Respiratory System 1

Questions:
1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should
the nurse plan to do?
A. Place the end of the chest tube in a container of sterile saline.
B. Apply an occlusive dressing and notify the physician.
C. Clamp the chest tube immediately.
D. Secure the chest tube with tape.
2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications.
What is the most common complication of influenza?
A. Septicemia
B. Pneumonia
C. Meningitis
D. Pulmonary edema
3. A female client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the
tracheostomy tube, the nurse initially should plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse
discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?
A. Hypoxia
B. Delirium
C. Hyperventilation
D. Semiconsciousness
5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which
combination of arterial blood gas (ABG) values confirms respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client
teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the
drug abruptly. A client who discontinues prednisone abruptly may experience:
A. hyperglycemia and glycosuria.
B. acute adrenocortical insufficiency.
C. GI bleeding.
D. restlessness and seizures.
7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing
diagnosis is most important for this client?
A. Activity intolerance related to fatigue
B. Anxiety related to actual threat to health status
C. Risk for infection related to retained secretions
D. Impaired gas exchange related to airflow obstruction
8. A 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?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed
respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?
A. Immediately before a meal
B. At least 2 hours after a meal
C. When bronchospasms occur
D. When secretions have mobilized
10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical
ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which
vital sign abnormality may alter pulse oximetry values?
A. Fever
B. Tachypnea
C. Tachycardia
D. Hypotension
11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a
tracheostomy is:
A. helping him communicate.
 B. keeping his airway patent.
C. encouraging him to perform activities of daily living.
D. preventing him from developing an infection.
12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent
airway?
A. Restricting fluid intake to 1,000 ml/day
B. Enforcing absolute bed rest
C. Teaching the client how to perform controlled coughing
D. Administering prescribed sedatives regularly and in large amounts
13. The amount of air inspired and expired with each breath is called:
A. tidal volume.
B. residual volume.
C. vital capacity.
D. dead-space volume.
14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s
placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to
no greater than:
A. 0.21
B. 0.35
C. 0.5
D. 0.7
15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements
concerning PPD testing is true?
A. A positive reaction indicates that the client has active tuberculosis (TB).
B. A positive reaction indicates that the client has been exposed to the disease.
C. A negative reaction always excludes the diagnosis of TB.
D. The PPD can be read within 12 hours after the injection.
16. Nurse Murphy administers albuterol (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the
drug is producing a therapeutic effect?
A. Respiratory rate of 22 breaths/minute
B. Dilated and reactive pupils
C. Urine output of 40 ml/hour
D. Heart rate of 100 beats/minute
17. What is the normal pH range for arterial blood?
A. 7 to 7.49
B. 7.35 to 7.45
C. 7.50 to 7.60
D. 7.55 to 7.65
18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?
A. Fluid intake for the last 24 hours
B. Baseline arterial blood gas (ABG) levels
C. Prior outcomes of weaning
D. Electrocardiogram (ECG) results
19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm
Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?
A. Administer a prescribed decongestant.
B. Instruct the client to breathe into a paper bag.
C. Offer the client fluids frequently.
D. Administer prescribed supplemental oxygen.
20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood
gas value is most important?
A. pH
B. Bicarbonate (HCO3–)
C. Partial pressure of arterial oxygen (PaO2)
D. Partial pressure of arterial carbon dioxide (PaCO2)
21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following
interventions will most likely lower the client’s arterial blood oxygen saturation?
A. Endotracheal suctioning
B. Encouragement of coughing
C. Use of cooling blanket
D. Incentive spirometry
22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which
action in the plan of care?
A. Measuring and documenting the drainage in the collection chamber
B. Maintaining continuous bubbling in the water-seal chamber
C. Keeping the collection chamber at chest level
D. Stripping the chest tube every hour
23. Nurse Eve 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.
24. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the
nurse should assess for cyanosis by inspecting the:
A. lips.
B. mucous membranes.
C. nail beds.
D. earlobes.
25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug
toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline
concentration falls within which range?
A. 1 to 2 mcg/ml
B. 2 to 5 mcg/ml
C. 5 to 10 mcg/ml
D. 10 to 20 mcg/ml
26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind
that:
A. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.
B. vancomycin may cause irreversible neutropenia.
C. vancomycin should be administered rapidly in a large volume of fluid.
D. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.
27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history.
Which condition is a predisposing factor for respiratory alkalosis?
A. Myasthenia gravis
B. Type 1 diabetes mellitus
C. Extreme anxiety
D. Narcotic overdose
28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s
anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol)
I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:
A. alprazolam (Xanax).
B. propranolol (Inderal)
C. morphine.
D. albuterol (Proventil).
29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
A. Encouraging the client to drink three glasses of fluid daily
B. Keeping the client in semi-Fowler’s position
C. Using a high-flow Venturi mask to deliver oxygen as prescribed
D. Administering a sedative as prescribed
30. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain
the purpose of this breathing technique. Which explanation should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength
C. It decreases use of accessory breathing muscles.
D. It prolongs the inspiratory phase of respiration.

Answers and Rationales:

1. Answer A. If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a container of
sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The
nurse should apply an occlusive dressing if the chest tube is pulled out — not if the system is disconnected. The nurse
shouldn’t clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the
chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected.
2. Answer B. Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia
or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of
chronic obstructive pulmonary disease, and Reye’s syndrome. Myocarditis, pericarditis, transverse myelitis, and
encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes
overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren’t associated with influenza.

3. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and then gradually
lengthen this interval according to the client’s respiratory status. A client who doesn’t require continuous mechanical
ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube
for only 15 to 60 seconds wouldn’t be long enough to reveal the client’s true tolerance to the procedure. Plugging the
 opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an
adjustment period to start breathing normally.

4. Answer A. As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia,
and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and
place. Hyperventilation (respiratory rate greater than that metabolically necessary for gas exchange) is marked by an
increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized
by limited motor and verbal responses and decreased orientation.

5. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon
dioxide (PaCO2) above 45 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 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B
and C represent normal ABG values, reflecting normal gas exchange in the lungs.

6. Answer B. Administration of a corticosteroid such as prednisone suppresses the body’s natural cortisol secretion, which
may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the
serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI
bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation.

7. Answer D. A patent airway and an adequate breathing pattern are the top priority for any client, making impaired gas
exchange related to airflow obstruction the most important nursing diagnosis. The other options also may apply to this
client but are less important.

8. Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other
modes — simple mask, face tent and nasal cannula — deliver lower levels of FIO2.

9. Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to reduce the risk of vomiting and
aspiration. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and
vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated
in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn’t available) are a
contraindication for postural drainage, another component of chest physiotherapy.

10. Answer D. Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry values by reducing arterial blood
flow. Likewise, movement of the finger to which the oximeter is applied may interfere with interpretation of SaO2. All of
these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia don’t affect pulse oximetry
values directly.

11. Answer B. Maintaining a patent airway is the most basic and critical human need. All other interventions are important to
the client’s well-being but not as important as having sufficient oxygen to breathe.

12. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate
fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives
may limit the client’s ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

13. Answer A. Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air
remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the
lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in the upper airways
that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways.

14. Answer C. An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and
surfactant activity. The ideal oxygen source is room air F IO 2 0.18 to 0.21.

15. Answer B. A positive reaction means the client has been exposed to TB; it isn’t conclusive of the presence of active
disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after
the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In
immunosuppressed clients, a negative reaction doesn’t exclude the presence of active disease.

16. Answer A. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute
indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve
oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is
an adverse, not therapeutic, effect.

17. Answer B. A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates alkalosis.

18. Answer B. Before weaning a client from mechanical ventilation, it’s most important to have baseline ABG levels. During
the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment
parameters are less critical. Measuring fluid volume intake and output is always important when a client is being
 mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client’s record, and the nurse
can refer to them before the weaning process begins.

19. Answer B. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have
the client breathe into a paper bag. All of the other options — such as administering a decongestant, offering fluids
frequently, and administering supplemental oxygen — wouldn’t raise the lowered PaCO2 level.

20. Answer C. The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the
PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow rate,
and oxygen percentage. The other options reflect the client’s ventilation status, not oxygenation.

21. Answer A. Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen
saturation (SaO2) level. Coughing and incentive spirometry improves oxygenation and should raise or maintain oxygen
saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation
readings, but SaO2 levels wouldn’t be affected.

22. Answer A. The nurse should measure and document the amount of chest tube drainage regularly to detect abnormal
drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling
in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse
should keep the collection chamber below chest level to allow fluids to drain into it. The nurse should not strip chest
tubes because doing so may traumatize the tissue or dislodge the tube.

23. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and
stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting
fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because
protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic
bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult;
however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic
bronchitis should eat small, frequent meals (up to six a day).

24. Answer B. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of
cyanosis because they’re affected by skin color.

25. Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10 mcg/ml
aren’t therapeutic.

26. Answer A. To avoid a hypotensive reaction from rapid I.V. administration, the nurse should infuse vancomycin slowly,
over 60 to 90 minutes, in a large volume of fluid. Although neutropenia may occur in approximately 5% to 10% of clients
receiving vancomycin, this adverse effect reverses rapidly when the drug is discontinued.

27. Answer C. Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon
dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, and injury
to the brain’s respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate
intoxication. Type 1 diabetes mellitus may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this
disorder (Kussmaul’s respirations) don’t cause excessive CO2 loss. Myasthenia gravis and narcotic overdose suppress the
respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial
oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering
bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It’s given by
nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.
Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing.
Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a
respiratory center depressant and is contraindicated in this situation.

29. Answer C. The client with COPD retains carbon 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 administering unspecified, unmonitored
amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to
deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn’t
affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory
distress should be placed in high Fowler’s position and shouldn’t receive sedatives or other drugs that may further
depress the respiratory center.

30. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control
respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle
strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use
and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip
 breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E
ratio as high as 1:4.).

Respiratory System 2
Questions:
1. A male client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory
distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include
information about complying with medication therapy if the client’s baseline theophylline level was:
A. 10 mcg/mL
B. 12 mcg/mL
C. 15 mcg/mL
D. 18mcg/mL
2. Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling
in the suction control chamber. What action is appropriate?
A. Do nothing, because this is an expected finding.
B. Immediately clamp the chest tube and notify the physician.
C. Check for an air leak because the bubbling should be intermittent.
D. Increase the suction pressure so that bubbling becomes vigorous.
3. A nurse has assisted a physician with the insertion of a chest tube. The nurse monitors the adult client and notes fluctuation of
the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?
A. Inform the physician.
B. Continue to monitor the client.
C. Reinforce the occlusive dressing.
D. Encourage the client to deep-breathe.
4. The nurse caring for a male client with a chest tube turns the client to the side, and the chest tube accidentally disconnects.
The initial nursing action is to:
A. Call the physician.
B. Place the tube in a bottle of sterile water.
C. Immediately replace the chest tube system.
D. Place the sterile dressing over the disconnection site.
5. Nurse Paul is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
A. Exhale slowly.
B. Stay very still.
C. Inhale and exhale quickly.
D. Perform the Valsalva maneuver.
6. While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is
to:
A. Call the physician to reinsert the tube.
B. Grasp the retention sutures to spread the opening.
C. Call the respiratory therapy department to reinsert the tracheotomy.
D. Cover the tracheostomy site with a sterile dressing to prevent infection.
7. A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following
signs immediately if experienced by the client?
A. Stridor
B. Occasional pink-tinged sputum
C. A few basilar lung crackles on the right
D. Respiratory rate of 24 breaths/min
8. An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs
would indicate the presence of a pneumothorax in this client?
A. A low respiratory
B. Diminished breathe sounds
C. The presence of a barrel chest
D. A sucking sound at the site of injury
9. A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the
following would the nurse expect to note on assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-ray
C. Increase oxygen saturation with exercise
D. A widened diaphragm noted on the chest x-ray
10. A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse
tells the group that one of the first symptoms associated with tuberculosis is:
A. Dyspnea
B. Chest pain
C. A bloody, productive cough
D. A cough with the expectoration of mucoid sputum
11. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the results
of which diagnostic test that will confirm this diagnosis?
 A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
12. The nursing instructor asks a nursing student to describe the route of transmission of tuberculosis. The instructor concludes
that the student understands this information if the student states that the tuberculosis is transmitted by:
A. Hand and mouth
B. The airborne route
C. The fecal-oral route
D. Blood and body fluids
13. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to
ensure that it does not exceed:
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
14. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of
this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:
A. Promote oxygen intake.
B. Strengthen the diaphragm.
C. Strengthen the intercostal muscles.
D. Promote carbon dioxide elimination.
15. Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate
obtaining the specimen?
A. Limiting fluids
B. Having the clients take three deep breaths
C. Asking the client to split into the collection container
D. Asking the client to obtain the specimen after eating
16. A nurse is caring for a female client after a bronchoscope and biopsy. Which of the following signs, if noted in the client,
should be reported immediately to the physicians?
A. Dry cough
B. Hematuria
C. Bronchospasm
D. Blood-streaked sputum
17. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning
time to a maximum of:
A. 1 minute
B. 5 seconds
C. 10 seconds
D. 30 seconds
18. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse
notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention?
A. Continue to suction.
B. Notify the physician immediately.
C. Stop the procedure and reoxygenate the client.
D. Ensure that the suction is limited to 15 seconds.
19. 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 dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate
the presence of:
A. Metabolic acidosis
B. Respiratory acidosis
C. Overcompensated respiratory acidosis
D. Combined respiratory and metabolic acidosis
20. A female client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following
is a common clinical manifestation of pulmonary embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respiratory
21. A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further
teaching?
A. Inhales the mist and quickly exhales
B. Removes the cap and shakes the inhaler well before use
C. Presses the canister down with the finger as he breathes in
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed
22. A female client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following
nursing interventions for this client?
 A. Administering atropine intravenously
B. Administering small doses of midazolam (Versed)
C. Encouraging additional fluids for the next 24 hours
D. Ensuring the return of the gag reflex before offering food or fluids
23. A nurse is assessing the respiratory status of a male client who has suffered a fractured rib. The nurse would expect to note
which of the following?
A. Slow deep respirations
B. Rapid deep respirations
C. Paradoxical respirations
D. Pain, especially with inspiration
24. A female client with chest injury has suffered flail chest. A nurse assesses the client for which most distinctive sign of flail
chest?
A. Cyanosis
B. Hypotension
C. Paradoxical chest movement
D. Dyspnea, especially on exhalation
25. A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation.
A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe
sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:
A. Right pneumothorax
B. Pulmonary embolism
C. Displaced endotracheal tube
D. Acute respiratory distress syndrome
26. A nurse is teaching a male client with chronic respiratory failure how to use a metered-dose inhaler correctly. The nurse
instructs the client to:
A. Inhale quickly
B. Inhale through the nose
C. Hold the breath after inhalation
D. Take two inhalations during one breath
27. A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome.
The nurse assesses for which earliest sign of acute respiratory distress syndrome?
A. Bilateral wheezing
B. Inspiratory crackles
C. Intercostal retractions
D. Increased respiratory rate
28. A nurse is taking pulmonary artery catheter measurements of a male client with acute respiratory distress syndrome. The
pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this reading is:
A. High and expected
B. Low and unexpected
C. Normal and expected
D. Uncertain and unexpected
29. A nurse is assessing a male client with chronic airflow limitations and notes that the client has a “barrel chest.” The nurse
interprets that this client has which of the following forms of chronic airflow limitations?
A. Emphysema
B. Bronchial asthma
C. Chronic obstructive bronchitis
D. Bronchial asthma and bronchitis
30. A nurse is caring for a female client diagnosed with tuberculosis. Which assessment, if made by the nurse, is inconsistent with
the usual clinical presentation of tuberculosis and may indicate the development of a concurrent
problem?
A. Cough
B. High-grade fever
C. Chills and night sweats
D. Anorexia and weight loss

Answers and Rationales:

1. Answer A. The therapeutic range for the serum theophylline level is 10 to 20 mcg/mL. If the level is below the therapeutic
range, the client may experience frequent exacerbations of the disorder. Although all the options identify values within
the therapeutic range, option A is the option that reflects a need for compliance with medication.

2. Answer A. Continuous gentle bubbling should be noted in the suction control chamber. Option B is incorrect. Chest tubes
should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option C
is incorrect. Bubbling should be continuous and not intermittent. Option D is incorrect because bubbling should be gentle.
Increasing the suction pressure only increases the rate of evaporation of water in the drainage system.

3. Answer B. The presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system.
With normal breathing, the water level rises with inspiration and falls with expiration. Fluctuation stops if the tube is
 obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has reexpanded. Options A, C,
and D are incorrect.

4. Answer B. If the chest drainage system is disconnected, the end of the tube is placed in a bottle of sterile water held
below the level of the chest. The system is replaced if it breaks or cracks or if the collection chamber is full. Placing a
sterile dressing over the disconnection site will not prevent complications resulting from the disconnection. The physician
may need to be notified, but this is not the initial action.

5. Answer D. When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath,
exhale, and bear down). The tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative
instruction is to ask the client to take a deep breath and hold the breath while the tube is removed. Options A, B, and C
are incorrect client instructions.

6. Answer B. If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures and spread the
opening. If agency policy permits, the nurse then attempts immediately to replace the tube. Covering the tracheostomy
site will block the airway. Options 1 and 3 will delay treatment in this emergency situation.

7. Answer A. The nurse reports stridor to the physician immediately. This is a high-pitched, coarse sound that is heard with
the stethoscope over the trachea. Stridor indicates airway edema and places the client at risk for airway obstruction.
Options B, C, and D are not signs that require immediate notification of the physician.

8. Answer B. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are
shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds,
and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury
would be noted with an open chest injury.

9. Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia,
dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration.
Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

10. Answer D. One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B,
and C are late symptoms and signify cavitation and extensive lung involvement.

11. Answer B. Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A
presumptive 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.

12. Answer B. Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis and is spread primarily
by the airborne route. Options A, C, and D are incorrect.

13. Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia that
occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels,
as is the case in a normal respiratory system.

14. Answer D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of
breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options
A, B, and C are not the purposes of this type of breathing.

15. Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and
then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain
sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water.
The optimal time to obtain a specimen is on arising in the morning.

16. Answer C. If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank
blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications,
which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
Hematuria is unrelated to this procedure.

17. Answer C. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells in the heart. A
vasovagal response may occur, causing bradycardia. The nurse must preoxygenate the client before suctioning and limit
the suctioning pass to 10 seconds.

18. Answer C. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac
irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and
paroxysmal coughing. If side effects develop, especially cardiac irregularities, the procedure is stopped and the client is
reoxygenated.
 19. Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along
with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect.

20. Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest
pain.

21. Answer A. The client should be instructed to hold his or her breath for at least 10 to 15 seconds before exhaling the mist.
Options B, C, and D are accurate instructions regarding the use of the inhaler.

22. Answer D. After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the
preoperative sedation and local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours.
Additional fluids are unnecessary because no contrast dye is used that would need flushing from the system. Atropine
and midazolam would be administered before the procedure, not after.

23. Answer D. Rib fractures are a common injury, especially in the older client, and result from a blunt injury or a fall. Typical
signs and symptoms include pain and tenderness localized at the fracture site and exacerbated by inspiration and
palpation, shallow respirations, splinting or guarding the chest protectively to minimize chest movement, and possible
bruising at the fracture site. Paradoxical respirations are seen with flail chest.

24. Answer C. Flail chest results from fracture of two or more ribs in at least two places each. This results in a “floating”
section of ribs. Because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical
chest movement. This means that the force of inspiration pulls the fractured segment inward, while the rest of the chest
expands. Similarly, during exhalation, the segment balloons outward while the rest of the chest moves inward. This is a
telltale sign of flail chest.

25. Answer A. Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical
chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway
pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not
characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but
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.

26. Answer C. Instructions for using a metered-dose inhaler include shaking the canister, holding it right side up, inhaling
slowly and evenly through the mouth, delivering one spray per breath, and holding the breath after inhalation.

27. Answer D. The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can
begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction
of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse
crackles.

28. Answer C. The normal pulmonary capillary wedge pressure (PCWP) is 8 to 13 mm Hg, and the client is considered to have
high readings if they exceed 18 to 20 mm Hg. The client with acute respiratory distress syndrome has a normal PCWP,
which is an expected finding because the edema is in the interstitium of the lung and is noncardiac.

29. Answer A. The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to
increased anteroposterior diameter, referred to as “barrel chest.” The client also has dyspnea with prolonged expiration
and has hyperresonant lungs to percussion.

30. Answer B. The client with tuberculosis usually experiences cough (productive or nonproductive), fatigue, anorexia, weight
loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.

Respiratory System 3
Questions:
1. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate
obtaining the specimen?
A. Limiting fluid
B. Having the client take deep breaths
C. Asking the client to spit into the collection container
D. Asking the client to obtain the specimen after eating
2. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should
be reported immediately to the physician?
A. Dry cough
B. Hematuria
C. Bronchospasm
D. Blood-streaked sputum
3. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning
time to a maximum of:
 A. 1 minute
B. 5 seconds
C. 10 seconds
D. 30 seconds
4. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse
notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?
A. Continue to suction
B. Notify the physician immediately
C. Stop the procedure and reoxygenate the client
D. Ensure that the suction is limited to 15 seconds
5. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the
following is a common clinical manifestation of pulmonary embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respirations
6. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to
an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination,
paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects
to elicit:
A. Resonant sounds.
B. Hyperresonant sounds.
C. Dull sounds.
D. Flat sounds.
7. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The
theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45
mg/kg/hour. The nurse should:
A. Question the order because it’s too low.
B. Question the order because it’s too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the theophylline measurement.
8. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse
include in the teaching?
A. Make inhalation longer than exhalation.
B. Exhale through an open mouth.
C. Use diaphragmatic breathing.
D. Use chest breathing.
9. Which phrase is used to describe the volume of air inspired and expired with a normal breath?
A. Total lung capacity
B. Forced vital capacity
C. Tidal volume
D. Residual volume
10. 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?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
11. 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?
A. Impaired color discrimination
B. Increased urinary frequency
C. Decreased hearing acuity
D. Increased appetite
12. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response
on the fact that the:
A. Area of redness is measured in 3 days and determines whether tuberculosis is present.
B. 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.
13. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client
from the tracheostomy tube, the nurse initially should plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
14. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the
nurse conclude?
A. The system is functioning normally
B. The client has a pneumothorax.
C. The system has an air leak.
D. The chest tube is obstructed.
15. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse
should assess for cyanosis by inspecting the:
A. Lips.
B. Mucous membranes.
C. Nail beds.
D. Earlobes.
16. For a male client with an endotracheal (ET) tube, which nursing action is most essential?
A. Auscultating the lungs for bilateral breath sounds
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
17. The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty
breathing?
A. Diaphragmatic breathing
B. Use of accessory muscles
C. Pursed-lip breathing
D. Controlled breathing
18. A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s
respiratory status, the nurse observes respiratory excursion to help assess:
A. Lung vibrations.
B. Vocal sounds.
C. Breath sounds.
D. Chest movements.
19. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough,
headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects legionnaires’ disease.
While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of
choice for treating legionnaires’ disease?
A. Erythromycin (Erythrocin)
B. Rifampin (Rifadin)
C. Amantadine (Symmetrel)
D. Amphotericin B (Fungizone)
20. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the
client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:
A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.
21. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to
explain the purpose of this breathing technique. Which explanation should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength.
C. It decreases use of accessory breathing muscles.
D. It prolongs the inspiratory phase of respiration.
22. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this
drug to work?” How should the nurse respond?
A. In 30 minutes
B. In 1 hour
C. In 2.5 hours
D. In 4 hours
23. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates
rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the
mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An ET cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
24. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8
hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous
theophylline in treating a nonreversible obstructive airway disease such as COPD?
A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, 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.
25. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being
treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which
feature?
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count
26. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which
combination of arterial blood gas (ABG) values confirms respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
27. 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 includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of
these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may
arise if the client receives a high oxygen concentration?
A. Apnea
B. Anginal pain
C. Respiratory alkalosis
D. Metabolic acidosis
28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s
anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol)
I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:
A. Alprazolam (Xanax).
B. Propranolol (Inderal)
C. Morphine.
D. Albuterol (Proventil).
29. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the
client has developed the most serious complication of epidural analgesia?
A. Heightened alertness
B. Increased heart rate
C. Numbness and tingling of the extremities
D. Respiratory depression
30. 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.

Answers and Rationales:

1. Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and
then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain
sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water.
The optimal time to obtain a specimen is on arising in the morning.
2. Answer D. If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank
blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications,
which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
Hematuria is unrelated to this procedure.
3. Answer C. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells in the heart. A
vasovagal response may occur, causing bradycardia. The nurse must preoxygenate the client before suctioning and limit
the suctioning pass to 10 seconds.
4. Answer C. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac
irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and
paroxysmal coughing. If side effects develop, especially cardiac irregularities, the procedure is stopped and the client is
reoxygenated.
5. Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest
pain.
6. Answer A. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds
heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder
and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and
pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and
heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium
 pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a
bony structure.
7. Answer A. A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5 mg/kg/hour of
aminophylline. Because the client’s theophylline level is sub-therapeutic, reducing the dose (which is what the physician’s
order would do) would be inappropriate. Therefore, the nurse should question the order.
8. Answer C. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing 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 pursed lips to prolong exhalation, keep the bronchioles from
collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
9. Answer C. Tidal volume refers to the volume of air inspired and expired with a normal breath. Total lung capacity is the
maximal amount of air the lungs and respiratory passages can hold after a forced inspiration. Forced vital capacity is the
vital capacity performed with a maximally forced expiration. Residual volume is the maximal amount of air left in the lung
after a maximal expiration.
10. Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other
modes — simple mask, face tent, and nasal cannula — deliver lower levels of FIO2.
11. Answer C. Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client
should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can
be prescribed. The other options aren’t associated with streptomycin. Impaired color discrimination indicates color
blindness; increased urinary frequency and increased appetite accompany diabetes mellitus.
12. Answer B. The Mantoux test doesn’t differentiate between active and dormant infections. If a positive reaction occurs, a
sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of
redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the
Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive
reaction. The presence of a wheal within 2 days doesn’t indicate active tuberculosis.
13. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually
lengthen this interval according to the client’s respiratory status. A client who doesn’t require continuous mechanical
ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube
for only 15 to 60 seconds wouldn’t be long enough to reveal the client’s true tolerance to the procedure. Plugging the
opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an
adjustment period to start breathing normally.
14. Answer C. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a
pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have
no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped
fluctuating in the water-seal chamber.
15. Answer B. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of
cyanosis because they’re affected by skin color.
16. Answer A. For a client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral
breath sounds to ensure proper tube placement and effective oxygen delivery. Although the other options are
appropriate for this client, they’re secondary to ensuring adequate oxygenation.
17. Answer B. The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic
and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.
18. Answer D. The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic expansion is
symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum
fracture. The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to
say “99,” the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of
the chest wall to the nurse’s palms. The nurse assesses breath sounds during auscultation.
19. Answer A. Erythromycin is the drug of choice for treating legionnaires’ disease. Rifampin may be added to the regimen if
erythromycin alone is ineffective; however, it isn’t administered first. Amantadine, an antiviral agent, and amphotericin B,
an antifungal agent, are ineffective against legionnaires’ disease, which is caused by bacterial infection.
20. Answer C. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging,
which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause pleural
effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an
ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t one of
them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.
21. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control
respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle
strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use
and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip
breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E
ratio as high as 1:4.)
22. Answer A. Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours;
and its duration of action is 4 to 6 hours.
23. Answer A. Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or
pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client’s being out of
breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure
alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.
 24. Answer A. Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive
to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating
asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than
stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or
emphysema, they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.
25. Answer A. The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending
organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial
pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most
types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to
penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics. Although pneumonia
usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t.
26. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon
dioxide (PaCO2) above 45 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 with a PaCO2value of 30 mm Hg indicates respiratory alkalosis. Options B
and C represent normal ABG values, reflecting normal gas exchange in the lungs.
27. Answer A. Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to
apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may
have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any
concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not
excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive,
leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.
28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial
oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering
bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It’s given by
nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.
Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing.
Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a
respiratory center depressant and is contraindicated in this situation.
29. Answer D. Respiratory depression is the most serious complication of epidural analgesia. Other potential complications
include hypotension, decreased sensation and movement of the extremities, allergic reactions, and urine retention.
Typically, epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased
heart rate and blood pressure.
30. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and
stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting
fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because
protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic
bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult;
however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic
bronchitis should eat small, frequent meals (up to six a day).

Respiratory System
Questions:
1. If we consider the given medical parameters – increased pH, typical bicarbonate levels (HCO3), ordinary base excess (BE), and
decreased partial pressure of carbon dioxide (pCO2), to which of these physiological states does this constellation of factors most
likely correspond?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis
2. If we look at the commonly accepted normal range for bicarbonate (HCO3) in the human body, how is this typically expressed
in milliequivalents per liter (mEq/L)?
A. From 15 to 30 mEq/L.
B. From 22 to 26 mEq/L.
C. From 24 to 29 mEq/L.
D. From 20 to 35 mEq/L.
3. Given the following criteria, which most accurately represents a negative reaction to the Tuberculin Skin Test (TST) for
tuberculosis (TB)?
A. Induration measuring between 0 to 4 millimeters after 48 hours.
B. Induration measuring between 0 to 6 millimeters after 48 hours.
C. Induration measuring between 0 to 5 millimeters after 48 hours.
D. Induration measuring between 0 to 7 millimeters after 48 hours.
4. Given these physiological observations:
– Elevated pH levels
– Increased bicarbonate (HCO3) concentration
– High base excess (BE)
– Normal levels of partial pressure of carbon dioxide (pCO2)
Which condition is most likely to be associated with this combination of indicators?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
5. Among the following cellular entities, which is responsible for the production and secretion of surfactant?
A. Ciliated columnar epithelial cell.
B. Alveolar cell of the second type.
C. Alveolar cell of the third type.
D. Alveolar cell of the first type.
6. Looking at the following respiratory terminologies, which term corresponds with the observation of blockage in the trachea or
larynx?
A. Wheezes
B. Vesicular
C. Stridor
D. Crackles
7. When referring to standard measurements of partial pressure of carbon dioxide (pCO2) in the human body, what is the range
typically expressed in millimeters of mercury (mmHg)?
A. Between 35 to 45 mmHg.
B. Between 30 to 40 mmHg.
C. Between 25 to 30 mmHg.
D. Between 20 to 40 mmHg.
8. The vital control center that manages our breathing patterns is situated within which two sections of the brain?
A. Medulla oblongata and Hypothalamus.
B. Pons and Medulla oblongata.
C. Midbrain and Pons.
D. Pons and Hypothalamus.
9. Out of the following varieties, which form of lung cancer is most frequently diagnosed?
A. Adenocarcinoma
B. Large cell carcinoma
C. Pleural mesothelioma
D. Oat cell carcinoma (also known as small cell lung cancer)
10. Reflecting on the subsequent biological indicators:
– Reduced pH levels
– Diminished bicarbonate (HCO3) concentration
– Low base excess (BE)
– Normal levels of partial pressure of carbon dioxide (pCO2)
Which physiological state could be connected with this specific set of attributes?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
11. Among the following conditions, which one is not typically associated with Chronic Obstructive Pulmonary Disease (COPD)?
A. Bronchitis
B. Bronchial hypotension
C. Emphysema
D. Bronchial asthma
12. Can you identify the term from the list of pulmonary concepts that corresponds to the phenomenon of bronchial wall spasms?
A. Stridor
B. Wheezes
C. Crackles
D. Pleural Rub
13. Out of the following medications, which one is recognized as an expectorant, aiding in the expulsion of mucus from the lungs?
A. Benadryl
B. Theophylline
C. Guaifenesin
D. Acetylcysteine
14. From the following list of medications, which one is recognized as a bronchodilator, designed to widen the bronchi and
bronchioles to facilitate breathing?
A. Acetaminophen
B. Acetylcysteine
C. Theophylline
D. Guaifenesin
15. Among the given medications, which one is typically used to combat infections caused by Pneumocystis carinii, a type of
fungus?
A. Lorazepam
B. Epinephrine HCL
C. Pentamidine
D. Chlorpropamide
16. Out of the provided list of drugs, which one belongs to the class of compounds known as xanthines?
A. Epinephrine Hydrochloride
B. Glimepiride
C. Theophylline
D. Guaifenesin
17. Among the following health issues, which one is not typically a result of Chronic Obstructive Pulmonary Disease (COPD)?
A. Right-sided heart failure
B. Headaches
C. Pneumonia
D. Cor pulmonale
18. Among the medications listed, which one is classified as a mucolytic, a drug that breaks down mucus to help clear the
airways?
A. Acetylcysteine
B. Theophylline
C. Guaifenesin
D. Atorvastatin
19. Considering the following respiratory terms, which one aligns with the definition: The maximum amount of air that can be
forcefully expelled after taking the deepest possible inhalation?
A. Inspiratory Reserve Volume
B. Inspiratory Capacity
C. Expiratory Reserve Volume
D. Vital Capacity
20. Among the following respiratory terms, which one fits the description: The quantity of air that can be drawn in after the
expiration of a normal tidal volume?
A. Inspiratory Reserve Volume
B. Inspiratory Capacity
C. Vital Capacity
D. Expiratory Reserve Volume

Answers and Rationales:

1. Correct answer:
A. Respiratory alkalosis. In the given scenario, the patient presents with an increased pH and decreased partial pressure of carbon
dioxide (pCO2), while bicarbonate levels (HCO3) and base excess (BE) are within normal ranges. This pattern aligns with the
diagnosis of respiratory alkalosis.
Respiratory alkalosis is a condition that occurs when there is a primary decrease in the partial pressure of carbon dioxide (pCO2)
due to hyperventilation. The decreased pCO2 level in the blood results in an increase in blood pH (alkalosis), as carbon dioxide
combines with water in the body to form carbonic acid, which then dissociates to contribute hydrogen ions (H+) and bicarbonate
ions (HCO3-) to body fluids. When CO2 levels fall, this reaction occurs less, resulting in fewer hydrogen ions, which raises the pH
of the blood.

2. Correct answer:
B. From 22 to 26 mEq/L. The commonly accepted normal range for bicarbonate (HCO3-) concentration in human blood is typically
around 22 to 26 milliequivalents per liter (mEq/L). This measure reflects the buffering capacity of the blood, with bicarbonate
being the major base in the body that helps to neutralize acids and maintain pH homeostasis.

3. Correct answer:
A. Induration measures between 0 to 4 millimeters after 48 hours. The Tuberculin Skin Test (TST), also known as the Mantoux
test, is used to identify individuals who may have been infected with Mycobacterium tuberculosis, the bacterium that causes
tuberculosis (TB). The test is based on measuring the induration (raised, hard area or swelling) that occurs in response to injection
of purified protein derivative (PPD) into the skin.
For most individuals, an induration of 0 to 4 millimeters (mm) in size at 48-72 hours post-injection is generally considered a
negative reaction, implying that the person likely does not have TB infection.

4. Correct answer:
C. Metabolic alkalosis. Given the data you’ve provided — elevated pH levels, increased bicarbonate (HCO3) concentration, high
base excess (BE), and normal levels of partial pressure of carbon dioxide (pCO2) — the most likely condition associated with these
findings is metabolic alkalosis.
Metabolic alkalosis occurs when there is an elevation of bicarbonate concentration in the body, often due to the loss of acid from
the body or the gain of bicarbonate. This increases the pH of the blood, resulting in alkalosis. The normal pCO2 suggests that the
respiratory system is not the primary cause of the change in pH, supporting a metabolic rather than a respiratory origin of the
alkalosis.

5. Correct answer:
B. Alveolar cell of the second type. Type II alveolar cells, also known as alveolar cells of the second type or pneumocytes, are
responsible for the production and secretion of pulmonary surfactant. This substance is critical for reducing surface tension
within the alveoli (the tiny air sacs in the lungs), preventing their collapse upon exhalation, and aiding in lung elasticity and gas
exchange.

6. Correct answer:
C. Stridor. Stridor refers to a high-pitched, wheezing sound caused by disrupted airflow. It is typically caused by blockage or
narrowing in the trachea (windpipe) or larynx (voice box) and is often heard during inhalation. It can be a sign of serious
respiratory conditions, like foreign body obstruction, laryngeal or tracheal stenosis, and certain types of tumors.

7. Correct answer:
A. Between 35 to 45 mmHg. In the human body, the normal range for partial pressure of carbon dioxide (pCO2) in arterial blood is
typically between 35 to 45 millimeters of mercury (mmHg). This range represents a standard reference for evaluating the
efficiency of carbon dioxide removal from the body, an essential aspect of respiratory function.

8. Correct answer:
B. Pons and Medulla oblongata. The control center for our breathing patterns is primarily located within two areas of the
brainstem: the pons and the medulla oblongata. The medulla oblongata contains the dorsal and ventral respiratory groups that
mainly control the rhythm of respiration, while the pons contains the pneumotaxic and apneustic centers that regulate the rate
and depth of respiration.

9. Correct answer:
A. Adenocarcinoma. Adenocarcinoma is the most commonly diagnosed type of lung cancer, especially in non-smokers. It
originates from the cells that line the alveoli and bronchial tubes’ smaller branches and produce substances such as mucus. The
growth of adenocarcinoma is usually slower compared to other types of lung cancer, providing a somewhat better prognosis.

10. Correct answer:

D. Metabolic acidosis. The provided parameters—reduced pH levels, diminished bicarbonate concentration, and low base
excess—suggest metabolic acidosis. This condition occurs when the body produces too much acid or when the kidneys do not
remove enough acid from the body. In response, the body utilizes bicarbonate (HCO3-) to neutralize the excess acid, hence its
reduced level. The low base excess also implies an acid-base disturbance where there is a deficit of base in the body.

11. Correct answer:

B. Bronchial hypotension. This term does not typically exist in the context of pulmonary diseases or COPD. Hypotension refers to
low blood pressure and is not directly related to COPD or bronchial conditions.

12. Correct answer:

B. Wheezes. Wheezing refers to a high-pitched whistling sound made while breathing, typically on exhalation (breathing out). It’s
caused by narrowed airways or inflammation. Bronchial spasms, also called bronchospasms, are sudden constrictions of the
muscles in the walls of the bronchioles. This results in narrowing of the airways, which can cause wheezing. Bronchospasm is a
key feature in diseases such as asthma and chronic obstructive pulmonary disease (COPD).

13. Correct answer:

C. Guaifenesin. Guaifenesin is an expectorant that is commonly used to relieve chest congestion. It works by thinning the mucus
in the air passages, making it easier to cough up and clear the airways. This helps to enhance respiratory tract fluidity and
facilitate mucus clearance.

14. Correct answer:

C. Theophylline. Theophylline is a bronchodilator medication. It belongs to a class of drugs called xanthines, and it works by
relaxing the smooth muscle around the airways in your lungs. This allows the bronchi and bronchioles to expand, leading to
increased airflow and easier breathing. Theophylline also has some anti-inflammatory effects which may further aid in reducing
bronchoconstriction. Theophylline is used in the treatment of respiratory diseases like asthma and chronic obstructive pulmonary
disease (COPD).

15. Correct answer:

C. Pentamidine. Pentamidine is an antimicrobial agent that is specifically used for treating Pneumocystis carinii pneumonia (also
known as Pneumocystis jirovecii pneumonia), a type of fungal infection. It is typically used in patients who are
immunocompromised, such as those with HIV/AIDS, as they are at a higher risk of developing this type of infection.

16. Correct answer:

C. Theophylline. Theophylline is a drug that belongs to a class of compounds known as xanthines. Xanthines act as
bronchodilators, meaning they relax and widen the bronchi and bronchioles in the lungs, facilitating airflow and making it easier
for patients to breathe. This class of drugs, which also includes caffeine and theobromine, has been used to treat respiratory
diseases such as asthma and chronic obstructive pulmonary disease (COPD).

17. Correct answer:

B. Headaches. While headaches can be a symptom experienced by some patients with Chronic Obstructive Pulmonary Disease
(COPD), especially those with severe disease or during exacerbations due to hypoxia or hypercapnia, they are not typically a
direct result of the disease. Most COPD-related complications affect the respiratory system or other parts of the body due to low
oxygen levels. In contrast, headaches can be caused by a wide variety of conditions, not just COPD.

18. Correct answer:

A. Acetylcysteine. Acetylcysteine is a mucolytic drug. It works by breaking down the chemical structure of mucus, making it less
thick and sticky and easier to cough up. This helps clear the airways in conditions where mucus is a problem, such as in chronic
obstructive pulmonary disease (COPD) or cystic fibrosis.

19. Correct answer:

D. Vital Capacity. Vital Capacity (VC) is the maximum amount of air a person can expel from the lungs after a maximum inhalation.
It is equal to the sum of the Inspiratory Reserve Volume (IRV), the Expiratory Reserve Volume (ERV), and the Tidal Volume (TV).
Essentially, it represents the total volume of air that can be moved in and out of the lungs and it is useful in assessing the strength
of thoracic muscles and the function of the lungs.

20. Correct answer:

A. Inspiratory Reserve Volume. The Inspiratory Reserve Volume (IRV) is defined as the amount of air that can be forcefully inhaled
after a normal, quiet inhalation. This measurement is used to help evaluate lung function and capacity.

Asthma
Questions:
1. Asthma is fundamentally classified as:
A. A harmful, cancerous condition.
B. A disease that results from the body’s immune system mistakenly attacking its own cells.
C. A disease caused by harmful bacteria, viruses, or other microbes.
D. A disease associated with allergic reactions and hypersensitivity.
2. The distinguishing trait of chronic asthma is:
A. Wheezing during the night.
B. A familial pattern of the disease.
C. The requirement for orally administered steroids.
D. Inflammation of the airways.
3. A basic tool that is often used for an approximate assessment of lung function is:
A. A barometer.
B. A manometer.
C. A sphygmomanometer.
D. A peak flow meter.
4. The following pharmaceutical substance does not contribute to the development of asthma:
A. Histamine
B. Ibuprofen
C. Atropine
D. Beta-blocker
5. Which of these examinations is incapable of identifying inflammation in the airways?
A. Bronchoalveolar lavage.
B. Sputum eosinophil counts.
C. Spirometry
D. Bronchial mucosal biopsy.
6. The specific measure used to identify reversibility in airflow obstruction during a spirometry test is:
A. FEV1
B. RV
C. FVC
D. MVV
7. The bronchodilator typically employed during a reversibility test is:
A. Theophylline anhydrous
B. Atropine
C. Salbutamol
D. Montelukast
8. In addition to histamine, bronchoprovocation tests frequently employ _________ to stimulate the airways:
A. Prednisolone
B. Ipratropium bromide
C. Methacholine
D. Adrenocorticotropic hormone
9. During an intense episode of acute asthma, why is it crucial to conduct a chest radiograph examination? The goal is to confirm
the absence of:
A. Chronic Obstructive Pulmonary Disease (COPD)
B. A malignant growth in the lungs.
C. Fluid accumulation in the pleural space.
D. A pneumothorax.
10. Which of the following factors is NOT useful in assessing the severity of an acute asthma attack?
A. Swelling of the lower legs, or pedal edema.
B. The patient’s capacity to speak full sentences.
C. The peak rate of expiratory flow.
D. The engagement of supplementary respiratory muscles.

Answers and Rationales:

1. Correct answer:
D. A disease associated with allergic reactions and hypersensitivity. Asthma is a chronic condition where your airways become
inflamed and narrow, leading to difficulty in breathing. It is often triggered by allergens such as dust, pollen, and pet dander, as
well as certain types of exercise or stress. Asthma is considered a type of hypersensitivity or allergic reaction where the body’s
immune system overreacts to certain stimuli, causing inflammation and swelling in the airways.

2. Correct answer:
D. Inflammation of the airways. Chronic asthma is fundamentally characterized by persistent inflammation of the bronchial tubes
or airways. This inflammation leads to swollen airways, excess mucus production, and bronchial hyperreactivity, all of which
contribute to symptoms like wheezing, coughing, chest tightness, and shortness of breath. The inflammation is typically a
response to various triggers, such as allergens or irritants, and can be present even when symptoms aren’t noticeable.

3. Correct answer:
D. A peak flow meter. A peak flow meter is a portable, easy-to-use device that measures peak expiratory flow rate (PEFR), which
reflects how well air is moving out of a person’s lungs. This measurement can provide a general assessment of lung function,
particularly in individuals with asthma or other obstructive lung diseases. It is often used in both healthcare settings and at home
to monitor the severity of asthma, guide decisions about treatment, and even detect impending asthma attacks.

4. Correct answer:
C. Atropine. Atropine is an anticholinergic medication that is used to treat a variety of medical conditions such as bradycardia,
certain types of poisonings, and to reduce salivation during surgery. It is not known to contribute to the development of asthma.
Instead, anticholinergic agents like ipratropium bromide are sometimes used as bronchodilators to relieve asthma symptoms.

5. Correct answer:
C. Spirometry. Spirometry is a common pulmonary function test used to measure the amount (volume) and speed (flow) of air
that can be inhaled and exhaled. It provides information about how well the lungs are working but does not directly measure
inflammation in the airways. It is useful for diagnosing conditions like asthma and chronic obstructive pulmonary disease (COPD),
as well as monitoring disease progression and response to treatment. However, it does not reveal information about
inflammation or other microscopic changes in the airways.

6. Correct answer:
A. FEV1. Forced expiratory volume in 1 second (FEV1) is the volume of air that can be forcefully exhaled in one second after taking
a deep breath. It is a key measure used during spirometry testing. In conditions like asthma, where there is a reversible airflow
obstruction, FEV1 is often reduced. However, after administration of a bronchodilator medication (such as albuterol), FEV1
typically improves. This post-bronchodilator improvement in FEV1 (often defined as an increase of 12% and 200 ml from the
baseline value) is used to indicate reversibility in airflow obstruction, which is characteristic of asthma.

7. Correct answer:
C. Salbutamol. Salbutamol (also known as albuterol in the United States) is a short-acting beta-2 agonist (SABA) that is typically
used during a reversibility test (bronchodilator response test) as part of spirometry. This bronchodilator works quickly to relax the
muscles of the airways, which widens the airways (bronchodilation), allowing more air to flow through and alleviating symptoms
such as wheezing and shortness of breath.
The reversibility test, also known as a bronchodilator response test, is an additional step in spirometry, which is a type of
pulmonary function test. This test is performed to assess how well your lungs work by measuring airflow and lung capacity.
In the context of diseases like asthma, a key characteristic is reversible airway obstruction. This means that the constriction or
“narrowing” of the airways seen in these conditions can be reversed or improved with the use of medications called
bronchodilators, such as salbutamol (albuterol).

8. Correct answer:
C. Methacholine. Methacholine is a muscarinic receptor agonist that is often used in bronchoprovocation tests to assess the
reactivity of the airways, particularly in the diagnosis of asthma. These tests are designed to provoke a response in the airways,
and methacholine works by mimicking the action of acetylcholine, causing bronchoconstriction, or narrowing of the airways. A
positive methacholine challenge test (increased airway reactivity) often indicates a diagnosis of asthma.
*Bronchoprovocation is a special test where the airways are intentionally made narrower to see how well someone can breathe.

9. Correct answer:
D. A pneumothorax. During an acute episode of asthma, it is important to conduct a chest radiograph to exclude the presence of
a pneumothorax. In severe asthma attacks, the increased pressure in the lungs due to airway obstruction can lead to the rupture
of small, weakened areas of the lung tissues, causing a pneumothorax, or lung collapse. This is a medical emergency and needs to
be addressed immediately to prevent further complications, which can be life-threatening.
10. Correct answer:
A. Swelling of the lower legs, or pedal edema. Pedal edema, or swelling in the lower legs, is not typically associated with acute
asthma attacks. It’s more commonly seen in conditions such as heart failure, chronic kidney disease, or liver disease. In the
context of an acute asthma attack, symptoms and signs related to the respiratory system are more relevant to assessing severity.

Asthma 2

Questions:
1) In the small but bustling neighborhood pharmacy, pharmacist Jane is counseling a middle-aged man recently prescribed a
bronchodilator for his asthma symptoms. As she outlines the possible side effects of the medication, she emphasizes that one of
the following is not typically associated with bronchodilator use:
A. Shaking or trembling (tremor).
B. Headaches.
C. An abnormally fast heart rate (tachycardia).
D. The development of oral thrush, a type of fungal infection in the mouth.
2) Late in the evening, Susan, a dedicated nurse, meets her neighbor Linda in their apartment complex. Linda, who has been
diagnosed with asthma, anxiously asks for advice on managing her condition. Pondering the best advice, Susan thinks of the
following actions. Which one should Linda adopt for her asthma management?
A. Disregard dietary control.
B. Overutilize her asthma medication.
C. Take up smoking.
D. Diligently use her prescribed medicines.
3) In the bustling pediatric ward, Nurse Ben finds himself frequently treating a certain health issue. Out of curiosity, he decides to
look up the prevalence of this condition in various age groups. In which demographic is asthma most commonly diagnosed?
A. Children
B. Elderly
C. Adults
D. Teens
4) Nurse Ava is preparing medication for her patient who has a history of asthma. She remembers that some medications can
potentially trigger asthma symptoms and is double-checking her patient’s prescription. Which of the following medications is not
associated with causing asthma?
A. The anticholinergic agent, Atropine.
B. The common pain reliever, Ibuprofen.
C. The heart medication, Beta-blocker.
D. The allergy substance, Histamine.
5) In the middle of a bustling hospital, a patient suddenly arrives at the emergency department, showing severe signs of a
respiratory issue. As a nurse, you need to identify the situation quickly. Given the following respiratory disorders, which one
would you unequivocally recognize as a medical emergency, demanding immediate intervention?
A. An intense bout of Asthma.
B. The sudden onset of Epiglottitis.
C. An advanced case of Cystic Fibrosis.
D. The development of Laryngotracheobronchitis (LTB).
6) In the midst of an ongoing evaluation in the pulmonology department, a nurse is asked to perform a reversibility test. The
intent is to understand the patient’s lung function better and measure the extent of bronchodilation that can be achieved. Among
the options below, which bronchodilator would you primarily use in this scenario?
A. The anticholinergic Atropine.
B. The xanthine derivative Theophylline anhydrous.
C. The beta2-adrenergic agonist Salbutamol.
D. The catecholamine hormone Adrenaline.
7) Imagine a woman with a slight weight problem, a background of allergy-triggered asthma, high blood pressure, and an issue
with her mitral valve, presenting herself for a planned surgical procedure in a hospital. As a nurse, you meticulously collect her
health history and perform an exhaustive physical examination, focusing particularly on her heart and lung systems. During the
percussion of the patient’s chest wall, what kind of sound would you anticipate to hear?
A. Muted, flat-like sounds.
B. Clear and hollow, resonant sounds.
C. Dense, dull-like sounds.
D. Extraordinarily clear and booming, hyperresonant sounds.
8) You’re a pediatric nurse, and a young patient comes in for a routine immunization. Prior to administering the vaccine, you’re
aware that certain conditions could pose a risk. Which of the following circumstances would you be most concerned about before
giving the child the immunization?
A. Mild sniffles or a slight cough.
B. A long standing condition of asthma.
C. A weakened immune response.
D. A known allergy to eggs.
9) It’s a typical weekday at your nursing station when the school calls regarding a 9-year-old boy, Teddy, who they believe might
be showing signs of a health issue. They provide the following list of symptoms that Teddy has been exhibiting: persistent
coughing, audibly wheezing when exhaling, a feeling of constriction in his chest, labored breathing, and restless sleep due to
breathlessness.
A. These symptoms collectively indicate a likely diagnosis of asthma.
B. These symptoms do not align with the typical indicators of asthma.
10) A patient with frequent bouts of wheezing, shortness of breath, and tightness in their chest coming to you, a healthcare
provider, for assistance. You identify these symptoms as being characteristic of a particular respiratory condition. Which of the
following best describes the fundamental nature of asthma?
A. A condition triggered by the body’s immune system attacking its own cells.
B. A disease related to a predisposition towards developing certain allergic hypersensitivity reactions.
C. A disease resulting from an invasion of microorganisms.
D. A condition characterized by uncontrolled, abnormal cell growth.
11. In the bustling heart of a city hospital, Nurse Maya diligently educates a patient with asthma about the proper use of a peak
flow meter. This small but powerful device can be a lifeline in managing her condition, alerting her to changes in her respiratory
status and guiding her actions. What will be a clear sign that the patient has fully understood Nurse Maya’s instruction?
A. The patient plans to use montelukast when the meter readings fall into the red zone.
B. The patient intentionally breathes out slowly into the mouthpiece to get a reading.
C. The patient decides to employ her albuterol inhaler when the meter indicates readings in the yellow zone.
D. The patient intends to reach out to her healthcare provider when the readings stay in the green zone.
12) You’re in a health education session, where a curious patient asks you to explain a certain condition that involves recurrent
episodes of wheezing, coughing, chest tightness, and shortness of breath. How would you best describe asthma?
A. A persistent condition affecting the respiratory system.
B. A disorder impacting the digestive system.
C. A condition characterized by the heart’s inability to pump sufficient blood.
D. A minor health concern with few symptoms or complications.
13) As a nurse in a busy urban clinic, you are addressing a patient who complains of frequent asthma attacks at home. Upon
inquiry, she mentions a recent cockroach infestation. She wonders if the presence of these insects could possibly aggravate her
condition.
A. Yes, cockroaches may indeed act as a catalyst for asthma attacks.
B. No, cockroaches cannot precipitate asthma attacks.
14) You’re advising a patient with asthma on how to minimize potential triggers in their environment. Dust and dust mites are
known to exacerbate their symptoms. Which of the following recommendations would you provide to reduce their exposure and
thus lower the chances of an asthma flare-up?
A. Regularly wipe down furniture using a damp cloth and ensure it dries properly.
B. Frequently launder pillows, blankets, and stuffed animals.
C. Maintain classrooms, or similar spaces, in a tidy and uncluttered state.
D. Follow all of the choices.
15) As a nurse, you are counseling a patient who has just been diagnosed with asthma. The patient expresses concerns about
starting a course of inhaled steroids as a preventer or controller due to fear of significant side effects. The prescribed dosages fall
within the standard recommendation. How would you address this worry?
A. Yes, inhaled steroids, even at recommended dosages, may result in major side effects.
B. No, inhaled steroids at prescribed dosages typically do not lead to major side effects.
16) In the midst of a medical discussion, you, a knowledgeable nurse, are asked about chronic obstructive pulmonary disease
(COPD) and its associated conditions. Among the options given, which one would you not categorize as a disease related to
COPD?
A. Lower-than-normal pressure in the bronchial airways, known as Bronchial hypotension.
B. Abnormal widening of the bronchi or their branches causing risk of infection, called Bronchiectasis.
C. Inflammation of the bronchi in the lungs, termed Bronchitis.
D. A chronic inflammatory lung condition that causes obstructed airflow from the lungs, known as Bronchial asthma.
17) You are in the Emergency Department when a 19-year-old patient arrives, showing signs of an acute asthma attack. His
breaths are coming in at a rapid rate of 44 per minute, and it’s evident he’s in severe respiratory distress. What is the immediate
step you should take in managing this patient?
A. Administer a bronchodilator via a nebulizer.
B. Attach a cardiac monitor to the patient.
C. Conduct a comprehensive medical history interview.
D. Offer emotional reassurance to the patient.
18) A patient comes to you, displaying certain signs and symptoms, and you suspect they might have asthma. Which of the
following would you consider as a genuine symptom indicative of this respiratory condition?
A. Experiencing constant tiredness and lack of energy.
B. Inflammation and narrowing of the air passages.
C. Troubles related to emotional wellbeing.
D. Persistent and uncontrollable bouts of sneezing.
19) You’re a nurse performing a spirometry test on a patient to evaluate their lung function. You’re specifically interested in
assessing the reversibility in airflow obstruction. Which of the following parameters would you primarily rely on for this
determination?
A. The Forced Expiratory Volume in the first second (FEV1)
B. The Residual Volume (RV)
C. The Maximum Voluntary Ventilation (MVV)
D. The Forced Vital Capacity (FVC)
20. The on-call nurse, Laura, has just received a new patient, a ten-year-old boy with severe asthma. He’s wheezing, his breaths
are rapid, and his oxygen levels are dropping. Laura has seen acute asthma exacerbations before but this one looks serious. In this
case, she needs to recall the most crucial information from her recent training about handling such conditions. What would that
key piece of knowledge be?
A. The steroid drug, Methylprednisolone, is reserved solely for instances of respiratory arrest.
B. First-line treatment usually incorporates short-acting beta-2 agonists.
C. The severity of an acute asthma exacerbation is determined solely by the patient’s physical signs and symptoms, without
considering variations in their Peak Expiratory Flow (PEF) values.
D. Oxygen supplementation is typically not a recommended course of action.
21) Marianne is a long-term asthma patient. Despite religiously adhering to her prescribed medication regimen, she continues to
experience persistent symptoms. These symptoms are notably worse at night, leading to frequent sleep disruptions. Given these
circumstances, would you think about gastroesophageal reflux disease (GERD) as a potential contributing factor to her poorly
managed asthma?
A. Absolutely, it’s a plausible consideration.
B. No, it’s an unrelated concern.
22) Liam, an active teenager with a passion for soccer, has recently been diagnosed with asthma. He’s worried that his diagnosis
might mean the end of his sports pursuits. Is it accurate to say that having asthma prevents participation in physical activities?
A. Yes, asthma sufferers should avoid all physical activities.
B. No, people with asthma can still engage in physical activities with appropriate management.
23) Tommy, a seven-year-old boy, has recently been diagnosed with asthma. His family is trying to adapt to this new situation and
make the necessary changes for Tommy’s well-being. However, one of their statements about managing Tommy’s asthma
suggests they might benefit from further education. Which statement is that?
A. “We’ll encourage him to drink more fluids frequently to help make his respiratory secretions less thick.”
B. “We’re keen to identify potential triggers for his asthma flare-ups to minimize exposure.”
C. “He needs to use his bronchodilator inhaler first, then his steroid inhaler.”
D. “We will ensure that he avoids physical activities to prevent asthma attacks.”
24) You are a nurse and have just admitted Emma, a 10-year-old girl, to the emergency room due to a sudden asthma attack. To
gauge the severity of her condition, you plan to assess various factors. However, one of the following is not useful in determining
the severity of Emma’s acute asthma attack. Which one is it?
A. Emma’s ability to finish sentences.
B. Emma’s peak expiratory flow rate.
C. Presence of swelling in Emma’s lower extremities.
D. Emma’s use of accessory muscles to aid in breathing.
25) Greg, a newly diagnosed asthmatic, is learning to use his inhaler. He wonders if mastering the correct inhalation technique
will ensure that the medication reaches his lung airways effectively. Is Greg’s assumption correct?
A. Yes, a proper inhalation technique ensures effective medication delivery to the lung airways.
B. No, inhalation technique doesn’t impact the delivery of medication to the lung airways.
26) Liza’s close friend, Robert, has recently been diagnosed with asthma. She’s been reading up about the condition to better
understand what Robert is experiencing. She believes that symptoms of asthma include wheezing, coughing, and difficulty in
breathing. Is Liza’s understanding correct?
A. Yes, wheezing, coughing, and difficulty in breathing are indeed symptoms of asthma.
B. No, wheezing, coughing, and difficulty in breathing are not symptoms of asthma.
27) Susan, a Caucasian woman with a history of bronchial asthma, exogenous obesity, and iron deficiency anemia, has been
admitted to the hospital following a stroke (cerebrovascular accident or CVA). Looking at Susan’s medical history, which aspect
could have increased her risk for a CVA?
A. Her ethnicity as a Caucasian.
B. Her gender being female.
C. Her struggle with bronchial asthma.
D. Her condition of obesity.
28) Peter, an asthmatic, is attending a friend’s outdoor garden party. He loves pets and his friend’s dog is running around the
garden. As the pollen from the garden’s plants fills the air, he also strokes the furry dog. Could such allergens as pollen and animal
fur trigger his asthma?
A. Yes, allergens such as pollen and animal fur can indeed trigger asthma.
B. No, allergens like pollen and animal fur do not trigger asthma.
29) Anna Smith, a patient with asthma, is currently being treated with bronchodilators. As her nurse, you have to vigilantly
monitor certain side effects related to the medication she’s taking. Which of the following sets of symptoms should you be
particularly attentive to?
A. Impaired vision, accelerated heart rate, high blood pressure, headaches, sleeplessness, and decreased urine output.
B. Fast heartbeat, headache, shortness of breath, temperature of 101°F, and wheezing sounds.
C. Feelings of restlessness, insomnia, blurred vision, high blood pressure, chest pain, and muscle weakness.
D. Fast heartbeat, feelings of nausea and vomiting, heart palpitations, inability to sleep, restlessness, and seizures.
30) Let’s consider a teenager, Alex, who’s been recently diagnosed with allergic asthma. Certain symptoms and triggers align with
his diagnosis, but one of the following statements doesn’t accurately characterize his allergic asthma. Which one is it?
A. Alex’s asthma is provoked by specific allergens, such as dust mites and pollen.
B. Alex experiences bronchoconstriction and inflammation of the airways.
C. Alex’s asthma is a result of a viral infection.
D. Alex’s asthma began during his childhood or adolescence.
31) Jane, a pulmonologist, is preparing to perform a bronchoprovocation test on a patient to evaluate their airway
responsiveness. While histamine is often used for this purpose, she is considering an alternative agent to challenge the airways.
Which of the following could she potentially use instead of histamine?
A. Adrenocorticotropic hormone
B. Prednisolone
C. Methacholine
D. Ipratropium bromide
32) Jessa, a young girl recently diagnosed with asthma, is ready for discharge from the hospital after recovering from a severe
episode of status asthmaticus. As part of the discharge process, Jessa and her family need to receive specific education. Which of
the following points should this teaching emphasize?
A. The restrictions in sports activities imposed by her asthma condition.
B. Detailed instructions on maintaining calm during an asthma attack.
C. Understanding the link between her asthma symptoms and specific triggers, like physical exercise.
D. Information on the frequency of status asthmaticus in children and teenagers.
33) Benjamin, a patient who has been experiencing persistent coughing and wheezing for over a year, comes to see you. Given
the length of time that Benjamin has been exhibiting these symptoms, would you completely discount the possibility of a foreign
object lodged in his airway?
A. Yes, the idea of a foreign object causing these symptoms can be ruled out since they’ve persisted for over a year.
B. No, even with these symptoms persisting for over a year, a foreign object could still be a potential cause.
34) Claire, a mother concerned about her daughter, is trying to understand the risk factors associated with the development of
asthma. She’s found several potential risk factors, but one of them isn’t correct. Which one doesn’t increase the risk of
developing asthma?
A. Having parents with a history of asthma.
B. Being diagnosed with atopic dermatitis by a physician.
C. Having peripheral eosinophilia and allergic rhinitis.
D. Experiencing recurrent ear infections (otitis media).
35) Two-year-old Lily, who has recently been diagnosed with acute asthma, is under your care as a nurse. You’re planning a
healthy snack for her. Considering her condition, which of the following would be the best snack option for her?
A. Slices of apple.
B. A glass of milk.
C. A glass of cola.
D. A few grapes.
36) Sam, a curious teenager, is researching asthma for a school project. He comes across a statement claiming that asthma is
caused by inflammation of the airways in the lungs. Is this statement accurate?
A. Yes, asthma is indeed caused by inflammation of the airways in the lungs.
B. No, asthma is not caused by inflammation of the airways in the lungs.
37) George, a middle-aged man with asthma, is trying to understand what triggers his asthma attacks. He knows it’s vital to avoid
these triggers to manage his condition better. Which of the following could potentially provoke an asthma attack?
A. Blockage of the airways.
B. Irritability in the airways.
C. Inflammation within the airways.
D. All of the factors listed.
38) Emily, newly diagnosed with asthma, is learning about her medications. She’s trying to distinguish between a ‘preventer’ and
a ‘reliever’ in the context of asthma management. Which of the following statements correctly represents the role of these
medications?
A. A preventer is used to alleviate asthma attacks.
B. A reliever is used to alleviate asthma attacks.
39) Emma, an individual with asthma, has noticed that strong emotional reactions such as crying, laughing hard, or yelling
sometimes make her feel short of breath. Could these emotional responses trigger her asthma?
A. Yes, strong emotional reactions like crying, laughing hard, or yelling can indeed trigger asthma.
B. No, emotional reactions such as crying, laughing hard, or yelling don’t trigger asthma.
40) As a public health official, Alice is planning a campaign focused on primary prevention of asthma. She has been researching
the crucial factors that could help prevent asthma onset. Which of the following options correctly describes these factors?
A. Taking medication for related diseases, avoiding sedentary behavior, and avoiding exposure to second-hand smoke.
B. Avoiding exposure to second-hand smoke, breastfeeding during infancy, and avoiding allergens.
C. Breastfeeding during infancy, living at least 20 km outside of a major city, and spending at least 3 hours outdoors each day for
oxygen.
D. Avoiding household pets, preventing obesity, and avoiding allergens.
41) Eman, a 7-year-old boy, is rushed to the emergency department. He’s breathing rapidly (tachypneic) without a fever
(afebrile), has a respiratory rate of 36 breaths per minute, and presents with a dry cough. He also had a cold recently. Considering
these details, which of the following health conditions might Eman be experiencing?
A. Emphysema
B. Acute asthma
C. Bronchial pneumonia
D. Chronic obstructive pulmonary disease (COPD)
42) Nathan, a nursing student, is preparing for an exam on respiratory disorders and is studying asthma. He’s trying to identify the
defining features of this condition. However, one of the following isn’t a characteristic of asthma. Which one is it?
A. Dynamic collapse of the airways.
B. Swelling (edema).
C. Damage to the epithelial cells lining the airways.
D. Contraction of the muscles in the airways (bronchospasm).
43) Austin, a patient experiencing an acute asthma attack, is presenting with wheezing during both inhalation and exhalation,
along with a reduced forced expiratory volume. As his healthcare provider, which category of medication should you administer
immediately to manage his symptoms?
A. Oral corticosteroids
B. Beta-adrenergic blockers
C. Bronchodilators
D. Inhaled corticosteroids
44) Elizabeth, a patient suffering from nocturnal asthma, is trying to understand the pattern of her symptoms better. She’s
uncertain about the typical time frame during which nocturnal asthma occurs. When does nocturnal asthma typically manifest?
A. Nocturnal asthma is a myth; it doesn’t exist.
B. It usually occurs early in the night.
C. It usually manifests between 2 am and 4 am.
D. It typically happens close to dawn.
45) James, an individual with asthma, is curious about potential triggers for his condition. He comes across a claim that fragrant
substances like perfumes and cleaning products can set off an asthma attack. Is this claim accurate?
A. Yes, perfumes and cleaning products can indeed trigger an asthma attack.
B. No, perfumes and cleaning products don’t trigger asthma attacks.
46) In a parent-teacher meeting at a local school, a proposal is put forward to ban all classroom pets to prevent asthma triggers
among the students. Is this a necessary action to prevent potential asthma triggers?
A. Yes, all classroom pets should be banned to prevent possible asthma triggers.
B. No, it’s not necessary to ban all classroom pets to prevent asthma triggers.
47) As part of a health awareness program at a school, there’s a discussion about how personal habits of the staff could impact
students with asthma. One point of discussion is whether staff who smoke during their personal time could potentially harm
children with asthma. Is this statement accurate?
A. Yes, staff who smoke during their personal time cannot harm children with asthma.
B. No, staff who smoke during their personal time can indeed harm children with asthma.
48) A child has been rushed to the emergency room experiencing an asthma attack. As the attending nurse, what symptoms and
signs should you anticipate in this situation?
A. Underinflation of the alveoli leading to poor gas exchange due to increasingly shallow breaths.
B. An extended duration of inhaling and a short duration of exhaling.
C. Regular coughing that produces clear, frothy, thin mucus, gradually progressing to thick, sticky mucus that can only be heard
during examination.
D. Inflammation of the lining of the bronchial tubes, with wheezing beginning during exhalation and progressing to a continuous
state.
49) Jane, a health researcher, is analyzing the prevalence of asthma across different age and gender groups. She finds that two
particular groups have the highest rates of asthma. Which two population groups have the greatest prevalence of asthma?
A. Boys aged 15-19 years & girls aged 10-14 years.
B. Boys aged 10-14 years & women aged 20-24 years.
C. Men aged 25-44 years & girls aged 10-14 years.
D. Men aged 20-24 years & women aged 25-44 years.
50) Liam, a newly diagnosed asthmatic, is having a conversation with his healthcare provider about his treatment options. They
discuss the two main categories of medications used to manage asthma. What are these two categories?
A. Inhalable drugs and orally administered drugs.
B. Bronchodilators and anti-inflammatory drugs.
C. B2 adrenoceptor antagonists and bronchodilators.
D. Anti-inflammatory drugs and glucocorticoids.
51) Olivia, recently diagnosed with asthma, is researching her condition. She reads a statement that says there’s no singular cause
for asthma and, as of now, there is no cure for the disease. Is this statement accurate?
A. Yes, there’s no single cause for asthma and currently, there’s no cure for the disease.
B. No, the statement is incorrect.
52) Max, a young boy with asthma, loves outdoor activities but is concerned about possible triggers. He’s trying to understand
common outdoor triggers for asthma. Which of the following best describes common outdoor asthma triggers?
A. Weather and temperature changes.
B. Pollen.
C. Air pollution.
D. All of the choices listed.
53) A 5-year-old African American boy with a history of asthma visits your clinic. He’s not currently on any regular medication but
uses his Albuterol Metered Dose Inhaler (MDI) with a spacer once every two weeks during daytime. Additionally, he wakes up
coughing 2-3 times per week at night. Based on these details, how would you classify his asthma?
A. Mild Persistent
B. Intermittent
C. Severe Persistent
D. Moderate Persistent
54) You are a nurse caring for a hospitalized 6-year-old child. Which piece of information would raise your concern that this child
could potentially face a severe exacerbation of asthma?
A. The child has a history of asthma requiring steroid medication.
B. There are no visible intercostal or substernal retractions.
C. The child has an oxygen saturation level of 95%.
D. The child has only mild difficulty in breathing.
55) As a health professional, you are discussing the distinct features of different types of asthma with your peers. When it comes
to persistent asthma, what would you say is its characteristic feature?
A. A family history of the disease.
B. Nocturnal wheezing.
C. Inflammation of the airways.
D. The necessity for oral steroids.
56) As a health educator, you are preparing a presentation about asthma for a school community. You plan to include a
statement about the impact of asthma on children nationwide. Which of the following statements is accurate?
A. On average, one in every 10 school-aged children has asthma, leading to 10.5 million missed school days each year due to the
condition.
B. Asthma ranks as the third most common cause of hospitalization among children under 15.
C. Asthma is among the most prevalent chronic diseases nationwide, affecting the lives and families of over 7 million children.
D. All of the statements are true.
57) During one of your nursing shifts, you encounter a young patient, Maddie, a seven-year-old girl who is a frequent visitor to
the hospital due to her ongoing battle with asthma. Maddie’s condition got you thinking about the fundamental biological
changes that occur in the body during the onset of this respiratory disorder.
In this context, which of the following options best describes the main physiological alteration in the progression of asthma?
A. Overproduction of unusually thick and sticky lung secretions.
B. Uncontrolled contraction of the bronchial smooth muscle.
C. Inflammation of bronchioles leading to shortness of breath.
D. Infection-driven processes resulting in swelling of the mucus lining.
58) Late one evening, the emergency department where you’re working as a nurse gets busy. A patient with asthma, Mr.
Johnson, walks in, experiencing severe respiratory distress. Given Mr. Johnson’s darker skin tone, evaluating cyanosis becomes
slightly tricky.
Where should you as a nurse focus your assessment for cyanosis considering Mr. Johnson’s dark skin?
A. The nail beds.
B. The mucous membranes.
C. The earlobes.
D. The lips.
59) As a dedicated nurse on duty, you’re carefully monitoring the condition of Mr. Kim, an asthmatic patient. Initially, you noted
low-pitched wheezes in the latter half of his exhalation. However, an hour later, you observe high-pitched wheezes throughout
the entire exhalation.
Given this change in Mr. Kim’s condition, what does it suggest to you as a nurse?
A. There is a reduction in airway obstruction.
B. He needs to undergo suctioning.
C. He is showing signs of rapid breathing or hyperventilation.
D. There is an escalation in airway obstruction.
60) In a bustling community health center, Nurse Jamie needed a basic tool to roughly gauge the lung function of Mr. Sullivan, an
older patient with a history of respiratory issues. Which instrument would Nurse Jamie likely utilize?
A. Peak flow meter
B. Sphygmomanometer
C. Manometer
D. Barometer
61) During a hectic shift at the hospital, Nurse Emma was tending to Kenneth, a patient in the midst of a severe asthma attack.
Suddenly, Kenneth’s wheezing ceased and his breath sounds become inaudible. What might be the reason behind this startling
development?
A. The patient’s airways have become so inflamed that air cannot pass.
B. The wheezing has been superseded by crackles.
C. The asthma attack has concluded.
D. The inflammation has reduced.
62) In the heart of spring, Amelia, a recently graduated nurse, found herself faced with a case that puzzled her. She was treating
Matthew, a young boy, who every year, like clockwork, would develop asthmatic symptoms only during the season of blossoms.
Amelia wondered, “What could be triggering Matthew’s seasonal asthma?”
A. Could it be due to him breathing in the smoke from his father’s cigars?
B. Might it be the result of his encounters with the pollen-rich trees, grasses, and blooming flowers in his neighborhood?
C. Or perhaps it’s exposure to his grandpa’s paint thinners and house dust during spring cleaning?
63) Sam, a seasoned physiotherapist, had a new client, Jasmine, who had recently been diagnosed with asthma. Now, Sam
needed to determine the vital part he would play in her asthma management. What was his key responsibility?
A. Was it to impart knowledge about the importance of exercise and inform Jasmine about the availability of pulmonary
rehabilitation classes?
B. Should he focus on teaching and facilitating airway clearance techniques for Jasmine?
C. Was his main duty to enlighten Jasmine about her condition and the various treatment alternatives?
D. All of the choices.
64) In the midst of a bustling emergency room, a nurse tends to Samantha, a middle-aged woman who’s been experiencing
sporadic bouts of shortness of breath, a tight chest, and intermittent coughing. She’s particularly concerned about her wheezing –
a novel symptom she hasn’t experienced before. From a healthcare perspective, these symptoms suggest a condition that may
be:
A. An ongoing inflammatory condition of the respiratory tract, characterized by sporadic episodes of wheezing, breathlessness,
chest tightness, and coughing.
B. A localized and irreversible expansion of a section of the bronchial tree, consequent to the destruction of muscle and elastic
tissue.
C. A recurring cough that leads to the production of sputum and mucus for at least three months a year for two consecutive
years.
D. The deflation and subsequent closure of the alveoli, leading to impaired or absent gas exchange that could affect a portion or
the entirety of the lung.
65) In the peaceful quietude of the hospital lab, technician Mike is readying a series of tests for John, a patient presenting with a
persistent cough and wheezing. A host of diagnostic procedures lie ahead, each designed to probe for a different aspect of his
condition. Which among the following tests, however, won’t be able to reveal any inflammation in John’s airways?
A. The analysis of eosinophil levels in the sputum.
B. The procurement and examination of a biopsy from the bronchial mucosa.
C. The performance of a bronchoalveolar lavage, a procedure that involves washing out the bronchial tree and retrieving the
washings for examination.
D. The conduction of a spirometry test to assess the volume and flow of air that can be inhaled and exhaled.
66) Late one chilly night, emergency room nurse Clara finds herself rushing to attend to young Oliver, a 7-year-old boy battling an
intense asthma attack. His labored breathing sends a stark reminder of a critical fact about the condition he’s struggling against.
Does it hold the potential to be life-threatening?
A. Yes
B. No
67) At a local healthcare clinic, Dr. Amelia studies the charts of a newly diagnosed asthma patient. Through the stethoscope, the
telltale signs of the condition whisper clearly into her ears: the wheezing, the struggle of breath against the obstruction. She
ponders over the implications of this disease for the patient’s airways. Does asthma cause them to:
A. Narrow down or constrict?
B. Get coated with a substantial amount of mucus?
C. Undergo inflammation?
D. Exhibit all of the described changes?
68) Emma, an experienced nurse, was called into the emergency department to assist in managing Jacob, a young adult
experiencing a severe, acute asthma attack. While helping stabilize Jacob, Emma knew that some diagnostic measures were
crucial to rule out other potential issues during such a severe episode. She reflected on the essential need for a chest x-ray to
exclude:
A. A malignant growth in the lung.
B. A pneumothorax, or a collapsed lung.
C. A pleural effusion, an abnormal collection of fluid in the pleural space.
D. Chronic Obstructive Pulmonary Disease (COPD).
69) In the calm of her office at the local clinic, family nurse practitioner Rachel prepares for her next appointment. She glances at
the file of a new patient, Emma, whose medical history indicates asthma. Anticipating the array of symptoms Emma might
present, Rachel considers the likelihood of:
A. Feeble respiratory effort.
B. Inflamed, sensitive, and swollen linings of the airway.
C. The presence of malignant growth within the airway.
D. An elevated and irregular heart rate.
70) In a cozy corner of the pediatric clinic, nurse Miranda sits across from a concerned mother whose 8-year-old son has asthma.
With a hint of apprehension in her voice, the mother inquires about the effectiveness of her son’s ongoing treatment. To ensure
an accurate response, Miranda considers the need to:
A. Initially examine the frequency of prescription refills required by the child over the previous six months.
B. Initially track the child’s height progression on a growth chart.
C. Initially determine the number of times the child has visited the pediatrician in the last six months.
D. Initially check the child’s weight progression on a growth chart.
Answers and Rationales:
1) Correct answer:
D. The development of oral thrush, a type of fungal infection in the mouth. Oral thrush is typically not a side effect associated
with bronchodilators. Bronchodilators are used to open up the airways in the lungs, alleviating asthma symptoms. The
mechanism of action usually involves relaxing the smooth muscles that line the airways, leading to bronchial dilation and easier
breathing. The typical side effects associated with bronchodilators, due to their systemic effects, include shaking or trembling
(tremor), headaches, and an abnormally fast heart rate (tachycardia). Oral thrush, on the other hand, is more commonly
associated with the use of inhaled corticosteroids, which can alter the balance of microorganisms in the mouth and throat,
allowing fungi such as Candida albicans (which causes oral thrush) to proliferate.

2) Correct answer:
D. Diligently use her prescribed medicines. Properly managing asthma involves several key components, one of the most critical
being regular and diligent use of prescribed medications. Asthma medications, typically including bronchodilators and anti-
inflammatory drugs, help control inflammation in the airways and prevent or alleviate asthma attacks. This regular usage assists
in maintaining long-term control over asthma symptoms and prevents acute exacerbations.

3) Correct answer:
A. Children. Asthma is most commonly diagnosed in children. According to the Centers for Disease Control and Prevention (CDC),
asthma is the leading chronic disease in children. It often starts in childhood and can persist into adulthood. The prevalence of
asthma is higher in children compared to adults, and it is more common in boys than in girls during childhood; however, in
adulthood, it is more common in women than men.

4) Correct answer:
A. The anticholinergic agent, Atropine. Atropine is not typically associated with causing asthma symptoms. Anticholinergics,
including atropine, can actually be used as bronchodilators in the treatment of asthma because they inhibit the actions of
acetylcholine on smooth muscles in the airways, leading to muscle relaxation and bronchodilation.

5) Correct answer:
B. The sudden onset of Epiglottitis. Epiglottitis is a life-threatening condition that requires immediate medical intervention. This
disorder is characterized by inflammation and swelling of the epiglottis, a flap of tissue located at the base of the tongue that
keeps food from going into the windpipe during swallowing. When the epiglottis is inflamed, it can rapidly obstruct the airway,
leading to severe difficulty breathing, and can quickly become a medical emergency. Immediate hospitalization and treatment are
necessary to prevent asphyxiation.

6) Correct answer:
C. The beta2-adrenergic agonist Salbutamol. Salbutamol (also known as albuterol) is commonly used in reversibility tests to
measure lung function. As a short-acting beta2-adrenergic agonist, salbutamol works by relaxing the smooth muscle in the
airways, leading to bronchodilation and an increase in airflow. The response to salbutamol during the test can provide insights
into the degree of reversible airway obstruction in conditions such as asthma.

7) Correct answer:
B. Clear and hollow, resonant sounds. During a physical examination, percussion of the chest wall in a healthy individual typically
produces clear and hollow, resonant sounds. These sounds are produced by the air-filled lung tissue beneath the chest wall. It is
important to note that in the case of this patient with allergy-triggered asthma, you may also listen for wheezing or other
abnormal breath sounds, but these would be detected during auscultation (listening), not percussion.

8) Correct answer:
C. A weakened immune response. Children with a weakened immune response, often due to conditions like cancer, HIV/AIDS, or
as a result of certain medications, may not be suitable candidates for some vaccines, especially live vaccines. This is because their
immune system might not be able to mount an adequate response to the vaccine or, in rare cases, might not be able to control
the replication of the live attenuated vaccine strains, leading to disease.

9) Correct answer:
A. These symptoms collectively indicate a likely diagnosis of asthma. The symptoms mentioned — persistent coughing, audible
wheezing during exhalation, a feeling of chest tightness, labored breathing, and restless sleep due to breathlessness — are all
characteristic signs of asthma. Asthma is a chronic condition that causes inflammation and narrowing of the airways, leading to
difficulty in breathing. These symptoms can be intermittent and vary in severity. They can also be triggered or worsened by
various factors, such as allergens, cold air, exercise, or respiratory infections.

10) Correct answer:

B. A disease related to a predisposition towards developing certain allergic hypersensitivity reactions. Asthma is a chronic
inflammatory disease of the airways that is often associated with airway hyper-responsiveness and variable airflow obstruction.
People with asthma often experience symptoms such as wheezing, shortness of breath, chest tightness, and coughing. These
symptoms can be triggered by various factors, including allergens, exercise, cold air, and viral respiratory infections. A
predisposition towards developing certain allergic reactions is a well-known risk factor for asthma. The pathophysiology of
asthma involves an inappropriate immune response, leading to inflammation and remodeling of the airways.
11. Correct answer:
C. The patient decides to employ her albuterol inhaler when the meter indicates readings in the yellow zone. The use of a peak
flow meter in managing asthma is intended to provide early warning signs of worsening asthma control, measured as a
percentage of the patient’s personal best reading. A fall into the yellow zone, generally 50-79% of the personal best, indicates a
cautionary period where the asthma is not well controlled and immediate action is required. This often involves the use of a
quick-relief medication like albuterol.

12) Correct answer:

A. A persistent condition affecting the respiratory system. Asthma is a chronic condition that affects the airways of the lungs.
During an asthma episode, the airways narrow and become inflamed, leading to symptoms such as wheezing, coughing, chest
tightness, and shortness of breath. It’s considered a long-term disease that requires ongoing management, not a minor health
concern with few symptoms or complications.

13) Correct answer:

A. Yes, cockroaches may indeed act as a catalyst for asthma attacks. Cockroach allergens, found in cockroach feces, saliva, and
body parts, can trigger asthma symptoms or an asthma attack in individuals with asthma who are allergic to these allergens. In
certain urban environments, cockroach allergens can be a significant factor contributing to asthma severity. Hence, it’s
recommended that patients with asthma manage potential allergens in their environment, which could include addressing a
cockroach infestation.

14) Correct answer:

D. Follow all of the choices. Dust and dust mites are common triggers for asthma, and all the recommendations given can reduce
the patient’s exposure to them.

15) Correct answer:

B. No, inhaled steroids at prescribed dosages typically do not lead to major side effects. Inhaled corticosteroids (ICS) are one of
the mainstay treatments for persistent asthma, as they help to reduce inflammation in the airways. When taken at recommended
dosages, they typically have fewer systemic side effects than oral corticosteroids because they are delivered directly to the lungs,
which limits their impact on the rest of the body. However, some local side effects can occur, such as hoarseness and oral thrush,
which can often be mitigated by rinsing the mouth after use.

16) Correct answer:

A. Lower-than-normal pressure in the bronchial airways, known as Bronchial hypotension. There’s no recognized condition called
“bronchial hypotension” in medical literature or practice.
Chronic obstructive pulmonary disease (COPD) is a term used to describe progressive lung diseases, which include emphysema,
chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. These diseases are characterized by
increasing breathlessness.

17) Correct answer:

A. Administer a bronchodilator via a nebulizer. In the case of an acute asthma attack, the immediate priority is to reverse the
bronchospasm and improve the patient’s ability to breathe. This is often achieved through the administration of a fast-acting
bronchodilator, such as albuterol, via a nebulizer. These medications work by relaxing the muscles around the airways, making it
easier for the patient to breathe.

18) Correct answer:

B. Inflammation and narrowing of the air passages. Asthma is a chronic condition characterized by inflammation and narrowing of
the bronchial tubes, the passageways that allow air to enter and leave the lungs. This causes periods of wheezing, chest tightness,
shortness of breath, and coughing, particularly in the early morning or at night.

19) Correct answer:

A. The Forced Expiratory Volume in the first second (FEV1). FEV1 is the amount of air a person can forcefully exhale in the first
second after taking a deep breath, and it is often measured before and after the administration of a medication that widens the
airways (bronchodilator). If there is significant improvement in FEV1 after bronchodilator use, it suggests reversibility in airflow
obstruction, which is a characteristic of asthma rather than chronic obstructive pulmonary disease (COPD).

20. Correct answer:

B. First-line treatment usually incorporates short-acting beta-2 agonists. Short-acting beta-2 agonists, such as albuterol, are the
first-line treatment for acute asthma exacerbations. They act rapidly to relax the smooth muscles around the airways, thereby
widening the airways (bronchodilation) and relieving symptoms like wheezing, breathlessness, and chest tightness.

21) Correct answer:

A. Absolutely, it’s a plausible consideration. Gastroesophageal reflux disease (GERD) can indeed be a contributing factor to poorly
managed asthma. GERD is a condition in which stomach acid frequently flows back into the esophagus, causing irritation. In some
people, the refluxed stomach contents may reach the larynx or lungs, potentially triggering an asthma attack. This is particularly
true when the GERD symptoms worsen at night due to the horizontal body position, which may explain the exacerbation of
Marianne’s asthma symptoms during sleep.
22) Correct answer:
B. No, people with asthma can still engage in physical activities with appropriate management. Many people with asthma are able
to participate fully in sports and physical activities. It is essential, however, to manage the condition properly. This management
includes taking prescribed medication, monitoring symptoms, and having an asthma action plan. When asthma is well-controlled,
it should not restrict participation in physical activity. In fact, regular physical activity can improve lung function and overall health
in individuals with asthma.

23) Correct answer:

D. “We will ensure that he avoids physical activities to prevent asthma attacks.” Physical activity is actually beneficial for children
with asthma and should not be avoided. Regular exercise can improve lung function and overall health, making it an important
part of asthma management. Encouraging Tommy to participate in suitable physical activities, with adequate precautions and
under the supervision of a healthcare professional, will contribute to his well-being. Tommy’s parents can work with his
healthcare team to create an asthma action plan that includes exercise and outlines what to do during an asthma attack.

24) Correct answer:

C. Presence of swelling in Emma’s lower extremities. Swelling in the lower extremities is not typically associated with an asthma
attack and would not be useful in determining its severity. It could be a symptom of other health problems, such as a heart or
kidney condition, but it does not directly relate to the severity of an acute asthma attack.

25) Correct answer:

A. Yes, a proper inhalation technique ensures effective medication delivery to the lung airways. Inhaler technique is crucial for
effective delivery of asthma medication. Using the inhaler incorrectly can mean that insufficient medicine reaches the lungs,
reducing its efficacy. The correct technique involves a coordinated effort of actuating the inhaler while inhaling the medicine
deeply into the lungs, and then holding the breath to allow the medication to settle in the airways.

26) Correct answer:

A. Yes, wheezing, coughing, and difficulty in breathing are indeed symptoms of asthma. Asthma is a condition characterized by
recurrent episodes of symptoms such as wheezing (a whistling sound when breathing), coughing, chest tightness, and shortness
of breath. These symptoms can vary in frequency and severity, and they may also change over time.

27) Correct answer:

D. Her condition of obesity. Obesity is a well-documented risk factor for stroke. Excessive body weight can contribute to the
development of other health issues such as high blood pressure, diabetes, and heart disease, which are all recognized risk factors
for stroke. Also, obesity is associated with dyslipidemia (abnormal amount of lipids in the blood) and inflammation, both of which
can also increase stroke risk.

28) Correct answer:

A. Yes, allergens such as pollen and animal fur can indeed trigger asthma. Asthma triggers can differ from person to person, but
some of the most common include airborne substances like pollen, dust mites, mold spores, pet dander, or particles of cockroach
waste. In some people, asthma can be triggered by exposure to certain pets, particularly cats and dogs, due to proteins found in
their skin cells, saliva, and urine.

29) Correct answer:

D. Fast heartbeat, feelings of nausea and vomiting, heart palpitations, inability to sleep, restlessness, and
seizures. Bronchodilators, such as beta-agonists used for the treatment of asthma, work by relaxing the muscles around the
airways to improve airflow, but they can also cause a variety of side effects. These can include a fast heartbeat, feelings of nausea
and vomiting, heart palpitations, inability to sleep, restlessness, and in severe cases, seizures.

30) Correct answer:

C. Alex’s asthma is a result of a viral infection. While viral infections can indeed trigger asthma symptoms or an asthma attack,
they are not the cause of allergic asthma. Allergic asthma, as the name suggests, is triggered by exposure to specific allergens,
such as dust mites, pet dander, or pollen. These allergens cause an immune response leading to inflammation and constriction of
the airways.

31) Correct answer:

C. Methacholine. A bronchoprovocation test, also known as a methacholine challenge test, is commonly used to evaluate airway
hyperresponsiveness, a characteristic feature of asthma. Methacholine is a synthetic choline ester that acts as a non-selective
muscarinic receptor agonist in the parasympathetic nervous system. It causes bronchoconstriction and is used in the diagnosis of
asthma because people with asthma will react to lower concentrations of methacholine than those without the condition.

32) Correct answer:

C. Understanding the link between her asthma symptoms and specific triggers, like physical exercise. One of the critical parts of
managing asthma involves understanding and avoiding triggers that can exacerbate the condition. Education should focus on
helping Jessa and her family identify potential asthma triggers (such as allergens, physical exercise, cold air, etc.), and develop
strategies to avoid or minimize exposure to these triggers. Jessa should also be taught how to recognize early signs of an asthma
exacerbation and what to do if symptoms worsen.
33) Correct answer:
B. No, even with these symptoms persisting for over a year, a foreign object could still be a potential cause. While it might seem
unusual for a foreign object to cause symptoms over such a long period, it is still a possibility and shouldn’t be completely ruled
out. Depending on the object’s size and location in the airway, it could potentially remain undetected for an extended period and
cause chronic symptoms, including persistent coughing and wheezing.

34) Correct answer:

D. Experiencing recurrent ear infections (otitis media). While recurrent ear infections can be a nuisance and potentially lead to
other health complications if left untreated, they are not typically recognized as a risk factor for the development of asthma.
Asthma is a chronic condition characterized by inflammation and narrowing of the bronchial tubes, which carry air in and out of
the lungs. Its development is typically influenced by a combination of genetic and environmental factors.

35) Correct answer:

A. Slices of apple. Apples are rich in antioxidants and dietary fiber. Certain studies suggest that a diet high in antioxidants may be
beneficial in managing asthma, potentially due to their anti-inflammatory properties. Dietary fiber can also contribute to a
healthy gut microbiome, which has been linked to better immune function and potentially reduced asthma symptoms.

36) Correct answer:

A. Yes, asthma is indeed caused by inflammation of the airways in the lungs. Asthma is a chronic disease of the airways in the
lungs that involves a combination of two major processes: inflammation and airway hyperresponsiveness. Inflammation in the
airways makes them swollen, leading to less air being able to pass through. This causes symptoms such as wheezing, shortness of
breath, tightness in the chest, and coughing. The inflammation can be triggered by a variety of stimuli, including allergens,
irritants, infections, exercise, and stress.

37) Correct answer:

D. All of the factors listed. Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring
symptoms, bronchospasm, and airflow obstruction. Therefore, anything that contributes to airway blockage, irritability, or
inflammation can potentially trigger an asthma attack.
▪ Blockage of the airways: This can occur due to mucus production or bronchospasm (contraction of the smooth muscle in
the walls of the bronchi), both of which can result from exposure to an asthma trigger.
▪ Irritability in the airways: Certain triggers can irritate the airways, making them more prone to narrowing in response to
stimuli. This irritability can lead to bronchospasm and thus trigger an asthma attack.
▪ Inflammation within the airways: Inflammation is a key aspect of asthma. Asthma triggers can cause an inflammatory
response within the airways, leading to swelling, increased mucus production, and bronchospasm, which can trigger an
asthma attack.

39) Correct answer:

A. Yes, strong emotional reactions like crying, laughing hard, or yelling can indeed trigger asthma. Asthma is a condition that can
be influenced by a variety of triggers, including emotional responses. Strong emotions such as crying, laughing, or yelling can lead
to changes in breathing patterns that might trigger an asthma attack. These emotional states can cause hyperventilation or rapid
breathing, which can provoke bronchospasm (contraction of the airways), leading to asthma symptoms. It’s also worth noting
that stress and anxiety, which often accompany strong emotional states, can exacerbate asthma symptoms.

40) Correct answer:

B. Avoiding exposure to second-hand smoke, breastfeeding during infancy, and avoiding allergens. Each of these factors has been
associated with a lower risk of developing asthma.
▪ Avoiding exposure to second-hand smoke: Second-hand smoke, especially from tobacco, can damage the lungs and has
been associated with a higher risk of asthma in children.
▪ Breastfeeding during infancy: Some studies suggest that breastfeeding may offer some protection against asthma,
although the evidence is not entirely clear. Breastfeeding supports the development of a healthy immune system, which
could potentially reduce the risk of asthma.
▪ Avoiding allergens: Exposure to certain allergens, such as dust mites, mold, pet dander, and pollen, can increase the risk
of developing asthma, especially in individuals who have a genetic predisposition to the condition. Reducing exposure to
these allergens may help prevent asthma.

41) Correct answer:

B. Acute asthma. The symptoms presented by Eman such as tachypnea (rapid breathing), dry cough, and a recent cold (a common
trigger for asthma exacerbations) are suggestive of an acute asthma attack. Asthma is one of the most common chronic diseases
among children, and it often presents with these symptoms.
An acute asthma attack, also known as an asthma exacerbation, signifies a sudden intensification of asthma symptoms. Such an
episode is characterized by heightened airway inflammation and increased airway constriction, impeding the flow of air in and
out of the lungs. In Eman’s case, the fast-paced breathing (tachypnea) is a compensatory mechanism initiated by the body to
counter the compromised oxygenation and ventilation. His body is striving to take in more oxygen and expel the carbon dioxide
buildup caused by the narrowed and inflamed airways.
Moreover, the recent history of a cold can’t be disregarded. Viral infections, such as the common cold, are well-recognized
triggers for asthma exacerbations, particularly in children. The immune response to the infection can amplify the already existing
inflammation in an asthmatic airway, leading to worsened symptoms. In addition, coughing, which is a common symptom of both
colds and asthma, can further irritate the airways, leading to an increased likelihood of an asthma attack. Coupled with the
absence of fever and the presence of a dry cough, these indications strongly align with an episode of acute asthma, underlining
the importance of prompt recognition and appropriate management to prevent a further escalation of Eman’s condition.

42) Correct answer:

C. Damage to the epithelial cells lining the airways. Asthma is primarily a disease of inflammation and bronchoconstriction. It is
characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing due to widespread, but variable,
airflow obstruction. This airflow obstruction is reversible, either spontaneously or with treatment. The features of asthma include
swelling of the airways (edema), contraction of the muscles in the airways (bronchospasm), and dynamic collapse of the airways.
However, it’s important to note that while inflammation can damage the epithelial cells over time, this is not a defining feature of
asthma and is more associated with chronic obstructive pulmonary disease (COPD).

43) Correct answer:

C. Bronchodilators. In the management of an acute asthma attack, bronchodilators are the first-line treatment. They work by
relaxing the smooth muscles around the airways (bronchi) and opening up the airways, thereby improving airflow and reducing
wheezing. The most common types of bronchodilators used in asthma are short-acting beta-agonists (SABAs), such as albuterol.

44) Correct answer:

C. It usually manifests between 2 am and 4 am. Nocturnal asthma, also known as nighttime asthma, involves the worsening of
asthma symptoms like coughing, wheezing, and shortness of breath during the night. This commonly occurs between 2 am and 4
am due to circadian variations in the body, specifically, lower levels of the hormones epinephrine and cortisol which have
bronchodilation and anti-inflammatory effects, respectively.

45) Correct answer:

A. Yes, perfumes and cleaning products can indeed trigger an asthma attack. Perfumes, cleaning products, and other strong odors
can indeed trigger asthma attacks in some individuals. These substances can irritate the airways, leading to bronchospasm and
other asthmatic symptoms. This is particularly true for individuals who have allergic asthma or a condition called “Multiple
Chemical Sensitivity” (MCS). However, it’s important to note that not everyone with asthma is sensitive to these substances, and
triggers can vary from person to person.

.
46) Correct answer:
B. No, it’s not necessary to ban all classroom pets to prevent asthma triggers. While it’s true that some individuals with asthma
may be allergic to certain animals and their dander can trigger asthma symptoms, it doesn’t mean that all classroom pets need to
be banned. Asthma triggers can be highly individual and not all people with asthma will be triggered by animals. For some
students, exposure to classroom pets might not cause any problems. It’s important to know the specific allergens that affect
students with asthma in the school. A blanket ban might not be necessary; instead, accommodations could be made on a case-by-
case basis for students known to have pet allergies or asthma.

47) Correct answer:

B. No, staff who smoke during their personal time can indeed harm children with asthma. Even if staff members are not smoking
around children, the residue of smoke (often termed “third-hand smoke”) can cling to their clothing, hair, and other personal
items. When they interact with children, especially those with asthma, this residue can become an asthma trigger. Second-hand
and third-hand smoke exposure can lead to asthma exacerbation, even if the individual is not actively smoking in the presence of
the child. Therefore, it’s beneficial for anyone working closely with children, particularly those with respiratory conditions like
asthma, to abstain from smoking.

48) Correct answer:

D. Inflammation of the lining of the bronchial tubes, with wheezing beginning during exhalation and progressing to a continuous
state. In an asthma attack, the bronchial tubes (airways) in the lungs become inflamed and narrowed. This inflammation can
cause wheezing, a high-pitched whistling sound that typically begins during exhalation and can progress to a continuous state as
the airways become more constricted. Other common symptoms include shortness of breath, chest tightness, and coughing.

49) Correct answer:

B. Boys aged 10-14 years & women aged 20-24 years. Asthma prevalence varies across age and gender. Boys have a higher
prevalence of asthma compared to girls during childhood, particularly in the 10-14 years age group. This is believed to be due to
the smaller size of airways in boys compared to girls of the same age. In the case of adults, women have a higher prevalence of
asthma than men, particularly in the 20-24 years age group. The reasons for this are multifactorial, including hormonal influences,
differences in lung size, and potentially other environmental and genetic factors.

50) Correct answer:

B. Bronchodilators and anti-inflammatory drugs. The two main categories of medications used to manage asthma are
bronchodilators and anti-inflammatory drugs. Bronchodilators, like albuterol, work by relaxing the smooth muscles surrounding
the airways to improve airflow. Anti-inflammatory drugs, such as corticosteroids, decrease the inflammation in the airways, which
can reduce the frequency and severity of asthma attacks.
51) Correct answer:
A. Yes, there’s no single cause for asthma and currently, there’s no cure for the disease. Asthma is a complex condition believed
to be caused by a combination of genetic and environmental factors. There isn’t a singular identifiable cause, and the factors that
trigger asthma can differ between individuals. The interactions between these factors can influence the onset, severity, and
progression of the disease. At present, there is no cure for asthma, but with good management and appropriate medication, most
individuals with asthma can lead normal, healthy lives.

52) Correct answer:

D. All of the choices listed. Outdoor triggers for asthma can vary widely and can indeed include all of the options listed.
▪ Weather and temperature changes can trigger asthma symptoms in some people. Cold air can cause the airways to
spasm, leading to an asthma attack, and sudden changes in weather can also be a trigger.
▪ Pollen is a common outdoor trigger for asthma, particularly for individuals who have allergies. When these individuals
inhale pollen, their immune system can overreact, causing an increase in inflammation and potentially leading to an
asthma attack.
▪ Air pollution, including traffic fumes and smog, can irritate the airways and trigger an asthma attack. Small particulates in
the air can penetrate deep into the lungs, causing inflammation and exacerbating asthma symptoms.

53) Correct answer:

A. Mild Persistent. The child’s asthma can be classified as mild persistent based on the frequency of his symptoms and his use of a
rescue inhaler. In mild persistent asthma, symptoms occur more than twice a week, but not daily, and nighttime symptoms occur
3-4 times per month. The child’s symptoms, which include using his Albuterol Metered Dose Inhaler (MDI) once every two weeks
and waking up with coughing 2-3 times per week at night, fit into this category.

54) Correct answer:

A. The child has a history of asthma requiring steroid medication. A history of asthma requiring steroid medication may indicate
that the child has a more severe form of asthma or has experienced severe exacerbations in the past. Such children may be at a
higher risk of experiencing severe exacerbations in the future, especially if their asthma is not well-controlled or if they are
exposed to triggers.

55) Correct answer:

C. Inflammation of the airways. Inflammation of the airways is a characteristic feature of persistent asthma. Persistent asthma is a
type of asthma where symptoms are present more often, and the inflammation of the airways is more constant. This
inflammation can cause the airways to become sensitive to certain inhaled substances, leading to asthma symptoms like
coughing, wheezing, and shortness of breath.

56) Correct answer:

D. All of the statements are true. All the statements are indeed true, reflecting the significant burden of asthma among children in
the United States.
▪ One in every 10 school-aged children has asthma, leading to 10.5 million missed school days each year due to the
condition. This statement emphasizes the prevalence of asthma among school-aged children and its impact on school
attendance.
▪ Asthma ranks as the third most common cause of hospitalization among children under 15. This statement highlights the
severity of the condition and the need for hospital care among children with asthma.
▪ Asthma is among the most prevalent chronic diseases nationwide, affecting the lives and families of over 7 million
children. This statement underscores the wide-reaching impact of asthma, both on the individuals affected and their
families.

57) Correct answer:

B. Uncontrolled contraction of the bronchial smooth muscle. Asthma is a chronic respiratory disease that causes inflammation
and narrowing of the airways, which can make it difficult to breathe. The main physiological alteration in the progression of
asthma is uncontrolled contraction of the bronchial smooth muscle. This occurs when the airways are exposed to a trigger, such
as allergens, cold air, or exercise. The trigger causes the airways to become inflamed and swollen, which makes it difficult for air
to flow in and out of the lungs. This can lead to symptoms such as wheezing, coughing, and shortness of breath.

58) Correct answer:

B. The mucous membranes. In a patient with darker skin, the best areas to assess for cyanosis are the mucous membranes such
as the lips, mouth, and conjunctiva of the eyes. These areas tend to show cyanosis more clearly than areas such as the skin or nail
beds, particularly in individuals with darker skin.
The mucous membranes in areas such as the lips, mouth, and conjunctiva of the eyes are usually less pigmented and therefore
less influenced by skin color. Cyanosis, which is a bluish discoloration of the skin and mucous membranes, is caused by an
increase in the deoxygenated hemoglobin in the blood. When oxygen levels in the blood are significantly reduced, hemoglobin, a
molecule in the red blood cells, changes from a bright red color to a darker, bluish color. This change is what creates the bluish
tint known as cyanosis.
The color contrast in these less pigmented areas makes cyanosis easier to detect. For example, the lips and oral mucosa are often
less pigmented than the surrounding skin, making the blue discoloration of cyanosis more noticeable. Similarly, the conjunctiva of
the eyes (the clear, thin membrane that covers the front of the eye) is typically less pigmented, making it another good site for
identifying cyanosis.
59) Correct answer:
D. There is an escalation in airway obstruction. High-pitched wheezing that occurs throughout the entire exhalation is typically a
sign of narrowed or obstructed airways. Wheezes are musical sounds produced primarily during expiration due to the oscillation
of opposing airway walls and the velocity of airflow. In asthma, chronic inflammation leads to airway hyperresponsiveness, and
triggers such as allergens, cold air, or exercise can lead to bronchospasm, edema, and mucus production which further narrow
the airways. When these airways become more obstructed, wheezing may become more pronounced, and extend throughout the
entire exhalation, indicating a severe condition.
Imagine listening to a musical instrument, like a flute or a guitar. A change in pitch can dramatically alter the sound and the mood
of the piece. Similarly, in a clinical scenario, changes in the pitch of respiratory sounds can provide significant clues about the
condition of a patient’s airways, revealing whether the obstruction has decreased or increased.

60) Correct answer:

A. Peak flow meter. A peak flow meter is a handheld device that measures how well air moves out of your lungs. In other words,
it gauges the airway’s capacity to push out air in a fast and robust manner. This measurement is critical for patients like Mr.
Sullivan, who has a history of respiratory issues. With diseases such as asthma or chronic obstructive pulmonary disease (COPD),
there’s often an obstruction in the airways that impedes the free flow of air. The peak flow meter could provide an approximate
measure of how severe this obstruction is and how it’s changing over time, assisting Nurse Jamie in tracking the progression of
Mr. Sullivan’s condition.

61) Correct answer:

A. The patient’s airways have become so inflamed that air cannot pass. During a severe asthma attack, the airways can become so
inflamed and constricted that air cannot pass through, leading to silent chest or inaudible breath sounds. This is a serious and
potentially life-threatening situation because it indicates a critical decrease in airflow. It’s also a sign that the patient could be
fatiguing and not able to maintain their breathing effort. The absence of wheezing, in this case, doesn’t mean that the patient’s
condition has improved. Instead, it’s a sign that immediate medical attention and intervention are required.

62) Correct answer:

B. Might it be the result of his encounters with the pollen-rich trees, grasses, and blooming flowers in his neighborhood? Seasonal
asthma, often linked with allergic rhinitis or hay fever, is commonly triggered by airborne allergens such as tree, grass, and weed
pollens. When Matthew inhales these pollens, his immune system overreacts and produces antibodies that cause the release of
chemicals, including histamines, into the bloodstream. This leads to the symptoms of asthma, such as coughing, wheezing,
shortness of breath, and chest tightness. This explanation aligns with Matthew’s symptoms appearing during the spring season
when many plants are in bloom and releasing pollen.

63) Correct answer:

D. All of the choices. As a physiotherapist, Sam would have several important roles in Jasmine’s asthma management.
A. He would certainly inform Jasmine about the importance of exercise. Regular, moderate exercise can improve overall lung
function and health, while helping to manage symptoms. Pulmonary rehabilitation classes, which may include physical exercises,
disease education, and breathing techniques, are often beneficial for people with chronic respiratory conditions like asthma.
B. Teaching and facilitating airway clearance techniques are also vital responsibilities for Sam. Techniques such as controlled
breathing exercises, coughing techniques, and chest physiotherapy can aid in clearing mucus from the airways, which can become
particularly useful during an asthma attack.
C. Education about the disease and various treatment options is another key responsibility for Sam. While he may not prescribe
treatments, he can provide information about how treatments work and how they may interact with physical therapy strategies.
In short, Sam’s role will encompass a multifaceted approach, combining education, physical training, and airway clearance
techniques to help Jasmine manage her asthma effectively.

64) Correct answer:

A. An ongoing inflammatory condition of the respiratory tract, characterized by sporadic episodes of wheezing, breathlessness,
chest tightness, and coughing. The symptoms described by Samantha – shortness of breath, a tight chest, coughing, and
especially the new symptom of wheezing – are classic indicators of asthma. Asthma is a chronic condition where your airways
narrow, swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of
breath. In some cases, symptoms are only present during certain situations, such as exercise-induced asthma or allergy-induced
asthma.

65) Correct answer:

D. The conduction of a spirometry test to assess the volume and flow of air that can be inhaled and exhaled. Spirometry is a
common test used in diagnosing and monitoring conditions that affect lung function, such as asthma and chronic obstructive
pulmonary disease (COPD). It measures how much air you can inhale and exhale, as well as how quickly you can exhale. While it’s
useful for determining the extent of airway obstruction, it doesn’t provide information about inflammation in the airways.

66) Correct answer:

A. Yes. Asthma can indeed be life-threatening. Asthma is a chronic disease that inflames and narrows the airways in the lungs,
which leads to wheezing, shortness of breath, chest tightness, and coughing. During an asthma attack, the smooth muscles
around the bronchi contract, causing the airways to narrow and reducing the flow of air into and out of the lungs. If left
untreated, severe asthma attacks can be life-threatening due to the potential for severe respiratory distress and oxygen
deprivation to the body’s tissues.
As with the case of young Oliver, immediate treatment in an emergency setting is crucial during an intense asthma attack.
Healthcare professionals, such as Clara, administer treatments like inhaled bronchodilators and systemic corticosteroids to relax
and open the airways, reducing inflammation and allowing Oliver to breathe more easily.

67) Correct answer:

D. Exhibit all of the described changes. Asthma is a chronic disease that affects the airways or bronchial tubes in the lungs. These
tubes allow air to come in and out of the lungs. In asthma, these airways undergo three major changes: they constrict or narrow
down, become inflamed, and produce excess mucus.
▪ Bronchoconstriction: In response to certain triggers such as allergens, cold air, or exercise, the muscles around the
airways contract, leading to narrowing of the airways. This is known as bronchoconstriction and it makes it harder for air
to flow in and out of the lungs, resulting in difficulty in breathing.
▪ Inflammation: Over time, the airways in people with asthma become swollen and inflamed. This inflammation further
narrows the airways and makes them more sensitive to triggers.
▪ Excess Mucus: The inflamed airways often produce more mucus than normal, which can further block the airways.
Think of it like a highway during a snowstorm. The snow (inflammation) covers the road, narrowing it (bronchoconstriction), and
accidents or abandoned cars (excess mucus) further obstruct the path. The snowplows (medicine) work to clear the way, but until
the storm (asthma attack) ends or is controlled, it’s difficult for cars (air) to get through.

68) Correct answer:

B. A pneumothorax, or a collapsed lung. In the midst of a severe acute asthma attack, a chest X-ray can be a valuable tool to rule
out other significant conditions that might mimic or compound the situation. A pneumothorax, or collapsed lung, is one such
condition. During a severe asthma attack, the extreme pressure changes in the chest caused by difficulty exhaling can lead to a
small tear in the lung tissue, allowing air to escape into the chest cavity. This air applies pressure to the outside of the lung,
potentially causing partial or even full lung collapse – a pneumothorax. A pneumothorax can be life-threatening and would
require immediate medical intervention.

69) Correct answer:

B. Inflamed, sensitive, and swollen linings of the airway. In patients with asthma, one of the key characteristic features of the
disease is inflammation of the airways. The airways in individuals with asthma are often inflamed, sensitive, and swollen, even in
the absence of obvious symptoms. This inflammation can cause the airways to react strongly to various triggers, leading to an
asthma attack. Triggers can include allergens (like dust mites, pollen, mold, and pet dander), irritants (like smoke, pollution, and
strong odors), respiratory infections, exercise, stress, and weather changes.

70) Correct answer:

A. Initially examine the frequency of prescription refills required by the child over the previous six months. Assessing the
frequency of prescription refills provides Nurse Miranda with a measure of how frequently the child’s asthma symptoms have
been severe enough to warrant the use of a rescue inhaler. For instance, if the child is frequently refilling a prescription for a
rescue medication like albuterol, it may indicate that the child’s asthma is not well-controlled. This approach also allows Miranda
to evaluate adherence to the treatment plan.

Asthma and COPD

Questions:

1. An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. fever and chills
C. Hemoptysis and dyspnea
D. Pleuretic chest pain and cough
2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
A. Atelectasis
B. Bronchiectasis
C. Effusion
D. Inflammation
3. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a
nonproductive cough. He recently had a cold. From his history, the client may have which of the following?
A. Acute asthma
B. Bronchial pneumonia
C. Chronic obstructive pulmonary disease (COPD)
D. Emphysema
4. Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the
disorder?
A. Circumoral cyanosis
B. Increased forced expiratory volume
C. Inspiratory and expiratory wheezing
D. Normal breath sounds
5. Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection?
A. Emotional
B. Extrinsic
C. Intrinsic
D. Mediated
6. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated
with which of the following classes of medication right away?
A. Beta-adrenergic blockers
B. Bronchodilators
C. Inhaled steroids
D. Oral steroids
7. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he
appears to be in acute respiratory distress. Which of the following actions should be taken first?
A. Take a full medication history
B. Give a bronchodilator by neubulizer
C. Apply a cardiac monitor to the client
D. Provide emotional support to the client.
8. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick
sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following
conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
9. The term “blue bloater” refers to which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
10. The term “pink puffer” refers to the client with which of the following conditions?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
11. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a
prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and
shoulders for breathing. This client has symptoms of which of the following respiratory disorders?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
12. It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations
for which of the following reasons?
A. All clients are recommended to have these vaccines
B. These vaccines produce bronchodilation and improve oxygenation.
C. These vaccines help reduce the tachypnea these clients experience.
D. Respiratory infections can cause severe hypoxia and possibly death in these clients.
13. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?
A. It enhances cardiovascular fitness.
B. It improves respiratory muscle strength.
C. It reduces the number of acute attacks.
D. It worsens respiratory function and is discouraged.
14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?
A. Reducing fluid volume reduces oxygen demand.
B. Reducing fluid volume improves clients’ mobility.
C. Restricting fluid volume reduces sputum production.
D. Reducing fluid volume improves respiratory function.
15. A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest
exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following
conditions?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which of
the following statements is correct about hypoxic drive?
A. The client doesn’t notice he needs to breathe.
 B. The client breathes only when his oxygen levels climb above a certain point.
C. The client breathes only when his oxygen levels dip below a certain point.
D. The client breathes only when his carbon dioxide level dips below a certain point.
17. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?
A. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
B. How to increase his oxygen therapy.
C. How to treat respiratory infections without going to the physician.
D. How to recognize the signs of an impending respiratory infection.
18. Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?
A. Atelectasis
B. Bronchitis
C. Pneumonia
D. Pneumothorax
19. Which of the following measures can reduce or prevent the incidence of atelectasis in a post-operative client?
A. Chest physiotherapy
B. Mechanical ventilation
C. Reducing oxygen requirements
D. Use of an incentive spirometer
20. Emergency treatment of a client in status asthmaticus includes which of the following medications?
A. Inhaled beta-adrenergic agents
B. Inhaled corticosteroids
C. I.V. beta-adrenergic agents
D. Oral corticosteroids
21. Which of the following treatment goals is best for the client with status asthmaticus?
A. Avoiding intubation
B. Determining the cause of the attack
C. Improving exercise tolerance
D. Reducing secretions
22. Dani was given dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she
might have which of the following reactions?
A. Asthma attack
B. Respiratory arrest
C. Be pissed about receiving Narcan
D. Wake up on her own
23. Which of the following additional assessment data should immediately be gathered to determine the status of a client with a
respiratory rate of 4 breaths/minute?
A. Arterial blood gas (ABG) and breath sounds
B. Level of consciousness and a pulse oximetry value.
C. Breath sounds and reflexes
D. Pulse oximetry value and heart sounds
24. A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is
obtained. The nurse would expect to PaCO2 to be which of the following values?
A. 15 mm Hg
B. 30 mm Hg
C. 40 mm Hg
D. 80 mm Hg
25. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and
becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following
conditions?
A. Asthma attack
B. Pulmonary embolism
C. respiratory failure
D. Rheumatoid arthritis
26. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of
the following actions first?
A. Administering oxygen
B. Inserting an I.V. catheter
C. Obtaining a complete blood count (CBC)
D. Taking vital signs
27. Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should
take which of the following steps next?
A. Administer beta-adrenergic blockers
B. Administer bronchodilators
C. Obtain serum electrolyte levels
D. Have the client lie flat in the bed.
28. A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3– 24 mEq/L; SaO2 81%. This ABG result
represents which of the following conditions?
 A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
29. A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience
what type of acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg.
The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted
in this condition?
A. Sodium level of 145 mEq/L
B. Potassium level of 3.0 mEq/L
C. Magnesium level of 2.0 mg/L
D. Phosphorus level of 4.0 mg/dl
31. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate
concentration of 22 mEq/L. The nurse analyzes these results as indicating:
A. Metabolic acidosis, compensated.
B. Metabolic alkalosis, uncompensated.
C. Respiratory alkalosis, compensated.
D. Respiratory acidosis, compensated.
32. A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before the blood is drawn, an
Allen’s test is performed to determine the adequacy of the:
A. Popliteal circulation
B. Ulnar circulation
C. Femoral circulation
D. Carotid circulation
33. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing
that the client is at risk for which acid-base disorder?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
34. A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base
disorder?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
35. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations.
Based on this documentation, which of the following did the nurse observe?
A. Respirations that are abnormally deep, regular, and increased in rate.
B. Respirations that are regular but abnormally slow.
C. Respirations that are labored and increased in depth and rate
D. Respirations that cease for several seconds.
36. A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
37. A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate
concentration of 20 mEq/L. The nurse has determined that the client is experiencing metabolic acidosis. Which of the following
laboratory values would the nurse expect to note?
A. Sodium level of 145 mEq/L
B. Magnesium level of 2.0 mg/dL
C. Potassium level of 5.2 mEq/L
D. Phosphorus level of 4.0 mg/dL
38. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen’s test on the client.
Number in order of priority the steps for performing the Allen’s test (#1 is first step).
A. Ask the client to open and close the hand repeatedly.
B. Apply pressure over the ulnar and radial arteries.
C. Assess the color of the extremity distal to the pressure point
D. Release pressure from the ulnar artery
E. Explain the procedure to the client.
39. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate
obtaining the specimen?
A. Limiting fluids
B. Having the client take 3 deep breaths.
C. Asking the client to spit into the collection container.
D. Asking the client to obtain the specimen after eating.
40. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be
reported immediately to the physician?
A. Blood-streaked sputum
B. Dry cough
C. Hematuria
D. Bronchospasm
41. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning to a
maximum of:
A. 5 seconds
B. 10 seconds
C. 30 seconds
D. 1 minute
42. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure, the nurse notes on
the monitor that the heart rate decreases. Which of the following is the most appropriate nursing intervention?
A. Continue to suction
B. Ensure that the suction is limited to 15 seconds
C. Stop the procedure and reoxyenate the client
D. Notify the physician immediately.
43. An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low
bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. An elevated potassium level is also present. These
results indicate the presence of:
A. Metabolic acidosis
B. Respiratory acidosis
C. Combined respiratory and metabolic acidosis
D. overcompensated respiratory acidosis
44. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to
note on assessment of this client?
A. Increased oxygen saturation with exercise
B. Hypocapnia
C. A hyperinflated chest on x-ray film
D. A widened diaphragm noted on chest x-ray film
45. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the
following types of oxygen delivery systems would the nurse anticipate to be prescribed?
A. Venturi mask
B. Aerosol mask
C. Face tent
D. Tracheostomy collar
46. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and the nurse instructs the client
about the medication. Which statement by the client indicates a need for further teaching?
A. “I will take the medication on an empty stomach.”
B. “I will take the medication with food.”
C. “I will continue to take the medication even if I am feeling better.”
D. “Periodic blood levels will need to be obtained.”
47. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to
ensure that it does not exceed
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
48. The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the following values would
indicate that this acid-base imbalance exists?
A. pH of 7.48
B. PCO2 of 32 mm Hg
C. pH of 7.30
D. HCO3– of 20 mEq/L
49. A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type
of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination
50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets
these values as indicating:
A. Respiratory acidosis uncompensated
B. Respiratory alkalosis uncompensated
C. Metabolic acidosis uncompensated
D. Metabolic acidosis partially compensated.
51. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing
that the primary action of this medication is to:
A. Promote expectoration
B. Suppress the cough
C. Relax smooth muscles of the bronchial airway
D. Prevent infection
52. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect
of this medication?
A. Constipation
B. Diarrhea
C. Bradycardia
D. Tachycardia
53. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further
teaching?
A. Removes the cap and shakes the inhaler well before use.
B. Presses the canister down with finger as he breathes in.
C. Inhales the mist and quickly exhales.
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
54. A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse
assessing this client?
A. “Is there any possibility that you could be pregnant?”
B. “Are you wearing any metal chains or jewelry?”
C. “Can you hold your breath easily?”
D. “Are you able to hold your arms above your head?”
55. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing
interventions for this client?
A. Encouraging additional fluids for the next 24 hours
B. Ensuring the return of the gag reflex before offering foods or fluids
C. Administering atropine intravenously
D. Administering small doses of midazolam (Versed).
56. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:
A. Brachial and radial arteries, and then releases them and observes the circulation of the hand.
B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.
C. Radial artery and observes for color changes in the affected hand.
D. Ulnar artery and observes for color changes in the affected hand.
57. A nurse is assessing a client with chronic airflow limitation and notes that the client has a “barrel chest.” The nurse interprets
that this client has which of the following forms of chronic airflow limitation?
A. Chronic obstructive bronchitis
B. Emphysema
C. Bronchial asthma
D. Bronchial asthma and bronchitis
58. A client has been taking benzonatate (Tessalin Perles) as prescribed. A nurse concludes that the medication is having the
intended effect if the client experiences:
A. Decreased anxiety level
B. Increased comfort level
C. Reduction of N/V
D. Decreased frequency and intensity of cough
59. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The
client will:
A. Maintain a fluid intake of 800ml every 24 hours.
B. Experience chills only once a day
C. Cough productively without chest discomfort.
D. Experience less nasal obstruction and discharge.
60. Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza
vaccination?
A. A 60-year-old man with a hiatal hernia
B. A 36-year-old woman with 3 children
C. A 50-year-old woman caring for a spouse with cancer
D. a 60-year-old woman with osteoarthritis
61. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions
would be appropriate for the nurse to give the client?
 A. “Use your nasal decongestant spray regularly to help clear your nasal passages.”
B. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”
C. “It is important to increase your activity. A daily brisk walk will help promote drainage.”
D. “Keep a diary if when your symptoms occur. This can help you identify what precipitates your attacks.”
62. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she develops a cough
productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret
these assessment findings?
A. It is likely that the client is developing a secondary bacterial pneumonia.
B. The assessment findings are consistent with influenza and are to be expected.
C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions.
D. The client has not been taking her decongestants and bronchodilators as prescribed.
63. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml.
How many mL should the nurse administer each dose?
A. 5.0 ml
B. 7.5 ml
C. 9.5 ml
D. 10 ml
64. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this
drug?
A. Constipation
B. Bradycardia
C. Diplopia
D. Restlessness
65. A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing
diagnoses would be most appropriate when planning nutritional interventions for this client?
A. Altered nutrition: Less than body requirements related to fatigue.
B. Activity intolerance related to dyspnea.
C. Weight loss related to COPD.
D. Ineffective breathing pattern related to alveolar hypoventilation.
66. When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will
do which of the following?
A. Develop infections easily
B. Maintain current status
C. Require less supplemental oxygen
D. Show permanent improvement.
67. Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:
A. Promises to do pursed lip breathing at home.
B. States actions to reduce pain.
C. States that he will use oxygen via a nasal cannula at 5 L/minute.
D. Agrees to call the physician if dyspnea on exertion increases.
68. Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?
A. Increased anteroposterior chest diameter
B. Underdeveloped neck muscles
C. Collapsed neck veins
D. Increased chest excursions with respiration
69. Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?
A. To promote oxygen intake
B. To strengthen the diaphragm
C. To strengthen the intercostal muscles
D. To promote carbon dioxide elimination
70. Which of the following is a priority goal for the client with COPD?
A. Maintaining functional ability
B. Minimizing chest pain
C. Increasing carbon dioxide levels in the blood
D. Treating infectious agents
71. A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3– 36 mEq/L. Which of the
following signs or symptoms would the nurse expect?
A. Cyanosis
B. Flushed skin
C. Irritability
D. Anxiety
72. When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:
A. While inhaling through an open mouth.
B. While exhaling through pursed lips
C. After exhaling but before inhaling.
D. While taking a deep breath and holding it.
73. The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be
included in the teaching plan?
A. Clubbing of nail beds
B. Hypertension
C. Peripheral edema
D. Increased appetite
74. The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper
respiratory tract infection. Which of the following findings would be expected?
A. Normal breath sounds
B. Prolonged inspiration
C. Normal chest movement
D. Coarse crackles and rhonchi
75. Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?
A. Increased PaCO2
B. Increased PaO2
C. Increased pH.
D. Increased oxygen saturation
76. Which of the following diets would be most appropriate for a client with COPD?
A. Low fat, low cholesterol
B. Bland, soft diet
C. Low-Sodium diet
D. High calorie, high-protein diet
77. The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be
included?
A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.
B. Lie flat on back, splint the thorax, take two deep breaths and cough.
C. Take several rapid, shallow breaths and then cough forcefully.
D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.
78. A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is
dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields
reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?
A. Initiate oxygen therapy and reassess the client in 10 minutes.
B. Draw blood for an ABG analysis and send the client for a chest x-ray.
C. Encourage the client to relax and breathe slowly through the mouth
D. Administer bronchodilators
79. The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack?
A. Decreased PaCO2, increased PaO2, and decreased pH.
B. Increased PaCO2, decreased PaO2, and decreased pH.
C. Increased PaCO2, increased PaO2, and increased pH.
D. Decreased PaCO2, decreased PaO2, and increased pH.
80. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in
clients with asthma?
A. Corticosteroids promote bronchodilation
B. Corticosteroids act as an expectorant
C. Corticosteroids have an anti-inflammatory effect
D. Corticosteroids prevent development of respiratory infections.
81. The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the
following client actions indicates that he us using the MDI correctly? Select all that apply.
A. The inhaler is held upright.
B. Head is tilted down while inhaling the medication
C. Client waits 5 minutes between puffs.
D. Mouth is rinsed with water following administration
E. Client lies supine for 15 minutes following administration.
82. A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4 hours. The nurse instructs
the client to report side effects. Which of the following are potential side effects of metaproterenol?
A. Irregular heartbeat
B. Constipation
C. Petal edema
D. Decreased heart rate.
83. A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has
painful, white patches in his mouth. Which response by the nurse would be the most appropriate?
A. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”
B. “You are using your inhaler too much and it has irritated your mouth.”
C. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”
D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”
84. Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with
asthma?
 A. Incorporate physical exercise as tolerated into the treatment plan.
B. Monitor peak flow numbers after meals and at bedtime.
C. Eliminate stressors in the work and home environment
D. Use sedatives to ensure uninterrupted sleep at night.
85. The client with asthma should be taught that which of the following is one of the most common precipitating factors of an
acute asthma attack?
A. Occupational exposure to toxins
B. Viral respiratory infections
C. Exposure to cigarette smoke
D. Exercising in cold temperatures
86. A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started
taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results
are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3– 24 mEq/L; SaO2 86%. Considering these results, the first
intervention is to:
A. Begin mechanical ventilation
B. Place the client on oxygen
C. Give the client sodium bicarbonate
D. Monitor for pulmonary embolism.
87. Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these are discrete, noncontinuous
sounds that are:
A. Caused by the sudden opening of alveoli
B. Usually more prominent during expiration
C. Produced by airflow across passages narrowed by secretions
D. Found primarily in the pleura.
88. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:
A. Wait until the client’s lab work is done.
B. Not administer oxygen unless ordered by the physician.
C. Administer oxygen at 2 L flow per minute.
D. Administer oxygen at 10 L flow per minute and check the client’s nailbeds.
89. Immediately following a thoeacentesis, which clinical manifestations indicate that a complication has occurred and the
physician should be notified?
A. Serosanguineous drainage from the puncture site
B. Increased temperature and blood pressure
C. Increased pulse and pallor
D. Hypotension and hypothermia
90. If a client continues to hypoventilate, the nurse will continually assess for a complication of:
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
91. A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the nurse notices he has an irregular
pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:
A. Respiratory acidosis
B. A build-up of carbon dioxide
C. A build-up of oxygen without adequate expelling of carbon dioxide.
D. An acute respiratory infection.
92. Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to:
A. Repeat auscultation after asking the client to deep breathe and cough.
B. Instruct the client to limit fluid intake to less than 2000 ml/day.
C. Inspect the client’s ankles and sacrum for the presence of edema
D. Place the client on bedrest in a semi-Fowlers position.
93. The most reliable index to determine the respiratory status of a client is to:
A. Observe the chest rising and falling
B. Observe the skin and mucous membrane color.
C. Listen and feel the air movement.
D. Determine the presence of a femoral pulse.
94. A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care
because of the polycythemia?
A. Fluid volume deficit related to blood loss.
B. Impaired tissue perfusion related to thrombosis
C. Activity intolerance related to dyspnea
D. Risk for infection related to suppressed immune response.
95. The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively
for his is the:
A. Unoperative side or back
B. Operative side or back
C. Back only
 D. Back or either side.
96. Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:
A. A flushed face
B. Dyspnea and pain
C. Decreased temperature
D. Severe cough and no pain.
97. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure
would be to:
A. Change the tracheostomy dressing
B. Provide humidity with a trach mask
C. Apply oral or nasal suction
D. Deflate the tracheal cuff
98. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse
explains that the tidal volume is the amount of air:
A. Exhaled forcibly after a normal expiration
B. Exhaled after there is a normal inspiration
C. Trapped in the alveoli that cannot be exhaled
D. Forcibly inspired over and above a normal respiration.
99. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:
A. A decreasing oxygen pressure in the blood
B. An increasing carbon dioxide pressure in the blood
C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.
D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.
100. Lisa is newly diagnosed with asthma and is being discharged from the hospital after an episode of status asthmaticus.
Discharge teaching should include which of the following:
A. Limitations in sports that will be imposed by the illness
B. Specific instructions on staying cal during an attack
C. The relationship of symptoms and a specific trigger such as physical exercise
D. Incidence of status asthmaticus in children and teens
Answers and Rationales:

1. A. Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms of pneumonia, but elderly
clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

2. D. The most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending
organism or agent. Atelectasis and brochiectasis indicate a collapse of a portion of the airway that doesn’t occur with
pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary
response to pneumonia.

3. A. Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial
pneumonia without a productive cough and fever and he’s too young to have developed COPD or emphysema.

4. C. Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may be present in extreme
cases of respiratory distress. The nurse would expect the client to have a decreased forced expiratory volume because
asthma is an obstructive pulmonary disease. Breath sounds will be “tight” sounding or markedly decreased; they won’t be
normal.

5. C. Intrinsic asthma doesn’t have an easily identifiable allergen and can be triggered by the common cold. Asthma caused
be emotional reasons is considered to be in the extrinsic category. Extrinsic asthma is caused by dust, molds, and pets;
easily identifiable allergens. Mediated asthma doesn’t exist.

6. B. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow.
Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be
given to reduce the inflammation but aren’t used for emergency relief.

7. B. The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized
bronchodilators open airways and increase the amount of oxygen delivered. First resolve the acute phase of the attack ad
how to prevent attacks in the future. It may not be necessary to place the client on a cardiac monitor because he’s only
19-years-old, unless he has a past medical history of cardiac problems.

8. C. Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis.
Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Clients with asthma and
emphysema tend not to have a chronic cough or peripheral edema.

9. C. Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema,
cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need
intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don’t exhibit characteristics of
chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting).

10. D. Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They’re pink
and usually breathe through pursed lips, hence the term “puffer”. Clients with ARDS are usually acutely short of breath.
 Clients with asthma don’t have any particular characteristics, and clients with chronic obstructive bronchitis are bloated
and cyanotic in appearance.

11. D. These are classic signs and symptoms of a client with emphysema. Clients with ARDS are acutely short of breath and
require emergency care; those with asthma are also acutely short of breath during an attack and appear very frightened.
Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.

12. D. It’s highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory
infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean
these clients from the ventilator. The vaccines have no effect on bronchodilation or respiratory care.

13. A. Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the
risk of heart attack. Most exercise has little effect on respiratory muscle strength, and these clients can’t tolerate the type
of exercise necessary to do this. Exercise won’t reduce the number of acute attacks. In some instances, exercise may be
contraindicated, and the client should check with his physician before starting any exercise program.

14. A. Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the
respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear
airways. Reducing fluid volume won’t improve respiratory function, but may improve oxygenation.

15. D. In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas
exchange. Very little air movement occurs in the lungs because of bronchiole collapse, as well. In ARDS, the client’s
condition is more acute and typically requires mechanical ventilation. In asthma and bronchitis, wheezing is prevalent.

16. C. Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as the hypoxic drive.
They don’t take a breath when their levels of carbon dioxide are higher than normal, as do those with healthy respiratory
physiology. If too much oxygen is given, the client has little stimulus to take another breath. In the meantime, his carbon
dioxide levels continue to climb, and the client will pass out, leading to a respiratory arrest.

17. D. Respiratory infection in clients with a respiratory disorder can be fatal. It’s important that the client understands how
to recognize the signs and symptoms of an impending respiratory infection. It isn’t appropriate for the wife to listen to his
lung sounds, besides, you can’t purchase stethoscopes from Wal-Mart. If the client has signs and symptoms of an
infection, he should contact his physician at once.

18. A. Atelectasis develops when there’s interference with the normal negative pressure that promotes lung expansion.
Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia. It’s
uncommon for any of the other respiratory disorders to develop.

19. D. Using an incentive spirometer requires the client to take deep breaths and promotes lung expansion. Chest
physiotherapy helps mobilize secretions but won’t prevent atelectasis. Reducing oxygen requirements or placing
someone on mechanical ventilation doesn’t affect the development of atelectasis.

20. A. Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation. I.V. beta-adrenergic
agents can be used but have to be monitored because of their greater systemic effects. They’re typically used when the
inhaled beta-adrenergic agents don’t work. Corticosteriods are slow-acting, so their use won’t reduce hypoxia in the
acute phase.

21. A. Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen are used to reduce bronchospasm,
improve oxygenation, and avoid intubation. Determining the trigger for the client’s attack and improving exercise
tolerance are later goals. Typically, secretions aren’t a problem in status asthmaticus.

22. B. Narcotics can cause respiratory arrest if given in large quantities. Its unlikely Dani will have an asthma attack or wake
up on her own. She may be pissed for a minute, but then she’d be grateful for saving her butt.

23. B. First, the nurse should attempt to rouse the client because this should increase the client’s respiratory rate. If available,
a spot pulse oximetry check should be done and breath sounds should be checked. The physician should be notified
immediately if of the findings. He’ll probably order ABG analysis to determine specific carbon dioxide and oxygen levels,
which will indicate the effectiveness of ventilation. Reflexes and heart sounds will be part of the more extensive
examination done after these initial actions are completed.

24. D. A client about to go into respiratory arrest will have inefficient ventilation and will be retaining carbon dioxide. The
value expected would be around 80 mm Hg. All other values are lower than expected.

25. C. The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventual
respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism, consider the new
drug first. Rheumatoid arthritis doesn’t manifest these signs.

26. A. Giving oxygen would be the best first action in this case. Vital signs then should be checked and the physician
immediately notified. If the client doesn’t already have an I.V. catheter, one may be inserted now if anaphylactic shock is
developing. Obtaining a CBC wouldn’t help the emergency situation.

27. B. Bronchodilators would help open the client’s airway and improve his oxygenation status. Beta-adrenergic blockers
aren’t indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values
wouldn’t be done on an emergency basis, and having the client lie flat in bed could worsen his ability to breathe.
28. C. You all should know this. Practice some problems if you got this wrong.

29. A. Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most commonly caused by
COPD. In end-stage disease, pathological changes lead to airway collapse, air trapping, and disturbance of ventilation-
perfusion relationships.

30. B. Clinical manifestations of respiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo, convulsions,
hypokalemia, and hypocalcemia. Options A, C, and D identify normal laboratory values. Option B identifies the presence
of hypokalemia.

31. C. The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite (see-saw) will be seen between the pH and the
PCO2. In this situation, the pH is at the high end of the normal value and the PCO2 is low. In an alkalotic condition, the pH is
up. Therefore, the values identified in the question indicate a respiratory alkalosis. Compensation occurs when the pH
returns to a normal value. Because the pH is in the normal range at the high end, compensation has occurred.

32. B. Before radial puncture for obtaining an ABG, you should perform an Allen’s test to determine adequate ulnar
circulation. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury o
the hand if damage to the radial artery occurs with arterial puncture.

33. D. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric
acid.

34. C. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an ileostomy or with
diarrhea (remember, diarrhea is coming out of thebase). These conditions result in metabolic acidosis.

35. A. Kussmaul’s respirations are abnormally deep, regular, and increased in rate.

36. D. Increases in base components occur as a result of oral or parenteral intake of bicarbonates, carbonates, acetates,
citrates, or lactates. Excessive use of oral antacids containing bicarbonate can cause metabolic alkalosis.

37. C. Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul’s respirations; headache; N/V, and
diarrhea; fruity-smelling breath resulting from improper fat metabolism; CNS depression, including mental dullness,
drowsiness, stupor, and coma; twitching, and coma. Hyperkalemia will occur.

38. E, B, A, D, and then C.

39. B. To obtain a sputum specimen, the client should rinse the mouth to prevent contamination, breathe deeply, and then
cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum.
Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal
time to obtain a specimen is on arising in the morning.

40. D. If a biopsy was performed during a bronchoscopy, blood streaked sputum is expected for several hours. Frank blood
indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which
would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
Hematuria is unrelated to this procedure.

41. B. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells within the heart. A vasovagal
response may occurm causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the
suctioning pass to 10 seconds.

42. C. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac
irregularities such as a decrease in HR resulting from vagal stimulation, mucousal trauma, hypotension, and paroxysmal
coughing. If side effects develop, especially cardiac irregularities, this procedure is stopped and the client is reoxygenated.

43. A. In an acidotic condition the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the
pH would indicate a metabolic state.

44. C. Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation
with exercise, and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a
flattened diaphragm is the disease is advanced.

45. A. The venture mask delivers the most accurate oxygen concentration. The Venturi mask is the best oxygen delivery
system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, the
aerosol mask, and the tracheostomy collar are also high-flow oxygen delivery systems but most often are used to
administer high humidity.

46. A. Theo-Dur is a bronchodilator. The medication should be administered with food such as milk and crackers to prevent GI
irritation.

47. B. One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to 60 to 80 mm Hg. However, oxygen is
used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia, the respiratory drive is
triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in normal respiratory system.

48. C.

49. D. Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. This type of breathing
allows better expiration by increasing airway pressure that keeps air passages open during exhalation.
50. B. In respiratory alkalosis the pH will be higher than normal and the PCO2 will be low.

51. C. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway.

52. D. Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia,
peripheral vasodilation, and dryness of the mouth or throat.

53. C. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.

54. A. The most important item to ask about is the client’s pregnancy status because pregnant women should not be exposed
to radiation. Clients are also asked to remove any chains or metal objects that could interfere with obtaining an adequate
film. A chest radiograph most often is done at full inspiration, which gives optimal lung expansion. If a lateral view of the
chest is ordered, the client is asked to raise the arms above the head. Most films are done in posterior-anterior view.

55. B. After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative
sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours.
Additional fluids is unnecessary because no contrast dye is used that would need to be flushed from the system. Atropine
and Versed would be administered before the procedure, not after.

56. B. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen’s test. This involves
compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to
become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The
nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is
adequate.

57. B. The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased
anteroposterior diameter, which is referred to as “barrel chest.” The client also has dyspnea with prolonged expiration
and has hyperresonant lungs to percussion.

58. D. Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases
the intensity and frequency of cough without eliminating the cough reflex.

59. D. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Daily fluid intake
should be increase to more than 1 L every 24 hours to liquefy secretions. The temperature should be below 100*F
(37.8*C) with no chills or diaphoresis. A productive cough with chest pain indicated pulmonary infection, not an URI.

60. C. Individuals who are household members or home care providers for high-risk individuals are high-priority targeted
groups for immunization against influenza to prevent transmission to those who have a decreased capacity to deal with
the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described.

61. D. It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided.
Keeping a diary can help identify these triggers. Nasal decongestant sprays should not be used regularly because they can
cause a rebound effect. Antibiotics are not appropriate. Increasing activity will not control the client’s symptoms; in fact,
walking outdoors may increase them if the client is allergic to pollen.

62. A. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent
cough and crackles may be indicative of a bacterial infection are not consistent with a diagnosis of influenza. These
findings are not indicative of dehydration. Decongestants and bronchodilators are not typically prescribed for the flu.

63. B.

64. D. Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic
effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and
weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias.
Constipation and diplopia are not side effects of pesudoephedrine. Tachycardia, not bradycardia, is a side effect of
pseudoephedrine.

65. A. The client’s problem is altered nutrition—specifically, less than required. The cause, as stated by the client, is the
fatigue associated with the disease process. Activity intolerance is a likely diagnosis but is not related to the client’s
nutritional problems. Weight loss is not a nursing diagnosis. Ineffective breathing pattern may be a problem, but this
diagnosis does not specifically address the problem of weight loss described by the client.

66. A. A client with COPD is at high risk for development of respiratory infections. COPD is a slowly progressive; therefore,
maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic
expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.

67. D. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the
physician should be notified. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom
of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/minute) to avoid suppressing the respiratory
drive, which, for these clients, is stimulated by hypoxia.

68. A. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended
alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly
developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of
breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client
 may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. Diminished, not
increased, chest excursion is associated with COPD.

69. D. Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide
elimination. By prolonged exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the
rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or
strengthen intercostal muscles.

70. A. A priority goal for the client with COPD is to manage the s/s of the disease process so as to maintain the client’s
functional ability. Chest pain is not a typical sign of COPD. The carbon dioxide concentration in the blood is increased to
an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be
a goal of care for the client with COPD.

71. B. The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon
dioxide has a depressant effect on the CNS. Cyanosis is a late sign of hypoxia. Irritability and anxiety are not common with
a PaCO2 level of 65 mm Hg but are associated with hypoxia.

72. B. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduced perceived
dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after
exhalation but before inhaling is similar to lifting with the breath held. This should not be recommended because it is
similar to the Valsalva maneuver, which can stimulate cardiac dysrhythmias.

73. C. Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and
symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight
gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxia. Hypertension is
associated with left-sided heart failure. Clients with heart failure have decreased appetites.

74. D. Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be
auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of
an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is
decreased as lungs become overdistended.

75. A. As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in
decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation.

76. D. The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that
results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat,
low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need
to follow a sodium-restricted diet, unless otherwise medically indicated.

77. A. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The
client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using
pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and
deeply inhale. After repeating this process 3 or 4 times, the client should take a deep abdominal breath, bend forward
and cough 3 or 4 times upon exhalation (“huff” cough). Lying flat does not enhance lung expansion; sitting upright
promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing
promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep
breathing.

78. D. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign of indicating lack of air
movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled
bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline. Administering oxygen and
reassessing the client 10 minutes later would delay needed medical intervention, as would drawing an ABG and obtaining
a chest x-ray. It would be futile to encourage the client to relax and breathe slowly without providing necessary
pharmacologic intervention.

79. B. As the severe asthma attack worsens, the client becomes fatigued and alveolar hypotension develops. This leads to
carbon dioxide retention and hypoxemia. The client develops respiratory acidosis. Therefore, the PaCO2 level increase, the
PaO2 level decreases, and the pH decreases, indicating acidosis.

80. C. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease
mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory
infections.

81. A and D.

82. A. Irregular heart rates should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat,
tachycardia, or anginal pain because of its adrenergic effect on the beta-adrenergic receptors in the heart. It is not
recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, petal edema,
or bradycardia.

83. C. Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush, a fungal infection.
Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own. Fungal infections can
 develop even without overuse of the Corticosteroid inhaler. Although good oral hygiene can help prevent development of
a fungal infection, it cannot be used alone to treat the problem.

84. A. Physical exercise is beneficial and should be incorporated as tolerated into the client’s schedule. Peak flow numbers
should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored
after each meal. Stressors in the client’s life should be modified but cannot be totally eliminated. Although adequate
sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.

85. B. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people
who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate
matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses.
Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic
attacks are triggered by exercising in cold weather.

86. B. The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are involved. The client should immediately be
placed on oxygen via mask so that the SaO2 is brought up to 95%. Encourage slow, regular breathing to decrease the
amount of CO2 she is losing. This client may have pulmonary embolism, so she should be monitored for this condition (D),
but it is not the first intervention. Sodium bicarbonate (C) would be given to reverse acidosis; mechanical ventilation (A)
may be ordered for acute respiratory acidosis.

87. A. Basilar crackles are usually heard during inspiration and are caused by sudden opening of the alveoli.

88. C. Administer oxygen at 2 L/minute and no more, for if the client if emphysemic and receives too high a level of oxygen,
he will develop CO2 narcosis and the respiratory system will cease to function.

89. C. Increased pulse and pallor are symptoms associated with shock. A compromised venous return may occur if there is a
mediastinal shift as a result of excessive fluid removal. Usually no more than 1 L of fluid is removed at one time to
prevent this from occurring.

90. A. Respiratory acidosis represents an increase in the acid component, carbon dioxide, and an increase in the hydrogen ion
concentration (decreased pH) of the arterial blood.

91. B. The arrhythmias are caused by a build-up of carbon dioxide and not enough oxygen so that the heart is in a constant
state of hypoxia.

92. A. Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a
deep breath or a cough. It is, therefore, premature to impose fluid (B) or activity (D) restrictions . Inspection for edema (C)
would be appropriate after reauscultation.

93. C. To check for breathing, the nurse places her ear and cheek next to the client’s mouth and nose to listen and feel for air
movement. The chest rising and falling (A) is not conclusive of a patent airway. Observing skin color (B) is not an accurate
assessment of respiratory status, nor is checking the femoral pulse.

94. B. Chronic hypoxia associated with COPD may stimulate excessive RBC production (polycythemia). This results in
increased blood viscosity and the risk of thrombosis. The other nursing diagnoses are not applicable in this situation.

95. B. Positioning the client on the operative side facilitates the accumulation of serisanguineous fluid. The fluid forms a solid
mass, which prevents the remaining lung from being drawn into the space.

96. B. Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients become short of breath, have a
high temperature, and usually experience severe pain but do not have a severe cough (D). The shortness of breath is a
result of decreased oxygen-carbon dioxide exchange at the alveolar level.

97. C. Before deflating the tracheal cuff (D), the nurse will apply oral or nasal suction to the airway to prevent secretions from
falling into the lung. Dressing change (A) and humidity (B) do not relate to suctioning.

98. B. Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.

99. C. The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated from the oxy-hemoglobin molecule.

100. C. COPD clients have low oxygen and high carbon dioxide levels. Therefore, hypoxia is the main stimulus for ventilation is
persons with chronic hypercapnea. Increasing the level of oxygen would decrease the stimulus to breathe.

COPD

Questions:
1. Susan, a seasoned nurse, is in the middle of her shift at a bustling urban hospital when a new patient, Mr. Martin, is wheeled
in. He’s a 67-year-old man with a history of heavy smoking, who is now experiencing persistent coughing and shortness of breath.
Susan knows that these symptoms point to chronic obstructive pulmonary disease (COPD), but she also understands that a
definitive diagnosis cannot be made without certain specific evaluations.
Which of the following methods would allow for a certain diagnosis of COPD?
A. Listening to the patient’s chest with a stethoscope (Auscultation).
B. Performing a general blood examination (Blood Test).
C. Conducting a test to measure the amount and speed of air the patient can inhale and exhale (Spirometry).
D. Taking an image of the patient’s chest using electromagnetic radiation (X-ray chest).
2. In the hospital, as Nurse Susan continues to provide care for Mr. Martin, she knows that his future health prospects will largely
be dictated by specific factors related to his COPD. Among the various parameters related to his condition, Susan understands
that one in particular is crucial in forecasting a patient’s longevity.
Which of the following holds the most weight in determining a COPD patient’s survival prognosis?
A. The total volume of air that the lungs can hold (Total lung capacity).
B. The volume of air a patient can forcibly exhale in one second after taking a bronchodilator (Post-bronchodilator FEV1).
C. The patient’s chronological age (Age).
D. The volume of air a patient can forcibly exhale in one second before taking a bronchodilator (Pre-bronchodilator FEV1).
3. While Mr. Martin rests after a lung function test, Nurse Susan reviews her notes on COPD to better understand the specifics of
the condition. She comes across several statements and realizes one of them isn’t quite accurate regarding the nature of COPD.
Which of these assertions about COPD doesn’t stand up to professional scrutiny?
A. The term COPD, known globally, refers to chronic bronchitis and emphysema.
B. A defining characteristic of COPD is the limited improvement of airflow obstruction, even with the administration of
bronchodilators.
C. COPD frequently manifests at a relatively young age.
D. COPD originates in the peripheral airways and air spaces within the lungs.
4. Nurse Susan spends the rest of her shift diligently caring for Mr. Martin and other patients, all the while making mental notes
about COPD symptoms and risk factors. She realizes that some signs and histories could hint at a COPD diagnosis, but what
exactly should she look out for?
Which of these factors, if present, might suggest a diagnosis of COPD?
A. Experiencing breathlessness primarily during physical activity, which progressively worsens.
B. Sustained cough accompanied by a large quantity of sputum.
C. Extended history of heavy tobacco use.
D. All of the given options.
5. As the day progresses, Nurse Susan prepares to administer Theophylline, a medication commonly used in managing COPD, to
Mr. Martin. She recalls that this drug has a wide range of benefits for patients with this condition, but she also knows that there’s
one statement about Theophylline that doesn’t quite line up with her knowledge.
Which of the following statements doesn’t accurately describe the effects of Theophylline in COPD patients?
A. Theophylline suppresses central respiratory activity.
B. Theophylline enhances the function of the right ventricle.
C. Theophylline lowers the pressure in the pulmonary artery.
D. Theophylline increases the tension of oxygen in the arteries.
6. Evening falls and Susan is getting ready to evaluate the effectiveness of the therapeutic plan for Mr. Martin’s COPD treatment.
She knows that forced expiratory volume (FEV1) is a key metric, but there are also other parameters that should be taken into
consideration.
Besides FEV1, which of the following aspects should also be examined when assessing the therapeutic potential of a compound
used for COPD treatment?
A. The patient’s ability to perform physical activities (Exercise tolerance).
B. The frequency of sudden worsening of the patient’s symptoms (Exacerbation rates).
C. The severity and type of symptoms experienced by the patient (Symptoms).
D. All the options listed.
7. In the final hours of her shift, Nurse Susan organizes the medications for her patients. She picks up a vial of Ipratropium, a
medication frequently administered to COPD patients like Mr. Martin. She remembers that this drug belongs to a particular
pharmacological category. What type of medication is Ipratropium?
A. A drug that stimulates the beta-adrenergic receptors (Beta agonist).
B. A drug that blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle (Anticholinergic).
C. A drug that reduces inflammation and immune response (Corticosteroid).
D. A drug that belongs to a group of medicines which includes caffeine (Methylxanthine).
8. As Susan’s shift ends, she reviews the potential complications of advanced COPD for a comprehensive report she will hand over
to the next nurse for Mr. Martin’s care. Among the myriad of complications, she knows some are more severe than others. Which
of the following conditions may result from advanced COPD?
A. High blood pressure in the arteries that supply the lungs (Pulmonary hypertension).
B. Right-sided heart failure caused by long-term high blood pressure in the pulmonary arteries (Cor pulmonale).
C. Swelling caused by excess fluid trapped in the body’s tissues (Oedema).
D. Any of the listed conditions.
9. As the new day begins, Nurse Susan begins her shift by preparing to administer medication to her patients. For Mr. Martin’s
COPD, she is about to give a beta-agonist. She knows there’s a preferred way to administer this type of medication to ensure the
most effective delivery.
What is the favored method of administering a beta-agonist in a patient with COPD?
A. Under the tongue (Sublingual).
B. Through the respiratory tract (Inhalation).
C. Through injection into the body tissue (Injectable).
D. Through the mouth and then into the digestive system (Oral).
10. As Susan continues her shift, she reviews her knowledge on factors that could potentially cause arrhythmias in COPD patients.
She knows that certain conditions and treatments can indeed lead to irregular heart rhythms, but one option doesn’t fit the bill.
Which of the following is not typically a factor that might cause arrhythmias in a patient with COPD?
A. Administration of Ipratropium.
B. Low levels of oxygen in the blood (Hypoxemia).
C. Disturbances in the balance of acid and base in the body.
D. Administration of Theophylline.
11. During her rounds, Nurse Susan checks on Mr. Martin and notes a slight tremor and increased heart rate. She considers that
these symptoms could be side effects of a medication he’s been receiving for his COPD. She recalls her training and reflects on
which drug could potentially cause such symptoms.
Which medication, used in the treatment of COPD, could potentially lead to tremor and tachycardia in a patient?
A. Theophylline
B. Salbutamol
C. Budesonide
D. Ipratropium
12. As Nurse Susan finalizes her notes for the day, she reflects on Mr. Martin’s prognosis. She knows that his age and lung
function, specifically the Forced Expiratory Volume in one second (FEV1), will play a crucial role in predicting his survival rate with
COPD. But she wonders, what would be the anticipated 3-year survival rate for a patient older than 60 years with an FEV1
between 40-49%?
A. Is it likely to be around 75%?
B. Or could it be as high as 90%?
C. Perhaps it’s lower, at about 25%?
D. Or is it around the midway point at 50%?
13. As the night shift begins, Susan prepares to educate Mr. Martin about using supplementary oxygen therapy at home for his
COPD. She wants to ensure that he understands the minimum amount of time per day he should use the oxygen to reap its
benefits. But what is this duration?
For it to be beneficial, home-based supplementary oxygen therapy should be administered for at least:
A. Five hours per day.
B. Ten hours per day.
C. Three hours per day.
D. Fifteen hours per day.

Answers and Rationales:

1. Correct answer:
C. Conducting a test to measure the amount and speed of air the patient can inhale and exhale (Spirometry). Spirometry is the
primary diagnostic method for COPD. It measures the volume and speed of air that the patient can inhale and exhale, providing a
direct measurement of lung function. In COPD, airflow is restricted (due to inflammation and/or damage to the airways), which
results in decreased FEV1/FVC ratio – a key indicator in a spirometry test.
Simply put, if our lungs were balloons, spirometry measures how quickly and completely these balloons can be inflated and
deflated.

2. Correct answer:
B. The volume of air a patient can forcibly exhale in one second after taking a bronchodilator (Post-bronchodilator FEV1). The
post-bronchodilator Forced Expiratory Volume in one second (FEV1) is a key metric in determining a COPD patient’s survival
prognosis. It indicates how well the patient’s lungs are functioning and how effectively they respond to bronchodilator therapy.
The greater the patient’s post-bronchodilator FEV1, the better their prognosis typically is.
Think of it like the horsepower of a car after being serviced; the higher it is, the better the performance and lifespan of the car.

3. Correct answer:
C. COPD frequently manifests at a relatively young age. While it’s true that COPD can technically begin to develop at any age, the
symptoms of the disease often do not become apparent until around the age of 40 or later, typically in individuals with a history
of smoking or exposure to environmental pollutants. In fact, COPD is most commonly diagnosed in people aged 65 or older.
Imagine if a car started showing wear and tear only a few days after being bought brand new. This scenario would be unusual and
cause for concern, just like COPD manifesting at a young age.

4. Correct answer:
D. All of the given options. Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease characterized by the
obstruction of lung airflow. It is primarily caused by exposure to harmful pollutants such as cigarette smoke, and symptoms
worsen over time.
All the options provided in the question can potentially hint at a diagnosis of COPD:
A. Experiencing breathlessness primarily during physical activity, which progressively worsens: Dyspnea, or breathlessness, is one
of the most common symptoms of COPD. This typically starts during exertion and progressively worsens over time, eventually
occurring even at rest in advanced stages of the disease.
B. Sustained cough accompanied by a large quantity of sputum: Chronic cough and sputum production are common in COPD. This
happens because of increased mucus production and impaired mucus clearance in the lungs, leading to a chronic productive
cough.
C. Extended history of heavy tobacco use: Tobacco smoke is the single most significant risk factor for COPD. Long-term exposure
to tobacco smoke can cause inflammation and damage to the airways and air sacs in the lungs, leading to COPD.
5. Correct answer:
A. Theophylline suppresses central respiratory activity. Theophylline, a methylxanthine derivative, is a bronchodilator medication
that is sometimes used in the management of COPD. Contrary to suppressing central respiratory activity, Theophylline actually
stimulates the central respiratory drive. It reduces bronchospasm and inflammation, increases the force of contraction of
diaphragmatic muscles, and reduces fatigue. This generally leads to better lung function and easier breathing.

6. Correct answer:
D. All the options listed. When assessing the effectiveness of a therapeutic plan for COPD treatment, it’s important to consider
several factors, not just FEV1. While FEV1 is a critical metric in assessing lung function, it doesn’t capture the full spectrum of
patient experiences with COPD. The approach to assessing COPD treatment should be holistic, taking into account not only lung
function but also the patient’s symptom experience, exacerbation rates, and exercise tolerance.

7. Correct answer:
B. A drug that blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle (Anticholinergic).

8. Correct answer:
D. Any of the listed conditions. Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating disease affecting
the lungs, causing breathing difficulties due to airflow obstruction. In advanced stages of COPD, there are indeed a variety of
complications that can occur. These include pulmonary hypertension, cor pulmonale, and oedema.
Pulmonary hypertension occurs due to increased pressure in the pulmonary arteries, the vessels that carry blood from the heart
to the lungs. This is due to the chronic hypoxia, or lack of oxygen, caused by COPD. Hypoxia causes the pulmonary arteries to
constrict, increasing the pressure within them.
Cor pulmonale is essentially right-sided heart failure. This results from the heart working harder to pump blood into the lungs,
due to the increased resistance caused by the pulmonary hypertension. Over time, the right side of the heart becomes enlarged
and less efficient, leading to symptoms of heart failure.
Oedema is a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body. In COPD patients,
oedema often occurs as a result of cor pulmonale. The failing right heart is unable to pump blood effectively leading to a build-up
of pressure in the veins, causing fluid to leak into the surrounding tissues.
In summary, all of the above conditions (pulmonary hypertension, cor pulmonale, and oedema) are potential complications of
advanced COPD, so the correct answer is D. Any of the listed conditions.

9. Correct answer:
B. Through the respiratory tract (Inhalation). Beta-agonists are a type of bronchodilator used for patients with Chronic
Obstructive Pulmonary Disease (COPD). They work by relaxing the muscles around the airways in the lungs, which can help open
up the airways and improve breathing. When administered via inhalation, the medication can directly target the lungs, which is
the site of action, leading to more effective and faster relief of symptoms with less systemic side effects.
It is similar to using a fire extinguisher directly at the source of the fire, the medication directly targets the lungs where the
inflammation and bronchoconstriction are occurring.

10. Correct answer:

A. Administration of Ipratropium. Ipratropium bromide is an inhaled medication often used in the treatment of COPD. It belongs
to a class of drugs known as anticholinergics, which work by blocking the action of acetylcholine, a neurotransmitter that
constricts the airways. By doing so, these drugs help relax and widen the airways, making it easier to breathe. Importantly, they
typically do not have a significant effect on the heart rate or rhythm, which sets them apart from some other COPD medications.
To make this relatable, think of your COPD medications as different types of tools in a toolbox, each with their specific role and
effect. In this case, Ipratropium would be like a wrench that is specifically designed to loosen tight airways – it’s not intended or
expected to affect the heart (which might be likened to a different part of the machine entirely).

11. Correct answer:

B. Salbutamol. Salbutamol is a short-acting beta2-adrenergic receptor agonist (SABA) used for the relief of bronchospasm in
conditions like COPD. It works by relaxing the smooth muscles of the bronchi, which leads to dilation of the airways. However,
one of the known side effects of this medication is stimulation of the heart, which can lead to an increased heart rate or
tachycardia. Tremors are another common side effect, particularly in the hands, due to the drug’s impact on skeletal muscle.
To put it in a relatable way, imagine the beta-2 receptors as locks and Salbutamol as a key. While the keys (Salbutamol) are
intended to open the locks (beta-2 receptors) on the lung muscles, sometimes they can also unintentionally open other locks that
lead to increased heart rate and tremors.

12. Correct answer:

A. Is it likely to be around 75%? For patients over 60 years of age with an FEV1 between 40-49%, studies indicate that the
anticipated 3-year survival rate is approximately 75%. The survival rate is largely determined by the patient’s lung function, with
lower FEV1 percentages indicating more severe disease and generally resulting in lower survival rates.
This can be compared to the lifespan of a car. A car’s performance (lung function in this analogy) depends on the quality of its
engine (lungs). If the engine’s efficiency is reduced to half (FEV1 at 40-49%), the car might not run as smoothly or as long (reduced
survival rate), but it can still operate reasonably well.
13. Correct answer:
D. Fifteen hours per day. To achieve the benefits of supplementary oxygen therapy, it should ideally be administered for at least
15 hours per day in patients with COPD. The benefits include improved survival, reduced hospitalizations, and better quality of
life. The more hours of oxygen used per day, the greater the survival benefit, with continuous 24-hour use being the most
beneficial.
Imagine you are trying to fill up a large water tank with a slow hose; the longer you keep the hose running, the more the tank will
fill. In this analogy, the water tank represents the oxygen level in the blood, and the hose represents the supplementary oxygen.
Therefore, to significantly increase the oxygen level in the blood (fill the water tank), the supplementary oxygen (hose) needs to
run for a considerable amount of time each day.

Acute Respiratory Distress Syndrome

Questions:
1) In a small town fire department, firefighter Jack had a challenging call responding to a massive house fire. His dedication to his
job meant he was right in the thick of it, battling the flames, and unfortunately, he ended up inhaling a significant amount of
smoke.
Two days later, a severe lack of oxygen triggered complications. Jack’s condition worsened so much that he required an artificial
airway and a ventilator to assist with his breathing. Given this situation, what medical condition do you think Jack has most
probably developed?
A. Bronchitis, inflammation of the lining of the bronchial tubes.
B. Pneumonia, an infection that inflames the air sacs in one or both lungs.
C. Atelectasis, partial or complete collapse of the entire lung.
D. Acute respiratory distress syndrome (ARDS), a life-threatening condition that prevents enough oxygen from getting to the
lungs and into the blood.
2) In a bustling intensive care unit, Nurse Martin is taking care of an ARDS patient, Mr. Thompson, who’s now moving into the
fibrotic phase of the syndrome. Martin, with a meticulous eye for detail, takes note of the various developments that this stage
brings. How would you describe this fibrotic phase of ARDS?
A. Is it the phase where the lung initiates self-repair, marking the point where the patient either starts to improve or the
condition begins to decline?
B. Could it be the stage where fibrous tissue begins to form, making the lungs less flexible, thus increasing the effort to breathe,
and consequently, the oxygen demand?
C. Or, is this the phase where fluids infiltrate the alveoli, leading to the collapse of alveoli and bronchi, and resulting in decreased
lung compliance?
3) Nurse Lauren, a seasoned professional, is at the helm of the ICU in a bustling city hospital. Tonight, she is attending to a male
patient who has been diagnosed with acute respiratory distress syndrome. Part of her role involves taking measurements via a
pulmonary artery catheter.
In her latest reading, she notes that the pulmonary capillary wedge pressure (PCWP) is at 12mm Hg. As an experienced
practitioner, how should Nurse Lauren interpret this finding?
A. As a typical and anticipated value.
B. As an unusually low and unexpected value.
C. As a value that is uncertain and not anticipated.
D. As a high value that was to be expected.
4) Matthew, a dedicated nurse, was attending to a male patient who had been admitted following a major car accident. The
patient suffered from chest trauma and was promptly intubated. Suddenly, the high-pressure alarm on the ventilator blares,
grabbing Matthew’s immediate attention. He rushes over to check the patient and finds an absence of breath sounds in the right
upper lobe of the patient’s lung.
Matthew’s mind instantly races, trying to identify what other signs he should be on the lookout for to pinpoint the cause of this
alarming development. What could this situation indicate?
A. A misplaced endotracheal tube.
B. The onset of acute respiratory distress syndrome.
C. The presence of a pulmonary embolism.
D. The development of a right pneumothorax.
5) At Mercy General Hospital, Nurse Benjamin is attending to an African American male patient who came in with an asthma
attack, now experiencing acute respiratory distress. Benjamin knows that detecting cyanosis, a sign of poor oxygenation, can be
more challenging in individuals with darker skin.
Given this situation, where should Nurse Benjamin focus his inspection to identify cyanosis in this patient?
A. The mucous membranes.
B. The lips.
C. The earlobes.
D. The nail beds.
6) At Haven County Hospital, medical professionals, including seasoned respiratory therapist David, are constantly working to
manage various conditions affecting their patients. One such condition is acute respiratory distress syndrome (ARDS), a severe
and often life-threatening disorder.
David reflects on his years of practice and thinks about the following statement: “Management of ARDS is largely supportive, with
limited options available to reverse the process.” Is this statement accurate or misleading?
A. Accurate
B. Misleading
7) In the bustling trauma unit of St. Luke’s Hospital, Nurse Emily diligently cares for a patient who has recently suffered a right
femur fracture. Given the nature of the injury, Emily is watchful for any signs that may hint at a fat embolism, a potential
complication in such cases.
What symptoms should she be on the lookout for that might suggest the development of a fat embolism?
A. Is it a series of migraine-like headaches?
B. Could it be numbness in the right leg?
C. Might it be muscle spasms in the right thigh?
D. Or could it be the onset of acute respiratory distress syndrome?
8) At Hope General Hospital, Nurse Rebecca is responsible for a female patient who has sustained multiple traumas. Aware of the
risk of the patient developing acute respiratory distress syndrome (ARDS), Rebecca is on high alert for early signs of this serious
condition.
What should she consider as the earliest indicator of ARDS?
A. The presence of inspiratory crackles.
B. Bilateral wheezing during respiration.
C. An escalated respiratory rate.
D. The appearance of intercostal retractions.
9) Amid the hustle and bustle of City General Hospital, Registered Nurse Joshua is providing care to a patient suffering from acute
respiratory distress syndrome (ARDS). Joshua knows that understanding the different phases of ARDS is critical for effective care.
When thinking about the Acute Exudative Phase of ARDS, how would Joshua describe it?
A. Does it involve fluids shifting into the alveoli, leading to the collapse of the alveoli and bronchi, and resulting in a loss of lung
compliance?
B. Is this the phase where fibrous tissue begins to form, the lungs don’t expand well, and increased effort to breathe escalates the
demand for oxygen?
C. Or, is this the stage where the lung begins to repair itself, and it’s the turning point where the patient starts to improve or their
condition worsens?
10) In a critical care unit, Nurse Sophie is attending to a male patient suffering from acute respiratory distress syndrome resulting
from shock. His condition rapidly worsens, necessitating endotracheal (ET) intubation and mechanical ventilation. When the high-
pressure alarm on the mechanical ventilator suddenly rings out, Sophie swiftly initiates a check to identify the cause.
What condition would most likely trigger the high-pressure alarm on the ventilator?
A. Could it be due to an alteration in the oxygen concentration without resetting the oxygen level alarm?
B. Might it be due to the kinking of the ventilator tubing?
C. Is it possible that an ET cuff leak has occurred?
D. Or could it be due to a disconnected ventilator tube?

Answers and Rationales:

1) Correct answer:
D. Acute respiratory distress syndrome (ARDS), a life-threatening condition that prevents enough oxygen from getting to the
lungs and into the blood. In the case of Jack, given the exposure to the massive house fire and the inhalation of a significant
amount of smoke, the most likely condition he developed is acute respiratory distress syndrome (ARDS). ARDS is a severe lung
condition leading to low oxygen levels in the blood. It can be triggered by many factors, but smoke inhalation is a common cause
because it can lead to direct injury to the lung tissue. Smoke inhalation causes the release of inflammatory mediators that
increase the permeability of the alveolar-capillary membrane, leading to the accumulation of fluid in the lungs, reducing lung
compliance and impairing gas exchange, which manifests as difficulty breathing and requires mechanical ventilation.

2) Correct answer:
B. Could it be the stage where fibrous tissue begins to form, making the lungs less flexible, thus increasing the effort to breathe,
and consequently, the oxygen demand? The fibrotic phase is the third and final stage of ARDS, typically starting one to three
weeks after the initial lung injury. The main characteristic of this phase is the development of fibrous tissue in the lungs due to
the ongoing inflammatory response. This fibrous tissue reduces the flexibility of the lungs, making them stiffer and thus increasing
the work of breathing and oxygen demand. Oxygen exchange becomes more difficult as the fibrosis progresses, and this may lead
to low levels of oxygen in the blood (hypoxemia).

3) Correct answer:
A. As a typical and anticipated value. The pulmonary capillary wedge pressure (PCWP), also known as the pulmonary artery
occlusion pressure, provides an estimation of the left atrial pressure. A normal PCWP is between 6 and 12 mm Hg. Hence, a
reading of 12 mm Hg in this context is within the typical range and anticipated.

4) Correct answer:
D. The development of a right pneumothorax. Given the scenario described, the patient most likely developed a right
pneumothorax. Pneumothorax occurs when air enters the pleural space and the lung collapses, leading to an interruption in the
exchange of gasses. Signs of a pneumothorax can include a sudden onset of respiratory distress, decreased or absent breath
sounds on the affected side (as mentioned in the question), and a high-pressure alarm on the ventilator due to increased
resistance to air flow.

5) Correct answer:
A. The mucous membranes. When assessing cyanosis in individuals with darker skin, it is most accurate to inspect the mucous
membranes (especially the oral mucosa) and the conjunctiva of the eyes. This is because these areas are less affected by skin
pigment and allow for a more accurate evaluation of color changes related to oxygenation.

6) Correct answer:
A. Accurate. This statement is indeed accurate. Acute Respiratory Distress Syndrome (ARDS) management is largely supportive.
The mainstay of ARDS management includes mechanical ventilation to maintain oxygenation, fluid management, and treating the
underlying cause, if identified. Unfortunately, there is no specific treatment available to reverse the inflammatory process that
occurs in the lungs during ARDS.

7) Correct answer:
D. Or could it be the onset of acute respiratory distress syndrome? A fat embolism is a serious complication that can occur after a
fracture, especially of the long bones like the femur. Fat droplets from the bone marrow can enter the bloodstream and
eventually reach the lungs, leading to a condition that can manifest similarly to acute respiratory distress syndrome (ARDS). It
may cause symptoms such as shortness of breath, rapid breathing, hypoxia, and mental confusion due to reduced oxygenation to
the brain. These signs can appear within 24-72 hours post-injury.

8) Correct answer:
C. An escalated respiratory rate. The earliest indicator of Acute Respiratory Distress Syndrome (ARDS) is often an increased
respiratory rate, also known as tachypnea. This increase is due to the body’s attempt to meet its oxygen demands as the
efficiency of gas exchange in the lungs is compromised. Hypoxemia, or low levels of oxygen in the blood, usually accompanies this
increased respiratory rate, despite supplemental oxygen. The dyspnea or difficulty in breathing may not be severe at first but can
worsen rapidly.

9) Correct answer:
A. Does it involve fluids shifting into the alveoli, leading to the collapse of the alveoli and bronchi, and resulting in a loss of lung
compliance? The Acute Exudative Phase is the initial phase of ARDS, typically within the first 1 to 7 days after the initial insult or
injury. The hallmark of this phase is increased permeability of the pulmonary capillaries, leading to leakage of protein-rich fluid
into the alveoli. This fluid disrupts surfactant production, which in turn results in alveolar collapse (atelectasis), contributing to
decreased lung compliance (the ease at which the lungs can expand). This significantly impairs gas exchange, leading to
hypoxemia.

10) Correct answer:

B. Might it be due to the kinking of the ventilator tubing? A high-pressure alarm on a ventilator typically indicates increased
resistance to airflow. This resistance can occur due to various reasons such as a kinked or obstructed tube, a mucus plug in the
airway, or the patient coughing, biting the tube, or fighting the ventilator. Among the given options, the most likely cause is the
kinking of the ventilator tubing, which obstructs the airflow and increases the pressure, thereby setting off the alarm.

Pneumonia and Tuberculosis

Questions:
1. Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?
A. Dehydration
B. Group living
C. Malnutrition
D. Severe periodontal disease
2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
A. Atelectasis
B. Bronchiectasis
C. Effusion
D. Inflammation
3. Which of the following organisms most commonly causes community-acquired pneumonia in adults?
A. Haemiphilus influenzae
B. Klebsiella pneumoniae
C. Steptococcus pneumoniae
D. Staphylococcus aureus
4. An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. Fever and chills
C. Hemoptysis and dyspnea
D. Pleuritic chest pain and cough
5. When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over
areas of consolidation?
A. Bronchial
B. Bronchovestibular
C. Tubular
D. Vesicular
6. A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
A. ABG analysis
B. Chest x-ray
C. Blood cultures
D. sputum culture and sensitivity
7. A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and difficulty expelling his secretions.
The nurse auscultates his lung fields and hears bronchial sounds in the left lower lobe. The nurse determines that the client
requires which of the following treatments first?
A. Antibiotics
B. Bed rest
C. Oxygen
D. Nutritional intake
8. A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will be discharged today.
Which of the following physical findings would lead the nurse to believe it is appropriate to discharge this client?
A. Continued dyspnea
B. Fever of 102*F
C. Respiratory rate of 32 breaths/minute
D. Vesicular breath sounds in right base
9. The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about
3mm where the test was given. This PPD would be read as having which of the following results?
A. Indeterminate
B. Needs to be redone
C. Negative
D. Positive
10. A client with primary TB infection can expect to develop which of the following conditions?
A. Active TB within 2 weeks
B. Active TB within 1 month
C. A fever that requires hospitalization
D. A positive skin test
11. A client was infected with TB 10 years ago but never developed the disease. He’s now being treated for cancer. The client
begins to develop signs of TB. This is known as which of the following types of infection?
A. Active infection
B. Primary infection
C. Superinfection
D. Tertiary infection
12. A client has active TB. Which of the following symptoms will he exhibit?
A. Chest and lower back pain
B. Chills, fever, night sweats, and hemoptysis
C. Fever of more than 104*F and nausea
D. Headache and photophobia
13. Which of the following diagnostic tests is definitive for TB?
A. Chest x-ray
B. Mantoux test
C. Sputum culture
D. Tuberculin test
14. A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is this done?
A. To confirm the diagnosis
B. To determine if a repeat skin test is needed
C. To determine the extent of the lesions
D. To determine if this is a primary or secondary infection
15. A chest x-ray should a client’s lungs to be clear. His Mantoux test is positive, with a 10mm if induration. His previous test was
negative. These test results are possible because:
A. He had TB in the past and no longer has it.
B. He was successfully treated for TB, but skin tests always stay positive.
C. He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.
D. He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
16. A client with a positive skin test for TB isn’t showing signs of active disease. To help prevent the development of active TB,
the client should be treated with isonaizid, 300mg daily, for how long?
A. 10 to 14 days
B. 2 to 4 weeks
C. 3 to 6 months
D. 9 to 12 months
17. A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of
the following actions?
A. Admit him to the hospital in respiratory isolation
B. Prescribe isoniazid and tell him to go home and rest
C. Give a tuberculin test and tell him to come back in 48 hours and have it read.
 D. Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home.
18. A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show
if therapy is inadequate?
A. Decreased shortness of breath
B. Improved chest x-ray
C. Nonproductive cough
D. Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
19. A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?
A. To evaluate his condition
B. To determine his compliance
C. to prevent spread of the disease
D. To determine the need for antibiotic therapy.
20. A high level of oxygen exerts which of the following effects on the lung?
A. Improves oxygen uptake
B. Increases carbon dioxide levels
C. Stabilizes carbon dioxide levels
D. Reduces amount of functional alveolar surface area
21. A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He reports that it
started suddenly. The assessment should include which of the following interventions?
A. Auscultation of breath sounds
B. Chest x-ray
C. Echocardiogram
D. Electrocardiogram (ECG)
22. A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which
of the following conditions would best explain this?
A. Acute asthma
B. Chronic bronchitis
C. Pneumonia
D. Spontaneous pneumothorax
23. Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
A. Antibiotics
B. Bronchodilators
C. Chest tube placement
D. Hyperbaric chamber
24. Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
A. Auscultate breath sounds
B. Have the client use an incentive spirometer
C. Take a chest x-ray
D. stick a needle in the area of decreased breath sounds
25. A pulse oximetry gives what type of information about the client?
A. Amount of carbon dioxide in the blood
B. Amount of oxygen in the blood
C. Percentage of hemoglobin carrying oxygen
D. Respiratory rate
26. What effect does hemoglobin amount have on oxygenation status?
A. No effect
B. More hemoglobin reduces the client’s respiratory rate
C. Low hemoglobin levels cause reduces oxygen-carrying capacity
D. Low hemoglobin levels cause increased oxygen-carrying capacity.
27. Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
A. Alveoli need oxygen to live
B. Alveoli have no effect on oxygenation
C. Collapsed alveoli increase oxygen demand
D. Gaseous exchange occurs in the alveolar membrane.
28. Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic
patients by which of the following methods?
A. The mask provides 100% oxygen to the client.
B. The mask provides continuous air that the client can breathe.
C. The mask provides pressurized oxygen so the client can breathe more easily.
D. The mask provides pressurized at the end of expiration to open collapsed alveoli.
29. Which of the following best describes pleural effusion?
A. The collapse of alveoli
B. The collapse of bronchiole
C. The fluid in the alveolar space
D. The accumulation of fluid between the linings of the pleural space.
30. If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural
space and proper lung status restored?
 A. Inserting a chest tube
B. Performing thoracentesis
C. Performing paracentesis
D. Allowing the pleural effusion to drain by itself.
31. A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which
action should the nurse take?
A. Remove the airway and insert a shorter one.
B. Reposition the airway.
C. Leave the airway in place until the client gets used to it.
D. Remove the airway and attempt suctioning without it.
32. An 87-year-old client requires long term ventilator therapy. He has a tracheostomy in place and requires frequent suctioning.
Which of the following techniques is correct?
A. Using intermittent suction while advancing the catheter.
B. Using continuous suction while withdrawing the catheter.
C. Using intermittent suction while withdrawing the catheter.
D. Using continuous suction while advancing the catheter.
33. A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3– of 24 mEq/L. What do these
values indicate?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
34. A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal
injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection?
A. 5/8” to ½” 25G to 27G needle.
B. 1” to 3” 20G to 25G needle.
C. ½” to 3/8” 26 or 27G needle.
D. 1” 20G needle.
35. A 76-year old client is admitted for elective knee surgery. Physical examination reveals shallow respirations but no signs of
respiratory distress. Which of the following is a normal physiologic change related to aging?
A. Increased elastic recoil of the lungs
B. Increased number of functional capillaries in the alveoli
C. Decreased residual volume
D. Decreased vital capacity
36. A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
A. Acute pain related to lung expansion secondary to lung infection
B. Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
C. Anxiety related to dyspnea and chest pain.
D. Ineffective airway clearance related to retained secretions.
37. A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the
group that one of the first symptoms associated with TB is:
A. A bloody, productive cough
B. A cough with the expectoration of mucoid sputum
C. Chest pain
D. Dyspnea
38. A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The
nurse would determine that a therapeutic blood level exists if which of the following were noted in the laboratory report?
A. 5 mcg/mL
B. 15 mcg/mL
C. 25 mcg/mL
D. 30 mcg/mL
39. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the
client. Which of the following, if noted in the client’s history, would require physician notification?
A. Heart disease
B. Allergy to penicillin
C. Hepatitis B
D. Rheumatic fever
40. A client is experiencing confusion and tremors is admitted to a nursing unit. An initial ABG report indicates that the PaCO2 level
is 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that the client is most likely experiencing:
A. Carbon monoxide poisoning
B. Carbon dioxide narcosis
C. Respiratory alkalosis
D. Metabolic acidosis
41. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse
interprets the results as:
A. Positive
B. Negative
 C. Inconclusive
D. The need for repeat testing.
42. A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the
usual clinical presentation of TB and may indicate the development of a concurrent problem?
A. Nonproductive or productive cough
B. Anorexia and weight loss
C. Chills and night sweats
D. High-grade fever
43. A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the
client increase intake of:
A. Meats and citrus fruits
B. Grains and broccoli
C. Eggs and spinach
D. Potatoes and fish
44. Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia?
Select all that apply.
A. Auscultation of breath sounds
B. Auscultation of bowel sounds
C. Presence of chest pain.
D. Presence of peripheral edema
E. Color of nail beds
45. A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive cough. The nurse should
include which of the following measures in the plan of care?
A. Position changes q4h
B. Nasotracheal suctioning to clear secretions
C. Frequent linen changes
D. Frequent offering of a bedpan.
46. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
A. Decreased cardiac output
B. Pleural effusion
C. Inadequate peripheral circulation
D. Decreased oxygenation of the blood.
47. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
A. Coma
B. Apathy
C. Irritability
D. Depression
48. A client with pneumonia has a temperature ranging between 101* and 102*F and periods of diaphoresis. Based on this
information, which of the following nursing interventions would be a priority?
A. Maintain complete bedrest
B. Administer oxygen therapy
C. Provide frequent linen changes.
D. Provide fluid intake of 3 L/day
49. Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial
pneumonia?
A. A respiratory rate of 25 to 30 breaths per minute
B. The ability to perform ADL’s without dyspnea
C. A maximum loss of 5 to 10 pounds of body weight
D. Chest pain that is minimized by splinting the ribcage.
50. Which of the following symptoms is common in clients with TB?
A. Weight loss
B. Increased appetite
C. Dyspnea on exertion
D. Mental status changes
51. The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the following laboratory
techniques is most commonly used to identify tubercle bacilli in sputum?
A. Acid-fast staining
B. Sensitivity testing
C. Agglunitnation testing
D. Dark-field illumination
52. Which of the following antituberculus drugs can cause damage to the eighth cranial nerve?
A. Streptomycin
B. Isoniazid
C. Para-aminosalicylic acid
D. Ethambutol hydrochloride
53. The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
A. Vertigo
 B. Facial paralysis
C. Impaired vision
D. Difficulty swallowing
54. Which of the following family members exposed to TB would be at highest risk for contracting the disease?
A. 45-year-old mother
B. 17-year-old daughter
C. 8-year-old son
D. 76-year-old grandmother
55. The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which
statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply.
A. “I will need to dispose of my old clothing when I return home.”
B. “I should always cover my mouth and nose when sneezing.”
C. “It is important that I isolate myself from family when possible.”
D. “I should use paper tissues to cough in and dispose of them properly.”
E. “I can use regular plate and utensils whenever I eat.”
56. A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:
A. Active TB
B. Had contact with Mycobacterium tuberculosis
C. Developed a resistance to tubercle bacilli
D. Developed passive immunity to TB.
57. INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would
the nurse teach the client to help prevent this complication?
A. Adhere to a low cholesterol diet
B. Supplement the diet with pyridoxine (vitamin B6)
C. Get extra rest
D. Avoid excessive sun exposure.
58. The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and
rifampin for treatment for TB?
A. Take the medication with antacids
B. Double the dosage if a drug dose is forgotten
C. Increase intake of dairy products
D. Limit alcohol intake
59. The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which
nursing action would be most appropriate for this client?
A. Ask the client’s spouse to supervise the daily administration of the medications.
B. Visit the clinic weekly to ask him whether he is taking his medications regularly.
C. Notify the physician of the client’s non-compliance and request a different prescription.
D. Remind the client that TB can be fatal if not taken properly.
60. The Causative agent of Tuberculosis is said to be:
A. Mycobacterium Tuberculosis
B. Hansen’s Bacilli
C. Bacillus Anthracis
D. Group A Beta Hemolytic Streptococcus

Answers and Rationales:

1. B. Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases
the chance of disease transmission.
2. D. The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or
agent. Atelectasis and bronchiecrasis indicate a collapse of a portion of the airway that doesn’t occur in pneumonia. An
effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to
pneumonia.
3. C. Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of
community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the
most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of
hospital-acquired pneumonia.
4. A. Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly
clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
5. A. Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchiovesicular are normal over
midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly
heard in the bases of the lung fields.
6. D. Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung
consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will
help determine if the infection is systemic.
7. C. The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can
provide oxygen without waiting for a physicians order. Antibiotics may be warranted, but this isn’t a nursing decision. The
client should be maintained on bedrest if he is dyspneic to minimize his oxygen demands, but providing additional will
 deal more immediately with his problem. The client will need nutritional support, but while dyspneic, he may be unable
to spare the energy needed to eat and at the same time maintain adequate oxygenation.
8. D. If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath
sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician
before discharge because he may have another source of infection or still have pneumonia.
9. C. This test would be classed as negative. A 5mm raised area would be a positive result if a client was HIV+ or had recent
close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the
PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC.
10. D. A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the
lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed
people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in
many cases because of a break in the body’s immune defenses. The active stage shows the classic symptoms of TB: fever,
hemoptysis, and night sweats.
11. A. Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection
containing TB bacilli may remain inactive for years and then activate when the client’s resistance is lowered, as when a
client is being treated for cancer. There’s no such thing as tertiary infection, and superinfection doesn’t apply in this case.
12. B. Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing,
but isn’t usual. Clients with TB typically have low-grade fevers, not higher than 102*F. Nausea, headache, and
photophobia aren’t usual TB symptoms.
13. C. The sputum culture for Myobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung
may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.
14. C. If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the
diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can’t determine if this is a primary
or secondary infection.
15. D. A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infected with TB and now has a
cell-mediated immune response to the skin test. The client’s blood and x-ray results may stay negative. It doesn’t mean
the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to
see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn’t mean the TB has gotten
into his bloodstream; it means it can be detected by a blood test.
16. D. Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some
cases, but treatment typically lasts for 9-12 months. Isoaizid is the most common medication used for the treatment of
TB, but other antibiotics are added to the regimen to obtain the best results.
17. A. The client is showing s/s of active TB and, because of the productive cough, is highly contagious. He should be admitted
to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He
would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed,
then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more
consecutive sputum cultures will be obtained. If they’re negative, he would be considered non-contagious and may be
sent home, although he’ll continue to take the antitubercular drugs for 9 to 12 months.
18. D. Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.
19. C. The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he’s put in
respiratory isolation in the hospital.
20. D. Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous
exchange, which results in increased carbon dioxide levels and decreased oxygen uptake.
21. A. Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG,
but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an
echocardiogram.
22. D. A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of
functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An
asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have
bronchial breath sounds over the area of consolidation.
23. C. The only way to reexpand the lung is to place a chest tube on the right side so the air in the pleural space can be
removed and the lung reexpanded.
24. C. A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural
space. Listening to breath sounds won’t confirm a diagnosis. An IS is used to encourage deep breathing. A needle
thoracostomy is done only in an emergency and only by someone trained to do it.
25. C. The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen
being carried through the bloodstream is actually being taken up by the tissue.
26. C. Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying
capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of
oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand
is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal
levels.
27. D. Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli
receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand,
though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.
28. C. The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to
deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to
 overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is
positive end-expiratory pressure (PEEP), not continuous positive airway pressure.
29. D. The pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is
reabsorbed by the visceral pleural capillaries and lymphatics. Any condition that interferes with either the secretion or
drainage of this fluid will lead to a pleural effusion.
30. B. Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s
transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low
protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and
have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy,
infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large
enough to warrant such a measure. Pleural effusions can’t drain by themselves.
31. A. If a client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove
it and insert a shorter one. Simply repositioning the airway won’t solve the problem. The client won’t get used to the tube
because it’s the wrong size. Suctioning without a nasopharyngeal airway causes trauma to the natural airway.
32. C. Intermittent suction should be applied during catheter withdrawal. To prevent hypoxia, suctioning shouldn’t last more
than 10-seconds at a time. Suction shouldn’t be applied while the catheter is being advanced.
33. D.
34. C. Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the
outer skin layers to produce a local effect. A TB syringe with a ½” to 3/8” 26G or 27G needle should be inserted about
1/8” below the epidermis.
35. D. Reduction in VC is a normal physiologic change in the older adult. Other normal physiologic changes include decreased
elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase is residual volume.
36. D. Pneumonia is an acute infection of the lung parenchyma. The inflammatory reaction may cause an outpouring of
exudate into the alveolar spaces, leading to an ineffective airway clearance related to retained secretions.
37. B. One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.
38. B. The therapeutic theophylline blood level range from 10-20 mcg/mL.
39. C. Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
40. B. Carbon dioxide narcosis is a condition that results from extreme hypercapnia, with carbon dioxide levels in excess of 70
mm Hg. The client experiences symptoms such as confusion and tremors, which may progress to convulsions and possible
coma.
41. A. The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of
induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.
42. D. The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea,
hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
43. A. The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.
44. A, C, E. A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a
priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment
as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for
peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with
pneumonia.
45. C. Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general
discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours.
Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated
by the data provided in this scenario.
46. D. A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory
pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes
cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation.
47. C. Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental
status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a
late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
48. D. A fluid intake of at least 3 L/day should be provided to replace any fluid loss occurring as a result the fever and
diaphoresis; this is a high-priority intervention.
49. B. An expected outcome for a client recovering from pneumonia would be the ability to perform ADL’s without
experiencing dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates the client is experiencing tachypnea, which
would not be expected on recovery. A weight loss of 5-10 pounds is undesirable; the expected outcome would be to
maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
50. A. TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and
night sweats.
51. A. The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface,
which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with
acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
52. A. Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from
amintoglycodsides.
53. A. The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin
can damage this nerve.
54. D. Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other
high-risk populations in the US include the urban poor, AIDS, and minority groups.
 55. B, D, E.
56. B. A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean
that active disease exists.
57. B. INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies
related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed.
58. D. INH and rifampin are hepatoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both
drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or
2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their
potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or
they may develop hypertension.
59. A. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a
responsible person, who may be a family member or a health care provider, observes the client taking the medication.
Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or
cannot follow the prescribed treatment.
60. A.

Bronchitis (Acute & Chronic)

1. Nurse Thomas is discussing chronic bronchitis during a respiratory health seminar. He wants to make sure the attendees are
aware of additional symptoms that might manifest with chronic bronchitis. Which of the following should he include in his
discussion?
A. Lips appearing blue-tinged due to low levels of oxygen.
B. Frequent respiratory infections, such as colds or the flu.
C. Swelling in the ankles, feet, and legs.
D. All of the mentioned symptoms.
✔Correct answer:
All of the mentioned symptoms. Chronic bronchitis is a long-term inflammation of the bronchi, which are the major airways in the
lungs. This condition is often part of a group of lung diseases known as chronic obstructive pulmonary disease (COPD). Nurse
Thomas should include all the mentioned symptoms—frequent respiratory infections, swelling in the ankles, feet, and legs, and
lips appearing blue-tinged due to low levels of oxygen—in his discussion. Frequent respiratory infections like colds or the flu can
exacerbate the condition, making it harder to manage. Swelling in the lower extremities is often a sign of fluid retention, which
can occur when the heart is unable to pump blood effectively due to decreased lung function. Lastly, blue-tinged lips indicate
cyanosis, a serious condition where the body is not getting enough oxygen, often due to severely impaired lung function.

2. Nurse Laura is caring for Johnny, a firefighter who was involved in putting out a house fire. Johnny has been admitted for
smoke inhalation and has developed severe hypoxia 48 hours post-incident, requiring intubation and mechanical ventilation.
Which condition is Johnny most likely experiencing?
A. Adult respiratory distress syndrome (ARDS)
B. Atelectasis
C. Bronchitis
D. Pneumonia
✔Correct answer:
Adult respiratory distress syndrome (ARDS). Johnny's severe hypoxia 48 hours after smoke inhalation, requiring intubation and
mechanical ventilation, strongly suggests that he is experiencing Adult Respiratory Distress Syndrome (ARDS). ARDS is a severe
lung condition that can occur in people who are critically ill or have significant injuries. It results from fluid accumulating in the
alveoli, which prevents the lungs from filling with enough air and leads to decreased oxygen levels in the blood. Smoke inhalation
is a known risk factor for ARDS, as it can cause direct injury to the alveolar walls and capillaries, leading to inflammation and fluid
leakage into the alveoli.

3. Nurse William is counseling Mrs. Adams, a 55-year-old patient who has been recently diagnosed with chronic bronchitis. During
their conversation, Nurse William aims to provide accurate information about the condition. Which statement should Nurse
William confirm as true regarding chronic bronchitis?
A. The primary cause of chronic bronchitis is exposure to cigarette smoke, including long-term exposure to second-hand smoke.
B. Chronic bronchitis is a condition that lasts for an extended period.
C. All mentioned statements are accurate.
D. Ongoing medical treatment is a necessity for managing the condition.
✔Correct answer:
All mentioned statements are accurate. Chronic bronchitis is a long-term condition characterized by inflammation of the
bronchial tubes, leading to a persistent cough and increased mucus production. It is primarily caused by exposure to irritants like
cigarette smoke, including second-hand smoke. Ongoing medical treatment is essential for managing the symptoms and
preventing complications. Nurse William should confirm all these statements as true to provide Mrs. Adams with a
comprehensive understanding of her condition.

4. Nurse Ethan is caring for Mr. Davis, a 67-year-old patient who recently had surgery on his right femur. Suddenly, Mr. Davis
develops acute shortness of breath and progressive hypoxia. Nurse Ethan needs to determine the most probable cause of these
symptoms. What should he consider?
A. Atelectasis
B. Fat embolism
C. Asthma attack
D. Bronchitis
✔Correct answer:
Fat embolism. Given that Mr. Davis is 67 years old and has recently undergone surgery on his right femur, the most probable
cause of his acute shortness of breath and progressive hypoxia is a fat embolism. Fat embolisms are a known complication of long
bone fractures and orthopedic surgeries. Fat globules from the bone marrow can enter the bloodstream and travel to the lungs,
obstructing blood flow and leading to respiratory distress and hypoxia. The symptoms usually manifest within 24 to 72 hours after
the injury or surgery, making it a critical consideration in the immediate postoperative period for patients like Mr. Davis.

5. Nurse Sophia is doing her morning rounds and is currently attending to Mr. Johnson, an 80-year-old man with a history of
chronic bronchitis. During her assessment, she notes that the pulse oximeter shows an O2 saturation level of 76%. What should
be Nurse Sophia's immediate course of action?
A. Contact the physician immediately.
B. Initiate oxygen administration via mask.
C. Wait and reevaluate the O2 saturation level after 15 minutes.
D. Evaluate Mr. Johnson's pulse rate.
✔Correct answer:
Initiate oxygen administration via mask. An O2 saturation level of 76% is critically low and indicates severe hypoxia, which is a
medical emergency requiring immediate intervention. In such a situation, the priority is to improve oxygenation as quickly as
possible to prevent life-threatening complications like organ failure or cardiac arrest. Initiating oxygen administration via a mask
is the most direct way to rapidly increase oxygen levels in the blood and tissues. This action can stabilize the patient while further
medical evaluation and treatment are arranged.

6. Nurse Emily is leading a community health seminar and addresses misconceptions about acute bronchitis. She poses the
question, "Is it uncommon to experience a dry, nagging cough that persists for several weeks even after acute bronchitis has
cleared?" What is the correct statement?
A. False
B. True
✔Correct answer:
False. It is not uncommon for a dry, nagging cough to persist for several weeks even after the acute phase of bronchitis has
resolved. The inflammation and irritation in the bronchial tubes can take time to fully heal, and during this period, a residual
cough may remain. This is often referred to as a "post-bronchitis syndrome" and can be quite bothersome, although it usually
resolves on its own over time. Nurse Emily should clarify this point to dispel the misconception that a lingering cough is unusual
after acute bronchitis.

7. Nurse Ethan is consulting with Mr. Wallace, a 45-year-old patient who has chronic bronchitis and recently suffered an acute
exacerbation. As part of the patient education, Nurse Ethan is advising Mr. Wallace on lifestyle changes that could help manage
his condition effectively. Which lifestyle modification should Nurse Ethan recommend as the most appropriate?
A. Begin a high-intensity interval training program.
B. Reduce caffeine intake and adopt a low-fiber diet.
C. Restrict fluid intake to reduce cough and mucus production.
D. Increase fluid intake and engage in regular aerobic exercise.
✔Correct answer:
Increase fluid intake and engage in regular aerobic exercise. Increasing fluid intake can help to thin mucus, making it easier to
expectorate and thereby improving airway clearance. Regular aerobic exercise can also benefit individuals with chronic bronchitis
by improving overall lung function and cardiovascular health. Exercise can help to increase the efficiency of oxygen exchange and
improve endurance, making daily activities easier. Nurse Ethan should recommend these lifestyle changes to Mr. Wallace as they
are directly aimed at managing the symptoms of chronic bronchitis and improving his quality of life.

8. Nurse Hannah is providing care to Ms. Rodriguez, a 50-year-old patient who has been experiencing a persistent, forceful cough
for several days. Ms. Rodriguez complains of aching chest and abdominal muscles. Nurse Hannah contemplates whether the
continued forceful coughing could be responsible for these aches. Is this a plausible explanation?
A. True
B. False
✔Correct answer:
True. Yes, it is plausible that Ms. Rodriguez's persistent, forceful coughing could be responsible for her aching chest and
abdominal muscles. Forceful and frequent coughing engages various muscle groups, including those in the chest and abdomen.
Over time, this can lead to muscle fatigue and soreness, similar to the way muscles might ache after a strenuous workout.
Therefore, Nurse Hannah's consideration that the forceful coughing could be causing Ms. Rodriguez's aches is valid.

9. Nurse Emily is educating Mr. Wilson, a patient with chronic bronchitis, on effective breathing exercises to help manage his
condition. What key point should she include in her teaching?
A. Employ diaphragmatic breathing techniques.
B. Utilize chest breathing techniques.
C. Make the inhalation phase longer than the exhalation phase.
D. Exhale through an open mouth.
✔Correct answer:
Employ diaphragmatic breathing techniques. Diaphragmatic breathing, also known as "belly breathing," is highly beneficial for
patients with chronic bronchitis. This technique involves using the diaphragm, a large muscle located between the chest and
abdomen, to help move air in and out of the lungs. By focusing on diaphragmatic breathing, Mr. Wilson can maximize the amount
of oxygen that reaches his lungs, which is crucial for managing his chronic bronchitis symptoms. This method is more efficient
than chest breathing, which uses secondary muscles and can lead to quicker fatigue and less effective ventilation.
10. Nurse Amelia is reviewing medical terms with her team during their weekly meeting. She asks her colleagues what the term
"pink puffer" refers to, particularly when describing a female client. What condition is this term associated with?
A. Emphysema
B. Adult respiratory distress syndrome (ARDS)
C. Asthma
D. Chronic obstructive bronchitis
✔Correct answer:
Emphysema. The term "pink puffer" is commonly associated with emphysema, a type of chronic obstructive pulmonary disease
(COPD). This colloquial term is used to describe the appearance and symptoms of individuals with emphysema. These patients
often have a pink complexion due to their body's effort to oxygenate the blood adequately. They also tend to "puff" or purse their
lips during exhalation to increase airway pressure and prevent airway collapse, hence the term "puffer." In the context of
describing a female client, the term would indicate that she likely has emphysema and exhibits these characteristic features.

11. Nurse Sophia is holding a workshop on respiratory diseases and has a segment focused on acute bronchitis. She aims to clarify
some common misconceptions about the condition. Which statement should Nurse Sophia confirm as true regarding acute
bronchitis?
A. Acute bronchitis initially impacts the nose, sinuses, and throat before spreading to the lungs.
B. All of the mentioned statements are true.
C. Smokers, as well as people with heart or lung diseases, are at a higher risk of contracting acute bronchitis.
D. Acute bronchitis often develops following a viral respiratory infection.
✔Correct answer:
All of the mentioned statements are true. Nurse Sophia should confirm that all the mentioned statements are true regarding
acute bronchitis. Acute bronchitis often develops following a viral respiratory infection such as the common cold or flu. The
bronchial tubes become inflamed, leading to coughing and other respiratory symptoms. Smokers and people with pre-existing
heart or lung diseases are indeed at a higher risk of contracting acute bronchitis because their respiratory systems are already
compromised. Lastly, acute bronchitis can initially impact the upper respiratory tract—including the nose, sinuses, and throat—
before spreading to the bronchial tubes in the lungs.

12. Nurse Emma is conducting a health education session for a group of patients at risk for developing respiratory illnesses. One
topic on the agenda is bronchitis, and Nurse Emma wants to highlight its most prevalent symptom. Which symptom should she
emphasize as being the most common in bronchitis?
A. Wheezing, feeling tired, fever, and discomfort in the chest.
B. All mentioned symptoms are equally common.
C. Persistent coughing.
D. Difficulty breathing that worsens with physical activity or mild exertion.
✔Correct answer:
Persistent coughing. The most prevalent symptom of bronchitis is a persistent cough, often producing mucus. This symptom is the
hallmark of the condition and is usually the first to appear. In bronchitis, the bronchial tubes become inflamed and produce
excess mucus, leading to a persistent cough as the body tries to clear the airways. Nurse Emma should emphasize this symptom
because it's often the earliest and most noticeable sign that prompts individuals to seek medical attention.

13. Nurse Emily is caring for Karen, a patient with chronic bronchitis. Emily has formulated a nursing diagnosis of "Activity
intolerance related to inadequate oxygenation and dyspnea." To help Karen minimize this problem, Emily plans to educate her on
conditions that could heighten her oxygen demands. What should Emily recommend Karen avoid?
A. Consuming more than three large meals a day.
B. Drinking more than 1,500 ml of fluid daily.
C. Having excess body weight.
D. Eating a high-protein snack at bedtime.
✔Correct answer:
Having excess body weight. Excess body weight is a significant factor that can increase oxygen demands, particularly in patients
with chronic bronchitis. Carrying extra weight puts additional strain on the respiratory system, making it work harder to provide
adequate oxygenation. This can exacerbate symptoms of dyspnea and further contribute to activity intolerance. For Karen, who
already has a compromised respiratory system due to chronic bronchitis, maintaining a healthy weight is crucial to minimize
additional stress on her lungs and improve her overall quality of life.

14. Nurse Sarah is caring for Mr. Thompson, a patient who has been admitted to the hospital with acute bronchitis. One challenge
is managing the expectoration of thick sputum. As she develops a plan of care, what nursing action should she consider as most
effective for this issue?
A. Provide fluids at regular intervals to the client.
B. Utilize humidified oxygen.
C. Reposition the client into a lateral position every 2 hours.
D. Splint the patient's chest with pillows during coughing episodes.
✔Correct answer:
Provide fluids at regular intervals to the client. One of the most effective ways to manage the expectoration of thick sputum in a
patient with acute bronchitis is to keep the patient well-hydrated. Providing fluids at regular intervals can help thin the mucus,
making it easier for Mr. Thompson to expectorate. Thick sputum can be a breeding ground for bacteria and can also cause airway
obstruction, so it's crucial to address this issue promptly. Adequate hydration not only helps in loosening the mucus but also
supports overall bodily functions, which is particularly important when the body is fighting off an infection.

15. Nurse Michelle is reviewing patient charts and comes across a new admission diagnosed with bronchitis. She recalls the
characteristics of a cough commonly associated with this condition. Which of the following best describes such a cough?
A. The cough can be severe enough at times to cause injury to the chest wall.
B. All of the choices are true.
C. The cough may be either dry or produce phlegm.
D. The cough may persist for over two weeks.
✔Correct answer:
All of the choices are true. Bronchitis is an inflammation of the bronchial tubes, which carry air to and from the lungs. The
condition is often characterized by a persistent cough that can manifest in various ways. The cough may be severe enough at
times to cause injury to the chest wall, such as muscle strains or even rib fractures in extreme cases. It's also common for the
cough to persist for over two weeks, sometimes even lasting for several months in chronic cases. Additionally, the cough may be
either dry or produce phlegm, depending on the individual and the stage of the illness.

16. Nurse Sara is evaluating Jackson, a patient who has been experiencing shortness of breath. Upon auscultation, she finds
decreased to absent breath sounds on the right side of his chest, from apex to base. What condition would be most likely to cause
these findings?
A. Spontaneous pneumothorax
B. Pneumonia
C. Acute asthma
D. Chronic bronchitis
✔Correct answer:
Spontaneous pneumothorax. The most likely condition causing decreased to absent breath sounds on the right side of Jackson's
chest, from apex to base, is spontaneous pneumothorax. In this condition, air leaks into the space between the lung and the chest
wall, causing the lung to collapse. This leads to an absence of breath sounds on the affected side because the lung is not
expanding as it should, and air is not flowing through it. The absence of breath sounds from apex to base is a strong indicator of a
collapsed lung, as it suggests that the entire lung field on that side is affected.

17. Nurse Rachel is conducting a health education session focusing on respiratory issues, including bronchitis. She wants to inform
the audience about the initial symptoms they should be aware of. What should Nurse Rachel include in her teaching?
A. Fatigue, accompanied by fever and chills, as well as chest discomfort.
B. All of the mentioned symptoms.
C. Shortness of breath that worsens with exertion or mild activity.
D. A cough that produces mucus.
✔Correct answer:
All of the mentioned symptoms. Nurse Rachel should include all of the mentioned symptoms—shortness of breath that worsens
with exertion or mild activity, fatigue accompanied by fever and chills as well as chest discomfort, and a cough that produces
mucus—when educating her audience about the initial symptoms of bronchitis. Bronchitis is an inflammation of the bronchial
tubes, which carry air to and from the lungs. The condition can be acute or chronic and is often caused by viral or bacterial
infections, though irritants like smoke can also contribute. The symptoms are a combination of respiratory and systemic signs,
making option D the most comprehensive and accurate choice for health education.

18. Nurse William is discussing clinical terms with his team during a shift change. He brings up the term "blue bloater" and asks
his colleagues which condition it typically describes, especially in reference to a male client. What does this term refer to?
A. Chronic obstructive bronchitis
B. Asthma
C. Emphysema
D. Adult respiratory distress syndrome (ARDS)
✔Correct answer:
Chronic obstructive bronchitis. The term "blue bloater" is commonly used to describe individuals with chronic obstructive
bronchitis, a subtype of chronic obstructive pulmonary disease (COPD). The term "blue" refers to the cyanotic appearance of the
patient, which is due to low levels of oxygen in the blood. The term "bloater" refers to the fluid retention and swelling, often seen
in the ankles, feet, and legs, that these patients may experience. In the context of a male client, the term would indicate that he
likely has chronic obstructive bronchitis and exhibits these characteristic features, such as cyanosis and edema.

19. Nurse Olivia is attending to Mr. Johnson, a 62-year-old male who was involved in a motor vehicle accident as an unrestrained
driver. He is in the emergency department complaining of difficulty breathing and chest pain. Upon auscultation, Nurse Olivia
notes an absence of breath sounds in the upper lobe of the lung. What condition might Mr. Johnson have?
A. Pneumothorax
B. Tuberculosis (TB)
C. Bronchitis
D. Pneumonia
✔Correct answer:
Pneumothorax. Given Mr. Johnson's recent involvement in a motor vehicle accident, his symptoms of difficulty breathing and
chest pain, along with the absence of breath sounds in the upper lobe of the lung, strongly suggest a pneumothorax.
Pneumothorax occurs when air leaks into the space between the lung and the chest wall, causing the lung to collapse partially or
completely. This condition can be particularly acute following trauma, such as a car accident, where the integrity of the lung or
chest wall may be compromised.

20. Nurse Laura is conducting a smoking cessation workshop and meets Mr. Thompson, a 52-year-old lifelong smoker concerned
about respiratory issues. Nurse Laura wants to stress the link between smoking and chronic bronchitis. Is it correct for Nurse
Laura to inform Mr. Thompson that cigarette smoking is the primary cause of chronic bronchitis?
A. False
B. True
✔Correct answer:
True. Yes, it is correct for Nurse Laura to inform Mr. Thompson that cigarette smoking is the primary cause of chronic bronchitis.
Smoking is the leading risk factor for developing chronic bronchitis, as it leads to irritation and inflammation of the bronchial
tubes. Over time, this inflammation can become chronic, leading to the persistent cough and mucus production characteristic of
chronic bronchitis. Therefore, Nurse Laura should emphasize this point to Mr. Thompson to underline the importance of quitting
smoking for respiratory health.

Cystic Fibrosis

1. Nurse Angela is monitoring a young patient with cystic fibrosis who is undergoing inhalation therapy with Pulmozyme (dornase
alfa). She needs to be aware of potential side effects of this medication. Which side effect should Nurse Angela look out for?
A. Throat soreness.
B. Increased weight.
C. Loss of hair.
D. Fragile nails.
✔Correct answer:
Throat soreness. Pulmozyme (dornase alfa) is a mucolytic agent used in the management of cystic fibrosis. It works by breaking
down the DNA in the mucus, reducing its viscosity and making it easier to clear from the airways. A common side effect of
inhalation therapy with Pulmozyme is throat soreness. This occurs because the medication can cause irritation of the mucous
membranes in the throat and airways.
Pulmozyme is an enzyme that specifically targets and cleaves extracellular DNA, which is a major component of the thick, sticky
mucus in the lungs of patients with cystic fibrosis. By breaking down the DNA, Pulmozyme reduces the viscosity of the mucus,
facilitating its clearance through coughing or suctioning. However, the enzyme's action can also irritate the lining of the throat
and upper airways, leading to soreness and discomfort.

2. Nurse Kelly is coordinating chest physiotherapy sessions for an 8-year-old client with cystic fibrosis who has been admitted to
the hospital. To maximize the effectiveness of the treatment and minimize discomfort, when should Nurse Kelly schedule these
sessions in coordination with the respiratory therapy department?
A. After meals.
B. Between meals.
C. Around the child’s play schedule.
D. After medication.
✔Correct answer:
Between meals. Chest physiotherapy (CPT) is a critical component in the management of cystic fibrosis (CF) to help clear mucus
from the lungs and improve respiratory function. Scheduling these sessions between meals is optimal because it reduces the risk
of nausea and vomiting that can occur if the therapy is performed immediately after eating. This timing also helps ensure that the
child is comfortable and able to participate fully in the therapy sessions, enhancing their effectiveness.
Chest physiotherapy involves techniques such as percussion, vibration, and postural drainage to mobilize and clear mucus from
the airways. If performed after meals, the physical manipulation of the chest and abdomen can lead to discomfort and
gastrointestinal upset. By scheduling CPT between meals, the therapy can be done when the child’s stomach is not full,
minimizing discomfort and the risk of aspiration.

3. Nurse Emily is discussing the prognosis of cystic fibrosis with a patient's family. She addresses the question of whether there is
a cure for cystic fibrosis.
A. True
B. False
✔Correct answer:
False. Currently, there is no cure for cystic fibrosis (CF). CF is a genetic disorder caused by mutations in the CFTR gene, which leads
to the production of thick and sticky mucus that can clog the airways and ducts in various organs. While significant advances in
treatment have improved the quality of life and life expectancy for individuals with CF, the disease remains chronic and incurable.
The defective CFTR protein affects the movement of salt and water in and out of cells, resulting in thickened secretions in the
lungs, pancreas, and other organs. These secretions can cause respiratory infections, pancreatic enzyme insufficiency, and other
complications. Treatments aim to manage these symptoms and complications, rather than cure the underlying genetic defect.
4. Nurse Olivia is assessing a child who has recently been diagnosed with cystic fibrosis at a pediatric clinic. She is aware of the
expected findings of the disease at various stages. Which later finding would Nurse Olivia not expect to see in this newly
diagnosed child?
A. Recurrent respiratory infections.
B. Failure to thrive despite good appetite.
C. Chronic cough with mucus production.
D. Digital clubbing of fingers and toes.
✔Correct answer:
Digital clubbing of fingers and toes. Digital clubbing is a later finding in cystic fibrosis (CF) that typically develops after prolonged
hypoxia and chronic lung disease. It involves the enlargement of the fingertips and toes and is usually seen in older children and
adults who have had the disease for a longer period. Since the child in question has been newly diagnosed, Nurse Olivia would
not expect to see digital clubbing at this early stage.
Digital clubbing results from chronic low oxygen levels in the blood, which is often a consequence of long-standing respiratory
issues in cystic fibrosis patients. The pathophysiology behind digital clubbing is not entirely understood, but it is believed to
involve increased blood flow to the distal digits and subsequent changes in connective tissue. Early stages of cystic fibrosis do not
typically cause the prolonged hypoxia necessary for clubbing to develop.

5. Nurse Ramirez is speaking with the mother of a child with cystic fibrosis, who mentions that her child makes "snoring" sounds
when breathing. Nurse Ramirez knows that many children with cystic fibrosis often have which of the following conditions that
could cause this symptom?
A. Choanal atresia
B. Septal deviations
C. Nasal polyps
D. Enlarged adenoids
✔Correct answer:
Nasal polyps. Children with cystic fibrosis (CF) often develop nasal polyps, which are non-cancerous growths in the nasal passages
or sinuses. These polyps can obstruct the airways, leading to difficulty in breathing and causing sounds such as snoring or noisy
breathing. The thick and sticky mucus characteristic of CF creates an environment prone to chronic inflammation and infection,
which can lead to the formation of these polyps.
Nasal polyps develop due to chronic inflammation of the nasal and sinus mucosa. In cystic fibrosis, the mucus is abnormally thick
and sticky, contributing to persistent sinus infections and inflammation. Over time, this inflammation can cause the mucous
membrane to swell and form polyps, which can obstruct airflow through the nasal passages.

6. Nurse James is educating the parents of a child recently diagnosed with cystic fibrosis about alternative names for the
condition. What is another name for cystic fibrosis?
A. Irritating cough disease
B. Sticky mucus disease
C. Bronchiectasis
D. Mucoviscidosis
✔Correct answer:
Mucoviscidosis. Another name for cystic fibrosis is mucoviscidosis. This term highlights the hallmark characteristic of the disease,
which is the production of abnormally thick and sticky mucus. The term "mucoviscidosis" is derived from "muco," referring to
mucus, and "viscous," indicating the thick, sticky nature of the mucus. This mucus affects various organs, particularly the lungs
and digestive system, leading to the typical symptoms and complications associated with cystic fibrosis.
Cystic fibrosis is caused by mutations in the CFTR gene, leading to defective chloride ion transport across epithelial cells. This
defect results in the production of thick, sticky mucus that can obstruct the airways and ducts in organs such as the lungs and
pancreas. The term "mucoviscidosis" effectively captures the essence of this pathophysiological process.

7. Nurse Faith is administering pancrelipase (Pancreases capsules) to a child with cystic fibrosis. When should Nurse Faith give this
medication?
A. After each bowel movement and following postural drainage.
B. With meals and snacks.
C. Every three hours while awake.
D. Upon awakening, after meals, and at bedtime.
✔Correct answer:
With meals and snacks. Pancrelipase (Pancrease capsules) is a pancreatic enzyme replacement therapy used to aid digestion in
patients with cystic fibrosis. It should be given with meals and snacks to ensure that the enzymes are present in the
gastrointestinal tract when food is ingested. This timing helps facilitate the digestion and absorption of nutrients, particularly fats,
proteins, and carbohydrates, which patients with cystic fibrosis often struggle to digest due to pancreatic insufficiency.
In cystic fibrosis, the thick mucus blocks the pancreatic ducts, preventing digestive enzymes from reaching the intestines. This
leads to malabsorption and nutritional deficiencies. By taking pancrelipase with meals and snacks, the enzymes can mix with the
food and aid in its breakdown, improving nutrient absorption and preventing gastrointestinal symptoms such as steatorrhea
(fatty stools).

8. Nurse Patel is advising Mark, a 10-year-old with cystic fibrosis, about the appropriate dietary regimen to support his health.
What type of diet should Nurse Patel recommend for Mark?
A. A high-calorie diet.
B. A low-fat diet.
C. A high-calorie and high-fat diet.
D. A high-fat diet.
✔Correct answer:
A high-calorie and high-fat diet. Children with cystic fibrosis (CF) have increased energy needs due to their condition, which
affects both respiratory and digestive systems. They often have difficulty absorbing nutrients because of pancreatic insufficiency,
which leads to malabsorption of fats and fat-soluble vitamins. To support their growth and overall health, a diet that is both high
in calories and high in fat is recommended.
Cystic fibrosis affects the CFTR gene, which is crucial for the proper function of chloride channels in various tissues. This
malfunction leads to the production of thick and sticky mucus that blocks ducts in organs such as the pancreas and lungs. The
blockage in the pancreas prevents digestive enzymes from reaching the intestines, leading to malabsorption of nutrients,
particularly fats. Therefore, a high-calorie, high-fat diet helps compensate for these malabsorption issues and meets the increased
energy demands of children with CF.

9. Nurse Sarah is preparing to administer Creon to a 7-year-old patient with cystic fibrosis. She needs to know the appropriate
timing for this medication. When should Nurse Sarah give Creon?
A. Alongside meals and snacks.
B. Two times per day.
C. Before bedtime.
D. Once every morning.
✔Correct answer:
Alongside meals and snacks. Creon is a pancreatic enzyme replacement therapy (PERT) used in cystic fibrosis (CF) patients to aid
in the digestion and absorption of nutrients. It contains a mixture of digestive enzymes, including lipases, proteases, and
amylases, which help break down fats, proteins, and carbohydrates in the food. For maximum effectiveness, Creon must be taken
with every meal and snack to ensure that the enzymes are present in the small intestine when the food arrives, enabling proper
digestion.
In cystic fibrosis, thick mucus blocks the pancreatic ducts, preventing digestive enzymes from reaching the small intestine. This
leads to malabsorption and nutritional deficiencies. Creon provides these necessary enzymes to facilitate digestion. Timing is
crucial because the enzymes need to be in the intestine at the same time as the food to work effectively.

10. Nurse Reynolds is preparing educational materials about cystic fibrosis for a community health seminar. She wants to include
information on the approximate prevalence ratio of the condition. What is the correct prevalence ratio for cystic fibrosis?
A. 1 in 50,000
B. 1 in 2,500
C. 1 in 7,500
D. 1 in 25,000
✔Correct answer:
1 in 2,500. Cystic fibrosis (CF) is a genetic disorder that is most commonly found in individuals of Northern European descent. The
prevalence of cystic fibrosis is approximately 1 in 2,500 live births in this population. This prevalence ratio indicates that cystic
fibrosis is relatively common among genetic disorders, necessitating widespread awareness and early diagnosis for effective
management.
Cystic fibrosis is caused by mutations in the CFTR gene, which is responsible for the production of a protein that regulates the
movement of salt and water in and out of cells. When this gene is mutated, it leads to the production of thick and sticky mucus
that can clog the airways and ducts in various organs, causing severe respiratory and digestive problems.

11. Nurse Laura is explaining the genetic inheritance of cystic fibrosis to a patient's family. She mentions that if one parent has the
disease, does that mean their child has a chance of getting the infection?
A. False
B. True
✔Correct answer:
False. Cystic fibrosis (CF) is a genetic disorder inherited in an autosomal recessive pattern. This means that in order for a child to
develop cystic fibrosis, they must inherit two copies of the defective CFTR gene—one from each parent. If only one parent has
cystic fibrosis (and thus two copies of the defective gene), the parent can only pass one defective gene to their child. The other
parent would need to carry at least one defective CFTR gene for the child to potentially have the disease. Therefore, if the other
parent does not carry a defective CFTR gene, the child cannot have cystic fibrosis.
The CFTR gene provides instructions for making a protein that regulates the movement of salt and water in and out of cells.
Mutations in the CFTR gene disrupt the function of this protein, leading to the production of thick and sticky mucus that can clog
airways and ducts in the lungs, pancreas, and other organs. In an autosomal recessive inheritance pattern, a child must inherit
two defective genes (one from each parent) to manifest the disease.

12. Nurse Stevens is assessing the risk factors for developmental issues in various pediatric clients. She needs to determine which
child is most likely to face developmental challenges. Which client should Nurse Stevens identify as having a high risk for
developmental problems?
A. A 5-year-old with asthma managed on cromolyn sodium.
B. A 2 1/2-year-old boy with cystic fibrosis.
C. A toddler with acute glomerulonephritis being treated with antihypertensives and antibiotics.
D. A preschooler diagnosed with tonsillitis.
✔Correct answer:
A 2 1/2-year-old boy with cystic fibrosis. Cystic fibrosis (CF) is a chronic, progressive, and life-threatening genetic disorder that
primarily affects the lungs and digestive system. Children with cystic fibrosis are at high risk for developmental problems due to
multiple factors associated with the disease. These include frequent hospitalizations, chronic respiratory infections,
malabsorption of nutrients, and the extensive daily treatment regimens required to manage their condition.
Cystic fibrosis is caused by mutations in the CFTR gene, leading to defective chloride channels in epithelial cells. This defect results
in the production of thick, sticky mucus that obstructs the airways and ducts in various organs. The thick mucus can lead to
respiratory infections, decreased lung function, and pancreatic insufficiency, which impacts digestion and nutrient absorption.
These issues can significantly affect a child's growth and development.

13. Nurse Williams is planning the care for a patient with cystic fibrosis, focusing on pulmonary treatments. What is one of the
most crucial pulmonary treatments for this condition?
A. Corticosteroids taken by inhalation.
B. Taking oral enzyme supplements.
C. Performing chest physiotherapy.
D. Inhaled beta agonist medications.
✔Correct answer:
Performing chest physiotherapy. Chest physiotherapy (CPT) is one of the most crucial pulmonary treatments for patients with
cystic fibrosis (CF). CPT helps clear mucus from the lungs, improving breathing and reducing the risk of respiratory infections. This
therapy involves techniques such as percussion (clapping on the chest), vibration, and postural drainage to loosen and mobilize
the thick, sticky mucus characteristic of CF, allowing it to be coughed up or suctioned out more easily.
In cystic fibrosis, the defective CFTR protein causes mucus to become thick and sticky, which can block airways and lead to
chronic infections and inflammation. Regular chest physiotherapy helps maintain lung function by preventing mucus buildup and
facilitating its clearance. This is vital because accumulated mucus provides a breeding ground for bacteria, increasing the risk of
recurrent respiratory infections and lung damage.

14. Nurse Patel is caring for an adult male patient with cystic fibrosis who has been admitted with an acute respiratory infection.
The prescribed treatment includes chest physiotherapy. When should Nurse Patel perform this procedure?
A. Once the secretions have mobilized.
B. During episodes of bronchospasm.
C. Right before a meal.
D. At least two hours after a meal.
✔Correct answer:
At least two hours after a meal. Performing chest physiotherapy (CPT) at least two hours after a meal is recommended to
minimize the risk of nausea and vomiting. Chest physiotherapy involves techniques like percussion, vibration, and postural
drainage to help mobilize and clear mucus from the lungs. Doing this procedure when the stomach is less full reduces discomfort
and the likelihood of gastrointestinal upset, which can be especially important for patients with cystic fibrosis who may already
have digestive issues.
CPT helps in mobilizing and clearing thick mucus from the lungs, which is crucial in managing cystic fibrosis. The timing of CPT is
essential to ensure the patient’s comfort and effectiveness of the therapy. Performing CPT on a full stomach can increase intra-
abdominal pressure and lead to regurgitation, nausea, or vomiting, potentially aspirating stomach contents into the lungs and
complicating respiratory issues.

15. Nurse Adams is providing education to the mother of a 7-year-old with cystic fibrosis regarding the child's medication
regimen. After explaining how to administer enzyme capsules, which statement by the mother suggests she needs more
information?
A. "If the meal has a lot of fat, my child might need an extra enzyme capsule."
B. "My child dislikes taking pills, so I'll mix the capsule into a cup of hot chocolate."
C. "I'll give an enzyme capsule before every meal."
D. "I'll give an enzyme capsule before every snack."
✔Correct answer:
"My child dislikes taking pills, so I'll mix the capsule into a cup of hot chocolate." Mixing enzyme capsules into hot chocolate
indicates a misunderstanding of how to administer pancreatic enzymes. Pancreatic enzyme supplements are essential for children
with cystic fibrosis to aid in the digestion and absorption of nutrients. These enzymes are sensitive to heat, which can destroy
their effectiveness. Therefore, mixing them into hot beverages can render them ineffective.
Pancreatic enzymes help break down fats, proteins, and carbohydrates in the small intestine. For children with cystic fibrosis,
whose pancreatic ducts are often blocked by thick mucus, these enzymes must be taken with meals and snacks to facilitate
proper digestion. Enzyme capsules should be taken with a cold or room temperature food or liquid to preserve their activity.

16. Nurse Kelly is caring for a 3-year-old child with cystic fibrosis who is confined to bed and not permitted to go to the playroom.
Which of the following toys should Nurse Kelly choose for the child?
A. Stuffed animal.
B. Crayons and coloring book.
C. Building blocks.
D. Puzzle with small pieces.
✔Correct answer:
Crayons and coloring book. Crayons and a coloring book are an excellent choice for a 3-year-old child with cystic fibrosis who is
confined to bed. This type of activity is not only age-appropriate but also helps to keep the child engaged and entertained without
posing any health risks. Coloring can provide a calm and creative outlet for the child while they are unable to participate in more
physical activities.
Children with cystic fibrosis can be more susceptible to respiratory infections and may have weakened immune systems. Stuffed
animals can harbor dust and allergens, which could pose a risk to the child's respiratory health. Building blocks and puzzles with
small pieces may present a choking hazard or may be difficult to manage if the child is confined to bed and has limited mobility.

17. Nurse Clara is reviewing the prenatal history of her patient and is identifying potential genetic risk factors. Which finding in
the patient's history would indicate a genetic risk factor?
A. The patient has a child with cystic fibrosis.
B. The patient was exposed to rubella at 36 weeks' gestation.
C. The patient has a history of preterm labor at 32 weeks' gestation.
D. The patient is 25 years old.
✔Correct answer:
The patient has a child with cystic fibrosis. Having a child with cystic fibrosis (CF) indicates a genetic risk factor because CF is an
inherited genetic disorder caused by mutations in the CFTR gene. If a patient has one child with CF, it suggests that both parents
are likely carriers of the mutated CFTR gene. This increases the risk that future children could also inherit the disorder.
Cystic fibrosis is an autosomal recessive disorder, meaning that a child must inherit two copies of the mutated gene (one from
each parent) to develop the condition. If both parents are carriers, there is a 25% chance with each pregnancy that the child will
have cystic fibrosis, a 50% chance that the child will be a carrier, and a 25% chance that the child will have two normal copies of
the gene.

18. Nurse Martinez is reviewing the diagnostic tests for a young patient suspected of having cystic fibrosis. Which test should
Nurse Martinez identify as used to diagnose cystic fibrosis?
A. Chest X-ray
B. Sweat test
C. Echocardiogram
D. Complete blood panel
✔Correct answer:
Sweat test. The sweat test, also known as the sweat chloride test, is the primary diagnostic test used to diagnose cystic fibrosis
(CF). This test measures the concentration of chloride in the sweat. People with cystic fibrosis have elevated levels of chloride in
their sweat due to a malfunctioning CFTR protein, which affects the movement of chloride ions across cell membranes. The sweat
test is considered the gold standard for diagnosing cystic fibrosis.
In cystic fibrosis, mutations in the CFTR gene lead to the production of a defective CFTR protein, which disrupts the normal
transport of chloride and sodium across epithelial cells. This disruption causes the accumulation of thick, sticky mucus in various
organs, particularly the lungs and digestive system. The sweat glands are also affected, resulting in higher-than-normal
concentrations of chloride in the sweat.

19. Nurse Daniels is explaining the treatment plan to Sarah, a 12-year-old with cystic fibrosis, and her parents. She needs to
describe the comprehensive approach to managing cystic fibrosis. Which of the following treatment methods should Nurse
Daniels include?
A. Airway clearance techniques that aim to move the thick mucus from the lungs.
B. Taking special vitamins.
C. Taking pancreatic enzymes to help digest food.
D. All of the choices.
✔Correct answer:
All of the choices. The comprehensive approach to managing cystic fibrosis (CF) includes multiple treatment methods that
address various aspects of the disease. Nurse Daniels should explain that effective management of CF requires a combination of
airway clearance techniques, special vitamins, and pancreatic enzymes, among other interventions.
Cystic fibrosis affects multiple systems in the body, primarily the respiratory and digestive systems. The defective CFTR protein
leads to thick and sticky mucus production, which can block airways and ducts, causing respiratory and digestive complications.

20. Nurse Patel is assessing the stool characteristics of a young patient with cystic fibrosis. The foul-smelling, frothy nature of the
stool is likely due to the presence of large amounts of what?
A. Undigested fats.
B. Digestive enzymes like lipase, trypsin, and amylase.
C. Partially digested carbohydrates.
D. Sodium and chloride components.
✔Correct answer:
Undigested fats. In cystic fibrosis (CF), the thick mucus produced by the body can block the pancreatic ducts, preventing digestive
enzymes from reaching the intestines. This leads to malabsorption, particularly of fats, because the enzymes necessary to break
down fats (lipases) are not adequately present in the intestines. The undigested fats result in stool that is foul-smelling, frothy,
and greasy.
The pancreas normally secretes enzymes like lipase, protease, and amylase into the small intestine to aid in the digestion of fats,
proteins, and carbohydrates. In CF, the blockage of these enzymes causes malabsorption of nutrients, especially fats, leading to
steatorrhea (fatty stools). These fatty stools are characteristic of CF and are typically described as bulky, greasy, and malodorous.
21. Nurse Simmons is reviewing the health records of a group of patients diagnosed with cystic fibrosis to prepare a report on
early detection in her clinic. Based on her records, at what age range is cystic fibrosis typically diagnosed?
A. Childhood years [5-12]
B. Early years [0-5]
C. Adult years [18-50]
D. Teenage years [12-17]
✔Correct answer:
Early years [0-5]. Cystic fibrosis (CF) is typically diagnosed in the early years of life, often before the age of 5. Advances in newborn
screening programs have made it possible to diagnose CF very early, sometimes even within the first few weeks of life. Early
diagnosis is crucial as it allows for the initiation of treatment and management strategies that can significantly improve the
quality of life and prognosis for affected individuals.
Cystic fibrosis is a genetic disorder caused by mutations in the CFTR gene. These mutations result in the production of thick and
sticky mucus that can cause blockages in various organs, particularly the lungs and digestive system. Early detection through
newborn screening, which includes a blood test to check for elevated levels of immunoreactive trypsinogen (IRT), followed by a
sweat chloride test, if necessary, helps identify affected infants quickly. This early diagnosis allows for prompt intervention to
manage symptoms and prevent complications.

22. Nurse Patel is caring for a young patient with cystic fibrosis who is prescribed pancreatic enzymes. To ensure the medication is
effective, when should Nurse Patel administer these enzymes?
A. Four times daily.
B. Three times a day with meals.
C. Once daily in the morning.
D. Once daily at bedtime.
✔Correct answer:
Three times a day with meals. Pancreatic enzymes should be administered with meals to ensure they are present in the digestive
tract when food is ingested. This timing helps the enzymes mix with the food in the stomach and intestines, facilitating the
digestion and absorption of nutrients. In cystic fibrosis, thick mucus blocks the pancreatic ducts, preventing the natural enzymes
from reaching the small intestine, which is why supplementation with pancreatic enzymes is necessary.
Pancreatic enzymes include lipases, proteases, and amylases, which help break down fats, proteins, and carbohydrates,
respectively. When taken with meals, these enzymes help ensure that food is properly digested and that the patient receives
adequate nutrition. Without these enzymes, patients with cystic fibrosis would suffer from malabsorption, leading to poor
growth, weight loss, and nutrient deficiencies.

23. Nurse Taylor is providing education to Amanda, a 15-year-old recently diagnosed with cystic fibrosis, about the various body
systems that may be impacted by her condition. Nurse Taylor needs to identify which systems are affected by cystic fibrosis.
Which of the following should Nurse Taylor include?
A. The sweat glands.
B. All of the choices.
C. The lungs.
D. The pancreas.
✔Correct answer:
All of the choices. Cystic fibrosis (CF) is a genetic disorder that affects the exocrine glands, leading to the production of thick,
sticky mucus. This mucus can cause blockages and infections in various organs and systems of the body. Therefore, all the listed
options are correct as CF impacts multiple systems, including the pancreas, sweat glands, and lungs.
1. Pancreas: In CF, the thick mucus can block the pancreatic ducts, preventing digestive enzymes from reaching the
intestines. This can lead to malabsorption of nutrients, poor growth, and difficulty gaining weight. The blocked ducts can
also cause inflammation and damage to the pancreas, potentially leading to diabetes.
2. Sweat Glands: CF affects the sweat glands by causing them to produce sweat that is saltier than normal. This is due to a
defect in the CFTR protein, which affects salt transport in and out of cells. Patients with CF can lose large amounts of salt
when they sweat, leading to dehydration and electrolyte imbalances.
3. Lungs: The respiratory system is significantly affected by CF. The thick mucus can clog the airways, leading to chronic
respiratory infections, inflammation, and lung damage. This results in symptoms such as persistent coughing, frequent
lung infections, and difficulty breathing.

24. Nurse Thompson is explaining the underlying cause of cystic fibrosis to a patient's family. To clarify the condition's etiology,
what should Nurse Thompson identify as the cause of cystic fibrosis?
A. Autoimmune response
B. Genetic mutation
C. Bacterial infection
D. Viral infection
✔Correct answer:
Genetic mutation. Cystic fibrosis (CF) is caused by a genetic mutation in the CFTR (cystic fibrosis transmembrane conductance
regulator) gene. This gene is responsible for producing a protein that regulates the movement of chloride and sodium ions across
cell membranes. Mutations in the CFTR gene lead to the production of a defective CFTR protein, resulting in the thick, sticky
mucus that characterizes cystic fibrosis. This abnormal mucus affects various organs, particularly the lungs and digestive system.
The CFTR gene mutation disrupts the normal function of the chloride channels, leading to the production of thick and sticky
mucus. In the lungs, this mucus obstructs the airways and creates an environment conducive to chronic infections and
inflammation. In the digestive system, it blocks the pancreatic ducts, preventing digestive enzymes from reaching the intestines
and causing malabsorption of nutrients.

25. Nurse Linda is teaching the mother of a child with cystic fibrosis how to perform postural drainage. What should Nurse Linda
advise?
A. Use the heel of her hand during the percussion.
B. Change the child’s position every twenty minutes.
C. Perform percussion after meals and at bedtime.
D. Use cupped hands during the percussion.
✔Correct answer:
Use cupped hands during the percussion. When performing postural drainage for a child with cystic fibrosis, using cupped hands
during percussion is essential. This technique helps create an air cushion between the hand and the chest wall, producing a gentle
clapping sound that helps loosen mucus in the lungs. This method is more effective and less painful than using a flat hand or the
heel of the hand, ensuring the child remains comfortable during the procedure.
Postural drainage involves positioning the child in specific ways to use gravity to help drain mucus from different parts of the
lungs. Percussion (clapping) with cupped hands helps dislodge mucus from the bronchial walls, making it easier for the child to
cough up and clear the mucus from the airways. This is crucial for preventing infections and maintaining lung function in children
with cystic fibrosis.

Emphysema

1. Nurse Allen is educating Mr. Wallace, a client with emphysema, about the potential side effects of albuterol, a short-acting
beta-agonist that has been prescribed for him. What side effects should Nurse Allen advise Mr. Wallace to be vigilant for?
A. Tachycardia and nervousness.
B. Drowsiness and constipation.
C. Hyperglycemia and weight gain.
D. Hypotension and bradycardia.
✔Correct answer:
Tachycardia and nervousness. Albuterol is a short-acting beta-agonist that works by stimulating beta-2 receptors in the lungs,
leading to bronchodilation and improved airflow. However, it can also have some systemic effects, including an increase in heart
rate (tachycardia) and feelings of nervousness or jitteriness. These side effects occur because albuterol can also stimulate beta-1
receptors in the heart and beta-2 receptors in the skeletal muscles, leading to increased heart rate and muscle tremors.
Therefore, Nurse Allen should advise Mr. Wallace to be vigilant for these potential side effects and to report them if they become
bothersome or severe.

2. Nurse Peter is educating a group of high school students about respiratory health and the dangers of smoking. One student
asks about carbon monoxide. Nurse Peter considers explaining whether carbon monoxide is the waste product expelled from the
body during exhalation. Is this statement accurate?
A. False
B. True
✔Correct answer:
False. Carbon monoxide (CO) is not a waste product expelled from the body during exhalation. The primary waste product
expelled during exhalation is carbon dioxide (CO2). Carbon monoxide is a harmful gas that can be produced by burning fossil
fuels, and it can be particularly dangerous because it binds to hemoglobin more tightly than oxygen does. This can lead to
decreased oxygen delivery to tissues, resulting in hypoxia or even death in severe cases. Therefore, Nurse Peter should clarify that
carbon monoxide is not a waste product expelled during exhalation but is a dangerous gas that can be inhaled from external
sources like cigarette smoke or car exhaust.

3. Nurse Olivia is instructing a patient, Mr. Johnson, who has emphysema, on how to execute pursed-lip breathing. Mr. Johnson is
curious about why this specific technique is recommended for his condition. What rationale should Nurse Olivia offer to explain
the primary purpose of pursed-lip breathing?
A. It aids in preventing premature collapse of the airways.
B. It enhances the strength of the muscles used for inspiration.
C. It minimizes the usage of accessory muscles for breathing.
D. It extends the duration of the inspiratory phase of respiration.
✔Correct answer:
It aids in preventing premature collapse of the airways. Nurse Olivia should explain to Mr. Johnson that the primary purpose of
pursed-lip breathing is to prevent the premature collapse of the airways during exhalation. In emphysema, the elastic fibers in the
lungs are damaged, which makes it difficult to maintain open airways, especially during the exhalation phase. Pursed-lip breathing
creates a sort of back pressure or positive end-expiratory pressure (PEEP) in the airways, which helps keep them open longer. This
allows for more effective removal of stale air and trapped gases, improving overall gas exchange.
4. Nurse Michael is monitoring Mrs. Williams, a 68-year-old patient, two hours following her chest surgery. He notices signs of
subcutaneous emphysema along the suture line and the chest dressing. What is the most appropriate action for Nurse Michael to
take given this observation?
A. Promptly report the finding to the attending physician.
B. Place a compression dressing over the affected area.
C. Take the patient's pulse oximetry readings.
D. Simply document the observed subcutaneous emphysema.
✔Correct answer:
Promptly report the finding to the attending physician. Subcutaneous emphysema following chest surgery is a concerning sign
that may indicate a complication such as a pneumothorax or air leak from the surgical site. It occurs when air escapes into the
subcutaneous tissue, often due to a tear or hole in the respiratory tract. Given that Mrs. Williams is only two hours post-surgery,
the presence of subcutaneous emphysema along the suture line and the chest dressing is a critical finding that requires
immediate attention. Nurse Michael should promptly report this observation to the attending physician for further evaluation
and management.

5. Nurse Martin is caring for Mr. Green, a 70-year-old man newly diagnosed with emphysema. Mr. Green claims he never noticed
any symptoms before his diagnosis. Nurse Martin considers whether it's common for individuals with emphysema to not show
noticeable symptoms. Is this statement accurate?
A. True
B. False
✔Correct answer:
False. Emphysema is a type of Chronic Obstructive Pulmonary Disease (COPD) that generally presents with noticeable symptoms,
especially as the disease progresses. Common symptoms include shortness of breath, wheezing, and chronic cough. These
symptoms are usually significant enough to prompt medical evaluation. While it's possible for early stages of emphysema to be
less symptomatic, the nature of the disease typically leads to symptoms that are noticeable and often debilitating, affecting daily
activities and quality of life.

6. Nurse Karen is responsible for Mark, a 58-year-old male client with emphysema who is on oxygen therapy. Given his condition,
Nurse Karen is vigilant about making sure the oxygen flow rate doesn't surpass a particular limit to prevent complications. What is
the maximum oxygen flow rate she should aim for?
A. Not more than 10 L/min.
B. Not more than 1 L/min.
C. Not more than 2 L/min.
D. Not more than 6 L/min.
✔Correct answer:
Not more than 2 L/min. For patients with emphysema like Mark, it's crucial to maintain a low flow rate of oxygen, generally not
exceeding 2 L/min. The reason for this caution is that patients with chronic obstructive pulmonary diseases (COPD), such as
emphysema, often have a blunted respiratory drive. In a healthy individual, rising levels of carbon dioxide (CO2) in the blood
stimulate the urge to breathe. However, in patients with emphysema, the respiratory system becomes accustomed to higher
levels of CO2, and the primary stimulus for breathing shifts to lower levels of oxygen (hypoxia). Providing too much supplemental
oxygen can suppress this already weakened respiratory drive, leading to a dangerous rise in CO2 levels, a condition known as
hypercapnia.

7. Nurse Amanda is educating her nursing students on various respiratory conditions. When discussing emphysema, she asks her
students to describe the condition. Which statement would be the most accurate description of emphysema?
A. Chronic widening of a bronchus or multiple bronchi.
B. A disorder resulting in a commonly reversible limitation of airflow.
C. A respiratory disorder characterized by the degradation of walls in overly stretched alveoli.
D. The condition is marked by coughing and sputum production lasting a combined total of two or three months for two
consecutive years.
✔Correct answer:
A respiratory disorder characterized by the degradation of walls in overly stretched alveoli. The most accurate description of
emphysema is that it is a respiratory disorder characterized by the degradation or destruction of walls in overly stretched alveoli.
In emphysema, the elastic fibers within the alveoli are damaged, often due to long-term exposure to irritants like cigarette
smoke. This damage leads to the loss of alveolar walls, resulting in larger but fewer alveoli. The destruction of these walls reduces
the surface area available for gas exchange, leading to less effective oxygenation of the blood and removal of carbon dioxide.

8. Nurse Jasmine is attending to David, a 52-year-old male client diagnosed with emphysema. She observes that David is
becoming increasingly restless and confused. Given his condition and symptoms, what is the most appropriate immediate action
for Nurse Jasmine to take?
A. Advise the client to engage in pursed-lip breathing.
B. Elevate the oxygen flow rate for the client.
C. Assess the client's body temperature.
D. Evaluate the client's serum potassium levels.
✔Correct answer:
Advise the client to engage in pursed-lip breathing. Nurse Jasmine should immediately advise David to engage in pursed-lip
breathing. This technique involves inhaling through the nose and exhaling through pursed lips, which helps to improve the
efficiency of each breath by increasing the time spent in the exhalation phase. This is particularly important for patients with
emphysema, as they often have difficulty with air trapping and incomplete exhalation, leading to hyperinflation of the lungs and
decreased gas exchange. Restlessness and confusion in David could be signs of hypoxia, and pursed-lip breathing can help
improve oxygenation.

9. Nurse Lily is teaching a basic anatomy and physiology class to nursing students, focusing on the respiratory system. She
prepares to explain the pathway of air during the process of inspiration. Is it accurate for Nurse Lily to state that, upon inspiration,
air flows through the trachea and then splits into the left and right bronchi?
A. False
B. True
✔Correct answer:
True. Nurse Lily would be accurate in stating that upon inspiration, air flows through the trachea and then splits into the left and
right bronchi. This is the basic anatomical pathway of air during the process of inhalation. The trachea serves as the main airway
that connects the larynx (voice box) to the bronchi, which further divide into smaller bronchioles and eventually lead to the
alveoli where gas exchange occurs.

10. Nurse William is conducting a health education session for a group of young adults. He wants to emphasize the most
significant risk factor for the development of Chronic Obstructive Pulmonary Disease (COPD) to raise awareness. What should
Nurse William highlight as the leading risk factor?
A. Exposure to occupational hazards like fumes and dust.
B. Inherited genetic abnormalities.
C. Habitual cigarette smoking.
D. Prolonged exposure to air pollution.
✔Correct answer:
Habitual cigarette smoking. Nurse William should emphasize that habitual cigarette smoking is the leading risk factor for the
development of Chronic Obstructive Pulmonary Disease (COPD). According to various studies and clinical guidelines, smoking is
responsible for about 85-90% of all COPD cases. The toxins in cigarette smoke cause inflammation and damage to the lung tissue,
leading to chronic bronchitis and emphysema, the two main conditions that make up COPD. Over time, this damage becomes
irreversible, significantly impairing lung function and leading to the symptoms commonly associated with COPD, such as shortness
of breath, chronic cough, and frequent respiratory infections.

11. Nurse Allison is providing consultation to Mr. Harris, a 63-year-old man newly diagnosed with emphysema. Mr. Harris asks if
the disease will stay the same or get worse over time. Should Nurse Allison inform him that once diagnosed, the disease state of
emphysema remains constant?
A. False
B. True
✔Correct answer:
False. Nurse Allison should inform Mr. Harris that emphysema is a progressive disease, meaning it tends to worsen over time.
While treatments can help manage symptoms and slow down the rate of progression, they cannot stop the disease from
advancing altogether. The damage to the alveoli (air sacs in the lungs) is irreversible, and as the disease progresses, lung function
typically declines, leading to increased symptoms and decreased quality of life.

12. Nurse Andrew is talking to Ms. Williams, a 58-year-old woman concerned about developing emphysema due to her proximity
to a factory emitting pollutants. Nurse Andrew considers explaining the leading cause of emphysema cases. Is it accurate for him
to say that the inhalation of environmental air pollutants is the #1 cause of emphysema?
A. True
B. False
✔Correct answer:
False. The leading cause of emphysema is not environmental air pollutants but cigarette smoking. While exposure to air
pollutants, occupational dust, and chemicals can contribute to the development of emphysema, cigarette smoking is by far the
most significant risk factor. According to various studies and guidelines, up to 85-90% of emphysema cases are caused by
smoking. Therefore, Nurse Andrew should inform Ms. Williams that while her proximity to a factory emitting pollutants could be
a concern, smoking remains the primary cause of emphysema.

13. Nurse Olivia is counseling Mrs. Smith, a 65-year-old woman diagnosed with emphysema. Mrs. Smith is hopeful for a complete
cure for her condition. Nurse Olivia needs to provide her with accurate information. Is it correct for Nurse Olivia to say that
emphysema can be completely cured?
A. False
B. True
✔Correct answer:
False. Emphysema is a chronic, progressive lung disease that is part of the broader condition known as Chronic Obstructive
Pulmonary Disease (COPD). Unfortunately, there is no complete cure for emphysema. The damage to the alveoli (air sacs in the
lungs) is irreversible, and the primary goal of treatment is to manage symptoms, improve quality of life, and slow the progression
of the disease. Therefore, Nurse Olivia should inform Mrs. Smith that while her symptoms can be managed and her quality of life
can be improved, a complete cure for emphysema is not currently available.
14. Nurse Murphy gives albuterol (Proventil) to Mr. Thompson, a patient with emphysema, as per the doctor's prescription. How
can Nurse Murphy confirm that the medication is achieving its intended therapeutic effect?
A. Respiratory rate has stabilized at 22 breaths per minute.
B. Urine output is recorded at 40 ml per hour.
C. Heart rate is measured at 100 beats per minute.
D. Pupils are dilated and reactive.
✔Correct answer:
Respiratory rate has stabilized at 22 breaths per minute. Albuterol (Proventil) is a bronchodilator commonly used to treat
conditions like asthma and chronic obstructive pulmonary disease (COPD), which includes emphysema. The medication works by
relaxing the smooth muscles in the airways, allowing them to widen and facilitate better airflow. In a patient with emphysema
like Mr. Thompson, the primary therapeutic effect Nurse Murphy would look for is an improvement in respiratory rate and ease
of breathing. A stabilized respiratory rate at 22 breaths per minute would indicate that the medication is effectively opening up
the airways and improving gas exchange, thus achieving its intended therapeutic effect.

15. Nurse Emily is managing the care of Linda, a 74-year-old patient who has been admitted for acute respiratory distress. Linda's
blood oxygen levels are critically low, and Emily needs to choose an oxygen administration device that will deliver the highest
concentration of oxygen. Which device should Emily opt for?
A. Non-rebreather mask
B. Venturi mask
C. Intranasal catheter
D. Face tent
✔Correct answer:
Non-rebreather mask. Nurse Emily should opt for a non-rebreather mask to deliver the highest concentration of oxygen to Linda.
This type of mask is designed to allow for oxygen concentrations of up to 90-100%. It includes a reservoir bag that collects
oxygen, and one-way valves to prevent exhaled air from entering the bag. This ensures that the patient inhales a high
concentration of pure oxygen, which is crucial for Linda given her critically low blood oxygen levels.

16. Nurse Patrick is evaluating Mr. Stevens, a male client with chronic airflow limitations. Upon inspection, he notices that Mr.
Stevens has a "barrel chest." How should Nurse Patrick interpret this physical characteristic in terms of the client's form of chronic
airflow limitation?
A. The client has chronic obstructive bronchitis.
B. The client has a combination of bronchial asthma and bronchitis.
C. The client has bronchial asthma.
D. The client has emphysema.
✔Correct answer:
The client has emphysema. A "barrel chest" is a physical characteristic commonly associated with emphysema, a form of chronic
obstructive pulmonary disease (COPD). In emphysema, the alveoli (tiny air sacs in the lungs) are damaged, leading to air trapping
and hyperinflation of the lungs. This chronic hyperinflation alters the mechanics of the chest wall, leading to a barrel chest. The
increased anterior-posterior diameter of the chest is a compensatory mechanism to accommodate the larger lung volume.
Therefore, Nurse Patrick should interpret the presence of a barrel chest as indicative of emphysema in Mr. Stevens.
17. Nurse Sophia is conducting an assessment on Mr. Anderson, a 60-year-old client with a known history of emphysema. What
clinical signs would Nurse Sophia most likely anticipate observing in this patient?
A. Cyanotic skin coloration and clubbing of the fingers.
B. The presence of a barrel chest and utilization of pursed-lip breathing.
C. Signs of pitting edema and distended jugular veins.
D. A slow heart rate (bradycardia) and enhanced tactile fremitus.
✔Correct answer:
The presence of a barrel chest and utilization of pursed-lip breathing. Nurse Sophia would most likely anticipate observing a
barrel chest and the utilization of pursed-lip breathing in Mr. Anderson, given his known history of emphysema. A barrel chest is a
physical characteristic commonly seen in emphysema patients due to the chronic overinflation of the lungs. The rib cage expands
to accommodate the increased lung volume, leading to a more rounded, barrel-like appearance of the chest. Pursed-lip breathing
is a technique often used by emphysema patients to improve exhalation and prevent airway collapse, as it creates back pressure
in the airways, helping to keep them open for more effective gas exchange.

18. Nurse Claire is counseling Mr. Lee, a 68-year-old man with advanced emphysema. Mr. Lee is exploring treatment options and
wonders if a lung transplant is his only choice to slow the progression of the disease. Should Nurse Claire confirm that a lung
transplant is the only method to slow down emphysema's progression?
A. True
B. False
✔Correct answer:
False. Nurse Claire should inform Mr. Lee that a lung transplant is not the only method to slow down the progression of
emphysema. While a lung transplant is a treatment option for advanced cases, there are other less invasive treatments and
management strategies available. These include pharmacotherapy (bronchodilators, corticosteroids), pulmonary rehabilitation,
oxygen therapy, and lifestyle changes such as smoking cessation and exercise. Each of these can help manage symptoms and may
slow the progression of the disease to some extent.
19. Nurse Lisa is assessing Mr. Vasquez, a 56-year-old man who has smoked one to two packs of cigarettes daily for the past 40
years. He presents with a chronic cough that produces thick sputum, peripheral edema, and cyanotic nail beds. Based on these
clinical features, which condition is Mr. Vasquez most likely suffering from?
A. Emphysema
B. Asthma
C. Adult Respiratory Distress Syndrome (ARDS)
D. Chronic Obstructive Bronchitis
✔Correct answer:
Chronic Obstructive Bronchitis. Mr. Vasquez's symptoms of a chronic cough producing thick sputum, peripheral edema, and
cyanotic nail beds, along with his long history of smoking, strongly suggest that he is suffering from Chronic Obstructive
Bronchitis. This condition is a type of Chronic Obstructive Pulmonary Disease (COPD) characterized by inflammation of the
bronchi, leading to excessive mucus production and cough. The peripheral edema could be indicative of cor pulmonale, a
condition where the right side of the heart fails due to long-term high blood pressure in the pulmonary arteries, a complication
often seen in severe COPD cases. Cyanotic nail beds indicate poor oxygenation, which is consistent with chronic respiratory
issues.

20. Nurse Emily is leading a seminar on lung cancer and aims to educate her audience on the most common type of lung
carcinoma affecting both men and women. Which carcinoma should she highlight as the most prevalent?
A. Large cell carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Small cell carcinoma
✔Correct answer:
Adenocarcinoma. Adenocarcinoma is the most common type of lung cancer affecting both men and women. It accounts for about
40% of all lung cancer cases. This type of carcinoma originates in the mucus-producing glands in the lungs and is often found in
the outer parts of the lung. Adenocarcinoma is also more common in non-smokers compared to other types of lung cancer,
although smokers are also at risk. Given its prevalence, Nurse Emily should focus on adenocarcinoma to provide the most
relevant information to her audience.

Lung Cancer

1. Nurse Davis is caring for Mrs. Lee, a patient recently admitted with lung cancer. Her husband approaches Nurse Davis to inquire
about his wife's condition. How should Nurse Davis respond to his request?
A. Direct him to speak with the nurse supervisor.
B. Determine what information he is already aware of.
C. Advise him to have a conversation with his wife.
D. Suggest he consult the physician.
✔Correct answer:
Determine what information he is already aware of. When approached by Mrs. Lee's husband, Nurse Davis should first determine
what information he is already aware of regarding his wife's condition. This approach allows Nurse Davis to assess his
understanding, address any gaps in knowledge, and provide accurate and appropriate information within the boundaries of
patient confidentiality and consent. It also helps in identifying any misunderstandings or concerns that he may have, allowing for
a more supportive and informative conversation.
Understanding the patient's current medical condition, treatment plan, and potential outcomes is critical for family members.
Providing clear and accurate information helps them to be better prepared and involved in the patient's care and decision-making
process.

2. Nurse Jordan is explaining to a patient, Mr. Lee, who is scheduled for a navigational bronchoscopy. She outlines the procedure
and its benefits to help ease Mr. Lee's concerns. What is one of the primary benefits of a navigational bronchoscopy?
A. "It uses high-frequency sound waves to create images of the lungs."
B. "It allows for real-time imaging to guide the biopsy of small or hard-to-reach lung lesions."
C. "It involves the injection of a radioactive substance to highlight lung abnormalities."
D. "It is a non-invasive procedure with no need for anesthesia."
✔Correct answer:
"It allows for real-time imaging to guide the biopsy of small or hard-to-reach lung lesions." Navigational bronchoscopy is a
sophisticated procedure that combines advanced imaging technologies with bronchoscopy to allow for precise navigation within
the bronchial tree. This technique enables the physician to reach and biopsy small or difficult-to-access lesions in the lungs, which
might not be easily accessible through traditional bronchoscopy methods. The real-time imaging provides detailed guidance,
ensuring accurate biopsy and diagnosis, which is crucial for effective treatment planning.
The lungs consist of a complex network of airways that become progressively smaller and more intricate. Traditional
bronchoscopy may not always reach these smaller, peripheral airways, especially if the lesion is located deep within the lung
tissue. Navigational bronchoscopy uses electromagnetic navigation and 3D imaging, similar to a GPS system, to guide the
bronchoscope accurately to the targeted area. This ensures that even minute lesions can be biopsied effectively, increasing the
chances of early and accurate diagnosis.
3. Nurse Evans is conducting a routine examination for Mrs. Thompson, a 60-year-old woman who is concerned about her lung
cancer risk due to a long history of smoking one pack of cigarettes a day since she was 18. Mrs. Thompson inquires about
appropriate screening tests for lung cancer. Which statement should Nurse Evans provide?
A. "A low-dose CT scan is recommended for people with a significant smoking history."
B. "You should have a chest X-ray done every year to screen for lung cancer."
C. "Sputum cytology is the best method to screen for lung cancer in smokers."
D. "An MRI of the lungs is the standard screening test for lung cancer."
✔Correct answer:
"A low-dose CT scan is recommended for people with a significant smoking history." The most appropriate screening test for lung
cancer, particularly for individuals with a significant smoking history like Mrs. Thompson, is a low-dose CT (LDCT) scan. Studies
have shown that LDCT scans are more effective than chest X-rays in detecting lung cancer at an early, more treatable stage. The
US Preventive Services Task Force recommends annual lung cancer screening with LDCT for adults aged 50 to 80 years who have a
20 pack-year smoking history and currently smoke or have quit within the past 15 years.
A low-dose CT scan provides detailed images of the lungs using lower amounts of radiation compared to a standard CT scan. It is
sensitive enough to detect small nodules or abnormalities that may not be visible on a chest X-ray. Early detection through LDCT
can significantly improve survival rates by identifying lung cancer before symptoms develop and when it is more likely to be
localized and treatable.

4. Nurse Carter is educating a community group about lung cancer prevention. During the session, she discusses various risk
factors and mentions the significant impact of smoking. She asks the attendees to guess what percentage of lung cancer cases are
attributed to smoking.
A. 63%
B. 50%
C. 87%
D. 94%
✔Correct answer:
87%. Smoking is the leading cause of lung cancer, and it is responsible for a significant majority of cases. According to extensive
research and data from health organizations, approximately 87% of lung cancer cases are attributed to smoking. This high
percentage underscores the critical impact smoking has on lung cancer incidence and highlights the importance of smoking
cessation and prevention efforts in reducing lung cancer rates.
Smoking introduces carcinogens (cancer-causing substances) into the lungs, which can damage the cells lining the lungs. Over
time, this damage can cause mutations in the cellular DNA, leading to uncontrolled cell growth and the development of cancerous
tumors. The carcinogens in tobacco smoke include chemicals like tar, nicotine, and benzene, all of which contribute to the
carcinogenic process.

5. Nurse Thomas is providing education to Mr. Greene, a 55-year-old patient recently diagnosed with lung cancer. He explains the
different types of lung cancer and their associations. Which type of lung cancer is most consistently linked to a history of
smoking?
A. Adenocarcinoma.
B. Squamous cell carcinoma (epidermoid).
C. Undifferentiated carcinoma.
D. Bronchoalveolar carcinoma.
✔Correct answer:
Squamous cell carcinoma (epidermoid). Squamous cell carcinoma, also known as epidermoid carcinoma, is the type of lung
cancer most consistently linked to a history of smoking. This type of cancer typically arises in the central part of the lungs or the
main bronchial tubes and is strongly associated with tobacco exposure. Smoking introduces a variety of carcinogens into the
lungs, leading to cellular mutations and the development of squamous cell carcinoma.
Squamous cell carcinoma originates in the squamous cells that line the airways. When these cells are exposed to carcinogens in
cigarette smoke, they undergo genetic changes that can result in uncontrolled growth and the formation of a tumor. Over time,
the tumor can grow and invade surrounding tissues, leading to symptoms such as cough, chest pain, and difficulty breathing.

6. Nurse Thompson is explaining to Mr. Harris why bronchoscopes sometimes cannot reach tumors within the lung. What is the
most common reason for this limitation?
A. Lung malformations.
B. Tumor size is too small.
C. Narrow bronchi.
D. Presence of scar tissue.
✔Correct answer:
Narrow bronchi. The most common reason bronchoscopes sometimes cannot reach tumors within the lung is the narrowness of
the bronchi. Bronchoscopes are flexible instruments used to view the inside of the airways and conduct procedures such as
biopsies. However, the airways can be very narrow, particularly as they branch further into the lungs. This anatomical limitation
can prevent the bronchoscope from reaching tumors located in the smaller, peripheral bronchi or deeper within the lung tissue.
The bronchi progressively branch into smaller and smaller airways called bronchioles, leading to the alveoli where gas exchange
occurs. The further into the lung the bronchoscopist needs to go, the narrower these airways become. Tumors located in these
distal regions of the lung may be inaccessible to the bronchoscope due to these size constraints.
7. Nurse Daniels is supervising a student nurse who is caring for a client with lung cancer. The client has just received 10 mg of
oxycodone orally for pain management. Which observation by the student nurse should be reported to Nurse Daniels
immediately?
A. Heart rate of 90-100 per minute.
B. Pain level decreased from 6/10 to 2/10.
C. Respiratory rate of 8 to 10 per minute.
D. The client asks for the room door to be closed.
✔Correct answer:
Respiratory rate of 8 to 10 per minute. A respiratory rate of 8 to 10 breaths per minute is significantly lower than the normal
range of 12 to 20 breaths per minute and can indicate respiratory depression, a serious side effect of opioid medications like
oxycodone. Opioids can depress the central nervous system, leading to decreased respiratory drive. This condition can become
life-threatening if not addressed promptly, requiring immediate intervention.
Oxycodone, like other opioids, works by binding to opioid receptors in the brain and spinal cord to reduce pain perception.
However, it also affects the brainstem, which controls breathing. High doses or heightened sensitivity to opioids can suppress the
respiratory centers, leading to hypoventilation and potentially dangerous levels of carbon dioxide retention and oxygen
depletion.

8. Nurse Riley is educating Ms. Parker, a 62-year-old patient recently diagnosed with lung cancer, about the different types of
lung cancer and their prevalence. Which type of lung cancer is the most common?
A. Oat cell carcinoma.
B. Large cell carcinoma.
C. Adenocarcinoma.
D. Squamous cell carcinoma.
✔Correct answer:
Adenocarcinoma. Adenocarcinoma is the most common type of lung cancer, accounting for approximately 40% of all lung cancer
cases. It is a subtype of non-small cell lung cancer (NSCLC) and is more common in women and non-smokers compared to other
types of lung cancer. Adenocarcinoma typically originates in the outer regions of the lungs and can grow more slowly than other
lung cancers, which sometimes makes it more amenable to early detection and treatment.
Adenocarcinoma begins in the mucus-producing glandular cells that line the lungs. It tends to develop in the peripheral areas of
the lungs and is often found in people with a history of smoking, although it is also the most common lung cancer type among
non-smokers. Due to its location and slower growth rate, adenocarcinoma may present with fewer symptoms early on, making
regular screenings crucial for early detection.

9. Nurse Mitchell reviews the case of a 65-year-old woman with a chronic cough and recent complaints of right leg pain. A recent
chest x-ray revealed a spiculated mass in the right middle lobe and mediastinal lymphadenopathy, raising concerns for metastatic
disease. Considering these symptoms and findings, Nurse Mitchell considers the best approach for further diagnostic imaging to
assess for potential metastasis. Which imaging strategy should Nurse Mitchell recommend?
A. A CT scan focusing on the chest, head, and adrenal glands.
B. A comprehensive CT scan of the chest, head, and adrenal glands, alongside a bone scan.
C. A targeted CT scan of the chest only.
D. A CT scan of the chest and head, complemented by a bone scan.
✔Correct answer:
A comprehensive CT scan of the chest, head, and adrenal glands, alongside a bone scan. Given the patient's symptoms and the
findings on the chest X-ray, it is important to thoroughly assess for metastatic disease. Lung cancer commonly metastasizes to the
brain, adrenal glands, and bones, in addition to spreading within the chest. Therefore, a comprehensive imaging strategy that
includes a CT scan of the chest, head, and adrenal glands, as well as a bone scan, is the most appropriate approach. This
combination of imaging studies will provide a detailed assessment of potential metastatic sites.
Lung cancer can metastasize to various parts of the body, leading to secondary tumors. Common sites of metastasis include the
brain, bones, liver, and adrenal glands. The spiculated mass and mediastinal lymphadenopathy seen in the chest X-ray raise the
concern for advanced disease, making it critical to evaluate these areas thoroughly to guide treatment planning.

10. Nurse Davis is discussing lung cancer types with a group of nursing students during a clinical teaching session. She asks them
to identify the most prevalent type of lung cancer affecting both men and women. Which type of lung cancer does Nurse Davis
point out as the most common?
A. Small cell carcinoma, highly aggressive and quickly spreading.
B. Squamous cell carcinoma, often linked to smoking.
C. Adenocarcinoma, typically found in the outer areas of the lungs.
D. Large cell carcinoma, known for its rapid growth.
✔Correct answer:
Adenocarcinoma, typically found in the outer areas of the lungs. Adenocarcinoma is the most common type of lung cancer
affecting both men and women. It is a subtype of non-small cell lung cancer (NSCLC) and typically arises in the outer regions of
the lungs. Adenocarcinoma is more likely to occur in nonsmokers compared to other types of lung cancer, but it is still strongly
associated with smoking. It is characterized by its origin in glandular cells, which are involved in mucus production.
Adenocarcinoma develops from the cells that line the alveoli and make substances such as mucus. These cancer cells form
glandular patterns on histological examination. Because it often grows in the outer parts of the lungs, adenocarcinoma may be
detected at a relatively early stage compared to centrally located tumors, such as squamous cell carcinoma.
11. Nurse Harper is explaining various diagnostic tools to Mr. Jackson, a patient scheduled for an endobronchial ultrasound
(EBUS). What does an Endobronchial Ultrasound help do, and how does it work?
A. An Endobronchial Ultrasound helps place fiducial markers. An x-ray is taken of the lung and lymph nodes, and the
endobronchial ultrasound is used to guide the placement of fiducial markers near the tumor.
B. An Endobronchial Ultrasound evaluates lung function by measuring the volume and speed of air inhaled and exhaled.
C. An Endobronchial Ultrasound assists in staging tumors. A bronchoscope with an ultrasound probe at the tip is inserted into the
lung, and a needle in a special slot is used to biopsy the lymph nodes.
D. An Endobronchial Ultrasound captures images of the lung. A long scope is inserted into the chest cavity, taking 30 images with
a 360-degree rotation. These images are then analyzed by the oncologist.
✔Correct answer:
An Endobronchial Ultrasound assists in staging tumors. A bronchoscope with an ultrasound probe at the tip is inserted into the
lung, and a needle in a special slot is used to biopsy the lymph nodes. An Endobronchial Ultrasound (EBUS) is a minimally invasive
but highly effective procedure used to diagnose and stage lung cancer. It allows doctors to see beyond the bronchial walls and
into the surrounding areas, including the lymph nodes. The bronchoscope, equipped with an ultrasound probe at its tip, is
inserted through the mouth and into the trachea and lungs. The ultrasound helps visualize structures and guide the needle to
take biopsies from lymph nodes or other tissues.
The ability to biopsy lymph nodes is critical for accurately staging lung cancer, determining the extent of disease spread, and
planning appropriate treatment. By using ultrasound, EBUS provides real-time imaging, allowing for precise guidance of the
needle to collect tissue samples without the need for more invasive surgical procedures.

12. Nurse Allen is conducting an educational session for Jane, a 37-year-old patient with uterine cancer, who inquiries about the
most prevalent and deadliest cancers among women. After discussing the most common type, breast cancer, Jane then asks
which type causes the most deaths. How should Nurse Allen respond?
A. Brain cancer
B. Breast cancer
C. Lung cancer
D. Colon and rectal cancer
✔Correct answer:
Lung cancer. Lung cancer is the leading cause of cancer-related deaths among women, as well as men, in the United States and
worldwide. Despite the higher prevalence of breast cancer, lung cancer has a higher mortality rate due to its aggressive nature,
often late diagnosis, and limited effectiveness of current treatments compared to some other cancers.
Lung cancer is particularly deadly because it often goes undetected until it is in an advanced stage. The lungs have a large surface
area and can accommodate significant tumor growth before symptoms appear, leading to late detection. Additionally, lung
cancer tends to metastasize early and spreads to other organs rapidly, which complicates treatment and reduces survival rates.

13. Nurse Taylor is providing care for Mrs. Lopez, who is undergoing chemotherapy in conjunction with surgery for lung cancer.
Which special nursing consideration is not appropriate for patients receiving chemotherapy?
A. Monitoring the IV site where the drugs are administered.
B. Assisting the patient in managing depression related to the diagnosis and treatment.
C. Paying close attention to blood count results.
D. Informing the patient that reactions to chemotherapy are minimal.
✔Correct answer:
Informing the patient that reactions to chemotherapy are minimal. It is inappropriate to inform the patient that reactions to
chemotherapy are minimal because chemotherapy often comes with significant side effects. Chemotherapy drugs are potent and
can cause a range of adverse reactions, including nausea, vomiting, fatigue, hair loss, and myelosuppression (a decrease in the
production of blood cells). Patients need accurate information about potential side effects to prepare for and manage them
effectively. Providing false reassurance could lead to mistrust and inadequate preparation for the challenges of chemotherapy.
Chemotherapy works by targeting rapidly dividing cancer cells, but it also affects other rapidly dividing cells in the body, such as
those in the bone marrow, gastrointestinal tract, and hair follicles. This can lead to side effects like anemia, infections, bleeding,
gastrointestinal issues, and alopecia. Understanding and managing these side effects is a critical aspect of nursing care for
chemotherapy patients.

14. Nurse Angela is conducting a health education session on cancer awareness. She emphasizes the importance of
understanding the leading causes of cancer-related deaths. Which of the following statements accurately reflects the status of
lung cancer?
A. True
B. False
✔Correct answer:
True. Lung cancer is indeed the leading cause of cancer-related deaths worldwide, surpassing deaths from breast, prostate, and
colorectal cancers combined. This statistic underscores the severity of lung cancer and the critical importance of early detection,
prevention, and treatment strategies. Smoking is the primary risk factor, but non-smokers can also develop lung cancer due to
factors like secondhand smoke, radon exposure, and occupational hazards.
Lung cancer typically originates in the cells lining the air passages. It can metastasize quickly to other parts of the body, including
the lymph nodes, brain, liver, and bones, making it particularly deadly. Symptoms often do not appear until the disease is
advanced, which contributes to the high mortality rate.
15. Nurse Taylor is taking the admission history of a 66-year-old patient undergoing chemotherapy for lung cancer who has been
admitted with thrombocytopenia. During the conversation, the patient makes several statements. Which statement should Nurse
Taylor find most concerning?
A. "I've had a decreased appetite since starting chemotherapy."
B. "I take an aspirin every morning for my angina."
C. "I've been bruising more easily since starting chemotherapy."
D. "My bowel movements are soft and dark brown."
✔Correct answer:
"I take an aspirin every morning for my angina." Aspirin is an antiplatelet medication that inhibits platelet aggregation. In a
patient with thrombocytopenia, which is a condition characterized by abnormally low levels of platelets, taking aspirin can
significantly increase the risk of bleeding. Platelets are crucial for blood clotting, and their reduction, coupled with the blood-
thinning effects of aspirin, can lead to severe hemorrhagic complications. Therefore, Nurse Taylor should be most concerned
about this statement and should immediately discuss it with the healthcare provider to review the patient's medication regimen.
Platelets, or thrombocytes, are small blood cells that play a key role in hemostasis, the process of blood clotting to stop bleeding.
Thrombocytopenia can occur due to various factors, including chemotherapy, which can suppress bone marrow function and
reduce platelet production. Aspirin further impairs platelet function by irreversibly inhibiting cyclooxygenase-1 (COX-1), an
enzyme involved in the production of thromboxane A2, which is essential for platelet aggregation.

16. Nurse Susan is explaining advanced diagnostic procedures to Mr. Li, a patient scheduled for a bronchoscopy. She describes
autofluorescence bronchoscopy and its purpose. What does an autofluorescence bronchoscopy do?
A. It shows where treatment is being administered within the lung.
B. It is a diagnostic tool utilizing X-ray imaging to detect lung abnormalities.
C. It illuminates cancer cells, revealing cells that have not yet formed a tumor.
D. It lights up the path for the bronchoscope to follow.
✔Correct answer:
It illuminates cancer cells, revealing cells that have not yet formed a tumor. Autofluorescence bronchoscopy is an advanced
diagnostic technique used to detect early-stage lung cancer and precancerous lesions. This procedure involves the use of a
bronchoscope equipped with special light sources that cause abnormal cells to fluoresce (emit light) differently than normal cells.
This difference in fluorescence allows for the identification of abnormal or cancerous cells that may not yet have formed a visible
tumor, facilitating early detection and treatment.
Under autofluorescence bronchoscopy, normal bronchial tissue emits a green fluorescence when exposed to specific wavelengths
of light, whereas abnormal or cancerous tissue emits a red or brown fluorescence. This contrast in fluorescence helps in detecting
subtle changes in the bronchial epithelium that may indicate early malignancy or pre-malignant conditions. Early detection is
crucial for improving treatment outcomes and survival rates in lung cancer patients.

17. Nurse Alvarez is caring for Mr. Thompson, a patient in the terminal stages of lung cancer who has started to lose
consciousness. What should be Nurse Alvarez’s primary concern at this stage?
A. Insert an airway.
B. Elevate the head of the bed.
C. Discontinue all pain medications.
D. Ensure the patient is protected from injury.

✔Correct answer:
Ensure the patient is protected from injury. As Mr. Thompson is in the terminal stages of lung cancer and has started to lose
consciousness, the primary concern for Nurse Alvarez should be ensuring the patient’s safety and protecting him from injury. This
includes preventing falls, avoiding pressure sores, and ensuring that the environment is safe and free from hazards that could
cause harm to the patient. Protecting from injury is crucial in providing comfort and maintaining dignity in the end-of-life stage.
In the terminal stages of lung cancer, patients often experience significant weakness, reduced responsiveness, and altered levels
of consciousness. These changes increase the risk of injury due to falls, pressure ulcers from prolonged immobility, and aspiration
if the patient is unable to manage secretions effectively.

18. Nurse Hernandez is discussing interventional pulmonology with a group of nursing students during a lecture. She asks them to
identify the accurate statement about this specialized field. Which statement is correct regarding interventional pulmonology?
A. Interventional pulmonology eliminates the need for traditional lung surgery in all cases.
B. It is used to evaluate shortness of breath and can be applied to lung cancer, breast cancer, colon cancer, renal cancer, and
melanoma.
C. CTCA was the first to integrate interventional pulmonology with various cancer treatments.
D. It improves the likelihood of a cure by 29%.
✔Correct answer:
It is used to evaluate shortness of breath and can be applied to lung cancer, breast cancer, colon cancer, renal cancer, and
melanoma. Interventional pulmonology is a subspecialty of pulmonary medicine that focuses on the use of minimally invasive
techniques to diagnose and treat conditions of the lungs and airways. One of its primary uses is the evaluation and management
of shortness of breath (dyspnea), which can be a symptom of various cancers, including lung cancer, breast cancer, colon cancer,
renal cancer, and melanoma, especially when these cancers metastasize to the lungs or cause pleural effusions or airway
obstruction. Interventional pulmonology procedures include bronchoscopy, endobronchial ultrasound (EBUS), and various
therapeutic interventions to relieve airway obstructions and manage pleural diseases.
Shortness of breath can result from multiple pathologies within the respiratory system, including tumors obstructing the airways,
fluid accumulation in the pleural space (pleural effusion), or metastatic lesions in the lungs. By using techniques such as
bronchoscopy, interventional pulmonologists can directly visualize and treat these issues, providing relief from symptoms and
improving the patient’s quality of life.

19. During a teaching seminar on lung cancer, Nurse Thompson is describing different types of lung cancer to her students. She
focuses on one type known for its rapid growth and tendency to develop in the peripheral areas of the lungs. Which type of lung
cancer is Nurse Thompson explaining?
A. Large cell carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Bronchoalveolar carcinoma
✔Correct answer:
Large cell carcinoma. Nurse Thompson is describing large cell carcinoma, which is known for its rapid growth and tendency to
develop in the peripheral areas of the lungs. Large cell carcinoma is a type of non-small cell lung cancer (NSCLC) characterized by
large, undifferentiated cells. It can grow quickly and spread to other parts of the body, making it more aggressive compared to
other NSCLC subtypes.
Large cell carcinoma often occurs in the outer regions of the lungs and can grow and spread rapidly. Its cells are large and lack
specific features that classify them into other categories of lung cancer. This type of cancer can be more challenging to treat due
to its aggressive nature and tendency to metastasize early.

20. Nurse Thompson, a home health nurse, is visiting Mrs. Williams, a home care client with advanced lung cancer. During her
assessment, Nurse Thompson notices that Mrs. Williams is wheezing, has a bradycardic heart rate, and a respiratory rate of 10
breaths per minute. These symptoms are indicative of which condition?
A. Presence of hypoxia.
B. Condition of hyperventilation.
C. State of semiconsciousness.
D. Signs of delirium.
✔Correct answer:
Presence of hypoxia. Hypoxia is a condition in which there is an insufficient oxygen supply to the tissues of the body. This
condition can cause a variety of symptoms, including wheezing, bradycardia (slow heart rate), and a low respiratory rate (in this
case, 10 breaths per minute). Mrs. Williams' advanced lung cancer could impair lung function, leading to inadequate oxygenation
and resultant hypoxia.
Oxygen is essential for cellular metabolism and function. The lungs are responsible for oxygenating the blood and removing
carbon dioxide. When lung function is compromised, as in the case of advanced lung cancer, the oxygen levels in the blood drop,
leading to hypoxia. The body's response to low oxygen levels includes alterations in heart and respiratory rates in an attempt to
compensate for the lack of oxygen.

21. Nurse Roberts is preparing a patient for an MRI scan due to suspected lung cancer. She reviews the patient's medical history
to identify any potential contraindications for the MRI procedure. Which of the following would be a contraindication for
proceeding with the MRI?
A. The patient has a pacemaker implanted.
B. The patient is currently taking antipsychotic medication.
C. The patient has a known allergy to shellfish.
D. The patient suffers from claustrophobia.
✔Correct answer:
The patient has a pacemaker implanted. An MRI (Magnetic Resonance Imaging) scan uses strong magnetic fields and radio waves
to generate detailed images of the inside of the body. The presence of a pacemaker is a significant contraindication for MRI
because the magnetic fields can interfere with the functioning of the pacemaker, potentially leading to life-threatening situations
or damage to the device. Modern MRI-compatible pacemakers exist, but the specific type and compatibility must be confirmed
before proceeding.
MRI scanners create a powerful magnetic field around the patient. For patients with pacemakers or other implanted metallic
devices, this magnetic field can cause malfunction, movement, or heating of the device. This can disrupt the pacemaker's ability
to regulate the heart's rhythm or even cause injury to the patient.

22. Nurse Kelly is discussing treatment options with Ms. Roberts, a patient diagnosed with lung cancer. She mentions
intratumoral chemotherapy and its specific uses. For which condition is intratumoral chemotherapy typically utilized?
A. As a primary intervention for asthma flare-ups.
B. Non-small cell carcinoma of the lung.
C. Small cell carcinoma of the lung.
D. To alleviate pulmonary hypertension not related to cancer.
✔Correct answer:
Non-small cell carcinoma of the lung. Intratumoral chemotherapy is a localized treatment method where chemotherapy drugs are
directly injected into the tumor. This approach is particularly utilized for non-small cell carcinoma (NSCLC) of the lung. The direct
administration of chemotherapy into the tumor site allows for a higher concentration of the drug to be delivered to the cancer
cells, potentially reducing systemic side effects and enhancing the drug's effectiveness against the tumor.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for approximately 85% of all lung cancer
cases. It includes subtypes such as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Intratumoral
chemotherapy targets the tumor mass directly, which can help in shrinking the tumor and alleviating symptoms caused by the
tumor's growth and pressure on surrounding structures.

23. Nurse Smith is assessing a patient with lung cancer who has developed Horner’s syndrome due to tumor invasion affecting
the sympathetic nerve ganglia. Which signs and symptoms should Nurse Smith look for?
A. Hoarseness and difficulty swallowing.
B. Pupil constriction, partial drooping of the eyelid, and lack of sweating on the affected side of the face.
C. Pain in the arm and shoulder, and muscle atrophy in the arm and hand on the affected side.
D. Chest pain, shortness of breath, cough, weight loss, and fever.
✔Correct answer:
Pupil constriction, partial drooping of the eyelid, and lack of sweating on the affected side of the face. Horner’s syndrome is a
neurological condition that arises from disruption of the sympathetic nerves supplying the eye and face, often due to a tumor
invading the sympathetic nerve ganglia. The classic triad of symptoms associated with Horner’s syndrome includes ptosis (partial
drooping of the upper eyelid), miosis (constriction of the pupil), and anhidrosis (lack of sweating) on the affected side of the face.
The sympathetic nerves responsible for these functions run from the brain, down the spinal cord, and then up to the face. When
a lung cancer tumor invades or compresses the sympathetic nerve ganglia, particularly in the upper chest or neck, it can interrupt
the nerve pathways, leading to the characteristic signs of Horner’s syndrome.

24. Nurse Williams is leading an education session for a group of smokers in a "stop smoking" class. She discusses common
symptoms of lung cancer. Which symptom should Nurse Williams highlight as a common sign of lung cancer?
A. Persistent cough or a change in a chronic cough.
B. Foamy, blood-streaked sputum.
C. Shortness of breath with exertion.
D. Wheezing during inspiration.
✔Correct answer:
Persistent cough or a change in a chronic cough. One of the most common symptoms of lung cancer is a persistent cough that
does not go away or a change in the nature of a chronic cough. Smokers often have a chronic cough, so noticing changes in the
cough’s intensity, frequency, or character can be significant. This symptom is important to highlight because it can be an early
indication of lung cancer, prompting individuals to seek medical evaluation sooner.
Lung cancer can irritate the airways or cause obstruction, leading to a persistent cough. Tumors in the lung can also cause
inflammation and irritation of the bronchial lining, leading to changes in cough patterns. Recognizing these changes early can lead
to earlier diagnosis and treatment, potentially improving outcomes.

25. Nurse Miller is discussing common types of cancer with Mr. Evans, a 58-year-old patient concerned about his health risks. She
explains which cancer is the most common and deadly for males in their fifth to seventh decades of life. Which cancer is Nurse
Miller referring to?
A. Bowel cancer.
B. Lung cancer.
C. Pancreatic cancer.
D. Prostate cancer.
✔Correct answer:
Lung cancer. Nurse Miller is referring to lung cancer as the most common and deadly cancer for males in their fifth to seventh
decades of life. Lung cancer is the leading cause of cancer death among men, primarily because it is often diagnosed at an
advanced stage when treatment options are limited, and the prognosis is poor. Despite advances in diagnosis and treatment, lung
cancer has a high mortality rate, making it a significant health concern for this age group.
Lung cancer typically originates in the cells lining the air passages. It can be categorized into two main types: non-small cell lung
cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is more common and generally has a better prognosis than SCLC, which
tends to be more aggressive. Risk factors for lung cancer include smoking, exposure to secondhand smoke, radon, asbestos, and
other environmental toxins.

Pneumonia

1. Nurse Kelly is preparing to care for a patient diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. To
ensure proper infection control measures are in place, what type of isolation should Nurse Kelly implement for this patient?
A. Contact isolation.
B. Respiratory isolation.
C. Standard precautions.
D. Reverse isolation.
✔Correct answer:
Contact isolation. Nurse Kelly should implement contact isolation for a patient diagnosed with methicillin-resistant
Staphylococcus aureus (MRSA) pneumonia. MRSA is a highly contagious and antibiotic-resistant bacterium that can be
transmitted through direct contact with infected bodily fluids or contaminated surfaces. Contact isolation is essential to prevent
the spread of MRSA to other patients, healthcare workers, and visitors.
MRSA is a type of Staphylococcus aureus bacteria that has developed resistance to methicillin and other antibiotics. It can cause
various infections, including pneumonia, which can be severe, particularly in hospitalized or immunocompromised patients.
MRSA is primarily spread through direct skin-to-skin contact or indirect contact with contaminated objects, making contact
isolation crucial in preventing transmission.

2. Nurse Chen is admitting Emma, a 7-year-old patient, to the pediatric unit with a diagnosis of bacterial pneumonia. As Nurse
Chen conducts the initial assessment, which of the following findings would she most likely anticipate observing in Emma's
condition?
A. An elevated body temperature indicating a significant fever.
B. A persistent dry cough without sputum production.
C. Gastrointestinal distress manifesting as emesis and loose stools.
D. Inflammation and congestion of the nasal passages.
✔Correct answer:
An elevated body temperature indicating a significant fever. In a child with bacterial pneumonia, an elevated body temperature
or significant fever is a common and expected finding. Fever is a typical response of the body to infection, including bacterial
infections like pneumonia. The presence of a fever helps the body fight the infection by creating an environment less favorable
for bacterial growth and by enhancing the immune response.
Bacterial pneumonia causes inflammation of the lung parenchyma and alveoli, leading to symptoms such as fever, productive
cough, difficulty breathing, and chest pain. The immune system responds to the bacterial infection by releasing pyrogens, which
raise the body's temperature set point in the hypothalamus, resulting in a fever.

3. Nurse Patel is monitoring four clients in a step-down intensive care unit. She needs to identify which client is at the highest risk
for developing nosocomial pneumonia. Which client should Nurse Patel be most concerned about?
A. The client who is intubated and on a ventilator.
B. The client receiving feedings through a jejunostomy tube.
C. The client with a respiratory infection.
D. The client with pleural chest tubes.
✔Correct answer:
The client who is intubated and on a ventilator. Nurse Patel should be most concerned about the client who is intubated and on
a ventilator. Intubated patients are at the highest risk for developing nosocomial pneumonia, specifically ventilator-associated
pneumonia (VAP). The presence of an endotracheal tube provides a direct pathway for bacteria to enter the lower respiratory
tract, bypassing the body’s natural defense mechanisms.
Ventilator-associated pneumonia (VAP) occurs in patients who have been on mechanical ventilation for more than 48 hours. The
endotracheal tube can become colonized with bacteria, which can then enter the lungs and cause infection. Additionally, the
ventilator can impair normal clearance of secretions, further increasing the risk of infection. Prevention of VAP is crucial and
includes measures such as elevating the head of the bed, providing oral care with chlorhexidine, and ensuring proper hand
hygiene.

4. Nurse Thompson is assessing a 5-month-old baby girl brought in by her mother. The baby has been sleeping excessively, has a
decreased appetite, and has had a cold and fever for over a week. After evaluation, the physician diagnoses pneumonia. Based on
the presented symptoms, how should Nurse Thompson classify the severity of the baby's condition?
A. Pneumonia: characterized by cough and colds.
B. Severe pneumonia.
C. Very severe pneumonia.
D. Moderate pneumonia.
✔Correct answer:
Severe pneumonia. The symptoms presented by the 5-month-old baby girl—excessive sleeping (lethargy), decreased appetite, a
prolonged cold, and fever—indicate a more severe form of pneumonia. In infants, severe pneumonia often presents with general
signs of illness such as lethargy and poor feeding, in addition to respiratory symptoms. The extended duration of symptoms and
the presence of fever for over a week are also concerning indicators of severe pneumonia.
In infants, pneumonia can rapidly progress from mild to severe due to their underdeveloped immune systems and smaller
airways. Severe pneumonia is characterized by significant clinical symptoms that may include lethargy, difficulty feeding, high
fever, and signs of respiratory distress. Early recognition and treatment are crucial to prevent further complications.

5. Nurse Morgan is assessing tactile fremitus in a client diagnosed with pneumonia. To accurately perform this assessment, which
part of her hand should she use?
A. The pads of her fingers
B. The ulnar edge of her hand
C. The tips of her fingers
D. The back of her hand
✔Correct answer:
The ulnar edge of her hand. Nurse Morgan should use the ulnar edge of her hand to assess tactile fremitus in a client diagnosed
with pneumonia. The ulnar edge, or the side of the hand along the little finger, is the most effective part of the hand for detecting
vibrations transmitted through the chest wall when the patient speaks. This technique helps identify changes in lung density, such
as those caused by pneumonia.
Tactile fremitus is the palpable vibration of the chest wall that occurs during phonation (when the patient speaks). It is assessed
by asking the patient to say a phrase such as "ninety-nine" while the nurse palpates different areas of the chest with the ulnar
edge of her hand. Increased tactile fremitus can indicate areas of lung consolidation, such as in pneumonia, where the lung tissue
becomes dense and transmits sound vibrations more effectively.
6. Nurse Adams is caring for Mr. Thompson, a client with AIDS who has developed bacterial pneumonia and is currently in the
emergency department. Mr. Thompson's initial arterial blood gas results show a PaO2 of 80 mmHg, but a subsequent test reveals
a drop to 65 mmHg. What should Nurse Adams do?
A. Increase the flow rate of oxygen.
B. Request another arterial blood gas test to confirm the accuracy.
C. Reduce the tension of oxygen in the plasma.
D. Notify the physician immediately.
✔Correct answer:
Notify the physician immediately. Nurse Adams should notify the physician immediately. A drop in PaO2 from 80 mmHg to 65
mmHg indicates a significant decrease in the patient's oxygenation, which can be life-threatening and requires prompt medical
attention. The physician needs to be informed to assess the situation and make decisions about further diagnostic tests,
adjustments to the treatment plan, and any additional interventions that may be necessary to stabilize Mr. Thompson’s
condition.
PaO2 (partial pressure of oxygen in arterial blood) is a measure of how well oxygen is able to move from the lungs to the blood. A
normal PaO2 range is typically 75-100 mmHg. A drop to 65 mmHg signifies hypoxemia, indicating that Mr. Thompson's lungs are
not effectively oxygenating the blood, which can lead to respiratory distress and other complications. This is especially critical in a
patient with AIDS and bacterial pneumonia, as their immune system is already compromised.

7. Nurse Karen is assessing a 3-month-old infant who presents with respiratory symptoms. To determine if the child has non-
severe pneumonia, she needs to evaluate the respiratory rate. What respiratory rate should Nurse Karen expect to find in a child
of this age with non-severe pneumonia?
A. 60 breaths per minute
B. 40 breaths per minute
C. 20 breaths per minute
D. 80 breaths per minute
✔Correct answer:
60 breaths per minute. In a 3-month-old infant, a respiratory rate of 60 breaths per minute is indicative of non-severe
pneumonia. According to the World Health Organization (WHO) guidelines, tachypnea, or rapid breathing, is defined as a
respiratory rate of 60 breaths per minute or more in infants less than 2 months old and 50 breaths per minute or more in infants
aged 2 to 12 months. Therefore, a respiratory rate of 60 breaths per minute in a 3-month-old falls within the range that suggests
non-severe pneumonia.
Non-severe pneumonia in infants typically presents with an increased respiratory rate as the body attempts to compensate for
impaired gas exchange due to inflammation and infection in the lungs. Recognizing and assessing the respiratory rate is crucial for
early identification and treatment to prevent the condition from worsening.

8. Nurse Johnson is preparing a care plan for Mr. Rodriguez, a patient diagnosed with pneumonia. What is the most appropriate
nursing diagnosis for this patient?
A. Impaired gas exchange.
B. Decreased tissue perfusion.
C. Risk for infection.
D. Fluid volume deficit.
✔Correct answer:
Impaired gas exchange. The most appropriate nursing diagnosis for a patient diagnosed with pneumonia is "Impaired gas
exchange." Pneumonia is an infection that inflames the air sacs in one or both lungs, which can fill with fluid or pus, leading to
impaired oxygen and carbon dioxide exchange. This condition directly affects the patient's ability to adequately oxygenate the
blood and remove carbon dioxide, leading to symptoms such as shortness of breath, hypoxia, and altered blood gases.
In pneumonia, the alveoli (air sacs) in the lungs become inflamed and filled with fluid or pus due to the infection. This
inflammation and fluid accumulation hinder the exchange of gases in the alveoli, resulting in decreased oxygen levels in the blood
(hypoxemia) and potential buildup of carbon dioxide (hypercapnia). Effective gas exchange is crucial for maintaining cellular
function and overall homeostasis.

9. Nurse Patel is reviewing cases of community-acquired pneumonia in the clinic and notes a rise in certain types during the
summer and fall seasons. Which type of pneumonia should Nurse Patel recognize as having the highest occurrence during these
seasons?
A. Viral pneumonia.
B. Streptococcal (pneumococcal) pneumonia.
C. Mycoplasma pneumonia.
D. Legionnaires’ disease.
✔Correct answer:
Legionnaires’ disease. Nurse Patel should recognize that Legionnaires’ disease, caused by the bacterium Legionella pneumophila,
has the highest occurrence during the summer and early fall seasons. This type of pneumonia is often associated with
contaminated water sources, such as air conditioning systems, hot tubs, and water tanks, which are more frequently used and
maintained during warmer weather. Outbreaks tend to occur more commonly in these seasons due to the bacteria thriving in
warm water environments.
Legionella pneumophila is a waterborne pathogen that proliferates in warm, stagnant water. People can become infected by
inhaling aerosols or mist containing the bacteria, which then colonizes the lungs and causes severe pneumonia. Symptoms of
Legionnaires’ disease include high fever, chills, cough, muscle aches, and headaches. Early diagnosis and treatment with
appropriate antibiotics are crucial for managing this condition.

10. Nurse Emily is formulating a care plan for Ms. Johnson, a hospitalized patient suffering from bacterial pneumonia and
experiencing shortness of breath. Which of the following nursing diagnoses would be most appropriate for her condition?
A. Risk for self-care deficit related to fatigue.
B. Deficient fluid volume related to nausea and vomiting.
C. Ineffective cardiopulmonary tissue perfusion related to myocardial damage.
D. Disturbed thought processes related to inadequate relief of chest pain.
✔Correct answer:
Risk for self-care deficit related to fatigue. In the context of Ms. Johnson's bacterial pneumonia and associated symptoms, "Risk
for self-care deficit related to fatigue" is an appropriate nursing diagnosis. Pneumonia often causes significant fatigue and
weakness, which can hinder a patient's ability to perform daily self-care activities such as bathing, dressing, and eating.
Bacterial pneumonia leads to infection and inflammation in the lungs, which can cause symptoms such as fever, shortness of
breath, and fatigue. The body's immune response to infection and the increased work of breathing can deplete energy reserves,
resulting in profound fatigue. This fatigue can impact the patient's ability to engage in self-care activities, making them more
dependent on assistance from healthcare providers or caregivers.

11. Mr. Thompson is admitted to the hospital with a diagnosis of pneumonia and COPD. The physician prescribes oxygen therapy
for him. What is the most comfortable method of delivering oxygen to Mr. Thompson?
A. Using a partial rebreathing mask.
B. Using a nasal catheter.
C. Using a nasal cannula.
D. Using a croupette.
✔Correct answer:
Using a nasal cannula. The most comfortable method of delivering oxygen to Mr. Thompson, who has pneumonia and COPD, is
using a nasal cannula. A nasal cannula is a lightweight, flexible tube with prongs that fit into the nostrils. It is often preferred for
patients requiring low to moderate levels of supplemental oxygen because it allows them to talk, eat, and drink comfortably while
receiving oxygen therapy.
The nasal cannula can deliver oxygen at flow rates of 1 to 6 liters per minute, providing an oxygen concentration of approximately
24% to 44%. For patients with COPD, it is essential to maintain a careful balance to avoid suppressing the respiratory drive, as
they often rely on hypoxic drive to stimulate breathing. The nasal cannula allows for precise titration of oxygen levels to maintain
adequate oxygenation without causing respiratory depression.

12. Nurse Emily is caring for a 20-year-old patient undergoing treatment for pneumonia. The patient has a persistent cough and
reports severe pain associated with coughing. What advice should Nurse Emily give to help reduce the patient's discomfort?
A. "Limit your fluid intake to reduce sputum production."
B. "Try to suppress your cough as much as possible."
C. "Keep the head of your bed flat to assist with coughing."
D. "Use a pillow to splint your chest for added comfort."
✔Correct answer:
"Use a pillow to splint your chest for added comfort." Nurse Emily should advise the patient to use a pillow to splint their chest
when coughing. This technique involves holding a pillow firmly against the chest to provide support and reduce pain during
coughing. Splinting can help minimize the discomfort associated with the movement of the chest wall and reduce the strain on
the muscles and tissues involved in coughing.
Coughing generates significant pressure changes in the chest, which can cause pain, especially if the chest wall or underlying
tissues are inflamed or injured, as is often the case with pneumonia. By splinting the chest with a pillow, the patient can stabilize
the chest wall, reduce movement, and alleviate some of the pain associated with coughing.

13. Nurse Lisa is managing a male client with pneumonia who has developed respiratory failure, presenting with a partial pressure
of arterial oxygen (PaO2) of 55 mm Hg. The client is now on mechanical ventilation with an FIO2 of 0.9. What should be Nurse
Lisa's goal for reducing the FIO2 to a safer level?
A. 0.7
B. 0.21
C. 0.35
D. 0.5
✔Correct answer:
0.5. Nurse Lisa's goal should be to reduce the fraction of inspired oxygen (FIO2) to 0.5, which is considered a safer level for long-
term mechanical ventilation. An FIO2 of 0.9 (90% oxygen) is very high and can lead to oxygen toxicity if maintained for extended
periods. Oxygen toxicity can cause damage to the lungs and other organs due to the formation of reactive oxygen species.
The normal FIO2 in room air is 0.21 (21% oxygen). For patients on mechanical ventilation, it is often necessary to use higher levels
of FIO2 to maintain adequate oxygenation. However, prolonged exposure to high levels of FIO2 can result in oxygen toxicity,
which can damage lung tissue and lead to complications such as acute respiratory distress syndrome (ARDS) or absorption
atelectasis. Reducing FIO2 to 0.5 (50%) is a target level that balances the need to provide sufficient oxygen while minimizing the
risk of toxicity.
14. Mr. Adams is admitted to an acute care facility with pneumococcal pneumonia. The patient in the adjacent room is being
treated for mycoplasmal pneumonia. Although the causes of these types of pneumonia differ, what common feature do they
share?
A. Responsiveness to penicillin
B. Elevated white blood cell (WBC) count
C. Sudden onset
D. Inflamed lung tissue
✔Correct answer:
Inflamed lung tissue. The common feature shared by both pneumococcal pneumonia and mycoplasmal pneumonia is inflamed
lung tissue. Pneumonia, regardless of the causative agent, results in inflammation of the alveoli and the surrounding lung tissue.
This inflammation leads to the typical symptoms of pneumonia, such as cough, fever, chest pain, and difficulty breathing.
Pneumonia involves infection and inflammation of the lung parenchyma, leading to the accumulation of fluid and immune cells in
the alveoli. This process impairs gas exchange and causes respiratory symptoms. In pneumococcal pneumonia, caused by
Streptococcus pneumoniae, and mycoplasmal pneumonia, caused by Mycoplasma pneumoniae, the body's immune response to
these pathogens results in inflammation and consolidation of the lung tissue.

15. Nurse Patel is caring for Jake, a 32-year-old firefighter admitted to the ICU. Jake was involved in extinguishing a house fire 48
hours ago and was initially treated for smoke inhalation. Now, he has developed severe hypoxia requiring intubation and
mechanical ventilation. Based on this clinical presentation, which condition has Jake most likely developed?
A. Acute respiratory distress syndrome (ARDS)
B. Pneumonia
C. Atelectasis
D. Bronchitis
✔Correct answer:
Acute respiratory distress syndrome (ARDS). Based on Jake's clinical presentation of severe hypoxia requiring intubation and
mechanical ventilation, along with his recent history of smoke inhalation from a house fire, the most likely condition he has
developed is Acute Respiratory Distress Syndrome (ARDS). ARDS is a severe and sudden condition characterized by widespread
inflammation in the lungs, leading to fluid buildup in the alveoli, which impairs gas exchange and results in severe hypoxia.
ARDS can be triggered by various insults to the lungs, including smoke inhalation. The inhalation of toxic fumes and particulate
matter from the fire can cause direct injury to the lung tissue, leading to an inflammatory response. This response increases the
permeability of the pulmonary capillaries, causing fluid to leak into the alveoli and resulting in impaired oxygenation. The
hallmark of ARDS is the rapid onset of severe respiratory distress, refractory hypoxemia (low blood oxygen that does not improve
with oxygen therapy), and bilateral infiltrates on chest imaging.

16. Nurse Jackson is monitoring a postoperative client whose priority care involves respiratory hygiene to prevent complications.
Without proper gas exchange, the client is at high risk of developing severe atelectasis and eventually pneumonia. Achieving this
goal is dependent on effective pain management. What should Nurse Jackson watch for as an indicator of inadequate gas
exchange?
A. Pallor
B. Dyspnea
C. Involuntary muscle spasms
D. Increased temperature
✔Correct answer:
Dyspnea. Dyspnea, or difficulty breathing, is a primary indicator of inadequate gas exchange. This symptom signals that the
patient is struggling to breathe effectively, which can lead to hypoxia (insufficient oxygen in the blood) and hypercapnia (excess
carbon dioxide in the blood). In the postoperative setting, effective pain management is crucial to encourage deep breathing and
coughing, which help maintain proper lung expansion and clear secretions. Without proper gas exchange, the patient is at high
risk for developing atelectasis (collapsed lung tissue) and pneumonia.
Adequate gas exchange is vital for maintaining oxygenation and removing carbon dioxide from the body. Postoperative patients
often experience pain that can limit their ability to take deep breaths, leading to shallow breathing and inadequate ventilation.
This can result in areas of the lung collapsing (atelectasis), creating an environment for infection and pneumonia. Dyspnea is a
direct sign that the patient's respiratory function is compromised and that their gas exchange may be inadequate.

17. Nurse Oliver is assessing Mr. Harris, an 80-year-old man admitted with pneumonia. Mr. Harris lives alone and has not been
eating or drinking adequately. Nurse Oliver is evaluating him for signs of dehydration. Which assessment finding would be most
indicative of dehydration?
A. Rapid heart rate.
B. Swollen neck veins.
C. Elevated blood pressure.
D. Presence of hypothermia.
✔Correct answer:
Rapid heart rate. A rapid heart rate, or tachycardia, is the most indicative sign of dehydration in this scenario. When the body is
dehydrated, the volume of circulating blood decreases, leading to reduced blood flow and oxygen delivery to tissues. The heart
compensates by increasing its rate to maintain adequate circulation and blood pressure.
Dehydration leads to a decrease in blood volume (hypovolemia), which triggers compensatory mechanisms in the body to
maintain perfusion. One of these mechanisms is an increase in heart rate. Tachycardia helps to sustain cardiac output and blood
pressure despite the reduced volume of circulating blood.
18. Nurse Rodriguez is caring for Mr. Johnson, a 65-year-old patient admitted with pneumonia and currently receiving
intravenous garamycin (gentamicin) therapy. As part of her vigilant monitoring, Nurse Rodriguez knows she must pay close
attention to specific laboratory values to ensure patient safety. Which of the following lab results should she prioritize in her
assessment?
A. His platelet count and blood clotting time.
B. The patient's hemoglobin and hematocrit levels.
C. Mr. Johnson's blood urea nitrogen (BUN) and creatinine values.
D. The serum sodium and potassium concentrations.
✔Correct answer:
Mr. Johnson's blood urea nitrogen (BUN) and creatinine values. When administering gentamicin, a key concern is nephrotoxicity,
as this antibiotic can be harmful to the kidneys. Monitoring the blood urea nitrogen (BUN) and creatinine levels is essential
because these lab values are indicators of kidney function. Elevated levels of BUN and creatinine suggest impaired kidney
function, which can be a side effect of gentamicin therapy.
Gentamicin is an aminoglycoside antibiotic that is effective against various types of bacteria. However, it is known to be
nephrotoxic, which means it can cause damage to the kidneys. The kidneys filter waste products from the blood, and when they
are damaged, waste products such as BUN and creatinine accumulate in the blood. Monitoring these levels helps ensure that any
signs of kidney impairment are detected early, allowing for timely intervention to prevent further damage.

19. Nurse Carter is caring for Mr. Brown, an elderly gentleman admitted to the acute care unit with a diagnosis of influenza. As
part of her care, she keeps a close watch on him for any arising complications. What is the most frequent complication associated
with influenza in elderly patients?
A. Onset of pneumonia.
B. Occurrence of pulmonary edema.
C. Development of septicemia.
D. Emergence of meningitis.
✔Correct answer:
Onset of pneumonia. The most frequent complication associated with influenza in elderly patients is the onset of pneumonia.
Influenza can lead to both primary viral pneumonia and secondary bacterial pneumonia, with the latter being more common in
the elderly. Their immune systems are often weaker, making them more susceptible to secondary infections following an initial
viral infection like influenza.
Influenza causes inflammation and damage to the respiratory epithelium, impairing the natural defense mechanisms of the lungs.
This makes it easier for bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, to
invade the lungs and cause pneumonia. Pneumonia presents with symptoms such as fever, cough, sputum production, and
difficulty breathing, and it can be severe and life-threatening in elderly patients.

20. Nurse Lee is evaluating an HIV-positive patient receiving IV pentamidine (Pentam) for Pneumocystis carinii pneumonia. Which
information is most important for Nurse Lee to communicate to the physician?
A. The blood pressure decreased to 104/76 during administration.
B. The patient is not taking in an adequate amount of oral fluids.
C. The patient is complaining of pain at the infusion site.
D. Blood glucose is 55 mg/dL after medication administration.
✔Correct answer:
Blood glucose is 55 mg/dL after medication administration. The most important information for Nurse Lee to communicate to the
physician is that the blood glucose level is 55 mg/dL after medication administration. Hypoglycemia (low blood sugar) is a
potentially serious side effect of IV pentamidine. A blood glucose level of 55 mg/dL is significantly low and requires immediate
medical attention to prevent complications such as loss of consciousness, seizures, or even death.
Pentamidine is used to treat and prevent Pneumocystis carinii pneumonia (PCP), but it can cause hypoglycemia by affecting
insulin secretion and glucose metabolism. Monitoring blood glucose levels in patients receiving pentamidine is critical to ensure
that any episodes of hypoglycemia are promptly identified and treated.

21. Nurse Thompson is caring for Mr. Lewis, a patient with pneumonia who is receiving 2 L/min of supplemental oxygen through a
nasal cannula. Mr. Lewis has a medical history of chronic obstructive pulmonary disease (COPD) and coronary artery disease.
Given his health background, Nurse Thompson is vigilant in monitoring his oxygen levels and respiratory function. What potential
complication could develop if Mr. Lewis receives a higher concentration of oxygen?
A. Respiratory alkalosis.
B. Anginal pain.
C. Apnea
D. Metabolic acidosis.
✔Correct answer:
Apnea. In patients with chronic obstructive pulmonary disease (COPD), the primary drive to breathe can shift from the normal
response to elevated carbon dioxide levels to a hypoxic drive, which is a response to low oxygen levels. Administering high
concentrations of supplemental oxygen can suppress this hypoxic drive, potentially leading to hypoventilation and apnea
(cessation of breathing).
Under normal circumstances, the primary respiratory drive is triggered by elevated levels of carbon dioxide (CO2) in the blood.
However, in some patients with COPD, the chronic retention of CO2 results in a diminished response to this stimulus. Instead,
their breathing becomes more dependent on low oxygen levels (hypoxia) to stimulate respiration. If these patients receive too
much supplemental oxygen, the hypoxic drive may be suppressed, leading to decreased respiratory effort and potentially apnea.
22. Nurse Anderson is monitoring a recumbent, immobilized patient for potential respiratory complications. What are common
issues that can arise due to altered lung ventilation in such patients?
A. Apneustic breathing, atypical pneumonia and respiratory alkalosis.
B. Respiratory acidosis, atelectasis, and hypostatic pneumonia.
C. Cheyne-Stokes respirations and spontaneous pneumothorax.
D. Kussmail’s respirations and hypoventilation.
✔Correct answer:
Respiratory acidosis, atelectasis, and hypostatic pneumonia. When a patient is recumbent and immobilized, there are several
respiratory complications that can arise due to altered lung ventilation and decreased movement. The most common issues
include respiratory acidosis, atelectasis, and hypostatic pneumonia.
▪ Respiratory Acidosis: This occurs when the lungs cannot effectively remove carbon dioxide, leading to its accumulation in
the blood and a decrease in blood pH. Immobilized patients may have shallow breathing, reducing ventilation and
increasing carbon dioxide retention.
▪ Atelectasis: This is the collapse of part or all of a lung, which can occur when areas of the lung are not fully ventilated.
Immobilized patients are at higher risk because their lungs may not fully expand, leading to collapse of the alveoli.
▪ Hypostatic Pneumonia: This type of pneumonia results from the pooling of secretions in the lungs due to immobility.
Without regular movement, secretions are not effectively cleared, providing a breeding ground for bacteria and leading
to infection.

23. Nurse Gonzalez is evaluating an elderly patient who has been diagnosed with pneumonia. Considering the typical
presentation in elderly clients, which symptoms are most likely to appear first?
A. Experiencing sharp chest pain and frequent coughing.
B. Coughing up blood (hemoptysis) and experiencing shortness of breath (dyspnea).
C. Changes in mental status and signs of dehydration.
D. Presence of fever and chills.
✔Correct answer:
Changes in mental status and signs of dehydration. In elderly patients, the presentation of pneumonia can often be atypical
compared to younger adults. The most common early symptoms in elderly individuals are changes in mental status (such as
confusion, lethargy, or delirium) and signs of dehydration. These symptoms are particularly important to recognize because they
can be subtle and are sometimes mistakenly attributed to other age-related conditions or comorbidities.
The immune system's response to infection can be blunted in the elderly, leading to less pronounced typical symptoms such as
fever and chills. Dehydration can occur due to reduced fluid intake or increased fluid loss associated with infection, further
complicating the clinical picture. Changes in mental status are often one of the first signs of an underlying infection or illness in
older adults due to decreased physiological reserves and the brain's sensitivity to altered metabolic states.

24. Nurse Harper is assessing a young child suspected of having severe pneumonia. Which sign would indicate that the child is
experiencing severe pneumonia?
A. Chest indrawing during inhalation.
B. Presence of wheezing sounds.
C. Rapid breathing rate.
D. Difficulty in breathing (dyspnea).
✔Correct answer:
Chest indrawing during inhalation. Chest indrawing during inhalation is a sign of severe pneumonia in children. This occurs when
the child uses accessory muscles to breathe, indicating that they are working very hard to get enough air into their lungs. This is a
serious sign and often requires immediate medical intervention to prevent respiratory failure.
Chest indrawing, also known as retractions, happens when the effort to breathe is so great that the chest wall is pulled inward
with each breath. This can be seen in the spaces between the ribs, below the ribs, or above the collarbones. It indicates that the
child's airways are obstructed or the lungs are not sufficiently exchanging gases, leading to increased work of breathing and the
use of accessory muscles.

25. Nurse Chen is caring for Lucas, a 38-year-old patient diagnosed with pneumocystis pneumonia who is currently receiving
trimetrexate therapy. As part of the treatment plan, leucovorin calcium is also being administered. Nurse Chen needs to
understand and explain to Lucas the purpose of this additional medication. What should Nurse Chen identify as the primary
reason for including leucovorin calcium in Lucas's treatment regimen?
A. To enhance the therapeutic efficacy of trimetrexate.
B. To stimulate the production of white blood cells.
C. To address potential anemia associated with the infection.
D. To mitigate the toxic effects of the primary medication.
✔Correct answer:
To mitigate the toxic effects of the primary medication. Leucovorin calcium is included in Lucas's treatment regimen primarily to
mitigate the toxic effects of trimetrexate. Trimetrexate is a potent antifolate drug used to treat pneumocystis pneumonia, but it
can also cause significant toxicity by inhibiting the action of folic acid, which is necessary for DNA synthesis and cell replication.
Leucovorin calcium (also known as folinic acid) is a form of folic acid that helps protect healthy cells from the toxic effects of
trimetrexate without interfering with its therapeutic efficacy against the infection.
Trimetrexate works by inhibiting dihydrofolate reductase, an enzyme involved in the folate pathway, which is essential for
synthesizing nucleic acids and cell division. This inhibition is effective against the Pneumocystis jirovecii organism but can also
damage rapidly dividing healthy cells, leading to side effects like bone marrow suppression and gastrointestinal toxicity.
Leucovorin calcium bypasses the blocked enzyme and provides the necessary folate for normal cell function, thereby reducing
these toxic effects.

Pneumothorax

1. Nurse Lisa is in the emergency room, caring for Karen, a 30-year-old woman who has suffered a blunt injury to her chest wall
following a car accident. To identify potential complications like pneumothorax, Nurse Lisa needs to know which sign is most
indicative. What should she be particularly alert for?
A. Reduced breath sounds upon auscultation.
B. Audible sucking sounds at the site of the injury.
C. A decreased respiratory rate.
D. The development of a barrel-shaped chest.
✔Correct answer:
Reduced breath sounds upon auscultation. In cases of chest wall injury where there is suspicion of pneumothorax, reduced or
absent breath sounds upon auscultation are a significant indicator. A pneumothorax occurs when there is air in the pleural space,
which can cause lung collapse. When a lung or a portion of it collapses, it would not participate in ventilation, leading to an
absence or significant reduction in breath sounds when listening with a stethoscope. Nurse Lisa should be keen to perform
auscultation on both sides of Karen's chest to compare the breath sounds. If she notices reduced breath sounds on the side of the
injury, this is a strong indicator that a pneumothorax could be present, necessitating immediate medical intervention

2. Nurse Emily is preparing discharge instructions for Sophia, a young female patient who has recently been treated for a
pneumothorax. As part of the education, Emily plans to include signs and symptoms of a pneumothorax. She should instruct
Sophia to seek medical assistance if she experiences which of the following?
A. Intense shortness of breath.
B. Frequent episodes of heart palpitations.
C. Feeling dizzy upon standing up.
D. Pain below the breastbone.
✔Correct answer:
Intense shortness of breath. Intense shortness of breath is a hallmark symptom of pneumothorax, which occurs when air leaks
into the space between the lung and the chest wall, causing the lung to collapse. This compromises the lung's ability to expand
and contract, leading to decreased oxygen exchange and resulting in shortness of breath. Nurse Emily should emphasize the
importance of seeking immediate medical attention if Sophia experiences intense shortness of breath, as this could indicate a
recurrence of pneumothorax or another serious respiratory issue.

3. Nurse Taylor is preparing to educate Jordan, a patient who has experienced a spontaneous pneumothorax, about his condition.
For effective teaching, Nurse Taylor's understanding of spontaneous pneumothorax would be based on which of the following?
A. The heart and major vessels will shift towards the side with the pneumothorax.
B. The unaffected lung will also collapse if not treated urgently.
C. Inhaled air will leak from the lung into the pleural space.
D. There exists an increased negative pressure within the chest cavity.
✔Correct answer:
Inhaled air will leak from the lung into the pleural space. Spontaneous pneumothorax occurs when air leaks into the pleural space
between the lung and the chest wall. Normally, the pleural space is filled with a small amount of fluid that allows the lung to
expand and retract smoothly within the chest cavity. In the case of a spontaneous pneumothorax, a rupture in the lung tissue
allows inhaled air to escape into this pleural space, leading to partial or complete lung collapse. It's crucial to understand that the
issue lies in the leak of air into an area where it doesn't belong, thereby disrupting the equilibrium required for normal
respiration.

4. Nurse Matthew is caring for Sophia, a 40-year-old patient diagnosed with a spontaneous pneumothorax. A chest tube needs to
be inserted, and Nurse Matthew must explain its primary function to Sophia. What is the BEST explanation he should provide?
A. "The tube will siphon off fluid from your chest."
B. "The tube will regulate the volume of air entering your chest."
C. "The tube will plug the puncture in your lung."
D. "The tube will extract excess air from your chest cavity."
✔Correct answer:
"The tube will extract excess air from your chest cavity." The primary function of a chest tube in the context of a spontaneous
pneumothorax is to remove excess air that has entered the pleural space. This air disrupts the normal negative pressure that
helps the lungs to stay inflated. By removing the air, the chest tube allows the lungs to re-expand, restoring proper lung function.
This is essential for alleviating symptoms like shortness of breath and promoting faster healing.

5. Nurse Carlos is managing the care of Ethan, a 50-year-old patient who was treated for a pneumothorax with a chest tube
insertion. Carlos needs to assess whether Ethan is ready to have his chest tube removed. What is the best measure to determine
this?
A. Normal levels in the arterial blood gas (ABG) report.
B. Continued evidence on the chest X-ray that the lung is 35% deflated.
C. Lack of fluctuation in the water-seal chamber when no suction is applied.
D. Significant drainage being noted from the chest tube.
✔Correct answer:
Lack of fluctuation in the water-seal chamber when no suction is applied. The absence of fluctuation in the water-seal chamber
when no suction is applied is indicative that the lung has successfully re-expanded and there is no more air leaking into the
pleural space. Essentially, the "tiding" or "fluctuations" in the water-seal chamber reflect the intrathoracic pressure changes
occurring during inhalation and exhalation. When the lung has re-expanded and sealed itself, these fluctuations will stop,
indicating that the pneumothorax has resolved and it may be safe to remove the chest tube after confirming with additional
diagnostics such as a chest X-ray.

6. Nurse Olivia is caring for Rachel, a 55-year-old female patient with a pneumothorax, who has had a chest tube inserted and
connected to a water-seal drainage system. To avert potential air leaks from the chest tube, what should Nurse Olivia prioritize?
A. Positioning the chest drainage system lower than the patient's chest level.
B. Ensuring that the chest tube remains patent.
C. Maintaining the head of the bed at a slight elevation.
D. Verifying and securely taping all tube connections.
✔Correct answer:
Verifying and securely taping all tube connections. Nurse Olivia should prioritize verifying and securely taping all tube connections
to prevent air leaks in the system. Air leaks can compromise the integrity of the water-seal drainage system and may lead to
ineffective management of the pneumothorax. A secure and air-tight system ensures that air is removed from the pleural space,
allowing for optimal lung re-expansion. Additionally, air leaks can also cause inaccurate measurements of pleural drainage,
potentially leading to improper clinical decisions.

7. Nurse Emily is attending to Mike, a 45-year-old man who was admitted following a motor vehicle accident and has been
intubated. When the high-pressure alarm on the ventilator sounds, Nurse Emily quickly performs an assessment and notices an
absence of breath sounds in the right upper lobe of Mike's lung. What should Nurse Emily immediately assess for additional signs
of?
A. Development of a right-sided pneumothorax.
B. Presence of a pulmonary embolism.
C. Dislocation of the endotracheal tube.
D. Acute Respiratory Distress Syndrome (ARDS).
✔Correct answer:
Development of a right-sided pneumothorax. Nurse Emily should immediately assess for additional signs of a right-sided
pneumothorax. The absence of breath sounds in the right upper lobe along with a high-pressure alarm on the ventilator strongly
suggest this condition. A pneumothorax occurs when air leaks into the space between the lung and the chest wall (pleural space),
leading to a partial or complete lung collapse. The high-pressure alarm on the ventilator could be the machine's way of indicating
that it’s having difficulty inflating the lung, which is often the case with a pneumothorax. Prompt diagnosis and intervention are
crucial to prevent complications like tension pneumothorax, which can be life-threatening.

8. Nurse Emma is caring for Chloe, a patient with a small, persistent left upper lobe pneumothorax. She plans to replace Chloe's
Pleur-O-Vac with a Heimlich Flutter Valve. What is the best rationale for making this change?
A. To avert the tube from becoming kinked.
B. To facilitate both air and pleural fluid drainage.
C. To obviate the need for applying a dressing.
D. To negate the necessity for a water-seal drainage system.
✔Correct answer:
To negate the necessity for a water-seal drainage system. The Heimlich Flutter Valve serves as a one-way valve system that lets
air escape from the pleural space without allowing it to re-enter. It is specifically designed for ambulatory patients with small,
persistent air leaks who do not require a continuous vacuum. Replacing a Pleur-O-Vac (a traditional water-seal drainage system)
with a Heimlich Flutter Valve simplifies the chest drainage process and allows the patient more mobility. The Flutter Valve is a
more convenient alternative for patients with smaller pneumothoraces that still require drainage but do not necessitate the full
apparatus of a water-seal drainage system like Pleur-O-Vac.

9. Nurse Zoe is caring for Liam, a patient who has sustained a lateral crushing injury to his chest, causing obvious right-sided
paradoxical motion indicative of multiple rib fractures and a flail chest. What complication should Nurse Zoe be most vigilant in
monitoring for?
A. Open pneumothorax.
B. Laceration of the trachea.
C. Shift of the mediastinum.
D. Pericardial tamponade.
✔Correct answer:
Shift of the mediastinum. Nurse Zoe should be most vigilant in monitoring for a shift of the mediastinum, as this could indicate a
life-threatening tension pneumothorax. A flail chest with multiple rib fractures can compromise the integrity of the chest wall,
leading to the accumulation of air in the pleural space. This air can exert pressure on the mediastinum, which houses critical
structures like the heart and major blood vessels, and shift it to the opposite side. This shift can compress the vena cava and
other major vessels, leading to decreased venous return to the heart and subsequent cardiovascular collapse if not promptly
addressed.
10. Nurse William is caring for Jack, a patient who has suffered a chest injury. A thoracentesis is performed, revealing neither fluid
nor air. Despite administering fluids and blood intravenously (IV), Jack's vital signs don't improve. A central venous pressure line
shows an initial reading of 20 cm H₂O. What is the most likely explanation for these findings?
A. Presence of a pericardial tamponade.
B. Rupture of the diaphragm.
C. Development of a hemothorax.
D. Occurrence of a spontaneous pneumothorax.
✔Correct answer:
Presence of a pericardial tamponade. The combination of a lack of fluid or air in the thoracic cavity (ruled out by thoracentesis),
unresponsive vital signs despite IV fluid and blood administration, and an elevated central venous pressure (CVP) of 20 cm H₂O
strongly suggests pericardial tamponade. In this condition, fluid accumulates in the pericardial sac around the heart, leading to
impaired cardiac function and elevated venous pressures. Fluid resuscitation would typically improve vitals, but if tamponade is
present, this measure will be ineffective due to the mechanical obstruction caused by the fluid around the heart.

11. While attending to Ethan, a patient with a pneumothorax who has a chest tube inserted, Nurse Kate should incorporate which
of the following into her care plan?
A. Advocate for coughing, deep inhalations, and arm mobility on the side with the pneumothorax.
B. Provide cough suppressants at regulated times, as prescribed.
C. Drain and quantify the fluid in the collection chamber during each shift.
D. Utilize clamps beneath the insertion site when assisting the patient to get out of bed.
✔Correct answer:
Advocate for coughing, deep inhalations, and arm mobility on the side with the pneumothorax. Nurse Kate should encourage
Ethan to cough, take deep inhalations, and move his arm on the side with the pneumothorax. These actions are essential for
promoting lung expansion and preventing atelectasis (collapse of the alveoli). Coughing helps to clear secretions that could
otherwise lead to infection. Deep inhalations encourage the lung to fully expand, aiding in the healing process and helping to re-
establish normal respiratory function. Arm mobility can also facilitate better lung expansion by allowing the chest wall to move
more freely.

12. Nurse Robert is monitoring a patient with a closed chest drainage system and notices continuous bubbling in the water-seal
chamber. What conclusion should Nurse Robert draw from this observation?
A. The drainage system is operating as expected.
B. The patient is suffering from a pneumothorax.
C. The chest tube is experiencing an obstruction.
D. The drainage system has an air leak present.
✔Correct answer:
The drainage system has an air leak present. Continuous bubbling in the water-seal chamber of a closed chest drainage system is
an abnormal finding that usually indicates the presence of an air leak somewhere in the system. This could be from the chest tube
itself, from the connections between tubing, or even from the drainage system. In any case, this is a situation that warrants
immediate investigation to identify and resolve the source of the leak. Failing to address this issue could compromise the
patient's respiratory status, as the system will not effectively remove air from the pleural space, preventing lung re-expansion and
resolving the pneumothorax.

13. Nurse Andrew is caring for Sarah, a patient who is recumbent and immobilized for an extended period. Andrew understands
that Sarah's lung ventilation could be compromised, leading to which of the following respiratory complications?
A. Kussmaul's respirations and hypoventilation.
B. Apneustic breathing, atypical pneumonia, and respiratory alkalosis.
C. Cheyne-Stokes respirations and spontaneous pneumothorax.
D. Respiratory acidosis, atelectasis, and hypostatic pneumonia.
✔Correct answer:
Respiratory acidosis, atelectasis, and hypostatic pneumonia. Patients who are recumbent and immobilized for extended periods
are at increased risk for respiratory complications due to decreased lung expansion and ineffective cough. This can lead to the
accumulation of carbon dioxide (respiratory acidosis), collapse of the alveoli (atelectasis), and pooling of secretions that can cause
infection (hypostatic pneumonia).

14. Nurse Kim is attending to George, a 65-year-old patient who was recently diagnosed with pneumothorax and has had a chest
tube inserted. While monitoring the chest drainage system, Nurse Kim observes continuous, gentle bubbling in the suction
control chamber. What should be her appropriate course of action?
A. Elevate the suction pressure to make the bubbling more vigorous.
B. Immediately clamp the chest tube and alert the healthcare provider.
C. Examine the system for an air leak as the bubbling should only be intermittent.
D. Take no action, as this is an expected observation.
✔Correct answer:
Take no action, as this is an expected observation. In a chest drainage system with active suction, continuous, gentle bubbling in
the suction control chamber is a normal and expected finding. The bubbling indicates that the suction is being applied to the
system, helping to evacuate air, blood, or other fluids from the pleural space, and thereby facilitating lung re-expansion. The
bubbling should be gentle; if it is vigorous, that could indicate that the suction is set too high, which could potentially lead to
complications. Therefore, in this scenario, Nurse Kim should take no action regarding the bubbling, as it is indicative of the system
functioning as it should.

15. Nurse Allison is caring for Ava, a patient newly diagnosed with spontaneous pneumothorax. Ava appears anxious and
complains of acute, stabbing pain in her chest. What intervention should Nurse Allison prioritize in this situation?
A. Assisting the client into Fowler's position.
B. Preparing the client for chest tube insertion.
C. Administering subcutaneous heparin.
D. Administering intravenous analgesics as prescribed.
✔Correct answer:
Preparing the client for chest tube insertion. In the case of a newly diagnosed spontaneous pneumothorax with acute, stabbing
chest pain and anxiety, the priority intervention would be to prepare Ava for chest tube insertion. A chest tube is essential for
evacuating the air that has leaked into the pleural space, causing the lung to collapse. This will help in re-expanding the lung,
improving respiratory function, and subsequently alleviating the acute pain and anxiety that Ava is experiencing. The procedure is
often urgent, especially if the pneumothorax is affecting Ava's respiratory status, so prompt preparation is crucial.