its peak concentration

nebulization or metered-dose inhalation and may be given as often

occurs in about 1 hour; its half -life, in 2.5 hours; and its duration of

as every 30 to 60 minutes until relief is accomplished. Alprazolam is

action is 4 to 6 hours.

an anxiolytic and central nervous system depressant, which could suppress the client’s breathing. Propranolol is c ontraindicated in a

53.

Answer: A. Kinking of the ventilator tubing

client who’s wheezing because it’s a beta2 adrenergic antagonist.

Conditions that trigger the high-pressure alarm include kinking of

Morphine is a respiratory center depressant and is contraindicated

the ventilator tubing, bronchospasm or pulmonary embolus, mucus

in this situation.

plugging, water in the tube, coughing or biting on the ET tube, and

59.

Answer: D. Respiratory depression

the client’s being out of breathing rhythm with the ventilator. A

Respiratory depression is the most serious complic ation of epidural

disconnected ventilator tube or an ET cuff leak would trigger the

analgesia.

low-pressure alarm. Changing the oxygen concentration without

decreased sensation and movement of the extremities, allergic

resetting the oxygen level alarm would trigger the oxygen alarm.

reactions, and urine retention. Typically, epidural analgesia causes

Other

potential

complications

include

hypotension,

central nervous system depression (indicated by drowsiness) as well 54.

Answer: A. It makes the central respiratory center more sensitive

as a decreased heart rate and blood pressure.

to carbon dioxide and stimulates the respiratory drive. Anhydrous theophylline and other methylxanthine agents make the

60.

Answer: B. Being overweight.

central respiratory center more sensitive to CO2 and stimulate the

Conditions that increase oxygen demands include obesity, smoking,

respiratory drive. Inhibition of phosphodiesterase is the drug’s

exposure to temperature extremes, and stress. A client with chronic

mechanism

reversible

bronchitis should drink at least 2,000 ml of fluid daily to thin mucus

obstructive airway diseases — not COPD. Methylxanthine agents

secretions; restricting fluid intake may be harmful. The nurse should

inhibit rather than stimulate adenosine receptors. Although these

encourage the client to eat a high -protein snack at bedtime because

agents

chronic

protein digestion produces an amino acid with sedating effects that

bronchitis or emphy sema, they don’t alter diaphragm movement to

may ease the insomnia associated with chronic bronchitis. Eating

increase chest expansion and enhance gas exchange.

more than three large meals a day may cause fullness, making

of

reduce

action

in

treating

diaphragmatic

asthma

fatigue

in

and

other

clients

with

breathing uncomfortable and difficult; however, it doesn’t increase 55.

Answer: A. Inflamed lung tissue

oxygen demands. To help maintain adequate nutritional intake, th e

The common feature of all types of pneumonia is an inflammatory

client with chronic bronchitis should eat small, frequent meals (up

pulmonary response to the offending organism or agent. Although

to six a day).

most types of pneumonia have a sudden onset, a few (such as

- 15 -